Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Creatine Kinase-MB

Facility

$308.00

Service Code	CPT 82553
Hospital Charge Code	785969
Hospital Revenue Code	301
Min. Negotiated Rate	$80.08
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Bisbee Police All Plans	$80.08
Rate for Payer: Cash Price	$246.40
Rate for Payer: Self Pay Self Pay	$246.40

Creatine Kinase-MB

Facility

$308.00

Service Code	CPT 82553
Hospital Charge Code	785969
Hospital Revenue Code	301
Min. Negotiated Rate	$49.28
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Aetna of AZ Medicare	$86.24
Rate for Payer: Allwell Medicare	$49.28
Rate for Payer: Amerigroup Medicare	$49.28
Rate for Payer: APIPA Medicare/Medicaid	$115.04
Rate for Payer: AZCH Complete Medicare	$49.28
Rate for Payer: Banner UC Health Medicare	$49.28
Rate for Payer: Bisbee Police All Plans	$80.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$209.44
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cigna of AZ Commercial	$200.20
Rate for Payer: Copperpoint Commercial	$76.23
Rate for Payer: Health Net of AZ Commercial	$184.80
Rate for Payer: Health Net of AZ Medicare	$86.24
Rate for Payer: Humana of AZ Medicare	$49.28
Rate for Payer: Self Pay Self Pay	$246.40
Rate for Payer: TriWest Medicare	$49.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$179.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.44

Creatinine

Facility

$80.00

Service Code	CPT 82565
Hospital Charge Code	22525233
Hospital Revenue Code	301
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Self Pay Self Pay	$64.00

Creatinine

Facility

$80.00

Service Code	CPT 82565
Hospital Charge Code	22525233
Hospital Revenue Code	301
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: Allwell Medicare	$12.80
Rate for Payer: Amerigroup Medicare	$12.80
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicare	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

Creatinine

Facility

$76.00

Service Code	CPT 82565
Hospital Charge Code	633606
Hospital Revenue Code	301
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$12.16
Rate for Payer: Amerigroup Medicare	$12.16
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

Creatinine

Facility

$76.00

Service Code	CPT 82565
Hospital Charge Code	633606
Hospital Revenue Code	301
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

Creatinine Clearance Standard

Facility

$159.00

Service Code	CPT 82575
Hospital Charge Code	22141049
Hospital Revenue Code	301
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: Allwell Medicare	$25.44
Rate for Payer: Amerigroup Medicare	$25.44
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$103.35
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

Creatinine Clearance Standard

Facility

$159.00

Service Code	CPT 82575
Hospital Charge Code	22141049
Hospital Revenue Code	301
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

Creatinine Kinase

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	22525239
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

Creatinine Kinase

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	22525239
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

Creatinine Level Urine

Facility

$76.00

Service Code	CPT 82570
Hospital Charge Code	633607
Hospital Revenue Code	301
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

Creatinine Level Urine

Facility

$76.00

Service Code	CPT 82570
Hospital Charge Code	633607
Hospital Revenue Code	301
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$12.16
Rate for Payer: Amerigroup Medicare	$12.16
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

CREATININE S

Facility

$80.00

Service Code	CPT 82565
Hospital Charge Code	22481470
Hospital Revenue Code	301
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: Allwell Medicare	$12.80
Rate for Payer: Amerigroup Medicare	$12.80
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicare	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

CREATININE S

Facility

$80.00

Service Code	CPT 82565
Hospital Charge Code	22481470
Hospital Revenue Code	301
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Self Pay Self Pay	$64.00

CREATININE URINE 24

Facility

$94.00

Service Code	CPT 82570
Hospital Charge Code	22481471
Hospital Revenue Code	301
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of AZ Commercial	$84.60
Rate for Payer: Aetna of AZ Medicare	$26.32
Rate for Payer: Allwell Medicare	$15.04
Rate for Payer: Amerigroup Medicare	$15.04
Rate for Payer: APIPA Medicare/Medicaid	$35.11
Rate for Payer: AZCH Complete Medicare	$15.04
Rate for Payer: Banner UC Health Medicare	$15.04
Rate for Payer: Bisbee Police All Plans	$24.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.92
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cigna of AZ Commercial	$61.10
Rate for Payer: Copperpoint Commercial	$23.27
Rate for Payer: Health Net of AZ Commercial	$56.40
Rate for Payer: Health Net of AZ Medicare	$26.32
Rate for Payer: Humana of AZ Medicare	$15.04
Rate for Payer: Self Pay Self Pay	$75.20
Rate for Payer: TriWest Medicare	$15.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.92

CREATININE URINE 24

Facility

$94.00

Service Code	CPT 82570
Hospital Charge Code	22481471
Hospital Revenue Code	301
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of AZ Commercial	$84.60
Rate for Payer: Bisbee Police All Plans	$24.44
Rate for Payer: Cash Price	$75.20
Rate for Payer: Self Pay Self Pay	$75.20

Creatinine, Urine LC

Facility

$84.00

Service Code	CPT 82570
Hospital Charge Code	1285619
Hospital Revenue Code	301
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Cash Price	$67.20
Rate for Payer: Self Pay Self Pay	$67.20

Creatinine, Urine LC

Facility

$84.00

Service Code	CPT 82570
Hospital Charge Code	1285619
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Aetna of AZ Medicare	$23.52
Rate for Payer: Allwell Medicare	$13.44
Rate for Payer: Amerigroup Medicare	$13.44
Rate for Payer: APIPA Medicare/Medicaid	$31.37
Rate for Payer: AZCH Complete Medicare	$13.44
Rate for Payer: Banner UC Health Medicare	$13.44
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.12
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$20.79
Rate for Payer: Health Net of AZ Commercial	$50.40
Rate for Payer: Health Net of AZ Medicare	$23.52
Rate for Payer: Humana of AZ Medicare	$13.44
Rate for Payer: Self Pay Self Pay	$67.20
Rate for Payer: TriWest Medicare	$13.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.12

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	1681878
Hospital Revenue Code	302
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	1681878
Hospital Revenue Code	302
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	4662835
Hospital Revenue Code	302
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	4662835
Hospital Revenue Code	302
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

Crossmatch Immediate Spin

Facility

$177.00

Service Code	CPT 86920
Hospital Charge Code	22107850
Hospital Revenue Code	302
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

Crossmatch Immediate Spin

Facility

$177.00

Service Code	CPT 86920
Hospital Charge Code	22107850
Hospital Revenue Code	302
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, LESS T

Facility

$1,790.00

Service Code	CPT 52317
Hospital Charge Code	27881569
Hospital Revenue Code	360
Min. Negotiated Rate	$465.40
Max. Negotiated Rate	$1,611.00
Rate for Payer: Aetna of AZ Commercial	$1,611.00
Rate for Payer: Bisbee Police All Plans	$465.40
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Self Pay Self Pay	$1,432.00

Know your out-of-pocket cost for care.

All Charges