Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: AHCCCS Medicaid	$7,972.81
Rate for Payer: Allwell Medicaid	$7,972.81
Rate for Payer: AZCH Complete Medicaid	$7,972.81
Rate for Payer: Banner UC Health Medicaid	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: AHCCCS Medicaid	$8,143.96
Rate for Payer: Allwell Medicaid	$8,143.96
Rate for Payer: AZCH Complete Medicaid	$8,143.96
Rate for Payer: Banner UC Health Medicaid	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: AHCCCS Medicaid	$28,590.47
Rate for Payer: Allwell Medicaid	$28,590.47
Rate for Payer: AZCH Complete Medicaid	$28,590.47
Rate for Payer: Banner UC Health Medicaid	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: AHCCCS Medicaid	$11,545.04
Rate for Payer: Allwell Medicaid	$11,545.04
Rate for Payer: AZCH Complete Medicaid	$11,545.04
Rate for Payer: Banner UC Health Medicaid	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: AHCCCS Medicaid	$11,545.04
Rate for Payer: Allwell Medicaid	$11,545.04
Rate for Payer: AZCH Complete Medicaid	$11,545.04
Rate for Payer: Banner UC Health Medicaid	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: AHCCCS Medicaid	$8,143.96
Rate for Payer: Allwell Medicaid	$8,143.96
Rate for Payer: AZCH Complete Medicaid	$8,143.96
Rate for Payer: Banner UC Health Medicaid	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7592
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: AHCCCS Medicaid	$7,972.81
Rate for Payer: Allwell Medicaid	$7,972.81
Rate for Payer: AZCH Complete Medicaid	$7,972.81
Rate for Payer: Banner UC Health Medicaid	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7592
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: AHCCCS Medicaid	$8,143.96
Rate for Payer: Allwell Medicaid	$8,143.96
Rate for Payer: AZCH Complete Medicaid	$8,143.96
Rate for Payer: Banner UC Health Medicaid	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96

EBv ab VCA, IGG

Facility

$148.00

Service Code	CPT 86665
Hospital Charge Code	23143918
Hospital Revenue Code	301
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

EBv ab VCA, IGG

Facility

$148.00

Service Code	CPT 86665
Hospital Charge Code	23143918
Hospital Revenue Code	301
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Aetna of AZ Medicare	$41.44
Rate for Payer: AHCCCS Medicaid	$18.14
Rate for Payer: Allwell Medicaid	$18.14
Rate for Payer: Allwell Medicare	$22.20
Rate for Payer: Amerigroup Medicare	$22.20
Rate for Payer: APIPA Medicare/Medicaid	$55.28
Rate for Payer: AZCH Complete Medicaid	$18.14
Rate for Payer: AZCH Complete Medicare	$22.20
Rate for Payer: Banner UC Health Medicaid	$18.14
Rate for Payer: Banner UC Health Medicare	$22.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.64
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$96.20
Rate for Payer: Copperpoint Commercial	$36.63
Rate for Payer: Health Net of AZ Commercial	$88.80
Rate for Payer: Health Net of AZ Medicare	$41.44
Rate for Payer: Humana of AZ Medicare	$22.20
Rate for Payer: Mercy Care Medicaid	$18.14
Rate for Payer: Self Pay Self Pay	$118.40
Rate for Payer: TriWest Medicare	$22.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.64

EBV Acute Infection Antibodies LC

Facility

$975.00

Service Code	CPT 87799
Hospital Charge Code	1285649
Hospital Revenue Code	301
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna of AZ Commercial	$877.50
Rate for Payer: Aetna of AZ Medicare	$273.00
Rate for Payer: AHCCCS Medicaid	$42.84
Rate for Payer: Allwell Medicaid	$42.84
Rate for Payer: Allwell Medicare	$146.25
Rate for Payer: Amerigroup Medicare	$146.25
Rate for Payer: APIPA Medicare/Medicaid	$364.16
Rate for Payer: AZCH Complete Medicaid	$42.84
Rate for Payer: AZCH Complete Medicare	$146.25
Rate for Payer: Banner UC Health Medicaid	$42.84
Rate for Payer: Banner UC Health Medicare	$146.25
Rate for Payer: Bisbee Police All Plans	$253.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$663.00
Rate for Payer: Cash Price	$780.00
Rate for Payer: Cash Price	$780.00
Rate for Payer: Cigna of AZ Commercial	$633.75
Rate for Payer: Copperpoint Commercial	$241.31
Rate for Payer: Health Net of AZ Commercial	$585.00
Rate for Payer: Health Net of AZ Medicare	$273.00
Rate for Payer: Humana of AZ Medicare	$146.25
Rate for Payer: Mercy Care Medicaid	$42.84
Rate for Payer: Self Pay Self Pay	$780.00
Rate for Payer: TriWest Medicare	$146.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$568.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$175.50

EBV Acute Infection Antibodies LC

Facility

$975.00

Service Code	CPT 87799
Hospital Charge Code	1285649
Hospital Revenue Code	301
Min. Negotiated Rate	$253.50
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna of AZ Commercial	$877.50
Rate for Payer: Bisbee Police All Plans	$253.50
Rate for Payer: Cash Price	$780.00
Rate for Payer: Self Pay Self Pay	$780.00

EBV Early AG aB igg

Facility

$163.00

Service Code	CPT 86663
Hospital Charge Code	23143917
Hospital Revenue Code	301
Min. Negotiated Rate	$42.38
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Cash Price	$130.40
Rate for Payer: Self Pay Self Pay	$130.40

EBV Early AG aB igg

Facility

$163.00

Service Code	CPT 86663
Hospital Charge Code	23143917
Hospital Revenue Code	301
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Aetna of AZ Medicare	$45.64
Rate for Payer: AHCCCS Medicaid	$13.12
Rate for Payer: Allwell Medicaid	$13.12
Rate for Payer: Allwell Medicare	$24.45
Rate for Payer: Amerigroup Medicare	$24.45
Rate for Payer: APIPA Medicare/Medicaid	$60.88
Rate for Payer: AZCH Complete Medicaid	$13.12
Rate for Payer: AZCH Complete Medicare	$24.45
Rate for Payer: Banner UC Health Medicaid	$13.12
Rate for Payer: Banner UC Health Medicare	$24.45
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$110.84
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cigna of AZ Commercial	$105.95
Rate for Payer: Copperpoint Commercial	$40.34
Rate for Payer: Health Net of AZ Commercial	$97.80
Rate for Payer: Health Net of AZ Medicare	$45.64
Rate for Payer: Humana of AZ Medicare	$24.45
Rate for Payer: Mercy Care Medicaid	$13.12
Rate for Payer: Self Pay Self Pay	$130.40
Rate for Payer: TriWest Medicare	$24.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.34

EBV Nuclear Ag AB Igg

Facility

$118.00

Service Code	CPT 86664
Hospital Charge Code	23143919
Hospital Revenue Code	301
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Aetna of AZ Medicare	$33.04
Rate for Payer: AHCCCS Medicaid	$15.29
Rate for Payer: Allwell Medicaid	$15.29
Rate for Payer: Allwell Medicare	$17.70
Rate for Payer: Amerigroup Medicare	$17.70
Rate for Payer: APIPA Medicare/Medicaid	$44.07
Rate for Payer: AZCH Complete Medicaid	$15.29
Rate for Payer: AZCH Complete Medicare	$17.70
Rate for Payer: Banner UC Health Medicaid	$15.29
Rate for Payer: Banner UC Health Medicare	$17.70
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$80.24
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$76.70
Rate for Payer: Copperpoint Commercial	$29.20
Rate for Payer: Health Net of AZ Commercial	$70.80
Rate for Payer: Health Net of AZ Medicare	$33.04
Rate for Payer: Humana of AZ Medicare	$17.70
Rate for Payer: Mercy Care Medicaid	$15.29
Rate for Payer: Self Pay Self Pay	$94.40
Rate for Payer: TriWest Medicare	$17.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.24

EBV Nuclear Ag AB Igg

Facility

$118.00

Service Code	CPT 86664
Hospital Charge Code	23143919
Hospital Revenue Code	301
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Cash Price	$94.40
Rate for Payer: Self Pay Self Pay	$94.40

eculizumab 10 mg/mL Sol[CQCH]

Facility

$217.43

Service Code	HCPCS J1300
Hospital Charge Code	189306752
Hospital Revenue Code	250
Min. Negotiated Rate	$32.61
Max. Negotiated Rate	$363.26
Rate for Payer: Aetna of AZ Commercial	$195.69
Rate for Payer: Aetna of AZ Medicare	$60.88
Rate for Payer: AHCCCS Medicaid	$363.26
Rate for Payer: Allwell Medicaid	$363.26
Rate for Payer: Allwell Medicare	$32.61
Rate for Payer: Amerigroup Medicare	$32.61
Rate for Payer: APIPA Medicare/Medicaid	$81.21
Rate for Payer: AZCH Complete Medicaid	$363.26
Rate for Payer: AZCH Complete Medicare	$32.61
Rate for Payer: Banner UC Health Medicaid	$363.26
Rate for Payer: Banner UC Health Medicare	$32.61
Rate for Payer: Bisbee Police All Plans	$56.53
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$147.85
Rate for Payer: Cash Price	$173.95
Rate for Payer: Cash Price	$173.95
Rate for Payer: Cigna of AZ Commercial	$141.33
Rate for Payer: Copperpoint Commercial	$53.81
Rate for Payer: Health Net of AZ Commercial	$130.46
Rate for Payer: Health Net of AZ Medicare	$60.88
Rate for Payer: Humana of AZ Medicare	$32.61
Rate for Payer: Mercy Care Medicaid	$363.26
Rate for Payer: Self Pay Self Pay	$173.94
Rate for Payer: TriWest Medicare	$32.61
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.14

eculizumab 10 mg/mL Sol[CQCH]

Facility

$217.43

Service Code	HCPCS J1300
Hospital Charge Code	189306752
Hospital Revenue Code	250
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$195.69
Rate for Payer: Aetna of AZ Commercial	$195.69
Rate for Payer: Bisbee Police All Plans	$56.53
Rate for Payer: Cash Price	$173.95
Rate for Payer: Self Pay Self Pay	$173.94

Edometrial Sampling (biopsy) w/ or w/o Endo

Facility

$661.00

Service Code	CPT 58100
Hospital Charge Code	22692053
Hospital Revenue Code	360
Min. Negotiated Rate	$99.15
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$594.90
Rate for Payer: Aetna of AZ Medicare	$185.08
Rate for Payer: AHCCCS Medicaid	$246.96
Rate for Payer: Allwell Medicaid	$246.96
Rate for Payer: Allwell Medicare	$99.15
Rate for Payer: Amerigroup Medicare	$99.15
Rate for Payer: APIPA Medicare/Medicaid	$246.88
Rate for Payer: AZCH Complete Medicaid	$246.96
Rate for Payer: AZCH Complete Medicare	$99.15
Rate for Payer: Banner UC Health Medicaid	$246.96
Rate for Payer: Banner UC Health Medicare	$99.15
Rate for Payer: Bisbee Police All Plans	$171.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$449.48
Rate for Payer: Cash Price	$528.80
Rate for Payer: Cash Price	$528.80
Rate for Payer: Cigna of AZ Commercial	$330.50
Rate for Payer: Copperpoint Commercial	$163.60
Rate for Payer: Health Net of AZ Commercial	$396.60
Rate for Payer: Health Net of AZ Medicare	$185.08
Rate for Payer: Humana of AZ Medicare	$99.15
Rate for Payer: Mercy Care Medicaid	$246.96
Rate for Payer: Self Pay Self Pay	$528.80
Rate for Payer: TriWest Medicare	$99.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$118.98

Edometrial Sampling (biopsy) w/ or w/o Endo

Facility

$661.00

Service Code	CPT 58100
Hospital Charge Code	22692053
Hospital Revenue Code	360
Min. Negotiated Rate	$171.86
Max. Negotiated Rate	$594.90
Rate for Payer: Aetna of AZ Commercial	$594.90
Rate for Payer: Bisbee Police All Plans	$171.86
Rate for Payer: Cash Price	$528.80
Rate for Payer: Self Pay Self Pay	$528.80

EGD

Facility

$1,528.00

Service Code	CPT 43235
Hospital Charge Code	885915
Hospital Revenue Code	750
Min. Negotiated Rate	$229.20
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$1,375.20
Rate for Payer: Aetna of AZ Medicare	$427.84
Rate for Payer: AHCCCS Medicaid	$1,173.92
Rate for Payer: Allwell Medicaid	$1,173.92
Rate for Payer: Allwell Medicare	$229.20
Rate for Payer: Amerigroup Medicare	$229.20
Rate for Payer: APIPA Medicare/Medicaid	$570.71
Rate for Payer: AZCH Complete Medicaid	$1,173.92
Rate for Payer: AZCH Complete Medicare	$229.20
Rate for Payer: Banner UC Health Medicaid	$1,173.92
Rate for Payer: Banner UC Health Medicare	$229.20
Rate for Payer: Bisbee Police All Plans	$397.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,039.04
Rate for Payer: Cash Price	$1,222.40
Rate for Payer: Cash Price	$1,222.40
Rate for Payer: Cigna of AZ Commercial	$1,069.60
Rate for Payer: Copperpoint Commercial	$378.18
Rate for Payer: Health Net of AZ Commercial	$916.80
Rate for Payer: Health Net of AZ Medicare	$427.84
Rate for Payer: Humana of AZ Medicare	$229.20
Rate for Payer: Mercy Care Medicaid	$1,173.92
Rate for Payer: Self Pay Self Pay	$1,222.40
Rate for Payer: TriWest Medicare	$229.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$275.04

EGD

Facility

$1,528.00

Service Code	CPT 43235
Hospital Charge Code	885915
Hospital Revenue Code	750
Min. Negotiated Rate	$397.28
Max. Negotiated Rate	$1,375.20
Rate for Payer: Aetna of AZ Commercial	$1,375.20
Rate for Payer: Bisbee Police All Plans	$397.28
Rate for Payer: Cash Price	$1,222.40
Rate for Payer: Self Pay Self Pay	$1,222.40

EGD

Facility

$2,340.00

Service Code	CPT 43235
Hospital Charge Code	22531756
Hospital Revenue Code	750
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$2,106.00
Rate for Payer: Aetna of AZ Medicare	$655.20
Rate for Payer: AHCCCS Medicaid	$1,173.92
Rate for Payer: Allwell Medicaid	$1,173.92
Rate for Payer: Allwell Medicare	$351.00
Rate for Payer: Amerigroup Medicare	$351.00
Rate for Payer: APIPA Medicare/Medicaid	$873.99
Rate for Payer: AZCH Complete Medicaid	$1,173.92
Rate for Payer: AZCH Complete Medicare	$351.00
Rate for Payer: Banner UC Health Medicaid	$1,173.92
Rate for Payer: Banner UC Health Medicare	$351.00
Rate for Payer: Bisbee Police All Plans	$608.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,591.20
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Cigna of AZ Commercial	$1,638.00
Rate for Payer: Copperpoint Commercial	$579.15
Rate for Payer: Health Net of AZ Commercial	$1,404.00
Rate for Payer: Health Net of AZ Medicare	$655.20
Rate for Payer: Humana of AZ Medicare	$351.00
Rate for Payer: Mercy Care Medicaid	$1,173.92
Rate for Payer: Self Pay Self Pay	$1,872.00
Rate for Payer: TriWest Medicare	$351.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$421.20

EGD

Facility

$2,340.00

Service Code	CPT 43235
Hospital Charge Code	22531756
Hospital Revenue Code	750
Min. Negotiated Rate	$608.40
Max. Negotiated Rate	$2,106.00
Rate for Payer: Aetna of AZ Commercial	$2,106.00
Rate for Payer: Bisbee Police All Plans	$608.40
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Self Pay Self Pay	$1,872.00

EGD DILATION

Facility

$6,347.00

Service Code	CPT 43249
Hospital Charge Code	23598980
Hospital Revenue Code	750
Min. Negotiated Rate	$952.05
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Aetna of AZ Medicare	$1,777.16
Rate for Payer: AHCCCS Medicaid	$2,356.28
Rate for Payer: Allwell Medicaid	$2,356.28
Rate for Payer: Allwell Medicare	$952.05
Rate for Payer: Amerigroup Medicare	$952.05
Rate for Payer: APIPA Medicare/Medicaid	$2,370.60
Rate for Payer: AZCH Complete Medicaid	$2,356.28
Rate for Payer: AZCH Complete Medicare	$952.05
Rate for Payer: Banner UC Health Medicaid	$2,356.28
Rate for Payer: Banner UC Health Medicare	$952.05
Rate for Payer: Bisbee Police All Plans	$1,650.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,315.96
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cigna of AZ Commercial	$4,442.90
Rate for Payer: Copperpoint Commercial	$1,570.88
Rate for Payer: Health Net of AZ Commercial	$3,808.20
Rate for Payer: Health Net of AZ Medicare	$1,777.16
Rate for Payer: Humana of AZ Medicare	$952.05
Rate for Payer: Mercy Care Medicaid	$2,356.28
Rate for Payer: Self Pay Self Pay	$5,077.60
Rate for Payer: TriWest Medicare	$952.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,142.46

Know your out-of-pocket cost for care.

All Charges