Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cholesterol Total

Facility

$80.00

Service Code	CPT 82465
Hospital Charge Code	633705
Hospital Revenue Code	301
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

cholestyramine 4 g/ PKT UD [CQCH]

Facility

$0.77

Service Code	NDC 245003642
Hospital Charge Code	105916320
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Aetna of AZ Medicare	$0.22
Rate for Payer: Allwell Medicare	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.29
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.52
Rate for Payer: Cash Price	$0.62
Rate for Payer: Cigna of AZ Commercial	$0.50
Rate for Payer: Copperpoint Commercial	$0.19
Rate for Payer: Health Net of AZ Commercial	$0.46
Rate for Payer: Health Net of AZ Medicare	$0.22
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Self Pay Self Pay	$0.62
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.14

cholestyramine 4 g/ PKT UD [CQCH]

Facility

$0.77

Service Code	NDC 245003642
Hospital Charge Code	105916320
Hospital Revenue Code	251
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Cash Price	$0.62
Rate for Payer: Self Pay Self Pay	$0.62

Chromium LC

Facility

$299.00

Service Code	CPT 82495
Hospital Charge Code	6738684
Hospital Revenue Code	301
Min. Negotiated Rate	$77.74
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Cash Price	$239.20
Rate for Payer: Self Pay Self Pay	$239.20

Chromium LC

Facility

$299.00

Service Code	CPT 82495
Hospital Charge Code	6738684
Hospital Revenue Code	301
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Aetna of AZ Medicare	$83.72
Rate for Payer: AHCCCS Medicaid	$20.28
Rate for Payer: Allwell Medicaid	$20.28
Rate for Payer: Allwell Medicare	$44.85
Rate for Payer: Amerigroup Medicare	$44.85
Rate for Payer: APIPA Medicare/Medicaid	$111.68
Rate for Payer: AZCH Complete Medicaid	$20.28
Rate for Payer: AZCH Complete Medicare	$44.85
Rate for Payer: Banner UC Health Medicaid	$20.28
Rate for Payer: Banner UC Health Medicare	$44.85
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$203.32
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cigna of AZ Commercial	$194.35
Rate for Payer: Copperpoint Commercial	$74.00
Rate for Payer: Health Net of AZ Commercial	$179.40
Rate for Payer: Health Net of AZ Medicare	$83.72
Rate for Payer: Humana of AZ Medicare	$44.85
Rate for Payer: Mercy Care Medicaid	$20.28
Rate for Payer: Self Pay Self Pay	$239.20
Rate for Payer: TriWest Medicare	$44.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.82

Chromogranin A LC

Facility

$413.00

Service Code	CPT 86316
Hospital Charge Code	2029214
Hospital Revenue Code	302
Min. Negotiated Rate	$107.38
Max. Negotiated Rate	$371.70
Rate for Payer: Aetna of AZ Commercial	$371.70
Rate for Payer: Bisbee Police All Plans	$107.38
Rate for Payer: Cash Price	$330.40
Rate for Payer: Self Pay Self Pay	$330.40

Chromogranin A LC

Facility

$413.00

Service Code	CPT 86316
Hospital Charge Code	2029214
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$371.70
Rate for Payer: Aetna of AZ Commercial	$371.70
Rate for Payer: Aetna of AZ Medicare	$115.64
Rate for Payer: AHCCCS Medicaid	$20.81
Rate for Payer: Allwell Medicaid	$20.81
Rate for Payer: Allwell Medicare	$61.95
Rate for Payer: Amerigroup Medicare	$61.95
Rate for Payer: APIPA Medicare/Medicaid	$154.26
Rate for Payer: AZCH Complete Medicaid	$20.81
Rate for Payer: AZCH Complete Medicare	$61.95
Rate for Payer: Banner UC Health Medicaid	$20.81
Rate for Payer: Banner UC Health Medicare	$61.95
Rate for Payer: Bisbee Police All Plans	$107.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$280.84
Rate for Payer: Cash Price	$330.40
Rate for Payer: Cash Price	$330.40
Rate for Payer: Cigna of AZ Commercial	$268.45
Rate for Payer: Copperpoint Commercial	$102.22
Rate for Payer: Health Net of AZ Commercial	$247.80
Rate for Payer: Health Net of AZ Medicare	$115.64
Rate for Payer: Humana of AZ Medicare	$61.95
Rate for Payer: Mercy Care Medicaid	$20.81
Rate for Payer: Self Pay Self Pay	$330.40
Rate for Payer: TriWest Medicare	$61.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$240.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$74.34

.CHROMOSOM IN SITU HYB <300 CELLS

Facility

$169.00

Service Code	CPT 88275
Hospital Charge Code	22481444
Hospital Revenue Code	310
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna of AZ Commercial	$152.10
Rate for Payer: Aetna of AZ Medicare	$47.32
Rate for Payer: AHCCCS Medicaid	$51.19
Rate for Payer: Allwell Medicaid	$51.19
Rate for Payer: Allwell Medicare	$25.35
Rate for Payer: Amerigroup Medicare	$25.35
Rate for Payer: APIPA Medicare/Medicaid	$63.12
Rate for Payer: AZCH Complete Medicaid	$51.19
Rate for Payer: AZCH Complete Medicare	$25.35
Rate for Payer: Banner UC Health Medicaid	$51.19
Rate for Payer: Banner UC Health Medicare	$25.35
Rate for Payer: Bisbee Police All Plans	$43.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$114.92
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cigna of AZ Commercial	$109.85
Rate for Payer: Copperpoint Commercial	$41.83
Rate for Payer: Health Net of AZ Commercial	$101.40
Rate for Payer: Health Net of AZ Medicare	$47.32
Rate for Payer: Humana of AZ Medicare	$25.35
Rate for Payer: Mercy Care Medicaid	$51.19
Rate for Payer: Self Pay Self Pay	$135.20
Rate for Payer: TriWest Medicare	$25.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$98.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.42

.CHROMOSOM IN SITU HYB <300 CELLS

Facility

$169.00

Service Code	CPT 88275
Hospital Charge Code	22481444
Hospital Revenue Code	310
Min. Negotiated Rate	$43.94
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna of AZ Commercial	$152.10
Rate for Payer: Bisbee Police All Plans	$43.94
Rate for Payer: Cash Price	$135.20
Rate for Payer: Self Pay Self Pay	$135.20

Chromotubation

Facility

$265.00

Service Code	CPT 58350
Hospital Charge Code	23390089
Hospital Revenue Code	982
Min. Negotiated Rate	$68.90
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna of AZ Commercial	$238.50
Rate for Payer: Bisbee Police All Plans	$68.90
Rate for Payer: Cash Price	$212.00
Rate for Payer: Self Pay Self Pay	$212.00

Chromotubation

Facility

$265.00

Service Code	CPT 58350
Hospital Charge Code	23390089
Hospital Revenue Code	982
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$238.50
Rate for Payer: Aetna of AZ Medicare	$74.20
Rate for Payer: Allwell Medicare	$39.75
Rate for Payer: Amerigroup Medicare	$39.75
Rate for Payer: APIPA Medicare/Medicaid	$98.98
Rate for Payer: AZCH Complete Medicare	$39.75
Rate for Payer: Banner UC Health Medicare	$39.75
Rate for Payer: Bisbee Police All Plans	$68.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$180.20
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cigna of AZ Commercial	$185.50
Rate for Payer: Copperpoint Commercial	$65.59
Rate for Payer: Health Net of AZ Commercial	$159.00
Rate for Payer: Health Net of AZ Medicare	$74.20
Rate for Payer: Humana of AZ Medicare	$39.75
Rate for Payer: Self Pay Self Pay	$212.00
Rate for Payer: TriWest Medicare	$39.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$47.70

Chronic Kidney Disease

Facility

$4,275.73

Service Code	APR-DRG 4702
Hospital Charge Code	APRDRG4701
Min. Negotiated Rate	$4,275.73
Max. Negotiated Rate	$4,275.73
Rate for Payer: AHCCCS Medicaid	$4,275.73
Rate for Payer: Allwell Medicaid	$4,275.73
Rate for Payer: AZCH Complete Medicaid	$4,275.73
Rate for Payer: Banner UC Health Medicaid	$4,275.73
Rate for Payer: Mercy Care Medicaid	$4,275.73

Chronic Kidney Disease

Facility

$6,330.84

Service Code	APR-DRG 4703
Hospital Charge Code	APRDRG4703
Min. Negotiated Rate	$6,330.84
Max. Negotiated Rate	$6,330.84
Rate for Payer: AHCCCS Medicaid	$6,330.84
Rate for Payer: Allwell Medicaid	$6,330.84
Rate for Payer: AZCH Complete Medicaid	$6,330.84
Rate for Payer: Banner UC Health Medicaid	$6,330.84
Rate for Payer: Mercy Care Medicaid	$6,330.84

Chronic Kidney Disease

Facility

$11,939.93

Service Code	APR-DRG 4704
Hospital Charge Code	APRDRG4704
Min. Negotiated Rate	$11,939.93
Max. Negotiated Rate	$11,939.93
Rate for Payer: AHCCCS Medicaid	$11,939.93
Rate for Payer: Allwell Medicaid	$11,939.93
Rate for Payer: AZCH Complete Medicaid	$11,939.93
Rate for Payer: Banner UC Health Medicaid	$11,939.93
Rate for Payer: Mercy Care Medicaid	$11,939.93

Chronic Kidney Disease

Facility

$11,939.93

Service Code	APR-DRG 4704
Hospital Charge Code	APRDRG4702
Min. Negotiated Rate	$11,939.93
Max. Negotiated Rate	$11,939.93
Rate for Payer: AHCCCS Medicaid	$11,939.93
Rate for Payer: Allwell Medicaid	$11,939.93
Rate for Payer: AZCH Complete Medicaid	$11,939.93
Rate for Payer: Banner UC Health Medicaid	$11,939.93
Rate for Payer: Mercy Care Medicaid	$11,939.93

Chronic Kidney Disease

Facility

$6,330.84

Service Code	APR-DRG 4703
Hospital Charge Code	APRDRG4701
Min. Negotiated Rate	$6,330.84
Max. Negotiated Rate	$6,330.84
Rate for Payer: AHCCCS Medicaid	$6,330.84
Rate for Payer: Allwell Medicaid	$6,330.84
Rate for Payer: AZCH Complete Medicaid	$6,330.84
Rate for Payer: Banner UC Health Medicaid	$6,330.84
Rate for Payer: Mercy Care Medicaid	$6,330.84

Chronic Kidney Disease

Facility

$3,170.33

Service Code	APR-DRG 4701
Hospital Charge Code	APRDRG4702
Min. Negotiated Rate	$3,170.33
Max. Negotiated Rate	$3,170.33
Rate for Payer: AHCCCS Medicaid	$3,170.33
Rate for Payer: Allwell Medicaid	$3,170.33
Rate for Payer: AZCH Complete Medicaid	$3,170.33
Rate for Payer: Banner UC Health Medicaid	$3,170.33
Rate for Payer: Mercy Care Medicaid	$3,170.33

Chronic Kidney Disease

Facility

$4,275.73

Service Code	APR-DRG 4702
Hospital Charge Code	APRDRG4702
Min. Negotiated Rate	$4,275.73
Max. Negotiated Rate	$4,275.73
Rate for Payer: AHCCCS Medicaid	$4,275.73
Rate for Payer: Allwell Medicaid	$4,275.73
Rate for Payer: AZCH Complete Medicaid	$4,275.73
Rate for Payer: Banner UC Health Medicaid	$4,275.73
Rate for Payer: Mercy Care Medicaid	$4,275.73

Chronic Kidney Disease

Facility

$11,939.93

Service Code	APR-DRG 4704
Hospital Charge Code	APRDRG4701
Min. Negotiated Rate	$11,939.93
Max. Negotiated Rate	$11,939.93
Rate for Payer: AHCCCS Medicaid	$11,939.93
Rate for Payer: Allwell Medicaid	$11,939.93
Rate for Payer: AZCH Complete Medicaid	$11,939.93
Rate for Payer: Banner UC Health Medicaid	$11,939.93
Rate for Payer: Mercy Care Medicaid	$11,939.93

Chronic Kidney Disease

Facility

$3,170.33

Service Code	APR-DRG 4701
Hospital Charge Code	APRDRG4701
Min. Negotiated Rate	$3,170.33
Max. Negotiated Rate	$3,170.33
Rate for Payer: AHCCCS Medicaid	$3,170.33
Rate for Payer: Allwell Medicaid	$3,170.33
Rate for Payer: AZCH Complete Medicaid	$3,170.33
Rate for Payer: Banner UC Health Medicaid	$3,170.33
Rate for Payer: Mercy Care Medicaid	$3,170.33

Chronic Kidney Disease

Facility

$3,170.33

Service Code	APR-DRG 4701
Hospital Charge Code	APRDRG4704
Min. Negotiated Rate	$3,170.33
Max. Negotiated Rate	$3,170.33
Rate for Payer: AHCCCS Medicaid	$3,170.33
Rate for Payer: Allwell Medicaid	$3,170.33
Rate for Payer: AZCH Complete Medicaid	$3,170.33
Rate for Payer: Banner UC Health Medicaid	$3,170.33
Rate for Payer: Mercy Care Medicaid	$3,170.33

Chronic Kidney Disease

Facility

$11,939.93

Service Code	APR-DRG 4704
Hospital Charge Code	APRDRG4703
Min. Negotiated Rate	$11,939.93
Max. Negotiated Rate	$11,939.93
Rate for Payer: AHCCCS Medicaid	$11,939.93
Rate for Payer: Allwell Medicaid	$11,939.93
Rate for Payer: AZCH Complete Medicaid	$11,939.93
Rate for Payer: Banner UC Health Medicaid	$11,939.93
Rate for Payer: Mercy Care Medicaid	$11,939.93

Chronic Kidney Disease

Facility

$6,330.84

Service Code	APR-DRG 4703
Hospital Charge Code	APRDRG4704
Min. Negotiated Rate	$6,330.84
Max. Negotiated Rate	$6,330.84
Rate for Payer: AHCCCS Medicaid	$6,330.84
Rate for Payer: Allwell Medicaid	$6,330.84
Rate for Payer: AZCH Complete Medicaid	$6,330.84
Rate for Payer: Banner UC Health Medicaid	$6,330.84
Rate for Payer: Mercy Care Medicaid	$6,330.84

Chronic Kidney Disease

Facility

$3,170.33

Service Code	APR-DRG 4701
Hospital Charge Code	APRDRG4703
Min. Negotiated Rate	$3,170.33
Max. Negotiated Rate	$3,170.33
Rate for Payer: AHCCCS Medicaid	$3,170.33
Rate for Payer: Allwell Medicaid	$3,170.33
Rate for Payer: AZCH Complete Medicaid	$3,170.33
Rate for Payer: Banner UC Health Medicaid	$3,170.33
Rate for Payer: Mercy Care Medicaid	$3,170.33

Chronic Kidney Disease

Facility

$4,275.73

Service Code	APR-DRG 4702
Hospital Charge Code	APRDRG4704
Min. Negotiated Rate	$4,275.73
Max. Negotiated Rate	$4,275.73
Rate for Payer: AHCCCS Medicaid	$4,275.73
Rate for Payer: Allwell Medicaid	$4,275.73
Rate for Payer: AZCH Complete Medicaid	$4,275.73
Rate for Payer: Banner UC Health Medicaid	$4,275.73
Rate for Payer: Mercy Care Medicaid	$4,275.73

Know your out-of-pocket cost for care.

All Charges