Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Throat Culture

Facility

$173.00

Service Code	CPT 87070
Hospital Charge Code	850755
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Aetna of AZ Medicare	$48.44
Rate for Payer: AHCCCS Medicaid	$8.62
Rate for Payer: Allwell Medicaid	$8.62
Rate for Payer: Allwell Medicare	$25.95
Rate for Payer: Amerigroup Medicare	$25.95
Rate for Payer: APIPA Medicare/Medicaid	$64.62
Rate for Payer: AZCH Complete Medicaid	$8.62
Rate for Payer: AZCH Complete Medicare	$25.95
Rate for Payer: Banner UC Health Medicaid	$8.62
Rate for Payer: Banner UC Health Medicare	$25.95
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$117.64
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$112.45
Rate for Payer: Copperpoint Commercial	$42.82
Rate for Payer: Health Net of AZ Commercial	$103.80
Rate for Payer: Health Net of AZ Medicare	$48.44
Rate for Payer: Humana of AZ Medicare	$25.95
Rate for Payer: Mercy Care Medicaid	$8.62
Rate for Payer: Self Pay Self Pay	$138.40
Rate for Payer: TriWest Medicare	$25.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.14

Throat Culture

Facility

$173.00

Service Code	CPT 87070
Hospital Charge Code	850755
Hospital Revenue Code	306
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Cash Price	$138.40
Rate for Payer: Self Pay Self Pay	$138.40

THROMBN CLTG

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	22481506
Hospital Revenue Code	305
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Self Pay Self Pay	$104.00

THROMBN CLTG

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	22481506
Hospital Revenue Code	305
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Aetna of AZ Medicare	$36.40
Rate for Payer: AHCCCS Medicaid	$5.77
Rate for Payer: Allwell Medicaid	$5.77
Rate for Payer: Allwell Medicare	$19.50
Rate for Payer: Amerigroup Medicare	$19.50
Rate for Payer: APIPA Medicare/Medicaid	$48.56
Rate for Payer: AZCH Complete Medicaid	$5.77
Rate for Payer: AZCH Complete Medicare	$19.50
Rate for Payer: Banner UC Health Medicaid	$5.77
Rate for Payer: Banner UC Health Medicare	$19.50
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$88.40
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.18
Rate for Payer: Health Net of AZ Commercial	$78.00
Rate for Payer: Health Net of AZ Medicare	$36.40
Rate for Payer: Humana of AZ Medicare	$19.50
Rate for Payer: Mercy Care Medicaid	$5.77
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$19.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD

Facility

$47.00

Service Code	CPT 85730
Hospital Charge Code	23090941
Hospital Revenue Code	301
Min. Negotiated Rate	$6.01
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: AHCCCS Medicaid	$6.01
Rate for Payer: Allwell Medicaid	$6.01
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicaid	$6.01
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicaid	$6.01
Rate for Payer: Banner UC Health Medicare	$7.05
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: 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	$7.05
Rate for Payer: Mercy Care Medicaid	$6.01
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD

Facility

$47.00

Service Code	CPT 85730
Hospital Charge Code	23090941
Hospital Revenue Code	301
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

Thyroglobulin Antibody LC

Facility

$228.00

Service Code	CPT 86800
Hospital Charge Code	22311207
Hospital Revenue Code	302
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

Thyroglobulin Antibody LC

Facility

$228.00

Service Code	CPT 86800
Hospital Charge Code	22311207
Hospital Revenue Code	302
Min. Negotiated Rate	$15.91
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: AHCCCS Medicaid	$15.91
Rate for Payer: Allwell Medicaid	$15.91
Rate for Payer: Allwell Medicare	$34.20
Rate for Payer: Amerigroup Medicare	$34.20
Rate for Payer: APIPA Medicare/Medicaid	$85.16
Rate for Payer: AZCH Complete Medicaid	$15.91
Rate for Payer: AZCH Complete Medicare	$34.20
Rate for Payer: Banner UC Health Medicaid	$15.91
Rate for Payer: Banner UC Health Medicare	$34.20
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: 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	$34.20
Rate for Payer: Mercy Care Medicaid	$15.91
Rate for Payer: Self Pay Self Pay	$182.40
Rate for Payer: TriWest Medicare	$34.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.04

Thyroid Antibodies LC

Facility

$228.00

Service Code	CPT 86800
Hospital Charge Code	2087653
Hospital Revenue Code	301
Min. Negotiated Rate	$15.91
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: AHCCCS Medicaid	$15.91
Rate for Payer: Allwell Medicaid	$15.91
Rate for Payer: Allwell Medicare	$34.20
Rate for Payer: Amerigroup Medicare	$34.20
Rate for Payer: APIPA Medicare/Medicaid	$85.16
Rate for Payer: AZCH Complete Medicaid	$15.91
Rate for Payer: AZCH Complete Medicare	$34.20
Rate for Payer: Banner UC Health Medicaid	$15.91
Rate for Payer: Banner UC Health Medicare	$34.20
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: 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	$34.20
Rate for Payer: Mercy Care Medicaid	$15.91
Rate for Payer: Self Pay Self Pay	$182.40
Rate for Payer: TriWest Medicare	$34.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.04

Thyroid Antibodies LC

Facility

$228.00

Service Code	CPT 86800
Hospital Charge Code	2087653
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

Thyroid Cascade Profile LC

Facility

$211.00

Service Code	CPT 84443
Hospital Charge Code	2087654
Hospital Revenue Code	301
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$189.90
Rate for Payer: Aetna of AZ Commercial	$189.90
Rate for Payer: Bisbee Police All Plans	$54.86
Rate for Payer: Cash Price	$168.80
Rate for Payer: Self Pay Self Pay	$168.80

Thyroid Cascade Profile LC

Facility

$211.00

Service Code	CPT 84443
Hospital Charge Code	2087654
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$189.90
Rate for Payer: Aetna of AZ Commercial	$189.90
Rate for Payer: Aetna of AZ Medicare	$59.08
Rate for Payer: AHCCCS Medicaid	$16.80
Rate for Payer: Allwell Medicaid	$16.80
Rate for Payer: Allwell Medicare	$31.65
Rate for Payer: Amerigroup Medicare	$31.65
Rate for Payer: APIPA Medicare/Medicaid	$78.81
Rate for Payer: AZCH Complete Medicaid	$16.80
Rate for Payer: AZCH Complete Medicare	$31.65
Rate for Payer: Banner UC Health Medicaid	$16.80
Rate for Payer: Banner UC Health Medicare	$31.65
Rate for Payer: Bisbee Police All Plans	$54.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$143.48
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cigna of AZ Commercial	$137.15
Rate for Payer: Copperpoint Commercial	$52.22
Rate for Payer: Health Net of AZ Commercial	$126.60
Rate for Payer: Health Net of AZ Medicare	$59.08
Rate for Payer: Humana of AZ Medicare	$31.65
Rate for Payer: Mercy Care Medicaid	$16.80
Rate for Payer: Self Pay Self Pay	$168.80
Rate for Payer: TriWest Medicare	$31.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$123.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.98

Thyroid Disorders

Facility

$7,267.91

Service Code	APR-DRG 4273
Hospital Charge Code	APRDRG4272
Min. Negotiated Rate	$7,267.91
Max. Negotiated Rate	$7,267.91
Rate for Payer: AHCCCS Medicaid	$7,267.91
Rate for Payer: Allwell Medicaid	$7,267.91
Rate for Payer: AZCH Complete Medicaid	$7,267.91
Rate for Payer: Banner UC Health Medicaid	$7,267.91
Rate for Payer: Mercy Care Medicaid	$7,267.91

Thyroid Disorders

Facility

$4,531.75

Service Code	APR-DRG 4272
Hospital Charge Code	APRDRG4271
Min. Negotiated Rate	$4,531.75
Max. Negotiated Rate	$4,531.75
Rate for Payer: AHCCCS Medicaid	$4,531.75
Rate for Payer: Allwell Medicaid	$4,531.75
Rate for Payer: AZCH Complete Medicaid	$4,531.75
Rate for Payer: Banner UC Health Medicaid	$4,531.75
Rate for Payer: Mercy Care Medicaid	$4,531.75

Thyroid Disorders

Facility

$4,531.75

Service Code	APR-DRG 4272
Hospital Charge Code	APRDRG4274
Min. Negotiated Rate	$4,531.75
Max. Negotiated Rate	$4,531.75
Rate for Payer: AHCCCS Medicaid	$4,531.75
Rate for Payer: Allwell Medicaid	$4,531.75
Rate for Payer: AZCH Complete Medicaid	$4,531.75
Rate for Payer: Banner UC Health Medicaid	$4,531.75
Rate for Payer: Mercy Care Medicaid	$4,531.75

Thyroid Disorders

Facility

$13,507.56

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG4271
Min. Negotiated Rate	$13,507.56
Max. Negotiated Rate	$13,507.56
Rate for Payer: AHCCCS Medicaid	$13,507.56
Rate for Payer: Allwell Medicaid	$13,507.56
Rate for Payer: AZCH Complete Medicaid	$13,507.56
Rate for Payer: Banner UC Health Medicaid	$13,507.56
Rate for Payer: Mercy Care Medicaid	$13,507.56

Thyroid Disorders

Facility

$7,267.91

Service Code	APR-DRG 4273
Hospital Charge Code	APRDRG4274
Min. Negotiated Rate	$7,267.91
Max. Negotiated Rate	$7,267.91
Rate for Payer: AHCCCS Medicaid	$7,267.91
Rate for Payer: Allwell Medicaid	$7,267.91
Rate for Payer: AZCH Complete Medicaid	$7,267.91
Rate for Payer: Banner UC Health Medicaid	$7,267.91
Rate for Payer: Mercy Care Medicaid	$7,267.91

Thyroid Disorders

Facility

$3,307.80

Service Code	APR-DRG 4271
Hospital Charge Code	APRDRG4273
Min. Negotiated Rate	$3,307.80
Max. Negotiated Rate	$3,307.80
Rate for Payer: AHCCCS Medicaid	$3,307.80
Rate for Payer: Allwell Medicaid	$3,307.80
Rate for Payer: AZCH Complete Medicaid	$3,307.80
Rate for Payer: Banner UC Health Medicaid	$3,307.80
Rate for Payer: Mercy Care Medicaid	$3,307.80

Thyroid Disorders

Facility

$13,507.56

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG4272
Min. Negotiated Rate	$13,507.56
Max. Negotiated Rate	$13,507.56
Rate for Payer: AHCCCS Medicaid	$13,507.56
Rate for Payer: Allwell Medicaid	$13,507.56
Rate for Payer: AZCH Complete Medicaid	$13,507.56
Rate for Payer: Banner UC Health Medicaid	$13,507.56
Rate for Payer: Mercy Care Medicaid	$13,507.56

Thyroid Disorders

Facility

$13,507.56

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG4274
Min. Negotiated Rate	$13,507.56
Max. Negotiated Rate	$13,507.56
Rate for Payer: AHCCCS Medicaid	$13,507.56
Rate for Payer: Allwell Medicaid	$13,507.56
Rate for Payer: AZCH Complete Medicaid	$13,507.56
Rate for Payer: Banner UC Health Medicaid	$13,507.56
Rate for Payer: Mercy Care Medicaid	$13,507.56

Thyroid Disorders

Facility

$7,267.91

Service Code	APR-DRG 4273
Hospital Charge Code	APRDRG4273
Min. Negotiated Rate	$7,267.91
Max. Negotiated Rate	$7,267.91
Rate for Payer: AHCCCS Medicaid	$7,267.91
Rate for Payer: Allwell Medicaid	$7,267.91
Rate for Payer: AZCH Complete Medicaid	$7,267.91
Rate for Payer: Banner UC Health Medicaid	$7,267.91
Rate for Payer: Mercy Care Medicaid	$7,267.91

Thyroid Disorders

Facility

$4,531.75

Service Code	APR-DRG 4272
Hospital Charge Code	APRDRG4272
Min. Negotiated Rate	$4,531.75
Max. Negotiated Rate	$4,531.75
Rate for Payer: AHCCCS Medicaid	$4,531.75
Rate for Payer: Allwell Medicaid	$4,531.75
Rate for Payer: AZCH Complete Medicaid	$4,531.75
Rate for Payer: Banner UC Health Medicaid	$4,531.75
Rate for Payer: Mercy Care Medicaid	$4,531.75

Thyroid Disorders

Facility

$3,307.80

Service Code	APR-DRG 4271
Hospital Charge Code	APRDRG4272
Min. Negotiated Rate	$3,307.80
Max. Negotiated Rate	$3,307.80
Rate for Payer: AHCCCS Medicaid	$3,307.80
Rate for Payer: Allwell Medicaid	$3,307.80
Rate for Payer: AZCH Complete Medicaid	$3,307.80
Rate for Payer: Banner UC Health Medicaid	$3,307.80
Rate for Payer: Mercy Care Medicaid	$3,307.80

Thyroid Disorders

Facility

$3,307.80

Service Code	APR-DRG 4271
Hospital Charge Code	APRDRG4274
Min. Negotiated Rate	$3,307.80
Max. Negotiated Rate	$3,307.80
Rate for Payer: AHCCCS Medicaid	$3,307.80
Rate for Payer: Allwell Medicaid	$3,307.80
Rate for Payer: AZCH Complete Medicaid	$3,307.80
Rate for Payer: Banner UC Health Medicaid	$3,307.80
Rate for Payer: Mercy Care Medicaid	$3,307.80

Thyroid Disorders

Facility

$3,307.80

Service Code	APR-DRG 4271
Hospital Charge Code	APRDRG4271
Min. Negotiated Rate	$3,307.80
Max. Negotiated Rate	$3,307.80
Rate for Payer: AHCCCS Medicaid	$3,307.80
Rate for Payer: Allwell Medicaid	$3,307.80
Rate for Payer: AZCH Complete Medicaid	$3,307.80
Rate for Payer: Banner UC Health Medicaid	$3,307.80
Rate for Payer: Mercy Care Medicaid	$3,307.80

Know your out-of-pocket cost for care.

All Charges