Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

US Aspiration Guidance

Facility

$895.00

Service Code	CPT 76942
Hospital Charge Code	1007706
Hospital Revenue Code	402
Min. Negotiated Rate	$232.70
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Bisbee Police All Plans	$232.70
Rate for Payer: Cash Price	$716.00
Rate for Payer: Self Pay Self Pay	$716.00

US Biopsy Needle Guided

Facility

$778.00

Service Code	CPT 76942
Hospital Charge Code	1007709
Hospital Revenue Code	402
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Aetna of AZ Medicare	$217.84
Rate for Payer: Allwell Medicare	$124.48
Rate for Payer: Amerigroup Medicare	$124.48
Rate for Payer: APIPA Medicare/Medicaid	$290.58
Rate for Payer: AZCH Complete Medicare	$124.48
Rate for Payer: Banner UC Health Medicare	$124.48
Rate for Payer: Bisbee Police All Plans	$202.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$529.04
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cigna of AZ Commercial	$544.60
Rate for Payer: Copperpoint Commercial	$192.56
Rate for Payer: Health Net of AZ Commercial	$466.80
Rate for Payer: Health Net of AZ Medicare	$217.84
Rate for Payer: Humana of AZ Medicare	$124.48
Rate for Payer: Self Pay Self Pay	$622.40
Rate for Payer: TriWest Medicare	$124.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$453.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$140.04

US Biopsy Needle Guided

Facility

$778.00

Service Code	CPT 76942
Hospital Charge Code	1007709
Hospital Revenue Code	402
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Bisbee Police All Plans	$202.28
Rate for Payer: Cash Price	$622.40
Rate for Payer: Self Pay Self Pay	$622.40

US Breast Bilateral Complete

Facility

$803.00

Service Code	CPT 76641 50
Hospital Charge Code	22009074
Hospital Revenue Code	402
Min. Negotiated Rate	$128.48
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Aetna of AZ Medicare	$224.84
Rate for Payer: Allwell Medicare	$128.48
Rate for Payer: Amerigroup Medicare	$128.48
Rate for Payer: APIPA Medicare/Medicaid	$299.92
Rate for Payer: AZCH Complete Medicare	$128.48
Rate for Payer: Banner UC Health Medicare	$128.48
Rate for Payer: Bisbee Police All Plans	$208.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$546.04
Rate for Payer: Cash Price	$642.40
Rate for Payer: Cigna of AZ Commercial	$562.10
Rate for Payer: Copperpoint Commercial	$198.74
Rate for Payer: Health Net of AZ Commercial	$481.80
Rate for Payer: Health Net of AZ Medicare	$224.84
Rate for Payer: Humana of AZ Medicare	$128.48
Rate for Payer: Self Pay Self Pay	$642.40
Rate for Payer: TriWest Medicare	$128.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$468.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.54

US Breast Bilateral Complete

Facility

$803.00

Service Code	CPT 76641 50
Hospital Charge Code	22009074
Hospital Revenue Code	402
Min. Negotiated Rate	$208.78
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Bisbee Police All Plans	$208.78
Rate for Payer: Cash Price	$642.40
Rate for Payer: Self Pay Self Pay	$642.40

US Breast Bilateral Complete.

Facility

$845.00

Service Code	CPT 76641 50
Hospital Charge Code	22009086
Hospital Revenue Code	402
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Aetna of AZ Medicare	$236.60
Rate for Payer: Allwell Medicare	$135.20
Rate for Payer: Amerigroup Medicare	$135.20
Rate for Payer: APIPA Medicare/Medicaid	$315.61
Rate for Payer: AZCH Complete Medicare	$135.20
Rate for Payer: Banner UC Health Medicare	$135.20
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$574.60
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Copperpoint Commercial	$209.14
Rate for Payer: Health Net of AZ Commercial	$507.00
Rate for Payer: Health Net of AZ Medicare	$236.60
Rate for Payer: Humana of AZ Medicare	$135.20
Rate for Payer: Self Pay Self Pay	$676.00
Rate for Payer: TriWest Medicare	$135.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$492.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$152.10

US Breast Bilateral Complete.

Facility

$845.00

Service Code	CPT 76641 50
Hospital Charge Code	22009086
Hospital Revenue Code	402
Min. Negotiated Rate	$219.70
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Cash Price	$676.00
Rate for Payer: Self Pay Self Pay	$676.00

US Breast Bilateral Limited

Facility

$683.00

Service Code	CPT 76642 50
Hospital Charge Code	21076256
Hospital Revenue Code	402
Min. Negotiated Rate	$177.58
Max. Negotiated Rate	$614.70
Rate for Payer: Aetna of AZ Commercial	$614.70
Rate for Payer: Bisbee Police All Plans	$177.58
Rate for Payer: Cash Price	$546.40
Rate for Payer: Self Pay Self Pay	$546.40

US Breast Bilateral Limited

Facility

$683.00

Service Code	CPT 76642 50
Hospital Charge Code	21076256
Hospital Revenue Code	402
Min. Negotiated Rate	$109.28
Max. Negotiated Rate	$614.70
Rate for Payer: Aetna of AZ Commercial	$614.70
Rate for Payer: Aetna of AZ Medicare	$191.24
Rate for Payer: Allwell Medicare	$109.28
Rate for Payer: Amerigroup Medicare	$109.28
Rate for Payer: APIPA Medicare/Medicaid	$255.10
Rate for Payer: AZCH Complete Medicare	$109.28
Rate for Payer: Banner UC Health Medicare	$109.28
Rate for Payer: Bisbee Police All Plans	$177.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$464.44
Rate for Payer: Cash Price	$546.40
Rate for Payer: Cigna of AZ Commercial	$478.10
Rate for Payer: Copperpoint Commercial	$169.04
Rate for Payer: Health Net of AZ Commercial	$409.80
Rate for Payer: Health Net of AZ Medicare	$191.24
Rate for Payer: Humana of AZ Medicare	$109.28
Rate for Payer: Self Pay Self Pay	$546.40
Rate for Payer: TriWest Medicare	$109.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$398.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.94

US Breast Bilateral Limited.

Facility

$802.00

Service Code	CPT 76641 50
Hospital Charge Code	21231067
Hospital Revenue Code	402
Min. Negotiated Rate	$128.32
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Aetna of AZ Medicare	$224.56
Rate for Payer: Allwell Medicare	$128.32
Rate for Payer: Amerigroup Medicare	$128.32
Rate for Payer: APIPA Medicare/Medicaid	$299.55
Rate for Payer: AZCH Complete Medicare	$128.32
Rate for Payer: Banner UC Health Medicare	$128.32
Rate for Payer: Bisbee Police All Plans	$208.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$545.36
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cigna of AZ Commercial	$561.40
Rate for Payer: Copperpoint Commercial	$198.50
Rate for Payer: Health Net of AZ Commercial	$481.20
Rate for Payer: Health Net of AZ Medicare	$224.56
Rate for Payer: Humana of AZ Medicare	$128.32
Rate for Payer: Self Pay Self Pay	$641.60
Rate for Payer: TriWest Medicare	$128.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$467.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.36

US Breast Bilateral Limited.

Facility

$802.00

Service Code	CPT 76641 50
Hospital Charge Code	21231067
Hospital Revenue Code	402
Min. Negotiated Rate	$208.52
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Bisbee Police All Plans	$208.52
Rate for Payer: Cash Price	$641.60
Rate for Payer: Self Pay Self Pay	$641.60

US Breast Left Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009077
Hospital Revenue Code	402
Min. Negotiated Rate	$219.70
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Cash Price	$676.00
Rate for Payer: Self Pay Self Pay	$676.00

US Breast Left Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009077
Hospital Revenue Code	402
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Aetna of AZ Medicare	$236.60
Rate for Payer: Allwell Medicare	$135.20
Rate for Payer: Amerigroup Medicare	$135.20
Rate for Payer: APIPA Medicare/Medicaid	$315.61
Rate for Payer: AZCH Complete Medicare	$135.20
Rate for Payer: Banner UC Health Medicare	$135.20
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$574.60
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Copperpoint Commercial	$209.14
Rate for Payer: Health Net of AZ Commercial	$507.00
Rate for Payer: Health Net of AZ Medicare	$236.60
Rate for Payer: Humana of AZ Medicare	$135.20
Rate for Payer: Self Pay Self Pay	$676.00
Rate for Payer: TriWest Medicare	$135.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$492.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$152.10

US Breast Left Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076259
Hospital Revenue Code	402
Min. Negotiated Rate	$185.64
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Cash Price	$571.20
Rate for Payer: Self Pay Self Pay	$571.20

US Breast Left Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076259
Hospital Revenue Code	402
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Aetna of AZ Medicare	$199.92
Rate for Payer: Allwell Medicare	$114.24
Rate for Payer: Amerigroup Medicare	$114.24
Rate for Payer: APIPA Medicare/Medicaid	$266.68
Rate for Payer: AZCH Complete Medicare	$114.24
Rate for Payer: Banner UC Health Medicare	$114.24
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$485.52
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cigna of AZ Commercial	$499.80
Rate for Payer: Copperpoint Commercial	$176.72
Rate for Payer: Health Net of AZ Commercial	$428.40
Rate for Payer: Health Net of AZ Medicare	$199.92
Rate for Payer: Humana of AZ Medicare	$114.24
Rate for Payer: Self Pay Self Pay	$571.20
Rate for Payer: TriWest Medicare	$114.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$416.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$128.52

US Breast Right Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009080
Hospital Revenue Code	402
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Aetna of AZ Medicare	$236.60
Rate for Payer: Allwell Medicare	$135.20
Rate for Payer: Amerigroup Medicare	$135.20
Rate for Payer: APIPA Medicare/Medicaid	$315.61
Rate for Payer: AZCH Complete Medicare	$135.20
Rate for Payer: Banner UC Health Medicare	$135.20
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$574.60
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Copperpoint Commercial	$209.14
Rate for Payer: Health Net of AZ Commercial	$507.00
Rate for Payer: Health Net of AZ Medicare	$236.60
Rate for Payer: Humana of AZ Medicare	$135.20
Rate for Payer: Self Pay Self Pay	$676.00
Rate for Payer: TriWest Medicare	$135.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$492.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$152.10

US Breast Right Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009080
Hospital Revenue Code	402
Min. Negotiated Rate	$219.70
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Cash Price	$676.00
Rate for Payer: Self Pay Self Pay	$676.00

US Breast Right Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076262
Hospital Revenue Code	402
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Aetna of AZ Medicare	$199.92
Rate for Payer: Allwell Medicare	$114.24
Rate for Payer: Amerigroup Medicare	$114.24
Rate for Payer: APIPA Medicare/Medicaid	$266.68
Rate for Payer: AZCH Complete Medicare	$114.24
Rate for Payer: Banner UC Health Medicare	$114.24
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$485.52
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cigna of AZ Commercial	$499.80
Rate for Payer: Copperpoint Commercial	$176.72
Rate for Payer: Health Net of AZ Commercial	$428.40
Rate for Payer: Health Net of AZ Medicare	$199.92
Rate for Payer: Humana of AZ Medicare	$114.24
Rate for Payer: Self Pay Self Pay	$571.20
Rate for Payer: TriWest Medicare	$114.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$416.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$128.52

US Breast Right Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076262
Hospital Revenue Code	402
Min. Negotiated Rate	$185.64
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Cash Price	$571.20
Rate for Payer: Self Pay Self Pay	$571.20

US Carotid Doppler Bilateral

Facility

$1,574.00

Service Code	CPT 93880
Hospital Charge Code	1021625
Hospital Revenue Code	921
Min. Negotiated Rate	$409.24
Max. Negotiated Rate	$1,416.60
Rate for Payer: Aetna of AZ Commercial	$1,416.60
Rate for Payer: Bisbee Police All Plans	$409.24
Rate for Payer: Cash Price	$1,259.20
Rate for Payer: Self Pay Self Pay	$1,259.20

US Carotid Doppler Bilateral

Facility

$1,574.00

Service Code	CPT 93880
Hospital Charge Code	1021625
Hospital Revenue Code	921
Min. Negotiated Rate	$166.84
Max. Negotiated Rate	$1,416.60
Rate for Payer: Aetna of AZ Commercial	$1,416.60
Rate for Payer: Aetna of AZ Medicare	$440.72
Rate for Payer: AHCCCS Medicaid	$166.84
Rate for Payer: Allwell Medicaid	$166.84
Rate for Payer: Allwell Medicare	$251.84
Rate for Payer: Amerigroup Medicare	$251.84
Rate for Payer: APIPA Medicare/Medicaid	$587.89
Rate for Payer: AZCH Complete Medicaid	$166.84
Rate for Payer: AZCH Complete Medicare	$251.84
Rate for Payer: Banner UC Health Medicaid	$166.84
Rate for Payer: Banner UC Health Medicare	$251.84
Rate for Payer: Bisbee Police All Plans	$409.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,070.32
Rate for Payer: Cash Price	$1,259.20
Rate for Payer: Cash Price	$1,259.20
Rate for Payer: Cigna of AZ Commercial	$1,101.80
Rate for Payer: Copperpoint Commercial	$389.56
Rate for Payer: Health Net of AZ Commercial	$944.40
Rate for Payer: Health Net of AZ Medicare	$440.72
Rate for Payer: Humana of AZ Medicare	$251.84
Rate for Payer: Mercy Care Medicaid	$166.84
Rate for Payer: Self Pay Self Pay	$1,259.20
Rate for Payer: TriWest Medicare	$251.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$917.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$283.32

US Color Doppler

Facility

$1,444.00

Service Code	CPT 93975
Hospital Charge Code	22427825
Hospital Revenue Code	921
Min. Negotiated Rate	$166.84
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna of AZ Commercial	$1,299.60
Rate for Payer: Aetna of AZ Medicare	$404.32
Rate for Payer: AHCCCS Medicaid	$166.84
Rate for Payer: Allwell Medicaid	$166.84
Rate for Payer: Allwell Medicare	$231.04
Rate for Payer: Amerigroup Medicare	$231.04
Rate for Payer: APIPA Medicare/Medicaid	$539.33
Rate for Payer: AZCH Complete Medicaid	$166.84
Rate for Payer: AZCH Complete Medicare	$231.04
Rate for Payer: Banner UC Health Medicaid	$166.84
Rate for Payer: Banner UC Health Medicare	$231.04
Rate for Payer: Bisbee Police All Plans	$375.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$981.92
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Cigna of AZ Commercial	$1,010.80
Rate for Payer: Copperpoint Commercial	$357.39
Rate for Payer: Health Net of AZ Commercial	$866.40
Rate for Payer: Health Net of AZ Medicare	$404.32
Rate for Payer: Humana of AZ Medicare	$231.04
Rate for Payer: Mercy Care Medicaid	$166.84
Rate for Payer: Self Pay Self Pay	$1,155.20
Rate for Payer: TriWest Medicare	$231.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$841.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$259.92

US Color Doppler

Facility

$1,444.00

Service Code	CPT 93975
Hospital Charge Code	22427825
Hospital Revenue Code	921
Min. Negotiated Rate	$375.44
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna of AZ Commercial	$1,299.60
Rate for Payer: Bisbee Police All Plans	$375.44
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Self Pay Self Pay	$1,155.20

US Echo 2D Limited

Facility

$730.00

Service Code	CPT 93308
Hospital Charge Code	1883704
Hospital Revenue Code	402
Min. Negotiated Rate	$189.80
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of AZ Commercial	$657.00
Rate for Payer: Bisbee Police All Plans	$189.80
Rate for Payer: Cash Price	$584.00
Rate for Payer: Self Pay Self Pay	$584.00

US Echo 2D Limited

Facility

$730.00

Service Code	CPT 93308
Hospital Charge Code	1883704
Hospital Revenue Code	402
Min. Negotiated Rate	$116.80
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of AZ Commercial	$657.00
Rate for Payer: Aetna of AZ Medicare	$204.40
Rate for Payer: AHCCCS Medicaid	$166.84
Rate for Payer: Allwell Medicaid	$166.84
Rate for Payer: Allwell Medicare	$116.80
Rate for Payer: Amerigroup Medicare	$116.80
Rate for Payer: APIPA Medicare/Medicaid	$272.65
Rate for Payer: AZCH Complete Medicaid	$166.84
Rate for Payer: AZCH Complete Medicare	$116.80
Rate for Payer: Banner UC Health Medicaid	$166.84
Rate for Payer: Banner UC Health Medicare	$116.80
Rate for Payer: Bisbee Police All Plans	$189.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$496.40
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cigna of AZ Commercial	$511.00
Rate for Payer: Copperpoint Commercial	$180.68
Rate for Payer: Health Net of AZ Commercial	$438.00
Rate for Payer: Health Net of AZ Medicare	$204.40
Rate for Payer: Humana of AZ Medicare	$116.80
Rate for Payer: Mercy Care Medicaid	$166.84
Rate for Payer: Self Pay Self Pay	$584.00
Rate for Payer: TriWest Medicare	$116.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$425.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$131.40

Know your out-of-pocket cost for care.

All Charges