Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

C. Diff Antigen and Toxin

Facility

$77.00

Service Code	CPT 87449
Hospital Charge Code	21986571
Hospital Revenue Code	306
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Aetna of AZ Medicare	$21.56
Rate for Payer: Allwell Medicare	$12.32
Rate for Payer: Amerigroup Medicare	$12.32
Rate for Payer: APIPA Medicare/Medicaid	$28.76
Rate for Payer: AZCH Complete Medicare	$12.32
Rate for Payer: Banner UC Health Medicare	$12.32
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$52.36
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$50.05
Rate for Payer: Copperpoint Commercial	$19.06
Rate for Payer: Health Net of AZ Commercial	$46.20
Rate for Payer: Health Net of AZ Medicare	$21.56
Rate for Payer: Humana of AZ Medicare	$12.32
Rate for Payer: Self Pay Self Pay	$61.60
Rate for Payer: TriWest Medicare	$12.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.86

C. Diff Antigen and Toxin

Facility

$77.00

Service Code	CPT 87449
Hospital Charge Code	21986571
Hospital Revenue Code	306
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Cash Price	$61.60
Rate for Payer: Self Pay Self Pay	$61.60

C. difficile Toxin Gene NAA LC

Facility

$441.00

Service Code	CPT 87493
Hospital Charge Code	21661560
Hospital Revenue Code	301
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of AZ Commercial	$396.90
Rate for Payer: Aetna of AZ Medicare	$123.48
Rate for Payer: Allwell Medicare	$70.56
Rate for Payer: Amerigroup Medicare	$70.56
Rate for Payer: APIPA Medicare/Medicaid	$164.71
Rate for Payer: AZCH Complete Medicare	$70.56
Rate for Payer: Banner UC Health Medicare	$70.56
Rate for Payer: Bisbee Police All Plans	$114.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$299.88
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cigna of AZ Commercial	$286.65
Rate for Payer: Copperpoint Commercial	$109.15
Rate for Payer: Health Net of AZ Commercial	$264.60
Rate for Payer: Health Net of AZ Medicare	$123.48
Rate for Payer: Humana of AZ Medicare	$70.56
Rate for Payer: Self Pay Self Pay	$352.80
Rate for Payer: TriWest Medicare	$70.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$257.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$79.38

C. difficile Toxin Gene NAA LC

Facility

$441.00

Service Code	CPT 87493
Hospital Charge Code	21661560
Hospital Revenue Code	301
Min. Negotiated Rate	$114.66
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of AZ Commercial	$396.90
Rate for Payer: Bisbee Police All Plans	$114.66
Rate for Payer: Cash Price	$352.80
Rate for Payer: Self Pay Self Pay	$352.80

C DIFF TOX GENE

Facility

$282.00

Service Code	CPT 87493
Hospital Charge Code	23298043
Hospital Revenue Code	301
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Cash Price	$225.60
Rate for Payer: Self Pay Self Pay	$225.60

C DIFF TOX GENE

Facility

$282.00

Service Code	CPT 87493
Hospital Charge Code	23298043
Hospital Revenue Code	301
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Aetna of AZ Medicare	$78.96
Rate for Payer: Allwell Medicare	$45.12
Rate for Payer: Amerigroup Medicare	$45.12
Rate for Payer: APIPA Medicare/Medicaid	$105.33
Rate for Payer: AZCH Complete Medicare	$45.12
Rate for Payer: Banner UC Health Medicare	$45.12
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Copperpoint Commercial	$69.80
Rate for Payer: Health Net of AZ Commercial	$169.20
Rate for Payer: Health Net of AZ Medicare	$78.96
Rate for Payer: Humana of AZ Medicare	$45.12
Rate for Payer: Self Pay Self Pay	$225.60
Rate for Payer: TriWest Medicare	$45.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$164.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.76

CEA LC

Facility

$236.00

Service Code	CPT 82378
Hospital Charge Code	2269423
Hospital Revenue Code	301
Min. Negotiated Rate	$37.76
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Aetna of AZ Medicare	$66.08
Rate for Payer: Allwell Medicare	$37.76
Rate for Payer: Amerigroup Medicare	$37.76
Rate for Payer: APIPA Medicare/Medicaid	$88.15
Rate for Payer: AZCH Complete Medicare	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$160.48
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$153.40
Rate for Payer: Copperpoint Commercial	$58.41
Rate for Payer: Health Net of AZ Commercial	$141.60
Rate for Payer: Health Net of AZ Medicare	$66.08
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Self Pay Self Pay	$188.80
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$137.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.48

CEA LC

Facility

$236.00

Service Code	CPT 82378
Hospital Charge Code	2269423
Hospital Revenue Code	301
Min. Negotiated Rate	$61.36
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Cash Price	$188.80
Rate for Payer: Self Pay Self Pay	$188.80

ceFAZolin 1 gm Inj [CQCH]

Facility

$0.63

Service Code	HCPCS J0690
Hospital Charge Code	105914847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Aetna of AZ Medicare	$0.18
Rate for Payer: Allwell Medicare	$0.10
Rate for Payer: Amerigroup Medicare	$0.10
Rate for Payer: APIPA Medicare/Medicaid	$0.24
Rate for Payer: AZCH Complete Medicare	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.43
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of AZ Commercial	$0.41
Rate for Payer: Copperpoint Commercial	$0.16
Rate for Payer: Health Net of AZ Commercial	$0.38
Rate for Payer: Health Net of AZ Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

ceFAZolin 1 gm Inj [CQCH]

Facility

$0.63

Service Code	HCPCS J0690
Hospital Charge Code	105914847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.51
Rate for Payer: Self Pay Self Pay	$0.50

ceFAZolin 1 gm IVPB[CQCH]

Facility

$3.34

Service Code	HCPCS J0690
Hospital Charge Code	135817684
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna of AZ Commercial	$3.01
Rate for Payer: Bisbee Police All Plans	$0.87
Rate for Payer: Cash Price	$2.67
Rate for Payer: Self Pay Self Pay	$2.67

ceFAZolin 1 gm IVPB[CQCH]

Facility

$3.34

Service Code	HCPCS J0690
Hospital Charge Code	135817684
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna of AZ Commercial	$3.01
Rate for Payer: Aetna of AZ Medicare	$0.94
Rate for Payer: Allwell Medicare	$0.53
Rate for Payer: Amerigroup Medicare	$0.53
Rate for Payer: APIPA Medicare/Medicaid	$1.25
Rate for Payer: AZCH Complete Medicare	$0.53
Rate for Payer: Banner UC Health Medicare	$0.53
Rate for Payer: Bisbee Police All Plans	$0.87
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.27
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cigna of AZ Commercial	$2.17
Rate for Payer: Copperpoint Commercial	$0.83
Rate for Payer: Health Net of AZ Commercial	$2.00
Rate for Payer: Health Net of AZ Medicare	$0.94
Rate for Payer: Humana of AZ Medicare	$0.53
Rate for Payer: Self Pay Self Pay	$2.67
Rate for Payer: TriWest Medicare	$0.53
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.60

ceFAZolin 2 gm REC [CQCH]

Facility

$4.28

Service Code	HCPCS J0690
Hospital Charge Code	213338088
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna of AZ Commercial	$3.85
Rate for Payer: Bisbee Police All Plans	$1.11
Rate for Payer: Cash Price	$3.42
Rate for Payer: Self Pay Self Pay	$3.42

ceFAZolin 2 gm REC [CQCH]

Facility

$4.28

Service Code	HCPCS J0690
Hospital Charge Code	213338088
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna of AZ Commercial	$3.85
Rate for Payer: Aetna of AZ Medicare	$1.20
Rate for Payer: Allwell Medicare	$0.68
Rate for Payer: Amerigroup Medicare	$0.68
Rate for Payer: APIPA Medicare/Medicaid	$1.60
Rate for Payer: AZCH Complete Medicare	$0.68
Rate for Payer: Banner UC Health Medicare	$0.68
Rate for Payer: Bisbee Police All Plans	$1.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.91
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cigna of AZ Commercial	$2.78
Rate for Payer: Copperpoint Commercial	$1.06
Rate for Payer: Health Net of AZ Commercial	$2.57
Rate for Payer: Health Net of AZ Medicare	$1.20
Rate for Payer: Humana of AZ Medicare	$0.68
Rate for Payer: Self Pay Self Pay	$3.42
Rate for Payer: TriWest Medicare	$0.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.77

cefdinir 125 mg/5 mL REC[CQCH]

Facility

$0.09

Service Code	NDC 16714039202
Hospital Charge Code	160942771
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.07

cefdinir 125 mg/5 mL REC[CQCH]

Facility

$0.09

Service Code	NDC 16714039202
Hospital Charge Code	160942771
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.06
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.06
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.07
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

cefdinir 300 mg Cap [CQCH]

Facility

$1.92

Service Code	NDC 16714039102
Hospital Charge Code	107734593
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.73
Rate for Payer: Aetna of AZ Commercial	$1.73
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Cash Price	$1.54
Rate for Payer: Self Pay Self Pay	$1.54

cefdinir 300 mg Cap [CQCH]

Facility

$1.92

Service Code	NDC 16714039102
Hospital Charge Code	107734593
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.73
Rate for Payer: Aetna of AZ Commercial	$1.73
Rate for Payer: Aetna of AZ Medicare	$0.54
Rate for Payer: Allwell Medicare	$0.31
Rate for Payer: Amerigroup Medicare	$0.31
Rate for Payer: APIPA Medicare/Medicaid	$0.72
Rate for Payer: AZCH Complete Medicare	$0.31
Rate for Payer: Banner UC Health Medicare	$0.31
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.31
Rate for Payer: Cash Price	$1.54
Rate for Payer: Cigna of AZ Commercial	$1.25
Rate for Payer: Copperpoint Commercial	$0.48
Rate for Payer: Health Net of AZ Commercial	$1.15
Rate for Payer: Health Net of AZ Medicare	$0.54
Rate for Payer: Humana of AZ Medicare	$0.31
Rate for Payer: Self Pay Self Pay	$1.54
Rate for Payer: TriWest Medicare	$0.31
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.35

cefepime 1 gm Inj [CQCH]

Facility

$3.96

Service Code	HCPCS J0692
Hospital Charge Code	105914993
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of AZ Commercial	$3.56
Rate for Payer: Bisbee Police All Plans	$1.03
Rate for Payer: Cash Price	$3.17
Rate for Payer: Self Pay Self Pay	$3.17

cefepime 1 gm Inj [CQCH]

Facility

$3.96

Service Code	HCPCS J0692
Hospital Charge Code	105914993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of AZ Commercial	$3.56
Rate for Payer: Aetna of AZ Medicare	$1.11
Rate for Payer: Allwell Medicare	$0.63
Rate for Payer: Amerigroup Medicare	$0.63
Rate for Payer: APIPA Medicare/Medicaid	$1.48
Rate for Payer: AZCH Complete Medicare	$0.63
Rate for Payer: Banner UC Health Medicare	$0.63
Rate for Payer: Bisbee Police All Plans	$1.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.69
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cigna of AZ Commercial	$2.57
Rate for Payer: Copperpoint Commercial	$0.98
Rate for Payer: Health Net of AZ Commercial	$2.38
Rate for Payer: Health Net of AZ Medicare	$1.11
Rate for Payer: Humana of AZ Medicare	$0.63
Rate for Payer: Self Pay Self Pay	$3.17
Rate for Payer: TriWest Medicare	$0.63
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.71

cefepime 2 gm Inj [CQCH]

Facility

$9.03

Service Code	HCPCS J0692
Hospital Charge Code	105914920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.13
Rate for Payer: Aetna of AZ Commercial	$8.13
Rate for Payer: Aetna of AZ Medicare	$2.53
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.37
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.35
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.14
Rate for Payer: Cash Price	$7.22
Rate for Payer: Cigna of AZ Commercial	$5.87
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.42
Rate for Payer: Health Net of AZ Medicare	$2.53
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.22
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.63

cefepime 2 gm Inj [CQCH]

Facility

$9.03

Service Code	HCPCS J0692
Hospital Charge Code	105914920
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$8.13
Rate for Payer: Aetna of AZ Commercial	$8.13
Rate for Payer: Bisbee Police All Plans	$2.35
Rate for Payer: Cash Price	$7.22
Rate for Payer: Self Pay Self Pay	$7.22

cefOXitin 1 gm Inj [CQCH]

Facility

$3.63

Service Code	HCPCS J0694
Hospital Charge Code	105915139
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna of AZ Commercial	$3.27
Rate for Payer: Bisbee Police All Plans	$0.94
Rate for Payer: Cash Price	$2.90
Rate for Payer: Self Pay Self Pay	$2.90

cefOXitin 1 gm Inj [CQCH]

Facility

$3.63

Service Code	HCPCS J0694
Hospital Charge Code	105915139
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna of AZ Commercial	$3.27
Rate for Payer: Aetna of AZ Medicare	$1.02
Rate for Payer: Allwell Medicare	$0.58
Rate for Payer: Amerigroup Medicare	$0.58
Rate for Payer: APIPA Medicare/Medicaid	$1.36
Rate for Payer: AZCH Complete Medicare	$0.58
Rate for Payer: Banner UC Health Medicare	$0.58
Rate for Payer: Bisbee Police All Plans	$0.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.47
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cigna of AZ Commercial	$2.36
Rate for Payer: Copperpoint Commercial	$0.90
Rate for Payer: Health Net of AZ Commercial	$2.18
Rate for Payer: Health Net of AZ Medicare	$1.02
Rate for Payer: Humana of AZ Medicare	$0.58
Rate for Payer: Self Pay Self Pay	$2.90
Rate for Payer: TriWest Medicare	$0.58
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.65

cefOXitin 2 gm Inj [CQCH]

Facility

$5.41

Service Code	HCPCS J0694
Hospital Charge Code	105915066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$4.87
Rate for Payer: Aetna of AZ Commercial	$4.87
Rate for Payer: Aetna of AZ Medicare	$1.51
Rate for Payer: Allwell Medicare	$0.87
Rate for Payer: Amerigroup Medicare	$0.87
Rate for Payer: APIPA Medicare/Medicaid	$2.02
Rate for Payer: AZCH Complete Medicare	$0.87
Rate for Payer: Banner UC Health Medicare	$0.87
Rate for Payer: Bisbee Police All Plans	$1.41
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.68
Rate for Payer: Cash Price	$4.33
Rate for Payer: Cigna of AZ Commercial	$3.52
Rate for Payer: Copperpoint Commercial	$1.34
Rate for Payer: Health Net of AZ Commercial	$3.25
Rate for Payer: Health Net of AZ Medicare	$1.51
Rate for Payer: Humana of AZ Medicare	$0.87
Rate for Payer: Self Pay Self Pay	$4.33
Rate for Payer: TriWest Medicare	$0.87
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.97

Know your out-of-pocket cost for care.

All Charges