Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CK ISOENZYMES

Facility

$160.00

Service Code	CPT 82552
Hospital Charge Code	22481468
Hospital Revenue Code	301
Min. Negotiated Rate	$25.60
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: Allwell Medicare	$25.60
Rate for Payer: Amerigroup Medicare	$25.60
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicare	$25.60
Rate for Payer: Banner UC Health Medicare	$25.60
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: 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	$25.60
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$25.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.80

CK ISOENZYMES

Facility

$160.00

Service Code	CPT 82552
Hospital Charge Code	22481468
Hospital Revenue Code	301
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

CK-MB

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	9091368
Hospital Revenue Code	301
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Cash Price	$256.80
Rate for Payer: Self Pay Self Pay	$256.80

CK-MB

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	9091368
Hospital Revenue Code	301
Min. Negotiated Rate	$51.36
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Aetna of AZ Medicare	$89.88
Rate for Payer: Allwell Medicare	$51.36
Rate for Payer: Amerigroup Medicare	$51.36
Rate for Payer: APIPA Medicare/Medicaid	$119.89
Rate for Payer: AZCH Complete Medicare	$51.36
Rate for Payer: Banner UC Health Medicare	$51.36
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$218.28
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$208.65
Rate for Payer: Copperpoint Commercial	$79.45
Rate for Payer: Health Net of AZ Commercial	$192.60
Rate for Payer: Health Net of AZ Medicare	$89.88
Rate for Payer: Humana of AZ Medicare	$51.36
Rate for Payer: Self Pay Self Pay	$256.80
Rate for Payer: TriWest Medicare	$51.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$187.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.78

CKMB

Facility

$337.00

Service Code	CPT 82553
Hospital Charge Code	22481469
Hospital Revenue Code	301
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Aetna of AZ Medicare	$94.36
Rate for Payer: Allwell Medicare	$53.92
Rate for Payer: Amerigroup Medicare	$53.92
Rate for Payer: APIPA Medicare/Medicaid	$125.87
Rate for Payer: AZCH Complete Medicare	$53.92
Rate for Payer: Banner UC Health Medicare	$53.92
Rate for Payer: Bisbee Police All Plans	$87.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$229.16
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cigna of AZ Commercial	$219.05
Rate for Payer: Copperpoint Commercial	$83.41
Rate for Payer: Health Net of AZ Commercial	$202.20
Rate for Payer: Health Net of AZ Medicare	$94.36
Rate for Payer: Humana of AZ Medicare	$53.92
Rate for Payer: Self Pay Self Pay	$269.60
Rate for Payer: TriWest Medicare	$53.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$196.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.66

CKMB

Facility

$337.00

Service Code	CPT 82553
Hospital Charge Code	22481469
Hospital Revenue Code	301
Min. Negotiated Rate	$87.62
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Bisbee Police All Plans	$87.62
Rate for Payer: Cash Price	$269.60
Rate for Payer: Self Pay Self Pay	$269.60

CK, Total+Isoenzymes, Serum LC

Facility

$78.00

Service Code	CPT 82550
Hospital Charge Code	2087571
Hospital Revenue Code	301
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: Allwell Medicare	$12.48
Rate for Payer: Amerigroup Medicare	$12.48
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicare	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

CK, Total+Isoenzymes, Serum LC

Facility

$78.00

Service Code	CPT 82550
Hospital Charge Code	2087571
Hospital Revenue Code	301
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

CLEANER WOUND BIOLEX 6OZ

Facility

$48.00

Hospital Charge Code	22355158
Hospital Revenue Code	270
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.68
Rate for Payer: Amerigroup Medicare	$7.68
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CLEANER WOUND BIOLEX 6OZ

Facility

$46.00

Hospital Charge Code	27567551
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

CLEANER WOUND BIOLEX 6OZ

Facility

$48.00

Hospital Charge Code	22355158
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CLEANER WOUND BIOLEX 6OZ

Facility

$46.00

Hospital Charge Code	27567551
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$7.36
Rate for Payer: Amerigroup Medicare	$7.36
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: AHCCCS Medicaid	$8,627.92
Rate for Payer: Allwell Medicaid	$8,627.92
Rate for Payer: AZCH Complete Medicaid	$8,627.92
Rate for Payer: Banner UC Health Medicaid	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: AHCCCS Medicaid	$8,627.92
Rate for Payer: Allwell Medicaid	$8,627.92
Rate for Payer: AZCH Complete Medicaid	$8,627.92
Rate for Payer: Banner UC Health Medicaid	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: AHCCCS Medicaid	$8,627.92
Rate for Payer: Allwell Medicaid	$8,627.92
Rate for Payer: AZCH Complete Medicaid	$8,627.92
Rate for Payer: Banner UC Health Medicaid	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Know your out-of-pocket cost for care.

All Charges