Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

.Anti-dsDNA Antibodies LC

Facility

$119.00

Service Code	CPT 86225
Hospital Charge Code	3033504
Hospital Revenue Code	302
Min. Negotiated Rate	$30.94
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of AZ Commercial	$107.10
Rate for Payer: Bisbee Police All Plans	$30.94
Rate for Payer: Cash Price	$95.20
Rate for Payer: Self Pay Self Pay	$95.20

Anti-dsDNA Antibodies LC

Facility

$172.00

Service Code	CPT 86225
Hospital Charge Code	1905934
Hospital Revenue Code	302
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

Anti-dsDNA Antibodies LC

Facility

$172.00

Service Code	CPT 86225
Hospital Charge Code	1905934
Hospital Revenue Code	302
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: AHCCCS Medicaid	$13.74
Rate for Payer: Allwell Medicaid	$13.74
Rate for Payer: Allwell Medicare	$25.80
Rate for Payer: Amerigroup Medicare	$25.80
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicaid	$13.74
Rate for Payer: AZCH Complete Medicare	$25.80
Rate for Payer: Banner UC Health Medicaid	$13.74
Rate for Payer: Banner UC Health Medicare	$25.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$25.80
Rate for Payer: Mercy Care Medicaid	$13.74
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$25.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

Antigen Type

Facility

$158.00

Service Code	CPT 86902
Hospital Charge Code	22245939
Hospital Revenue Code	302
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Cash Price	$126.40
Rate for Payer: Self Pay Self Pay	$126.40

Antigen Type

Facility

$158.00

Service Code	CPT 86902
Hospital Charge Code	22245939
Hospital Revenue Code	302
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Aetna of AZ Medicare	$44.24
Rate for Payer: AHCCCS Medicaid	$6.35
Rate for Payer: Allwell Medicaid	$6.35
Rate for Payer: Allwell Medicare	$23.70
Rate for Payer: Amerigroup Medicare	$23.70
Rate for Payer: APIPA Medicare/Medicaid	$59.01
Rate for Payer: AZCH Complete Medicaid	$6.35
Rate for Payer: AZCH Complete Medicare	$23.70
Rate for Payer: Banner UC Health Medicaid	$6.35
Rate for Payer: Banner UC Health Medicare	$23.70
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$107.44
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$102.70
Rate for Payer: Copperpoint Commercial	$39.10
Rate for Payer: Health Net of AZ Commercial	$94.80
Rate for Payer: Health Net of AZ Medicare	$44.24
Rate for Payer: Humana of AZ Medicare	$23.70
Rate for Payer: Mercy Care Medicaid	$6.35
Rate for Payer: Self Pay Self Pay	$126.40
Rate for Payer: TriWest Medicare	$23.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.44

Antigen Type w/ Charge

Facility

$237.00

Service Code	CPT 86885
Hospital Charge Code	22172090
Hospital Revenue Code	302
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Aetna of AZ Medicare	$66.36
Rate for Payer: AHCCCS Medicaid	$5.72
Rate for Payer: Allwell Medicaid	$5.72
Rate for Payer: Allwell Medicare	$35.55
Rate for Payer: Amerigroup Medicare	$35.55
Rate for Payer: APIPA Medicare/Medicaid	$88.52
Rate for Payer: AZCH Complete Medicaid	$5.72
Rate for Payer: AZCH Complete Medicare	$35.55
Rate for Payer: Banner UC Health Medicaid	$5.72
Rate for Payer: Banner UC Health Medicare	$35.55
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Copperpoint Commercial	$58.66
Rate for Payer: Health Net of AZ Commercial	$142.20
Rate for Payer: Health Net of AZ Medicare	$66.36
Rate for Payer: Humana of AZ Medicare	$35.55
Rate for Payer: Mercy Care Medicaid	$5.72
Rate for Payer: Self Pay Self Pay	$189.60
Rate for Payer: TriWest Medicare	$35.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.66

Antigen Type w/ Charge

Facility

$237.00

Service Code	CPT 86885
Hospital Charge Code	22172090
Hospital Revenue Code	302
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Cash Price	$189.60
Rate for Payer: Self Pay Self Pay	$189.60

ANTI GLIADIN AB IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481459
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

ANTI GLIADIN AB IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481459
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

Antihistone Antibodies LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	16937587
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

Antihistone Antibodies LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	16937587
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

.Anti-Jo-1 LC

Facility

$259.00

Service Code	CPT 86235
Hospital Charge Code	22531162
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Aetna of AZ Medicare	$72.52
Rate for Payer: AHCCCS Medicaid	$17.93
Rate for Payer: Allwell Medicaid	$17.93
Rate for Payer: Allwell Medicare	$38.85
Rate for Payer: Amerigroup Medicare	$38.85
Rate for Payer: APIPA Medicare/Medicaid	$96.74
Rate for Payer: AZCH Complete Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$38.85
Rate for Payer: Banner UC Health Medicaid	$17.93
Rate for Payer: Banner UC Health Medicare	$38.85
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$176.12
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$168.35
Rate for Payer: Copperpoint Commercial	$64.10
Rate for Payer: Health Net of AZ Commercial	$155.40
Rate for Payer: Health Net of AZ Medicare	$72.52
Rate for Payer: Humana of AZ Medicare	$38.85
Rate for Payer: Mercy Care Medicaid	$17.93
Rate for Payer: Self Pay Self Pay	$207.20
Rate for Payer: TriWest Medicare	$38.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$151.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.62

.Anti-Jo-1 LC

Facility

$259.00

Service Code	CPT 86235
Hospital Charge Code	22531162
Hospital Revenue Code	302
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Cash Price	$207.20
Rate for Payer: Self Pay Self Pay	$207.20

Anti-Jo-1 LC

Facility

$259.00

Service Code	CPT 86235
Hospital Charge Code	1285794
Hospital Revenue Code	302
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Cash Price	$207.20
Rate for Payer: Self Pay Self Pay	$207.20

Anti-Jo-1 LC

Facility

$259.00

Service Code	CPT 86235
Hospital Charge Code	1285794
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Aetna of AZ Medicare	$72.52
Rate for Payer: AHCCCS Medicaid	$17.93
Rate for Payer: Allwell Medicaid	$17.93
Rate for Payer: Allwell Medicare	$38.85
Rate for Payer: Amerigroup Medicare	$38.85
Rate for Payer: APIPA Medicare/Medicaid	$96.74
Rate for Payer: AZCH Complete Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$38.85
Rate for Payer: Banner UC Health Medicaid	$17.93
Rate for Payer: Banner UC Health Medicare	$38.85
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$176.12
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$168.35
Rate for Payer: Copperpoint Commercial	$64.10
Rate for Payer: Health Net of AZ Commercial	$155.40
Rate for Payer: Health Net of AZ Medicare	$72.52
Rate for Payer: Humana of AZ Medicare	$38.85
Rate for Payer: Mercy Care Medicaid	$17.93
Rate for Payer: Self Pay Self Pay	$207.20
Rate for Payer: TriWest Medicare	$38.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$151.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.62

Antineutrophil Cytoplasmic Ab LC

Facility

$735.00

Service Code	CPT 86256
Hospital Charge Code	1285639
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Aetna of AZ Medicare	$205.80
Rate for Payer: AHCCCS Medicaid	$12.05
Rate for Payer: Allwell Medicaid	$12.05
Rate for Payer: Allwell Medicare	$110.25
Rate for Payer: Amerigroup Medicare	$110.25
Rate for Payer: APIPA Medicare/Medicaid	$274.52
Rate for Payer: AZCH Complete Medicaid	$12.05
Rate for Payer: AZCH Complete Medicare	$110.25
Rate for Payer: Banner UC Health Medicaid	$12.05
Rate for Payer: Banner UC Health Medicare	$110.25
Rate for Payer: Bisbee Police All Plans	$191.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$499.80
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cigna of AZ Commercial	$477.75
Rate for Payer: Copperpoint Commercial	$181.91
Rate for Payer: Health Net of AZ Commercial	$441.00
Rate for Payer: Health Net of AZ Medicare	$205.80
Rate for Payer: Humana of AZ Medicare	$110.25
Rate for Payer: Mercy Care Medicaid	$12.05
Rate for Payer: Self Pay Self Pay	$588.00
Rate for Payer: TriWest Medicare	$110.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$428.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$132.30

Antineutrophil Cytoplasmic Ab LC

Facility

$735.00

Service Code	CPT 86256
Hospital Charge Code	1285639
Hospital Revenue Code	302
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Bisbee Police All Plans	$191.10
Rate for Payer: Cash Price	$588.00
Rate for Payer: Self Pay Self Pay	$588.00

Antinuclear Antibodies Direct LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	1285669
Hospital Revenue Code	300
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Aetna of AZ Medicare	$44.80
Rate for Payer: AHCCCS Medicaid	$12.09
Rate for Payer: Allwell Medicaid	$12.09
Rate for Payer: Allwell Medicare	$24.00
Rate for Payer: Amerigroup Medicare	$24.00
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicaid	$12.09
Rate for Payer: AZCH Complete Medicare	$24.00
Rate for Payer: Banner UC Health Medicaid	$12.09
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.80
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cigna of AZ Commercial	$104.00
Rate for Payer: Copperpoint Commercial	$39.60
Rate for Payer: Health Net of AZ Commercial	$96.00
Rate for Payer: Health Net of AZ Medicare	$44.80
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Mercy Care Medicaid	$12.09
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.80

Antinuclear Antibodies Direct LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	1285669
Hospital Revenue Code	300
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Self Pay Self Pay	$128.00

Antinuclear Antibodies, IFA LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	1285670
Hospital Revenue Code	300
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Aetna of AZ Medicare	$44.80
Rate for Payer: AHCCCS Medicaid	$12.09
Rate for Payer: Allwell Medicaid	$12.09
Rate for Payer: Allwell Medicare	$24.00
Rate for Payer: Amerigroup Medicare	$24.00
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicaid	$12.09
Rate for Payer: AZCH Complete Medicare	$24.00
Rate for Payer: Banner UC Health Medicaid	$12.09
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.80
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cigna of AZ Commercial	$104.00
Rate for Payer: Copperpoint Commercial	$39.60
Rate for Payer: Health Net of AZ Commercial	$96.00
Rate for Payer: Health Net of AZ Medicare	$44.80
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Mercy Care Medicaid	$12.09
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.80

Antinuclear Antibodies, IFA LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	1285670
Hospital Revenue Code	300
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Self Pay Self Pay	$128.00

Antipancreatic Islet Cells LC

Facility

$302.00

Service Code	CPT 86341
Hospital Charge Code	6780997
Hospital Revenue Code	302
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: AHCCCS Medicaid	$23.57
Rate for Payer: Allwell Medicaid	$23.57
Rate for Payer: Allwell Medicare	$45.30
Rate for Payer: Amerigroup Medicare	$45.30
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicaid	$23.57
Rate for Payer: AZCH Complete Medicare	$45.30
Rate for Payer: Banner UC Health Medicaid	$23.57
Rate for Payer: Banner UC Health Medicare	$45.30
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$196.30
Rate for Payer: Copperpoint Commercial	$74.74
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$45.30
Rate for Payer: Mercy Care Medicaid	$23.57
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$45.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

Antipancreatic Islet Cells LC

Facility

$302.00

Service Code	CPT 86341
Hospital Charge Code	6780997
Hospital Revenue Code	302
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

.Antiribosomal P Abs LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22531163
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

.Antiribosomal P Abs LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22531163
Hospital Revenue Code	302
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

Know your out-of-pocket cost for care.

All Charges