Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

THROMBN CLTG

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	22481506
Hospital Revenue Code	305
Min. Negotiated Rate	$20.80
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: Allwell Medicare	$20.80
Rate for Payer: Amerigroup Medicare	$20.80
Rate for Payer: APIPA Medicare/Medicaid	$48.55
Rate for Payer: AZCH Complete Medicare	$20.80
Rate for Payer: Banner UC Health Medicare	$20.80
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: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.17
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	$20.80
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$20.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

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

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

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	$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

THYROGLOBULIN

Facility

$80.00

Service Code	CPT 84432
Hospital Charge Code	28008411
Hospital Revenue Code	302
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: Allwell Medicare	$12.80
Rate for Payer: Amerigroup Medicare	$12.80
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicare	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

THYROGLOBULIN

Facility

$80.00

Service Code	CPT 84432
Hospital Charge Code	28008411
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Self Pay Self Pay	$64.00

Thyroglobulin Antibody LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	22311207
Hospital Revenue Code	302
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Aetna of AZ Medicare	$60.76
Rate for Payer: Allwell Medicare	$34.72
Rate for Payer: Amerigroup Medicare	$34.72
Rate for Payer: APIPA Medicare/Medicaid	$81.05
Rate for Payer: AZCH Complete Medicare	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$147.56
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Copperpoint Commercial	$53.71
Rate for Payer: Health Net of AZ Commercial	$130.20
Rate for Payer: Health Net of AZ Medicare	$60.76
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Self Pay Self Pay	$173.60
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.06

Thyroglobulin Antibody LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	22311207
Hospital Revenue Code	302
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Cash Price	$173.60
Rate for Payer: Self Pay Self Pay	$173.60

Thyroid Antibodies LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	2087653
Hospital Revenue Code	301
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Cash Price	$173.60
Rate for Payer: Self Pay Self Pay	$173.60

Thyroid Antibodies LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	2087653
Hospital Revenue Code	301
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Aetna of AZ Medicare	$60.76
Rate for Payer: Allwell Medicare	$34.72
Rate for Payer: Amerigroup Medicare	$34.72
Rate for Payer: APIPA Medicare/Medicaid	$81.05
Rate for Payer: AZCH Complete Medicare	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$147.56
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Copperpoint Commercial	$53.71
Rate for Payer: Health Net of AZ Commercial	$130.20
Rate for Payer: Health Net of AZ Medicare	$60.76
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Self Pay Self Pay	$173.60
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.06

Thyroid Cascade Profile LC

Facility

$200.00

Service Code	CPT 84443
Hospital Charge Code	2087654
Hospital Revenue Code	301
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Aetna of AZ Medicare	$56.00
Rate for Payer: Allwell Medicare	$32.00
Rate for Payer: Amerigroup Medicare	$32.00
Rate for Payer: APIPA Medicare/Medicaid	$74.70
Rate for Payer: AZCH Complete Medicare	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Bisbee Police All Plans	$52.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$136.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$130.00
Rate for Payer: Copperpoint Commercial	$49.50
Rate for Payer: Health Net of AZ Commercial	$120.00
Rate for Payer: Health Net of AZ Medicare	$56.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Self Pay Self Pay	$160.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$116.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.00

Thyroid Cascade Profile LC

Facility

$200.00

Service Code	CPT 84443
Hospital Charge Code	2087654
Hospital Revenue Code	301
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Bisbee Police All Plans	$52.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Self Pay Self Pay	$160.00

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

$7,267.91

Service Code	APR-DRG 4273
Hospital Charge Code	APRDRG4271
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	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

$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

$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

$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

$13,507.56

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG4273
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

$4,531.75

Service Code	APR-DRG 4272
Hospital Charge Code	APRDRG4273
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	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

$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

$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

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

$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

Know your out-of-pocket cost for care.

All Charges