Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

betamethasone-clotrimazole Top 0.05%-1% Crm [CQCH]

Facility

$11.20

Service Code	NDC 16714049602
Hospital Charge Code	105912979
Hospital Revenue Code	251
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna of AZ Commercial	$10.08
Rate for Payer: Bisbee Police All Plans	$2.91
Rate for Payer: Cash Price	$8.96
Rate for Payer: Self Pay Self Pay	$8.96

betamethasone-clotrimazole Top 0.05%-1% Crm [CQCH]

Facility

$11.20

Service Code	NDC 16714049602
Hospital Charge Code	105912979
Hospital Revenue Code	251
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna of AZ Commercial	$10.08
Rate for Payer: Aetna of AZ Medicare	$3.14
Rate for Payer: Allwell Medicare	$1.68
Rate for Payer: Amerigroup Medicare	$1.68
Rate for Payer: APIPA Medicare/Medicaid	$4.18
Rate for Payer: AZCH Complete Medicare	$1.68
Rate for Payer: Banner UC Health Medicare	$1.68
Rate for Payer: Bisbee Police All Plans	$2.91
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.62
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cigna of AZ Commercial	$7.28
Rate for Payer: Copperpoint Commercial	$2.77
Rate for Payer: Health Net of AZ Commercial	$6.72
Rate for Payer: Health Net of AZ Medicare	$3.14
Rate for Payer: Humana of AZ Medicare	$1.68
Rate for Payer: Self Pay Self Pay	$8.96
Rate for Payer: TriWest Medicare	$1.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.02

Bilirubin Direct

Facility

$118.00

Service Code	CPT 82248
Hospital Charge Code	633670
Hospital Revenue Code	301
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Cash Price	$94.40
Rate for Payer: Self Pay Self Pay	$94.40

Bilirubin Direct

Facility

$118.00

Service Code	CPT 82248
Hospital Charge Code	633670
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Aetna of AZ Medicare	$33.04
Rate for Payer: AHCCCS Medicaid	$5.02
Rate for Payer: Allwell Medicaid	$5.02
Rate for Payer: Allwell Medicare	$17.70
Rate for Payer: Amerigroup Medicare	$17.70
Rate for Payer: APIPA Medicare/Medicaid	$44.07
Rate for Payer: AZCH Complete Medicaid	$5.02
Rate for Payer: AZCH Complete Medicare	$17.70
Rate for Payer: Banner UC Health Medicaid	$5.02
Rate for Payer: Banner UC Health Medicare	$17.70
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$80.24
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$76.70
Rate for Payer: Copperpoint Commercial	$29.20
Rate for Payer: Health Net of AZ Commercial	$70.80
Rate for Payer: Health Net of AZ Medicare	$33.04
Rate for Payer: Humana of AZ Medicare	$17.70
Rate for Payer: Mercy Care Medicaid	$5.02
Rate for Payer: Self Pay Self Pay	$94.40
Rate for Payer: TriWest Medicare	$17.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.24

Bilirubin Total

Facility

$118.00

Service Code	CPT 82247
Hospital Charge Code	633672
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Aetna of AZ Medicare	$33.04
Rate for Payer: AHCCCS Medicaid	$5.02
Rate for Payer: Allwell Medicaid	$5.02
Rate for Payer: Allwell Medicare	$17.70
Rate for Payer: Amerigroup Medicare	$17.70
Rate for Payer: APIPA Medicare/Medicaid	$44.07
Rate for Payer: AZCH Complete Medicaid	$5.02
Rate for Payer: AZCH Complete Medicare	$17.70
Rate for Payer: Banner UC Health Medicaid	$5.02
Rate for Payer: Banner UC Health Medicare	$17.70
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$80.24
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$76.70
Rate for Payer: Copperpoint Commercial	$29.20
Rate for Payer: Health Net of AZ Commercial	$70.80
Rate for Payer: Health Net of AZ Medicare	$33.04
Rate for Payer: Humana of AZ Medicare	$17.70
Rate for Payer: Mercy Care Medicaid	$5.02
Rate for Payer: Self Pay Self Pay	$94.40
Rate for Payer: TriWest Medicare	$17.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.24

Bilirubin Total

Facility

$118.00

Service Code	CPT 82247
Hospital Charge Code	633672
Hospital Revenue Code	301
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Cash Price	$94.40
Rate for Payer: Self Pay Self Pay	$94.40

Bill 602503 Johnson Grass

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143910
Hospital Revenue Code	301
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

Bill 602503 Johnson Grass

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143910
Hospital Revenue Code	301
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

Bill 602872 Rye Grass

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143911
Hospital Revenue Code	301
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

Bill 602872 Rye Grass

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143911
Hospital Revenue Code	301
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

Bill 602931 Mimosa/acacia

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143912
Hospital Revenue Code	301
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

Bill 602931 Mimosa/acacia

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143912
Hospital Revenue Code	301
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

Bill ABID

Facility

$246.00

Service Code	CPT 86870
Hospital Charge Code	12537756
Hospital Revenue Code	302
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Cash Price	$196.80
Rate for Payer: Self Pay Self Pay	$196.80

Bill ABID

Facility

$246.00

Service Code	CPT 86870
Hospital Charge Code	12537756
Hospital Revenue Code	302
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Aetna of AZ Medicare	$68.88
Rate for Payer: AHCCCS Medicaid	$211.16
Rate for Payer: Allwell Medicaid	$211.16
Rate for Payer: Allwell Medicare	$36.90
Rate for Payer: Amerigroup Medicare	$36.90
Rate for Payer: APIPA Medicare/Medicaid	$91.88
Rate for Payer: AZCH Complete Medicaid	$211.16
Rate for Payer: AZCH Complete Medicare	$36.90
Rate for Payer: Banner UC Health Medicaid	$211.16
Rate for Payer: Banner UC Health Medicare	$36.90
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$167.28
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$159.90
Rate for Payer: Copperpoint Commercial	$60.88
Rate for Payer: Health Net of AZ Commercial	$147.60
Rate for Payer: Health Net of AZ Medicare	$68.88
Rate for Payer: Humana of AZ Medicare	$36.90
Rate for Payer: Mercy Care Medicaid	$211.16
Rate for Payer: Self Pay Self Pay	$196.80
Rate for Payer: TriWest Medicare	$36.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$143.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.28

Bill ABID/each panel media

Facility

$237.00

Service Code	CPT 86870
Hospital Charge Code	2465092
Hospital Revenue Code	300
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

Bill ABID/each panel media

Facility

$237.00

Service Code	CPT 86870
Hospital Charge Code	2465092
Hospital Revenue Code	300
Min. Negotiated Rate	$35.55
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	$211.16
Rate for Payer: Allwell Medicaid	$211.16
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	$211.16
Rate for Payer: AZCH Complete Medicare	$35.55
Rate for Payer: Banner UC Health Medicaid	$211.16
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	$211.16
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

Bill Allergen Test

Facility

$153.00

Service Code	CPT 86003
Hospital Charge Code	23568451
Hospital Revenue Code	301
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna of AZ Commercial	$137.70
Rate for Payer: Aetna of AZ Medicare	$42.84
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$22.95
Rate for Payer: Amerigroup Medicare	$22.95
Rate for Payer: APIPA Medicare/Medicaid	$57.15
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$22.95
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$22.95
Rate for Payer: Bisbee Police All Plans	$39.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$104.04
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cigna of AZ Commercial	$99.45
Rate for Payer: Copperpoint Commercial	$37.87
Rate for Payer: Health Net of AZ Commercial	$91.80
Rate for Payer: Health Net of AZ Medicare	$42.84
Rate for Payer: Humana of AZ Medicare	$22.95
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$122.40
Rate for Payer: TriWest Medicare	$22.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$89.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.54

Bill Allergen Test

Facility

$153.00

Service Code	CPT 86003
Hospital Charge Code	23568451
Hospital Revenue Code	301
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna of AZ Commercial	$137.70
Rate for Payer: Bisbee Police All Plans	$39.78
Rate for Payer: Cash Price	$122.40
Rate for Payer: Self Pay Self Pay	$122.40

Bill Anti gbm

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	23568532
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

Bill Anti gbm

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	23568532
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

Bill Anti-mullerian hormone

Facility

$374.00

Service Code	CPT 82397
Hospital Charge Code	23217725
Hospital Revenue Code	301
Min. Negotiated Rate	$97.24
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Cash Price	$299.20
Rate for Payer: Self Pay Self Pay	$299.20

Bill Anti-mullerian hormone

Facility

$374.00

Service Code	CPT 82397
Hospital Charge Code	23217725
Hospital Revenue Code	301
Min. Negotiated Rate	$14.12
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Aetna of AZ Medicare	$104.72
Rate for Payer: AHCCCS Medicaid	$14.12
Rate for Payer: Allwell Medicaid	$14.12
Rate for Payer: Allwell Medicare	$56.10
Rate for Payer: Amerigroup Medicare	$56.10
Rate for Payer: APIPA Medicare/Medicaid	$139.69
Rate for Payer: AZCH Complete Medicaid	$14.12
Rate for Payer: AZCH Complete Medicare	$56.10
Rate for Payer: Banner UC Health Medicaid	$14.12
Rate for Payer: Banner UC Health Medicare	$56.10
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$254.32
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cigna of AZ Commercial	$243.10
Rate for Payer: Copperpoint Commercial	$92.56
Rate for Payer: Health Net of AZ Commercial	$224.40
Rate for Payer: Health Net of AZ Medicare	$104.72
Rate for Payer: Humana of AZ Medicare	$56.10
Rate for Payer: Mercy Care Medicaid	$14.12
Rate for Payer: Self Pay Self Pay	$299.20
Rate for Payer: TriWest Medicare	$56.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$218.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$67.32

Bill BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMM

Facility

$99.00

Service Code	CPT 82274
Hospital Charge Code	23621407
Hospital Revenue Code	301
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Cash Price	$79.20
Rate for Payer: Self Pay Self Pay	$79.20

Bill BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMM

Facility

$99.00

Service Code	CPT 82274
Hospital Charge Code	23621407
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Aetna of AZ Medicare	$27.72
Rate for Payer: AHCCCS Medicaid	$15.92
Rate for Payer: Allwell Medicaid	$15.92
Rate for Payer: Allwell Medicare	$14.85
Rate for Payer: Amerigroup Medicare	$14.85
Rate for Payer: APIPA Medicare/Medicaid	$36.98
Rate for Payer: AZCH Complete Medicaid	$15.92
Rate for Payer: AZCH Complete Medicare	$14.85
Rate for Payer: Banner UC Health Medicaid	$15.92
Rate for Payer: Banner UC Health Medicare	$14.85
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$67.32
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Copperpoint Commercial	$24.50
Rate for Payer: Health Net of AZ Commercial	$59.40
Rate for Payer: Health Net of AZ Medicare	$27.72
Rate for Payer: Humana of AZ Medicare	$14.85
Rate for Payer: Mercy Care Medicaid	$15.92
Rate for Payer: Self Pay Self Pay	$79.20
Rate for Payer: TriWest Medicare	$14.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.82

Bill BRCAssure Comp

Facility

$5,269.00

Hospital Charge Code	23568393
Hospital Revenue Code	301
Min. Negotiated Rate	$790.35
Max. Negotiated Rate	$4,742.10
Rate for Payer: Aetna of AZ Commercial	$4,742.10
Rate for Payer: Aetna of AZ Medicare	$1,475.32
Rate for Payer: Allwell Medicare	$790.35
Rate for Payer: Amerigroup Medicare	$790.35
Rate for Payer: APIPA Medicare/Medicaid	$1,967.97
Rate for Payer: AZCH Complete Medicare	$790.35
Rate for Payer: Banner UC Health Medicare	$790.35
Rate for Payer: Bisbee Police All Plans	$1,369.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,582.92
Rate for Payer: Cash Price	$4,215.20
Rate for Payer: Cigna of AZ Commercial	$3,424.85
Rate for Payer: Copperpoint Commercial	$1,304.08
Rate for Payer: Health Net of AZ Commercial	$3,161.40
Rate for Payer: Health Net of AZ Medicare	$1,475.32
Rate for Payer: Humana of AZ Medicare	$790.35
Rate for Payer: Self Pay Self Pay	$4,215.20
Rate for Payer: TriWest Medicare	$790.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,071.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$948.42

Know your out-of-pocket cost for care.

All Charges