Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Coccidioides Abs, Qn, DID LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22242102
Hospital Revenue Code	309
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

Coccidioides CF Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311187
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Aetna of AZ Medicare	$37.80
Rate for Payer: Allwell Medicare	$21.60
Rate for Payer: Amerigroup Medicare	$21.60
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicare	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$87.75
Rate for Payer: Copperpoint Commercial	$33.41
Rate for Payer: Health Net of AZ Commercial	$81.00
Rate for Payer: Health Net of AZ Medicare	$37.80
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.30

Coccidioides CF Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311187
Hospital Revenue Code	302
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Cash Price	$108.00
Rate for Payer: Self Pay Self Pay	$108.00

Coccidioides ID Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311188
Hospital Revenue Code	302
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Cash Price	$108.00
Rate for Payer: Self Pay Self Pay	$108.00

Coccidioides ID Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311188
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Aetna of AZ Medicare	$37.80
Rate for Payer: Allwell Medicare	$21.60
Rate for Payer: Amerigroup Medicare	$21.60
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicare	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$87.75
Rate for Payer: Copperpoint Commercial	$33.41
Rate for Payer: Health Net of AZ Commercial	$81.00
Rate for Payer: Health Net of AZ Medicare	$37.80
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.30

Coccidioides Immitis Antibodies LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	17541370
Hospital Revenue Code	302
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

Coccidioides Immitis Antibodies LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	17541370
Hospital Revenue Code	302
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: Allwell Medicare	$22.72
Rate for Payer: Amerigroup Medicare	$22.72
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicare	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Copperpoint Commercial	$35.15
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

codeine-guaiFENesin 20 mg-200 mg/10 mL UD Oral Syrup

Facility

$0.03

Service Code	NDC 50383008712
Hospital Charge Code	105917195
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

codeine-guaiFENesin 20 mg-200 mg/10 mL UD Oral Syrup

Facility

$0.03

Service Code	NDC 50383008712
Hospital Charge Code	105917195
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

colchicine 0.6 mg Cap UD [CQCH]

Facility

$5.18

Service Code	NDC 904673204
Hospital Charge Code	145650361
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$4.66
Rate for Payer: Aetna of AZ Commercial	$4.66
Rate for Payer: Bisbee Police All Plans	$1.35
Rate for Payer: Cash Price	$4.14
Rate for Payer: Self Pay Self Pay	$4.14

colchicine 0.6 mg Cap UD [CQCH]

Facility

$5.18

Service Code	NDC 904673204
Hospital Charge Code	145650361
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$4.66
Rate for Payer: Aetna of AZ Commercial	$4.66
Rate for Payer: Aetna of AZ Medicare	$1.45
Rate for Payer: Allwell Medicare	$0.83
Rate for Payer: Amerigroup Medicare	$0.83
Rate for Payer: APIPA Medicare/Medicaid	$1.93
Rate for Payer: AZCH Complete Medicare	$0.83
Rate for Payer: Banner UC Health Medicare	$0.83
Rate for Payer: Bisbee Police All Plans	$1.35
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.52
Rate for Payer: Cash Price	$4.14
Rate for Payer: Cigna of AZ Commercial	$3.37
Rate for Payer: Copperpoint Commercial	$1.28
Rate for Payer: Health Net of AZ Commercial	$3.11
Rate for Payer: Health Net of AZ Medicare	$1.45
Rate for Payer: Humana of AZ Medicare	$0.83
Rate for Payer: Self Pay Self Pay	$4.14
Rate for Payer: TriWest Medicare	$0.83
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.93

collagenase Top 250 units/g Oint [CQCH]

Facility

$238.22

Service Code	NDC 50484001030
Hospital Charge Code	105917327
Hospital Revenue Code	251
Min. Negotiated Rate	$61.94
Max. Negotiated Rate	$214.40
Rate for Payer: Aetna of AZ Commercial	$214.40
Rate for Payer: Bisbee Police All Plans	$61.94
Rate for Payer: Cash Price	$190.58
Rate for Payer: Self Pay Self Pay	$190.58

collagenase Top 250 units/g Oint [CQCH]

Facility

$238.22

Service Code	NDC 50484001030
Hospital Charge Code	105917327
Hospital Revenue Code	251
Min. Negotiated Rate	$38.12
Max. Negotiated Rate	$214.40
Rate for Payer: Aetna of AZ Commercial	$214.40
Rate for Payer: Aetna of AZ Medicare	$66.70
Rate for Payer: Allwell Medicare	$38.12
Rate for Payer: Amerigroup Medicare	$38.12
Rate for Payer: APIPA Medicare/Medicaid	$88.98
Rate for Payer: AZCH Complete Medicare	$38.12
Rate for Payer: Banner UC Health Medicare	$38.12
Rate for Payer: Bisbee Police All Plans	$61.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.99
Rate for Payer: Cash Price	$190.58
Rate for Payer: Cigna of AZ Commercial	$154.84
Rate for Payer: Copperpoint Commercial	$58.96
Rate for Payer: Health Net of AZ Commercial	$142.93
Rate for Payer: Health Net of AZ Medicare	$66.70
Rate for Payer: Humana of AZ Medicare	$38.12
Rate for Payer: Self Pay Self Pay	$190.58
Rate for Payer: TriWest Medicare	$38.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.88

Collagen injection

Facility

$1,030.00

Service Code	CPT 51715
Hospital Charge Code	27267841
Hospital Revenue Code	360
Min. Negotiated Rate	$267.80
Max. Negotiated Rate	$927.00
Rate for Payer: Aetna of AZ Commercial	$927.00
Rate for Payer: Bisbee Police All Plans	$267.80
Rate for Payer: Cash Price	$824.00
Rate for Payer: Self Pay Self Pay	$824.00

Collagen injection

Facility

$1,030.00

Service Code	CPT 51715
Hospital Charge Code	27267841
Hospital Revenue Code	360
Min. Negotiated Rate	$164.80
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$927.00
Rate for Payer: Aetna of AZ Medicare	$288.40
Rate for Payer: AHCCCS Medicaid	$2,230.35
Rate for Payer: Allwell Medicaid	$2,230.35
Rate for Payer: Allwell Medicare	$164.80
Rate for Payer: Amerigroup Medicare	$164.80
Rate for Payer: APIPA Medicare/Medicaid	$384.70
Rate for Payer: AZCH Complete Medicaid	$2,230.35
Rate for Payer: AZCH Complete Medicare	$164.80
Rate for Payer: Banner UC Health Medicaid	$2,230.35
Rate for Payer: Banner UC Health Medicare	$164.80
Rate for Payer: Bisbee Police All Plans	$267.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$700.40
Rate for Payer: Cash Price	$824.00
Rate for Payer: Cash Price	$824.00
Rate for Payer: Cigna of AZ Commercial	$515.00
Rate for Payer: Copperpoint Commercial	$254.93
Rate for Payer: Health Net of AZ Commercial	$618.00
Rate for Payer: Health Net of AZ Medicare	$288.40
Rate for Payer: Humana of AZ Medicare	$164.80
Rate for Payer: Mercy Care Medicaid	$2,230.35
Rate for Payer: Self Pay Self Pay	$824.00
Rate for Payer: TriWest Medicare	$164.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$185.40

COLLAR CERVICAL CHILD/X-SMALL

Facility

$147.00

Service Code	CPT L0120
Hospital Charge Code	22354247
Hospital Revenue Code	270
Min. Negotiated Rate	$23.52
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Aetna of AZ Medicare	$41.16
Rate for Payer: Allwell Medicare	$23.52
Rate for Payer: Amerigroup Medicare	$23.52
Rate for Payer: APIPA Medicare/Medicaid	$54.90
Rate for Payer: AZCH Complete Medicare	$23.52
Rate for Payer: Banner UC Health Medicare	$23.52
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$99.96
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cigna of AZ Commercial	$102.90
Rate for Payer: Copperpoint Commercial	$36.38
Rate for Payer: Health Net of AZ Commercial	$88.20
Rate for Payer: Health Net of AZ Medicare	$41.16
Rate for Payer: Humana of AZ Medicare	$23.52
Rate for Payer: Self Pay Self Pay	$117.60
Rate for Payer: TriWest Medicare	$23.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$85.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.46

COLLAR CERVICAL CHILD/X-SMALL

Facility

$147.00

Service Code	CPT L0120
Hospital Charge Code	22354247
Hospital Revenue Code	270
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Cash Price	$117.60
Rate for Payer: Self Pay Self Pay	$117.60

COLLAR CERVICAL LARGE

Facility

$20.00

Service Code	CPT L0120
Hospital Charge Code	22354304
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

COLLAR CERVICAL LARGE

Facility

$20.00

Service Code	CPT L0120
Hospital Charge Code	22354304
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

COLLAR CERVICAL MED

Facility

$20.00

Service Code	CPT L0120
Hospital Charge Code	22354303
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

COLLAR CERVICAL MED

Facility

$20.00

Service Code	CPT L0120
Hospital Charge Code	22354303
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

COLLAR CERVICAL SMALL

Facility

$20.00

Service Code	CPT L0120
Hospital Charge Code	22354302
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

COLLAR CERVICAL SMALL

Facility

$20.00

Service Code	CPT L0120
Hospital Charge Code	22354302
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

COLLAR STIFF NECK INFANT

Facility

$46.00

Service Code	CPT L0120
Hospital Charge Code	22354176
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

COLLAR STIFF NECK INFANT

Facility

$46.00

Service Code	CPT L0120
Hospital Charge Code	22354176
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$7.36
Rate for Payer: Amerigroup Medicare	$7.36
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

Know your out-of-pocket cost for care.

All Charges