Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Heavy Metal Profile II, LC

Facility

$463.00

Service Code	CPT 82300
Hospital Charge Code	4976987
Hospital Revenue Code	301
Min. Negotiated Rate	$120.38
Max. Negotiated Rate	$416.70
Rate for Payer: Aetna of AZ Commercial	$416.70
Rate for Payer: Bisbee Police All Plans	$120.38
Rate for Payer: Cash Price	$370.40
Rate for Payer: Self Pay Self Pay	$370.40

Heavy Metal Profile II, LC

Facility

$463.00

Service Code	CPT 82300
Hospital Charge Code	4976987
Hospital Revenue Code	301
Min. Negotiated Rate	$74.08
Max. Negotiated Rate	$416.70
Rate for Payer: Aetna of AZ Commercial	$416.70
Rate for Payer: Aetna of AZ Medicare	$129.64
Rate for Payer: Allwell Medicare	$74.08
Rate for Payer: Amerigroup Medicare	$74.08
Rate for Payer: APIPA Medicare/Medicaid	$172.93
Rate for Payer: AZCH Complete Medicare	$74.08
Rate for Payer: Banner UC Health Medicare	$74.08
Rate for Payer: Bisbee Police All Plans	$120.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$314.84
Rate for Payer: Cash Price	$370.40
Rate for Payer: Cigna of AZ Commercial	$300.95
Rate for Payer: Copperpoint Commercial	$114.59
Rate for Payer: Health Net of AZ Commercial	$277.80
Rate for Payer: Health Net of AZ Medicare	$129.64
Rate for Payer: Humana of AZ Medicare	$74.08
Rate for Payer: Self Pay Self Pay	$370.40
Rate for Payer: TriWest Medicare	$74.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$269.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$83.34

HEEL BO S-M-L

Facility

$41.00

Hospital Charge Code	22355141
Hospital Revenue Code	270
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

HEEL BO S-M-L

Facility

$41.00

Hospital Charge Code	22355141
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
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: Allwell Medicare	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
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: Cigna of AZ Commercial	$28.70
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	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

Helicobacter pylori, IgA LC

Facility

$212.00

Service Code	CPT 86677
Hospital Charge Code	7328629
Hospital Revenue Code	302
Min. Negotiated Rate	$55.12
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Bisbee Police All Plans	$55.12
Rate for Payer: Cash Price	$169.60
Rate for Payer: Self Pay Self Pay	$169.60

Helicobacter pylori, IgA LC

Facility

$212.00

Service Code	CPT 86677
Hospital Charge Code	7328629
Hospital Revenue Code	302
Min. Negotiated Rate	$33.92
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Aetna of AZ Medicare	$59.36
Rate for Payer: Allwell Medicare	$33.92
Rate for Payer: Amerigroup Medicare	$33.92
Rate for Payer: APIPA Medicare/Medicaid	$79.18
Rate for Payer: AZCH Complete Medicare	$33.92
Rate for Payer: Banner UC Health Medicare	$33.92
Rate for Payer: Bisbee Police All Plans	$55.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.16
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cigna of AZ Commercial	$137.80
Rate for Payer: Copperpoint Commercial	$52.47
Rate for Payer: Health Net of AZ Commercial	$127.20
Rate for Payer: Health Net of AZ Medicare	$59.36
Rate for Payer: Humana of AZ Medicare	$33.92
Rate for Payer: Self Pay Self Pay	$169.60
Rate for Payer: TriWest Medicare	$33.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$123.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.16

Helper T-Lymph-CD4 LC

Facility

$331.00

Service Code	CPT 86361
Hospital Charge Code	22201913
Hospital Revenue Code	302
Min. Negotiated Rate	$52.96
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Medicare	$92.68
Rate for Payer: Allwell Medicare	$52.96
Rate for Payer: Amerigroup Medicare	$52.96
Rate for Payer: APIPA Medicare/Medicaid	$123.63
Rate for Payer: AZCH Complete Medicare	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.08
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Copperpoint Commercial	$81.92
Rate for Payer: Health Net of AZ Commercial	$198.60
Rate for Payer: Health Net of AZ Medicare	$92.68
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Self Pay Self Pay	$264.80
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.58

Helper T-Lymph-CD4 LC

Facility

$331.00

Service Code	CPT 86361
Hospital Charge Code	22201913
Hospital Revenue Code	302
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Cash Price	$264.80
Rate for Payer: Self Pay Self Pay	$264.80

Hematocrit

Facility

$48.00

Service Code	CPT 85014
Hospital Charge Code	633742
Hospital Revenue Code	305
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	$31.20
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

Hematocrit

Facility

$48.00

Service Code	CPT 85014
Hospital Charge Code	633742
Hospital Revenue Code	305
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

HEMATOCRIT

Facility

$66.00

Service Code	CPT 85014
Hospital Charge Code	22481477
Hospital Revenue Code	305
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Aetna of AZ Medicare	$18.48
Rate for Payer: Allwell Medicare	$10.56
Rate for Payer: Amerigroup Medicare	$10.56
Rate for Payer: APIPA Medicare/Medicaid	$24.65
Rate for Payer: AZCH Complete Medicare	$10.56
Rate for Payer: Banner UC Health Medicare	$10.56
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$42.90
Rate for Payer: Copperpoint Commercial	$16.34
Rate for Payer: Health Net of AZ Commercial	$39.60
Rate for Payer: Health Net of AZ Medicare	$18.48
Rate for Payer: Humana of AZ Medicare	$10.56
Rate for Payer: Self Pay Self Pay	$52.80
Rate for Payer: TriWest Medicare	$10.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$38.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.88

HEMATOCRIT

Facility

$66.00

Service Code	CPT 85014
Hospital Charge Code	22481477
Hospital Revenue Code	305
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Cash Price	$52.80
Rate for Payer: Self Pay Self Pay	$52.80

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE PROXIMAL END

Facility

$1,305.00

Service Code	CPT 28160
Hospital Charge Code	24043273
Hospital Revenue Code	360
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,174.50
Rate for Payer: Aetna of AZ Medicare	$365.40
Rate for Payer: AHCCCS Medicaid	$2,052.04
Rate for Payer: Allwell Medicaid	$2,052.04
Rate for Payer: Allwell Medicare	$208.80
Rate for Payer: Amerigroup Medicare	$208.80
Rate for Payer: APIPA Medicare/Medicaid	$487.42
Rate for Payer: AZCH Complete Medicaid	$2,052.04
Rate for Payer: AZCH Complete Medicare	$208.80
Rate for Payer: Banner UC Health Medicaid	$2,052.04
Rate for Payer: Banner UC Health Medicare	$208.80
Rate for Payer: Bisbee Police All Plans	$339.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$887.40
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cigna of AZ Commercial	$652.50
Rate for Payer: Copperpoint Commercial	$322.99
Rate for Payer: Health Net of AZ Commercial	$783.00
Rate for Payer: Health Net of AZ Medicare	$365.40
Rate for Payer: Humana of AZ Medicare	$208.80
Rate for Payer: Mercy Care Medicaid	$2,052.04
Rate for Payer: Self Pay Self Pay	$1,044.00
Rate for Payer: TriWest Medicare	$208.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$234.90

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE PROXIMAL END

Facility

$1,305.00

Service Code	CPT 28160
Hospital Charge Code	24043273
Hospital Revenue Code	360
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of AZ Commercial	$1,174.50
Rate for Payer: Bisbee Police All Plans	$339.30
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Self Pay Self Pay	$1,044.00

HEMO DRAIN 3/16

Facility

$185.00

Hospital Charge Code	22354978
Hospital Revenue Code	270
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Cash Price	$148.00
Rate for Payer: Self Pay Self Pay	$148.00

HEMO DRAIN 3/16

Facility

$185.00

Hospital Charge Code	22354978
Hospital Revenue Code	270
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Aetna of AZ Medicare	$51.80
Rate for Payer: Allwell Medicare	$29.60
Rate for Payer: Amerigroup Medicare	$29.60
Rate for Payer: APIPA Medicare/Medicaid	$69.10
Rate for Payer: AZCH Complete Medicare	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.80
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$129.50
Rate for Payer: Copperpoint Commercial	$45.79
Rate for Payer: Health Net of AZ Commercial	$111.00
Rate for Payer: Health Net of AZ Medicare	$51.80
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Self Pay Self Pay	$148.00
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.30

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	798796
Hospital Revenue Code	300
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	633741
Hospital Revenue Code	300
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	633741
Hospital Revenue Code	300
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	798796
Hospital Revenue Code	300
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

Hemoglobin A1C

Facility

$139.00

Service Code	CPT 83036
Hospital Charge Code	633743
Hospital Revenue Code	301
Min. Negotiated Rate	$22.24
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Aetna of AZ Medicare	$38.92
Rate for Payer: Allwell Medicare	$22.24
Rate for Payer: Amerigroup Medicare	$22.24
Rate for Payer: APIPA Medicare/Medicaid	$51.92
Rate for Payer: AZCH Complete Medicare	$22.24
Rate for Payer: Banner UC Health Medicare	$22.24
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$94.52
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$90.35
Rate for Payer: Copperpoint Commercial	$34.40
Rate for Payer: Health Net of AZ Commercial	$83.40
Rate for Payer: Health Net of AZ Medicare	$38.92
Rate for Payer: Humana of AZ Medicare	$22.24
Rate for Payer: Self Pay Self Pay	$111.20
Rate for Payer: TriWest Medicare	$22.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$81.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.02

Hemoglobin A1C

Facility

$139.00

Service Code	CPT 83036
Hospital Charge Code	633743
Hospital Revenue Code	301
Min. Negotiated Rate	$36.14
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Cash Price	$111.20
Rate for Payer: Self Pay Self Pay	$111.20

Hemoglobin A1c LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	1285548
Hospital Revenue Code	301
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Aetna of AZ Medicare	$62.16
Rate for Payer: Allwell Medicare	$35.52
Rate for Payer: Amerigroup Medicare	$35.52
Rate for Payer: APIPA Medicare/Medicaid	$82.92
Rate for Payer: AZCH Complete Medicare	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$150.96
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$144.30
Rate for Payer: Copperpoint Commercial	$54.95
Rate for Payer: Health Net of AZ Commercial	$133.20
Rate for Payer: Health Net of AZ Medicare	$62.16
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Self Pay Self Pay	$177.60
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$129.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.96

Hemoglobin A1c LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	1285548
Hospital Revenue Code	301
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Cash Price	$177.60
Rate for Payer: Self Pay Self Pay	$177.60

.Hemoglobin A1c, Please Note LC

Facility

$234.00

Service Code	CPT 84590
Hospital Charge Code	22311148
Hospital Revenue Code	306
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna of AZ Commercial	$210.60
Rate for Payer: Bisbee Police All Plans	$60.84
Rate for Payer: Cash Price	$187.20
Rate for Payer: Self Pay Self Pay	$187.20

Know your out-of-pocket cost for care.

All Charges