Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

EMERGE 4X6

Facility

$12,236.00

Service Code	CPT Q4297
Hospital Charge Code	28058743
Hospital Revenue Code	636
Min. Negotiated Rate	$3,181.36
Max. Negotiated Rate	$11,012.40
Rate for Payer: Aetna of AZ Commercial	$11,012.40
Rate for Payer: Bisbee Police All Plans	$3,181.36
Rate for Payer: Cash Price	$9,788.80
Rate for Payer: Self Pay Self Pay	$9,788.80

EMERGE 4X6

Facility

$12,236.00

Service Code	CPT Q4297
Hospital Charge Code	28058743
Hospital Revenue Code	636
Min. Negotiated Rate	$1,957.76
Max. Negotiated Rate	$11,012.40
Rate for Payer: Aetna of AZ Commercial	$11,012.40
Rate for Payer: Aetna of AZ Medicare	$3,426.08
Rate for Payer: Allwell Medicare	$1,957.76
Rate for Payer: Amerigroup Medicare	$1,957.76
Rate for Payer: APIPA Medicare/Medicaid	$4,570.15
Rate for Payer: AZCH Complete Medicare	$1,957.76
Rate for Payer: Banner UC Health Medicare	$1,957.76
Rate for Payer: Bisbee Police All Plans	$3,181.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8,320.48
Rate for Payer: Cash Price	$9,788.80
Rate for Payer: Cigna of AZ Commercial	$8,565.20
Rate for Payer: Copperpoint Commercial	$3,028.41
Rate for Payer: Health Net of AZ Commercial	$7,341.60
Rate for Payer: Health Net of AZ Medicare	$3,426.08
Rate for Payer: Humana of AZ Medicare	$1,957.76
Rate for Payer: Self Pay Self Pay	$9,788.80
Rate for Payer: TriWest Medicare	$1,957.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$7,133.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,202.48

emtricitabine-tenofovir 200 mg-300 mg Tab [CQCH]

Facility

$48.62

Service Code	NDC 61958070101
Hospital Charge Code	105920292
Hospital Revenue Code	250
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$43.76
Rate for Payer: Aetna of AZ Commercial	$43.76
Rate for Payer: Aetna of AZ Medicare	$13.61
Rate for Payer: Allwell Medicare	$7.78
Rate for Payer: Amerigroup Medicare	$7.78
Rate for Payer: APIPA Medicare/Medicaid	$18.16
Rate for Payer: AZCH Complete Medicare	$7.78
Rate for Payer: Banner UC Health Medicare	$7.78
Rate for Payer: Bisbee Police All Plans	$12.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$33.06
Rate for Payer: Cash Price	$38.90
Rate for Payer: Cigna of AZ Commercial	$31.60
Rate for Payer: Copperpoint Commercial	$12.03
Rate for Payer: Health Net of AZ Commercial	$29.17
Rate for Payer: Health Net of AZ Medicare	$13.61
Rate for Payer: Humana of AZ Medicare	$7.78
Rate for Payer: Self Pay Self Pay	$38.90
Rate for Payer: TriWest Medicare	$7.78
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.75

emtricitabine-tenofovir 200 mg-300 mg Tab [CQCH]

Facility

$48.62

Service Code	NDC 61958070101
Hospital Charge Code	105920292
Hospital Revenue Code	250
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$43.76
Rate for Payer: Aetna of AZ Commercial	$43.76
Rate for Payer: Bisbee Police All Plans	$12.64
Rate for Payer: Cash Price	$38.90
Rate for Payer: Self Pay Self Pay	$38.90

.ENA+DNA/DS+Sjorgen's LC

Facility

$224.00

Service Code	CPT 86235
Hospital Charge Code	1285801
Hospital Revenue Code	301
Min. Negotiated Rate	$35.84
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna of AZ Commercial	$201.60
Rate for Payer: Aetna of AZ Medicare	$62.72
Rate for Payer: Allwell Medicare	$35.84
Rate for Payer: Amerigroup Medicare	$35.84
Rate for Payer: APIPA Medicare/Medicaid	$83.66
Rate for Payer: AZCH Complete Medicare	$35.84
Rate for Payer: Banner UC Health Medicare	$35.84
Rate for Payer: Bisbee Police All Plans	$58.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$152.32
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cigna of AZ Commercial	$145.60
Rate for Payer: Copperpoint Commercial	$55.44
Rate for Payer: Health Net of AZ Commercial	$134.40
Rate for Payer: Health Net of AZ Medicare	$62.72
Rate for Payer: Humana of AZ Medicare	$35.84
Rate for Payer: Self Pay Self Pay	$179.20
Rate for Payer: TriWest Medicare	$35.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$130.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.32

.ENA+DNA/DS+Sjorgen's LC

Facility

$224.00

Service Code	CPT 86235
Hospital Charge Code	1285801
Hospital Revenue Code	301
Min. Negotiated Rate	$58.24
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna of AZ Commercial	$201.60
Rate for Payer: Bisbee Police All Plans	$58.24
Rate for Payer: Cash Price	$179.20
Rate for Payer: Self Pay Self Pay	$179.20

enalaprilat 1.25 mg inj Sol [CQCH]

Facility

$3.68

Service Code	NDC 143978710
Hospital Charge Code	108072662
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna of AZ Commercial	$3.31
Rate for Payer: Aetna of AZ Medicare	$1.03
Rate for Payer: Allwell Medicare	$0.59
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: APIPA Medicare/Medicaid	$1.37
Rate for Payer: AZCH Complete Medicare	$0.59
Rate for Payer: Banner UC Health Medicare	$0.59
Rate for Payer: Bisbee Police All Plans	$0.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.50
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cigna of AZ Commercial	$2.39
Rate for Payer: Copperpoint Commercial	$0.91
Rate for Payer: Health Net of AZ Commercial	$2.21
Rate for Payer: Health Net of AZ Medicare	$1.03
Rate for Payer: Humana of AZ Medicare	$0.59
Rate for Payer: Self Pay Self Pay	$2.94
Rate for Payer: TriWest Medicare	$0.59
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.66

enalaprilat 1.25 mg inj Sol [CQCH]

Facility

$3.68

Service Code	NDC 143978710
Hospital Charge Code	108072662
Hospital Revenue Code	251
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna of AZ Commercial	$3.31
Rate for Payer: Bisbee Police All Plans	$0.96
Rate for Payer: Cash Price	$2.94
Rate for Payer: Self Pay Self Pay	$2.94

Endocervical Curettage (alone)

Facility

$578.00

Service Code	CPT 57505
Hospital Charge Code	27281903
Hospital Revenue Code	360
Min. Negotiated Rate	$92.48
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$520.20
Rate for Payer: Aetna of AZ Medicare	$161.84
Rate for Payer: AHCCCS Medicaid	$459.22
Rate for Payer: Allwell Medicaid	$459.22
Rate for Payer: Allwell Medicare	$92.48
Rate for Payer: Amerigroup Medicare	$92.48
Rate for Payer: APIPA Medicare/Medicaid	$215.88
Rate for Payer: AZCH Complete Medicaid	$459.22
Rate for Payer: AZCH Complete Medicare	$92.48
Rate for Payer: Banner UC Health Medicaid	$459.22
Rate for Payer: Banner UC Health Medicare	$92.48
Rate for Payer: Bisbee Police All Plans	$150.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$393.04
Rate for Payer: Cash Price	$462.40
Rate for Payer: Cash Price	$462.40
Rate for Payer: Cigna of AZ Commercial	$289.00
Rate for Payer: Copperpoint Commercial	$143.06
Rate for Payer: Health Net of AZ Commercial	$346.80
Rate for Payer: Health Net of AZ Medicare	$161.84
Rate for Payer: Humana of AZ Medicare	$92.48
Rate for Payer: Mercy Care Medicaid	$459.22
Rate for Payer: Self Pay Self Pay	$462.40
Rate for Payer: TriWest Medicare	$92.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.04

Endocervical Curettage (alone)

Facility

$578.00

Service Code	CPT 57505
Hospital Charge Code	27281903
Hospital Revenue Code	360
Min. Negotiated Rate	$150.28
Max. Negotiated Rate	$520.20
Rate for Payer: Aetna of AZ Commercial	$520.20
Rate for Payer: Bisbee Police All Plans	$150.28
Rate for Payer: Cash Price	$462.40
Rate for Payer: Self Pay Self Pay	$462.40

ENDO CLIP

Facility

$290.00

Hospital Charge Code	22354200
Hospital Revenue Code	270
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Aetna of AZ Medicare	$81.20
Rate for Payer: Allwell Medicare	$46.40
Rate for Payer: Amerigroup Medicare	$46.40
Rate for Payer: APIPA Medicare/Medicaid	$108.31
Rate for Payer: AZCH Complete Medicare	$46.40
Rate for Payer: Banner UC Health Medicare	$46.40
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$197.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$203.00
Rate for Payer: Copperpoint Commercial	$71.78
Rate for Payer: Health Net of AZ Commercial	$174.00
Rate for Payer: Health Net of AZ Medicare	$81.20
Rate for Payer: Humana of AZ Medicare	$46.40
Rate for Payer: Self Pay Self Pay	$232.00
Rate for Payer: TriWest Medicare	$46.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$169.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.20

ENDO CLIP

Facility

$290.00

Hospital Charge Code	22354200
Hospital Revenue Code	270
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Self Pay Self Pay	$232.00

ENDOCLOT SIS

Facility

$525.00

Hospital Charge Code	27537158
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

ENDOCLOT SIS

Facility

$525.00

Hospital Charge Code	27537158
Hospital Revenue Code	270
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

ENDO KITS (INFECTION PREVENTION)

Facility

$55.85

Hospital Charge Code	23531708
Hospital Revenue Code	272
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$50.27
Rate for Payer: Aetna of AZ Commercial	$50.27
Rate for Payer: Bisbee Police All Plans	$14.52
Rate for Payer: Cash Price	$44.68
Rate for Payer: Self Pay Self Pay	$44.68

ENDO KITS (INFECTION PREVENTION)

Facility

$55.85

Hospital Charge Code	23531708
Hospital Revenue Code	272
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$50.27
Rate for Payer: Aetna of AZ Commercial	$50.27
Rate for Payer: Aetna of AZ Medicare	$15.64
Rate for Payer: Allwell Medicare	$8.94
Rate for Payer: Amerigroup Medicare	$8.94
Rate for Payer: APIPA Medicare/Medicaid	$20.86
Rate for Payer: AZCH Complete Medicare	$8.94
Rate for Payer: Banner UC Health Medicare	$8.94
Rate for Payer: Bisbee Police All Plans	$14.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.98
Rate for Payer: Cash Price	$44.68
Rate for Payer: Cigna of AZ Commercial	$39.09
Rate for Payer: Copperpoint Commercial	$13.82
Rate for Payer: Health Net of AZ Commercial	$33.51
Rate for Payer: Health Net of AZ Medicare	$15.64
Rate for Payer: Humana of AZ Medicare	$8.94
Rate for Payer: Self Pay Self Pay	$44.68
Rate for Payer: TriWest Medicare	$8.94
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.05

Endometrial Ablation hysteroscopic

Facility

$1,275.00

Service Code	CPT 58563
Hospital Charge Code	27291806
Hospital Revenue Code	360
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$3,196.92
Rate for Payer: Aetna of AZ Commercial	$1,147.50
Rate for Payer: Aetna of AZ Medicare	$357.00
Rate for Payer: AHCCCS Medicaid	$3,196.92
Rate for Payer: Allwell Medicaid	$3,196.92
Rate for Payer: Allwell Medicare	$204.00
Rate for Payer: Amerigroup Medicare	$204.00
Rate for Payer: APIPA Medicare/Medicaid	$476.21
Rate for Payer: AZCH Complete Medicaid	$3,196.92
Rate for Payer: AZCH Complete Medicare	$204.00
Rate for Payer: Banner UC Health Medicaid	$3,196.92
Rate for Payer: Banner UC Health Medicare	$204.00
Rate for Payer: Bisbee Police All Plans	$331.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$867.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cigna of AZ Commercial	$637.50
Rate for Payer: Copperpoint Commercial	$315.56
Rate for Payer: Health Net of AZ Commercial	$765.00
Rate for Payer: Health Net of AZ Medicare	$357.00
Rate for Payer: Humana of AZ Medicare	$204.00
Rate for Payer: Mercy Care Medicaid	$3,196.92
Rate for Payer: Self Pay Self Pay	$1,020.00
Rate for Payer: TriWest Medicare	$204.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$743.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$229.50

Endometrial Ablation hysteroscopic

Facility

$1,275.00

Service Code	CPT 58563
Hospital Charge Code	27291806
Hospital Revenue Code	360
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$1,147.50
Rate for Payer: Aetna of AZ Commercial	$1,147.50
Rate for Payer: Bisbee Police All Plans	$331.50
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Self Pay Self Pay	$1,020.00

Endometrial Ablation Thermal

Facility

$1,255.00

Service Code	CPT 58353
Hospital Charge Code	27291807
Hospital Revenue Code	360
Min. Negotiated Rate	$200.80
Max. Negotiated Rate	$3,196.92
Rate for Payer: Aetna of AZ Commercial	$1,129.50
Rate for Payer: Aetna of AZ Medicare	$351.40
Rate for Payer: AHCCCS Medicaid	$3,196.92
Rate for Payer: Allwell Medicaid	$3,196.92
Rate for Payer: Allwell Medicare	$200.80
Rate for Payer: Amerigroup Medicare	$200.80
Rate for Payer: APIPA Medicare/Medicaid	$468.74
Rate for Payer: AZCH Complete Medicaid	$3,196.92
Rate for Payer: AZCH Complete Medicare	$200.80
Rate for Payer: Banner UC Health Medicaid	$3,196.92
Rate for Payer: Banner UC Health Medicare	$200.80
Rate for Payer: Bisbee Police All Plans	$326.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$853.40
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cigna of AZ Commercial	$627.50
Rate for Payer: Copperpoint Commercial	$310.61
Rate for Payer: Health Net of AZ Commercial	$753.00
Rate for Payer: Health Net of AZ Medicare	$351.40
Rate for Payer: Humana of AZ Medicare	$200.80
Rate for Payer: Mercy Care Medicaid	$3,196.92
Rate for Payer: Self Pay Self Pay	$1,004.00
Rate for Payer: TriWest Medicare	$200.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$731.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$225.90

Endometrial Ablation Thermal

Facility

$1,255.00

Service Code	CPT 58353
Hospital Charge Code	27291807
Hospital Revenue Code	360
Min. Negotiated Rate	$326.30
Max. Negotiated Rate	$1,129.50
Rate for Payer: Aetna of AZ Commercial	$1,129.50
Rate for Payer: Bisbee Police All Plans	$326.30
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Self Pay Self Pay	$1,004.00

ENDOMYSIAL AB

Facility

$772.00

Service Code	CPT 86255
Hospital Charge Code	22481473
Hospital Revenue Code	302
Min. Negotiated Rate	$123.52
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Aetna of AZ Medicare	$216.16
Rate for Payer: Allwell Medicare	$123.52
Rate for Payer: Amerigroup Medicare	$123.52
Rate for Payer: APIPA Medicare/Medicaid	$288.34
Rate for Payer: AZCH Complete Medicare	$123.52
Rate for Payer: Banner UC Health Medicare	$123.52
Rate for Payer: Bisbee Police All Plans	$200.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$524.96
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cigna of AZ Commercial	$501.80
Rate for Payer: Copperpoint Commercial	$191.07
Rate for Payer: Health Net of AZ Commercial	$463.20
Rate for Payer: Health Net of AZ Medicare	$216.16
Rate for Payer: Humana of AZ Medicare	$123.52
Rate for Payer: Self Pay Self Pay	$617.60
Rate for Payer: TriWest Medicare	$123.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$450.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.96

ENDOMYSIAL AB

Facility

$772.00

Service Code	CPT 86255
Hospital Charge Code	22481473
Hospital Revenue Code	302
Min. Negotiated Rate	$200.72
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Bisbee Police All Plans	$200.72
Rate for Payer: Cash Price	$617.60
Rate for Payer: Self Pay Self Pay	$617.60

Endomysial Ab IgA w/Reflex LC

Facility

$60.00

Service Code	CPT 86231
Hospital Charge Code	28059750
Hospital Revenue Code	302
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

Endomysial Ab IgA w/Reflex LC

Facility

$60.00

Service Code	CPT 86231
Hospital Charge Code	28059750
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.60
Rate for Payer: Amerigroup Medicare	$9.60
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$39.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

Endomysial Antibody IgA LC

Facility

$713.00

Service Code	CPT 86255
Hospital Charge Code	2087582
Hospital Revenue Code	302
Min. Negotiated Rate	$185.38
Max. Negotiated Rate	$641.70
Rate for Payer: Aetna of AZ Commercial	$641.70
Rate for Payer: Bisbee Police All Plans	$185.38
Rate for Payer: Cash Price	$570.40
Rate for Payer: Self Pay Self Pay	$570.40

Know your out-of-pocket cost for care.

All Charges