Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

80331 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80331
Hospital Charge Code	28077246
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80337 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80337
Hospital Charge Code	28073686
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80337 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80337
Hospital Charge Code	28073686
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80338 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80338
Hospital Charge Code	28073687
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80338 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80338
Hospital Charge Code	28073687
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80341 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80341
Hospital Charge Code	28073688
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80341 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80341
Hospital Charge Code	28073688
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80344 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80344
Hospital Charge Code	28077248
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80344 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80344
Hospital Charge Code	28077248
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80347 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$104.00

Service Code	CPT 80347
Hospital Charge Code	28077249
Hospital Revenue Code	301
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

80347 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$104.00

Service Code	CPT 80347
Hospital Charge Code	28077249
Hospital Revenue Code	301
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$16.64
Rate for Payer: Amerigroup Medicare	$16.64
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$67.60
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

80348 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80348
Hospital Charge Code	28075338
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80348 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80348
Hospital Charge Code	28075338
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80353 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$239.00

Service Code	CPT 80353
Hospital Charge Code	28075339
Hospital Revenue Code	301
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

80353 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$239.00

Service Code	CPT 80353
Hospital Charge Code	28075339
Hospital Revenue Code	301
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

80354 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80354
Hospital Charge Code	28073689
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80354 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80354
Hospital Charge Code	28073689
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80355 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80355
Hospital Charge Code	28077250
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80355 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80355
Hospital Charge Code	28077250
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80357 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80357
Hospital Charge Code	28073690
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80357 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80357
Hospital Charge Code	28073690
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

80358 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$228.00

Service Code	CPT 80358
Hospital Charge Code	28077251
Hospital Revenue Code	301
Min. Negotiated Rate	$59.28
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna of AZ Commercial	$205.20
Rate for Payer: Bisbee Police All Plans	$59.28
Rate for Payer: Cash Price	$182.40
Rate for Payer: Self Pay Self Pay	$182.40

80358 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$228.00

Service Code	CPT 80358
Hospital Charge Code	28077251
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna of AZ Commercial	$205.20
Rate for Payer: Aetna of AZ Medicare	$63.84
Rate for Payer: Allwell Medicare	$36.48
Rate for Payer: Amerigroup Medicare	$36.48
Rate for Payer: APIPA Medicare/Medicaid	$85.16
Rate for Payer: AZCH Complete Medicare	$36.48
Rate for Payer: Banner UC Health Medicare	$36.48
Rate for Payer: Bisbee Police All Plans	$59.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$155.04
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cigna of AZ Commercial	$148.20
Rate for Payer: Copperpoint Commercial	$56.43
Rate for Payer: Health Net of AZ Commercial	$136.80
Rate for Payer: Health Net of AZ Medicare	$63.84
Rate for Payer: Humana of AZ Medicare	$36.48
Rate for Payer: Self Pay Self Pay	$182.40
Rate for Payer: TriWest Medicare	$36.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.04

80359 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80359
Hospital Charge Code	28077252
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

80359 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 80359
Hospital Charge Code	28077252
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

Know your out-of-pocket cost for care.

All Charges