Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

87906 HIV-1 Quant PCR

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173797
Hospital Revenue Code	301
Min. Negotiated Rate	$143.26
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Cash Price	$440.80
Rate for Payer: Self Pay Self Pay	$440.80

88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$4,067.00

Service Code	CPT 88184
Hospital Charge Code	23568455
Hospital Revenue Code	301
Min. Negotiated Rate	$1,057.42
Max. Negotiated Rate	$3,660.30
Rate for Payer: Aetna of AZ Commercial	$3,660.30
Rate for Payer: Bisbee Police All Plans	$1,057.42
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Self Pay Self Pay	$3,253.60

88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$4,067.00

Service Code	CPT 88184
Hospital Charge Code	23568455
Hospital Revenue Code	301
Min. Negotiated Rate	$650.72
Max. Negotiated Rate	$3,660.30
Rate for Payer: Aetna of AZ Commercial	$3,660.30
Rate for Payer: Aetna of AZ Medicare	$1,138.76
Rate for Payer: Allwell Medicare	$650.72
Rate for Payer: Amerigroup Medicare	$650.72
Rate for Payer: APIPA Medicare/Medicaid	$1,519.02
Rate for Payer: AZCH Complete Medicare	$650.72
Rate for Payer: Banner UC Health Medicare	$650.72
Rate for Payer: Bisbee Police All Plans	$1,057.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,765.56
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Cigna of AZ Commercial	$2,643.55
Rate for Payer: Copperpoint Commercial	$1,006.58
Rate for Payer: Health Net of AZ Commercial	$2,440.20
Rate for Payer: Health Net of AZ Medicare	$1,138.76
Rate for Payer: Humana of AZ Medicare	$650.72
Rate for Payer: Self Pay Self Pay	$3,253.60
Rate for Payer: TriWest Medicare	$650.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,371.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$732.06

88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$65.00

Service Code	CPT 88185
Hospital Charge Code	23568456
Hospital Revenue Code	301
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$65.00

Service Code	CPT 88185
Hospital Charge Code	23568456
Hospital Revenue Code	301
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS

Facility

$190.00

Service Code	CPT 88189
Hospital Charge Code	23568457
Hospital Revenue Code	301
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of AZ Commercial	$171.00
Rate for Payer: Aetna of AZ Medicare	$53.20
Rate for Payer: Allwell Medicare	$30.40
Rate for Payer: Amerigroup Medicare	$30.40
Rate for Payer: APIPA Medicare/Medicaid	$70.97
Rate for Payer: AZCH Complete Medicare	$30.40
Rate for Payer: Banner UC Health Medicare	$30.40
Rate for Payer: Bisbee Police All Plans	$49.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$129.20
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cigna of AZ Commercial	$123.50
Rate for Payer: Copperpoint Commercial	$47.02
Rate for Payer: Health Net of AZ Commercial	$114.00
Rate for Payer: Health Net of AZ Medicare	$53.20
Rate for Payer: Humana of AZ Medicare	$30.40
Rate for Payer: Self Pay Self Pay	$152.00
Rate for Payer: TriWest Medicare	$30.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$110.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.20

88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS

Facility

$190.00

Service Code	CPT 88189
Hospital Charge Code	23568457
Hospital Revenue Code	301
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of AZ Commercial	$171.00
Rate for Payer: Bisbee Police All Plans	$49.40
Rate for Payer: Cash Price	$152.00
Rate for Payer: Self Pay Self Pay	$152.00

90783 INTRA ARTERIAL

Facility

$98.00

Service Code	CPT 90783
Hospital Charge Code	22282929
Hospital Revenue Code	450
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Cash Price	$78.40
Rate for Payer: Self Pay Self Pay	$78.40

90783 INTRA ARTERIAL

Facility

$98.00

Service Code	CPT 90783
Hospital Charge Code	22282929
Hospital Revenue Code	450
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Aetna of AZ Medicare	$27.44
Rate for Payer: Allwell Medicare	$15.68
Rate for Payer: Amerigroup Medicare	$15.68
Rate for Payer: APIPA Medicare/Medicaid	$36.60
Rate for Payer: AZCH Complete Medicare	$15.68
Rate for Payer: Banner UC Health Medicare	$15.68
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$66.64
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Copperpoint Commercial	$24.25
Rate for Payer: Health Net of AZ Commercial	$58.80
Rate for Payer: Health Net of AZ Medicare	$27.44
Rate for Payer: Humana of AZ Medicare	$15.68
Rate for Payer: Self Pay Self Pay	$78.40
Rate for Payer: TriWest Medicare	$15.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.64

91034 ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CA

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23599031
Hospital Revenue Code	750
Min. Negotiated Rate	$493.48
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Self Pay Self Pay	$1,518.40

91034 ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CA

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23599031
Hospital Revenue Code	750
Min. Negotiated Rate	$303.68
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Aetna of AZ Medicare	$531.44
Rate for Payer: Allwell Medicare	$303.68
Rate for Payer: Amerigroup Medicare	$303.68
Rate for Payer: APIPA Medicare/Medicaid	$708.90
Rate for Payer: AZCH Complete Medicare	$303.68
Rate for Payer: Banner UC Health Medicare	$303.68
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,290.64
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Copperpoint Commercial	$469.75
Rate for Payer: Health Net of AZ Commercial	$1,138.80
Rate for Payer: Health Net of AZ Medicare	$531.44
Rate for Payer: Humana of AZ Medicare	$303.68
Rate for Payer: Self Pay Self Pay	$1,518.40
Rate for Payer: TriWest Medicare	$303.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,106.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$341.64

91322 Spikevax Medication Charge

Facility

$284.00

Service Code	CPT 91322
Hospital Charge Code	27620085
Hospital Revenue Code	521
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Bisbee Police All Plans	$73.84
Rate for Payer: Cash Price	$227.20
Rate for Payer: Self Pay Self Pay	$227.20

91322 Spikevax Medication Charge

Facility

$284.00

Service Code	CPT 91322
Hospital Charge Code	27620085
Hospital Revenue Code	521
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Aetna of AZ Medicare	$45.44
Rate for Payer: Allwell Medicare	$45.44
Rate for Payer: Amerigroup Medicare	$45.44
Rate for Payer: APIPA Medicare/Medicaid	$106.07
Rate for Payer: AZCH Complete Medicare	$45.44
Rate for Payer: Banner UC Health Medicare	$45.44
Rate for Payer: Bisbee Police All Plans	$73.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$193.12
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cigna of AZ Commercial	$198.80
Rate for Payer: Copperpoint Commercial	$70.29
Rate for Payer: Health Net of AZ Commercial	$170.40
Rate for Payer: Health Net of AZ Medicare	$79.52
Rate for Payer: Humana of AZ Medicare	$45.44
Rate for Payer: Self Pay Self Pay	$227.20
Rate for Payer: TriWest Medicare	$45.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$165.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.12

92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, A

Facility

$252.00

Service Code	CPT 92507 GN
Hospital Charge Code	27726434
Hospital Revenue Code	440
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of AZ Commercial	$226.80
Rate for Payer: Aetna of AZ Medicare	$70.56
Rate for Payer: Allwell Medicare	$40.32
Rate for Payer: Amerigroup Medicare	$40.32
Rate for Payer: APIPA Medicare/Medicaid	$94.12
Rate for Payer: AZCH Complete Medicare	$40.32
Rate for Payer: Banner UC Health Medicare	$40.32
Rate for Payer: Bisbee Police All Plans	$65.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$171.36
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cigna of AZ Commercial	$176.40
Rate for Payer: Copperpoint Commercial	$62.37
Rate for Payer: Health Net of AZ Commercial	$151.20
Rate for Payer: Health Net of AZ Medicare	$70.56
Rate for Payer: Humana of AZ Medicare	$40.32
Rate for Payer: Self Pay Self Pay	$201.60
Rate for Payer: TriWest Medicare	$40.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$146.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.36

92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, A

Facility

$252.00

Service Code	CPT 92507 GN
Hospital Charge Code	27726434
Hospital Revenue Code	440
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of AZ Commercial	$226.80
Rate for Payer: Bisbee Police All Plans	$65.52
Rate for Payer: Cash Price	$201.60
Rate for Payer: Self Pay Self Pay	$201.60

92520 STUDY OF VOICE BOX FUNCTION

Facility

$219.00

Service Code	CPT 92520 GN
Hospital Charge Code	27728009
Hospital Revenue Code	440
Min. Negotiated Rate	$35.04
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Aetna of AZ Medicare	$61.32
Rate for Payer: Allwell Medicare	$35.04
Rate for Payer: Amerigroup Medicare	$35.04
Rate for Payer: APIPA Medicare/Medicaid	$81.80
Rate for Payer: AZCH Complete Medicare	$35.04
Rate for Payer: Banner UC Health Medicare	$35.04
Rate for Payer: Bisbee Police All Plans	$56.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$148.92
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cigna of AZ Commercial	$153.30
Rate for Payer: Copperpoint Commercial	$54.20
Rate for Payer: Health Net of AZ Commercial	$131.40
Rate for Payer: Health Net of AZ Medicare	$61.32
Rate for Payer: Humana of AZ Medicare	$35.04
Rate for Payer: Self Pay Self Pay	$175.20
Rate for Payer: TriWest Medicare	$35.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$127.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.42

92520 STUDY OF VOICE BOX FUNCTION

Facility

$219.00

Service Code	CPT 92520 GN
Hospital Charge Code	27728009
Hospital Revenue Code	440
Min. Negotiated Rate	$56.94
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Bisbee Police All Plans	$56.94
Rate for Payer: Cash Price	$175.20
Rate for Payer: Self Pay Self Pay	$175.20

92521 EVALUATION OF SPEECH CONTINUITY, SMOOTHNESS, RATE, AND

Facility

$736.00

Service Code	CPT 92521 GN
Hospital Charge Code	27726435
Hospital Revenue Code	444
Min. Negotiated Rate	$191.36
Max. Negotiated Rate	$662.40
Rate for Payer: Aetna of AZ Commercial	$662.40
Rate for Payer: Bisbee Police All Plans	$191.36
Rate for Payer: Cash Price	$588.80
Rate for Payer: Self Pay Self Pay	$588.80

92521 EVALUATION OF SPEECH CONTINUITY, SMOOTHNESS, RATE, AND

Facility

$736.00

Service Code	CPT 92521 GN
Hospital Charge Code	27726435
Hospital Revenue Code	444
Min. Negotiated Rate	$117.76
Max. Negotiated Rate	$662.40
Rate for Payer: Aetna of AZ Commercial	$662.40
Rate for Payer: Aetna of AZ Medicare	$206.08
Rate for Payer: Allwell Medicare	$117.76
Rate for Payer: Amerigroup Medicare	$117.76
Rate for Payer: APIPA Medicare/Medicaid	$274.90
Rate for Payer: AZCH Complete Medicare	$117.76
Rate for Payer: Banner UC Health Medicare	$117.76
Rate for Payer: Bisbee Police All Plans	$191.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$500.48
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cigna of AZ Commercial	$515.20
Rate for Payer: Copperpoint Commercial	$182.16
Rate for Payer: Health Net of AZ Commercial	$441.60
Rate for Payer: Health Net of AZ Medicare	$206.08
Rate for Payer: Humana of AZ Medicare	$117.76
Rate for Payer: Self Pay Self Pay	$588.80
Rate for Payer: TriWest Medicare	$117.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$429.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$132.48

92522 EVALUATION OF SPEECH SOUND PRODUCTION (EG, ARTICULATIO

Facility

$584.00

Service Code	CPT 92522 GN
Hospital Charge Code	27728007
Hospital Revenue Code	444
Min. Negotiated Rate	$93.44
Max. Negotiated Rate	$525.60
Rate for Payer: Aetna of AZ Commercial	$525.60
Rate for Payer: Aetna of AZ Medicare	$163.52
Rate for Payer: Allwell Medicare	$93.44
Rate for Payer: Amerigroup Medicare	$93.44
Rate for Payer: APIPA Medicare/Medicaid	$218.12
Rate for Payer: AZCH Complete Medicare	$93.44
Rate for Payer: Banner UC Health Medicare	$93.44
Rate for Payer: Bisbee Police All Plans	$151.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$397.12
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cigna of AZ Commercial	$408.80
Rate for Payer: Copperpoint Commercial	$144.54
Rate for Payer: Health Net of AZ Commercial	$350.40
Rate for Payer: Health Net of AZ Medicare	$163.52
Rate for Payer: Humana of AZ Medicare	$93.44
Rate for Payer: Self Pay Self Pay	$467.20
Rate for Payer: TriWest Medicare	$93.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$340.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$105.12

92522 EVALUATION OF SPEECH SOUND PRODUCTION (EG, ARTICULATIO

Facility

$584.00

Service Code	CPT 92522 GN
Hospital Charge Code	27728007
Hospital Revenue Code	444
Min. Negotiated Rate	$151.84
Max. Negotiated Rate	$525.60
Rate for Payer: Aetna of AZ Commercial	$525.60
Rate for Payer: Bisbee Police All Plans	$151.84
Rate for Payer: Cash Price	$467.20
Rate for Payer: Self Pay Self Pay	$467.20

92523 EVALUATION OF SPEECH SOUND PRODUCTION WITH EVAL OF LAN

Facility

$1,199.00

Service Code	CPT 92523 GN
Hospital Charge Code	27728008
Hospital Revenue Code	444
Min. Negotiated Rate	$191.84
Max. Negotiated Rate	$1,079.10
Rate for Payer: Aetna of AZ Commercial	$1,079.10
Rate for Payer: Aetna of AZ Medicare	$335.72
Rate for Payer: Allwell Medicare	$191.84
Rate for Payer: Amerigroup Medicare	$191.84
Rate for Payer: APIPA Medicare/Medicaid	$447.83
Rate for Payer: AZCH Complete Medicare	$191.84
Rate for Payer: Banner UC Health Medicare	$191.84
Rate for Payer: Bisbee Police All Plans	$311.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$815.32
Rate for Payer: Cash Price	$959.20
Rate for Payer: Cigna of AZ Commercial	$839.30
Rate for Payer: Copperpoint Commercial	$296.75
Rate for Payer: Health Net of AZ Commercial	$719.40
Rate for Payer: Health Net of AZ Medicare	$335.72
Rate for Payer: Humana of AZ Medicare	$191.84
Rate for Payer: Self Pay Self Pay	$959.20
Rate for Payer: TriWest Medicare	$191.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$699.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$215.82

92523 EVALUATION OF SPEECH SOUND PRODUCTION WITH EVAL OF LAN

Facility

$1,199.00

Service Code	CPT 92523 GN
Hospital Charge Code	27728008
Hospital Revenue Code	444
Min. Negotiated Rate	$311.74
Max. Negotiated Rate	$1,079.10
Rate for Payer: Aetna of AZ Commercial	$1,079.10
Rate for Payer: Bisbee Police All Plans	$311.74
Rate for Payer: Cash Price	$959.20
Rate for Payer: Self Pay Self Pay	$959.20

92524 ANALYSIS OF VOICE AND RESONANCE PRODUCTION

Facility

$608.00

Service Code	CPT 92524 GN
Hospital Charge Code	27724316
Hospital Revenue Code	440
Min. Negotiated Rate	$158.08
Max. Negotiated Rate	$547.20
Rate for Payer: Aetna of AZ Commercial	$547.20
Rate for Payer: Bisbee Police All Plans	$158.08
Rate for Payer: Cash Price	$486.40
Rate for Payer: Self Pay Self Pay	$486.40

92524 ANALYSIS OF VOICE AND RESONANCE PRODUCTION

Facility

$608.00

Service Code	CPT 92524 GN
Hospital Charge Code	27724316
Hospital Revenue Code	440
Min. Negotiated Rate	$97.28
Max. Negotiated Rate	$547.20
Rate for Payer: Aetna of AZ Commercial	$547.20
Rate for Payer: Aetna of AZ Medicare	$170.24
Rate for Payer: Allwell Medicare	$97.28
Rate for Payer: Amerigroup Medicare	$97.28
Rate for Payer: APIPA Medicare/Medicaid	$227.09
Rate for Payer: AZCH Complete Medicare	$97.28
Rate for Payer: Banner UC Health Medicare	$97.28
Rate for Payer: Bisbee Police All Plans	$158.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$413.44
Rate for Payer: Cash Price	$486.40
Rate for Payer: Cigna of AZ Commercial	$425.60
Rate for Payer: Copperpoint Commercial	$150.48
Rate for Payer: Health Net of AZ Commercial	$364.80
Rate for Payer: Health Net of AZ Medicare	$170.24
Rate for Payer: Humana of AZ Medicare	$97.28
Rate for Payer: Self Pay Self Pay	$486.40
Rate for Payer: TriWest Medicare	$97.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$354.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$109.44

Know your out-of-pocket cost for care.

All Charges