Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cytomegalovirus (CMV) Ab, IgM LC

Facility

$230.00

Service Code	CPT 86645
Hospital Charge Code	2029230
Hospital Revenue Code	302
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Aetna of AZ Medicare	$64.40
Rate for Payer: Allwell Medicare	$36.80
Rate for Payer: Amerigroup Medicare	$36.80
Rate for Payer: APIPA Medicare/Medicaid	$85.91
Rate for Payer: AZCH Complete Medicare	$36.80
Rate for Payer: Banner UC Health Medicare	$36.80
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$156.40
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna of AZ Commercial	$149.50
Rate for Payer: Copperpoint Commercial	$56.92
Rate for Payer: Health Net of AZ Commercial	$138.00
Rate for Payer: Health Net of AZ Medicare	$64.40
Rate for Payer: Humana of AZ Medicare	$36.80
Rate for Payer: Self Pay Self Pay	$184.00
Rate for Payer: TriWest Medicare	$36.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.40

Cytomegalovirus (CMV) Ab, IgM LC

Facility

$230.00

Service Code	CPT 86645
Hospital Charge Code	2029230
Hospital Revenue Code	302
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Cash Price	$184.00
Rate for Payer: Self Pay Self Pay	$184.00

CYTOPATH CELL ENHANCE TECH

Facility

$177.00

Service Code	CPT 88112
Hospital Charge Code	22545729
Hospital Revenue Code	310
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

CYTOPATH CELL ENHANCE TECH

Facility

$177.00

Service Code	CPT 88112
Hospital Charge Code	22545729
Hospital Revenue Code	310
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

CYTOPATH CONCENTRATE TECH

Facility

$282.00

Service Code	CPT 88108
Hospital Charge Code	22545551
Hospital Revenue Code	310
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Cash Price	$225.60
Rate for Payer: Self Pay Self Pay	$225.60

CYTOPATH CONCENTRATE TECH

Facility

$282.00

Service Code	CPT 88108
Hospital Charge Code	22545551
Hospital Revenue Code	310
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Aetna of AZ Medicare	$78.96
Rate for Payer: Allwell Medicare	$45.12
Rate for Payer: Amerigroup Medicare	$45.12
Rate for Payer: APIPA Medicare/Medicaid	$105.33
Rate for Payer: AZCH Complete Medicare	$45.12
Rate for Payer: Banner UC Health Medicare	$45.12
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Copperpoint Commercial	$69.80
Rate for Payer: Health Net of AZ Commercial	$169.20
Rate for Payer: Health Net of AZ Medicare	$78.96
Rate for Payer: Humana of AZ Medicare	$45.12
Rate for Payer: Self Pay Self Pay	$225.60
Rate for Payer: TriWest Medicare	$45.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$164.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.76

CYTOPATH EVAL FNA REPORT

Facility

$379.00

Service Code	CPT 88173
Hospital Charge Code	22545710
Hospital Revenue Code	310
Min. Negotiated Rate	$98.54
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Cash Price	$303.20
Rate for Payer: Self Pay Self Pay	$303.20

CYTOPATH EVAL FNA REPORT

Facility

$379.00

Service Code	CPT 88173
Hospital Charge Code	22545710
Hospital Revenue Code	310
Min. Negotiated Rate	$60.64
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Aetna of AZ Medicare	$106.12
Rate for Payer: Allwell Medicare	$60.64
Rate for Payer: Amerigroup Medicare	$60.64
Rate for Payer: APIPA Medicare/Medicaid	$141.56
Rate for Payer: AZCH Complete Medicare	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$257.72
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$246.35
Rate for Payer: Copperpoint Commercial	$93.80
Rate for Payer: Health Net of AZ Commercial	$227.40
Rate for Payer: Health Net of AZ Medicare	$106.12
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Self Pay Self Pay	$303.20
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$220.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.22

CYTOPATH FL NON GYN FILTER

Facility

$343.00

Service Code	CPT 88106
Hospital Charge Code	22545728
Hospital Revenue Code	310
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna of AZ Commercial	$308.70
Rate for Payer: Bisbee Police All Plans	$89.18
Rate for Payer: Cash Price	$274.40
Rate for Payer: Self Pay Self Pay	$274.40

CYTOPATH FL NON GYN FILTER

Facility

$343.00

Service Code	CPT 88106
Hospital Charge Code	22545728
Hospital Revenue Code	310
Min. Negotiated Rate	$54.88
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna of AZ Commercial	$308.70
Rate for Payer: Aetna of AZ Medicare	$96.04
Rate for Payer: Allwell Medicare	$54.88
Rate for Payer: Amerigroup Medicare	$54.88
Rate for Payer: APIPA Medicare/Medicaid	$128.11
Rate for Payer: AZCH Complete Medicare	$54.88
Rate for Payer: Banner UC Health Medicare	$54.88
Rate for Payer: Bisbee Police All Plans	$89.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$233.24
Rate for Payer: Cash Price	$274.40
Rate for Payer: Cigna of AZ Commercial	$222.95
Rate for Payer: Copperpoint Commercial	$84.89
Rate for Payer: Health Net of AZ Commercial	$205.80
Rate for Payer: Health Net of AZ Medicare	$96.04
Rate for Payer: Humana of AZ Medicare	$54.88
Rate for Payer: Self Pay Self Pay	$274.40
Rate for Payer: TriWest Medicare	$54.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$199.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.74

CYTOPATH FL NON GYN SMEARS

Facility

$239.00

Service Code	CPT 88104
Hospital Charge Code	22545727
Hospital Revenue Code	310
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Cash Price	$191.20
Rate for Payer: Self Pay Self Pay	$191.20

CYTOPATH FL NON GYN SMEARS

Facility

$239.00

Service Code	CPT 88104
Hospital Charge Code	22545727
Hospital Revenue Code	310
Min. Negotiated Rate	$38.24
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Aetna of AZ Medicare	$66.92
Rate for Payer: Allwell Medicare	$38.24
Rate for Payer: Amerigroup Medicare	$38.24
Rate for Payer: APIPA Medicare/Medicaid	$89.27
Rate for Payer: AZCH Complete Medicare	$38.24
Rate for Payer: Banner UC Health Medicare	$38.24
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$162.52
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cigna of AZ Commercial	$155.35
Rate for Payer: Copperpoint Commercial	$59.15
Rate for Payer: Health Net of AZ Commercial	$143.40
Rate for Payer: Health Net of AZ Medicare	$66.92
Rate for Payer: Humana of AZ Medicare	$38.24
Rate for Payer: Self Pay Self Pay	$191.20
Rate for Payer: TriWest Medicare	$38.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.02

Cytopathology, cervical or vaginal (any reporting system), c

Facility

$126.00

Service Code	CPT 88175
Hospital Charge Code	22660588
Hospital Revenue Code	300
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Aetna of AZ Medicare	$35.28
Rate for Payer: Allwell Medicare	$20.16
Rate for Payer: Amerigroup Medicare	$20.16
Rate for Payer: APIPA Medicare/Medicaid	$47.06
Rate for Payer: AZCH Complete Medicare	$20.16
Rate for Payer: Banner UC Health Medicare	$20.16
Rate for Payer: Bisbee Police All Plans	$32.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$85.68
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna of AZ Commercial	$81.90
Rate for Payer: Copperpoint Commercial	$31.18
Rate for Payer: Health Net of AZ Commercial	$75.60
Rate for Payer: Health Net of AZ Medicare	$35.28
Rate for Payer: Humana of AZ Medicare	$20.16
Rate for Payer: Self Pay Self Pay	$100.80
Rate for Payer: TriWest Medicare	$20.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$73.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.68

Cytopathology, cervical or vaginal (any reporting system), c

Facility

$126.00

Service Code	CPT 88175
Hospital Charge Code	22660588
Hospital Revenue Code	300
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Bisbee Police All Plans	$32.76
Rate for Payer: Cash Price	$100.80
Rate for Payer: Self Pay Self Pay	$100.80

CYTOPATH SMEAR OTH SOURCE

Facility

$203.00

Service Code	CPT 88160
Hospital Charge Code	22545730
Hospital Revenue Code	310
Min. Negotiated Rate	$32.48
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: Allwell Medicare	$32.48
Rate for Payer: Amerigroup Medicare	$32.48
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicare	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$131.95
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

CYTOPATH SMEAR OTH SOURCE

Facility

$203.00

Service Code	CPT 88160
Hospital Charge Code	22545730
Hospital Revenue Code	310
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

CYTOPATH SMEAR OTH SOURCE 2

Facility

$179.00

Service Code	CPT 88161
Hospital Charge Code	22545736
Hospital Revenue Code	310
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Cash Price	$143.20
Rate for Payer: Self Pay Self Pay	$143.20

CYTOPATH SMEAR OTH SOURCE 2

Facility

$179.00

Service Code	CPT 88161
Hospital Charge Code	22545736
Hospital Revenue Code	310
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Aetna of AZ Medicare	$50.12
Rate for Payer: Allwell Medicare	$28.64
Rate for Payer: Amerigroup Medicare	$28.64
Rate for Payer: APIPA Medicare/Medicaid	$66.86
Rate for Payer: AZCH Complete Medicare	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$121.72
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$116.35
Rate for Payer: Copperpoint Commercial	$44.30
Rate for Payer: Health Net of AZ Commercial	$107.40
Rate for Payer: Health Net of AZ Medicare	$50.12
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Self Pay Self Pay	$143.20
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.22

CYTOPATH SMEAR OTH SOURCE 3

Facility

$297.00

Service Code	CPT 88162
Hospital Charge Code	22545737
Hospital Revenue Code	310
Min. Negotiated Rate	$77.22
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna of AZ Commercial	$267.30
Rate for Payer: Bisbee Police All Plans	$77.22
Rate for Payer: Cash Price	$237.60
Rate for Payer: Self Pay Self Pay	$237.60

CYTOPATH SMEAR OTH SOURCE 3

Facility

$297.00

Service Code	CPT 88162
Hospital Charge Code	22545737
Hospital Revenue Code	310
Min. Negotiated Rate	$47.52
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna of AZ Commercial	$267.30
Rate for Payer: Aetna of AZ Medicare	$83.16
Rate for Payer: Allwell Medicare	$47.52
Rate for Payer: Amerigroup Medicare	$47.52
Rate for Payer: APIPA Medicare/Medicaid	$110.93
Rate for Payer: AZCH Complete Medicare	$47.52
Rate for Payer: Banner UC Health Medicare	$47.52
Rate for Payer: Bisbee Police All Plans	$77.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$201.96
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna of AZ Commercial	$193.05
Rate for Payer: Copperpoint Commercial	$73.51
Rate for Payer: Health Net of AZ Commercial	$178.20
Rate for Payer: Health Net of AZ Medicare	$83.16
Rate for Payer: Humana of AZ Medicare	$47.52
Rate for Payer: Self Pay Self Pay	$237.60
Rate for Payer: TriWest Medicare	$47.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.46

CYTP DX EVAL FNA 1ST EA SITE

Facility

$93.00

Service Code	CPT 88172
Hospital Charge Code	22545708
Hospital Revenue Code	310
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Aetna of AZ Medicare	$26.04
Rate for Payer: Allwell Medicare	$14.88
Rate for Payer: Amerigroup Medicare	$14.88
Rate for Payer: APIPA Medicare/Medicaid	$34.74
Rate for Payer: AZCH Complete Medicare	$14.88
Rate for Payer: Banner UC Health Medicare	$14.88
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.24
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cigna of AZ Commercial	$60.45
Rate for Payer: Copperpoint Commercial	$23.02
Rate for Payer: Health Net of AZ Commercial	$55.80
Rate for Payer: Health Net of AZ Medicare	$26.04
Rate for Payer: Humana of AZ Medicare	$14.88
Rate for Payer: Self Pay Self Pay	$74.40
Rate for Payer: TriWest Medicare	$14.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.74

CYTP DX EVAL FNA 1ST EA SITE

Facility

$93.00

Service Code	CPT 88172
Hospital Charge Code	22545708
Hospital Revenue Code	310
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Cash Price	$74.40
Rate for Payer: Self Pay Self Pay	$74.40

CYTP FNA EVAL EA ADDL

Facility

$42.00

Service Code	CPT 88177
Hospital Charge Code	22545738
Hospital Revenue Code	310
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

CYTP FNA EVAL EA ADDL

Facility

$42.00

Service Code	CPT 88177
Hospital Charge Code	22545738
Hospital Revenue Code	310
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

D16 LOW PROFILE 3MM X 30MM BONE SCREW

Facility

$1,915.00

Hospital Charge Code	27663809
Hospital Revenue Code	270
Min. Negotiated Rate	$497.90
Max. Negotiated Rate	$1,723.50
Rate for Payer: Aetna of AZ Commercial	$1,723.50
Rate for Payer: Bisbee Police All Plans	$497.90
Rate for Payer: Cash Price	$1,532.00
Rate for Payer: Self Pay Self Pay	$1,532.00

Know your out-of-pocket cost for care.

All Charges