Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGEAL VARICIES BANDING

Facility

$6,347.00

Service Code	CPT 43244
Hospital Charge Code	23598982
Hospital Revenue Code	750
Min. Negotiated Rate	$1,650.22
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Bisbee Police All Plans	$1,650.22
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Self Pay Self Pay	$5,077.60

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACH

Facility

$1,898.00

Service Code	CPT 91035
Hospital Charge Code	23598979
Hospital Revenue Code	750
Min. Negotiated Rate	$493.48
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Self Pay Self Pay	$1,518.40

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACH

Facility

$1,898.00

Service Code	CPT 91035
Hospital Charge Code	23598979
Hospital Revenue Code	750
Min. Negotiated Rate	$303.68
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Aetna of AZ Medicare	$531.44
Rate for Payer: Allwell Medicare	$303.68
Rate for Payer: Amerigroup Medicare	$303.68
Rate for Payer: APIPA Medicare/Medicaid	$708.90
Rate for Payer: AZCH Complete Medicare	$303.68
Rate for Payer: Banner UC Health Medicare	$303.68
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,290.64
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Copperpoint Commercial	$469.75
Rate for Payer: Health Net of AZ Commercial	$1,138.80
Rate for Payer: Health Net of AZ Medicare	$531.44
Rate for Payer: Humana of AZ Medicare	$303.68
Rate for Payer: Self Pay Self Pay	$1,518.40
Rate for Payer: TriWest Medicare	$303.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,106.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$341.64

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23598977
Hospital Revenue Code	750
Min. Negotiated Rate	$493.48
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Self Pay Self Pay	$1,518.40

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23598977
Hospital Revenue Code	750
Min. Negotiated Rate	$303.68
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Aetna of AZ Medicare	$531.44
Rate for Payer: Allwell Medicare	$303.68
Rate for Payer: Amerigroup Medicare	$303.68
Rate for Payer: APIPA Medicare/Medicaid	$708.90
Rate for Payer: AZCH Complete Medicare	$303.68
Rate for Payer: Banner UC Health Medicare	$303.68
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,290.64
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Copperpoint Commercial	$469.75
Rate for Payer: Health Net of AZ Commercial	$1,138.80
Rate for Payer: Health Net of AZ Medicare	$531.44
Rate for Payer: Humana of AZ Medicare	$303.68
Rate for Payer: Self Pay Self Pay	$1,518.40
Rate for Payer: TriWest Medicare	$303.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,106.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$341.64

ESSURE PERMANENT BIRTH CONTROL SYSTEM

Facility

$2,527.00

Service Code	CPT 58565
Hospital Charge Code	22354170
Hospital Revenue Code	270
Min. Negotiated Rate	$657.02
Max. Negotiated Rate	$2,274.30
Rate for Payer: Aetna of AZ Commercial	$2,274.30
Rate for Payer: Bisbee Police All Plans	$657.02
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Self Pay Self Pay	$2,021.60

ESSURE PERMANENT BIRTH CONTROL SYSTEM

Facility

$2,527.00

Service Code	CPT 58565
Hospital Charge Code	22354170
Hospital Revenue Code	270
Min. Negotiated Rate	$404.32
Max. Negotiated Rate	$3,196.92
Rate for Payer: Aetna of AZ Commercial	$2,274.30
Rate for Payer: Aetna of AZ Medicare	$707.56
Rate for Payer: AHCCCS Medicaid	$3,196.92
Rate for Payer: Allwell Medicaid	$3,196.92
Rate for Payer: Allwell Medicare	$404.32
Rate for Payer: Amerigroup Medicare	$404.32
Rate for Payer: APIPA Medicare/Medicaid	$943.83
Rate for Payer: AZCH Complete Medicaid	$3,196.92
Rate for Payer: AZCH Complete Medicare	$404.32
Rate for Payer: Banner UC Health Medicaid	$3,196.92
Rate for Payer: Banner UC Health Medicare	$404.32
Rate for Payer: Bisbee Police All Plans	$657.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,718.36
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cigna of AZ Commercial	$1,768.90
Rate for Payer: Copperpoint Commercial	$625.43
Rate for Payer: Health Net of AZ Commercial	$1,516.20
Rate for Payer: Health Net of AZ Medicare	$707.56
Rate for Payer: Humana of AZ Medicare	$404.32
Rate for Payer: Mercy Care Medicaid	$3,196.92
Rate for Payer: Self Pay Self Pay	$2,021.60
Rate for Payer: TriWest Medicare	$404.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,473.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$454.86

Estradiol LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	1285575
Hospital Revenue Code	301
Min. Negotiated Rate	$52.96
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Medicare	$92.68
Rate for Payer: Allwell Medicare	$52.96
Rate for Payer: Amerigroup Medicare	$52.96
Rate for Payer: APIPA Medicare/Medicaid	$123.63
Rate for Payer: AZCH Complete Medicare	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.08
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Copperpoint Commercial	$81.92
Rate for Payer: Health Net of AZ Commercial	$198.60
Rate for Payer: Health Net of AZ Medicare	$92.68
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Self Pay Self Pay	$264.80
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.58

Estradiol LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	1285575
Hospital Revenue Code	301
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Cash Price	$264.80
Rate for Payer: Self Pay Self Pay	$264.80

Estradiol, Sensitive, LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	19106382
Hospital Revenue Code	301
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Cash Price	$264.80
Rate for Payer: Self Pay Self Pay	$264.80

Estradiol, Sensitive, LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	19106382
Hospital Revenue Code	301
Min. Negotiated Rate	$52.96
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Medicare	$92.68
Rate for Payer: Allwell Medicare	$52.96
Rate for Payer: Amerigroup Medicare	$52.96
Rate for Payer: APIPA Medicare/Medicaid	$123.63
Rate for Payer: AZCH Complete Medicare	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.08
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Copperpoint Commercial	$81.92
Rate for Payer: Health Net of AZ Commercial	$198.60
Rate for Payer: Health Net of AZ Medicare	$92.68
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Self Pay Self Pay	$264.80
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.58

Estriol, Serum LC

Facility

$327.00

Service Code	CPT 82677
Hospital Charge Code	22200848
Hospital Revenue Code	301
Min. Negotiated Rate	$85.02
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Bisbee Police All Plans	$85.02
Rate for Payer: Cash Price	$261.60
Rate for Payer: Self Pay Self Pay	$261.60

Estriol, Serum LC

Facility

$327.00

Service Code	CPT 82677
Hospital Charge Code	22200848
Hospital Revenue Code	301
Min. Negotiated Rate	$52.32
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Aetna of AZ Medicare	$91.56
Rate for Payer: Allwell Medicare	$52.32
Rate for Payer: Amerigroup Medicare	$52.32
Rate for Payer: APIPA Medicare/Medicaid	$122.13
Rate for Payer: AZCH Complete Medicare	$52.32
Rate for Payer: Banner UC Health Medicare	$52.32
Rate for Payer: Bisbee Police All Plans	$85.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$222.36
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cigna of AZ Commercial	$212.55
Rate for Payer: Copperpoint Commercial	$80.93
Rate for Payer: Health Net of AZ Commercial	$196.20
Rate for Payer: Health Net of AZ Medicare	$91.56
Rate for Payer: Humana of AZ Medicare	$52.32
Rate for Payer: Self Pay Self Pay	$261.60
Rate for Payer: TriWest Medicare	$52.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$190.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.86

Estrogens, Total LC

Facility

$257.00

Service Code	CPT 82672
Hospital Charge Code	1906843
Hospital Revenue Code	301
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Aetna of AZ Medicare	$71.96
Rate for Payer: Allwell Medicare	$41.12
Rate for Payer: Amerigroup Medicare	$41.12
Rate for Payer: APIPA Medicare/Medicaid	$95.99
Rate for Payer: AZCH Complete Medicare	$41.12
Rate for Payer: Banner UC Health Medicare	$41.12
Rate for Payer: Bisbee Police All Plans	$66.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$174.76
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Copperpoint Commercial	$63.61
Rate for Payer: Health Net of AZ Commercial	$154.20
Rate for Payer: Health Net of AZ Medicare	$71.96
Rate for Payer: Humana of AZ Medicare	$41.12
Rate for Payer: Self Pay Self Pay	$205.60
Rate for Payer: TriWest Medicare	$41.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$149.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.26

Estrogens, Total LC

Facility

$257.00

Service Code	CPT 82672
Hospital Charge Code	1906843
Hospital Revenue Code	301
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Bisbee Police All Plans	$66.82
Rate for Payer: Cash Price	$205.60
Rate for Payer: Self Pay Self Pay	$205.60

Estrone LC

Facility

$295.00

Service Code	CPT 82679
Hospital Charge Code	6738646
Hospital Revenue Code	301
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Cash Price	$236.00
Rate for Payer: Self Pay Self Pay	$236.00

Estrone LC

Facility

$295.00

Service Code	CPT 82679
Hospital Charge Code	6738646
Hospital Revenue Code	301
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Aetna of AZ Medicare	$82.60
Rate for Payer: Allwell Medicare	$47.20
Rate for Payer: Amerigroup Medicare	$47.20
Rate for Payer: APIPA Medicare/Medicaid	$110.18
Rate for Payer: AZCH Complete Medicare	$47.20
Rate for Payer: Banner UC Health Medicare	$47.20
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$200.60
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Copperpoint Commercial	$73.01
Rate for Payer: Health Net of AZ Commercial	$177.00
Rate for Payer: Health Net of AZ Medicare	$82.60
Rate for Payer: Humana of AZ Medicare	$47.20
Rate for Payer: Self Pay Self Pay	$236.00
Rate for Payer: TriWest Medicare	$47.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$171.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.10

Ethanol, Urine LC

Facility

$132.00

Service Code	CPT G6040
Hospital Charge Code	22201906
Hospital Revenue Code	306
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Aetna of AZ Medicare	$36.96
Rate for Payer: Allwell Medicare	$21.12
Rate for Payer: Amerigroup Medicare	$21.12
Rate for Payer: APIPA Medicare/Medicaid	$49.30
Rate for Payer: AZCH Complete Medicare	$21.12
Rate for Payer: Banner UC Health Medicare	$21.12
Rate for Payer: Bisbee Police All Plans	$34.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$89.76
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cigna of AZ Commercial	$85.80
Rate for Payer: Copperpoint Commercial	$32.67
Rate for Payer: Health Net of AZ Commercial	$79.20
Rate for Payer: Health Net of AZ Medicare	$36.96
Rate for Payer: Humana of AZ Medicare	$21.12
Rate for Payer: Self Pay Self Pay	$105.60
Rate for Payer: TriWest Medicare	$21.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$76.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.76

Ethanol, Urine LC

Facility

$132.00

Service Code	CPT G6040
Hospital Charge Code	22201906
Hospital Revenue Code	306
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Bisbee Police All Plans	$34.32
Rate for Payer: Cash Price	$105.60
Rate for Payer: Self Pay Self Pay	$105.60

ethyl chloride Topical spray-medium stream [CQCH]

Facility

$0.26

Service Code	NDC 386000111
Hospital Charge Code	105921705
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.21
Rate for Payer: Self Pay Self Pay	$0.21

ethyl chloride Topical spray-medium stream [CQCH]

Facility

$0.26

Service Code	NDC 386000111
Hospital Charge Code	105921705
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Aetna of AZ Medicare	$0.07
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.10
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.18
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of AZ Commercial	$0.17
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.16
Rate for Payer: Health Net of AZ Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.21
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

etomidate 20 mg Inj Sol [CQCH]

Facility

$4.80

Service Code	NDC 72266014610
Hospital Charge Code	105921770
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna of AZ Commercial	$4.32
Rate for Payer: Bisbee Police All Plans	$1.25
Rate for Payer: Cash Price	$3.84
Rate for Payer: Self Pay Self Pay	$3.84

etomidate 20 mg Inj Sol [CQCH]

Facility

$4.80

Service Code	NDC 72266014610
Hospital Charge Code	105921770
Hospital Revenue Code	251
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna of AZ Commercial	$4.32
Rate for Payer: Aetna of AZ Medicare	$1.34
Rate for Payer: Allwell Medicare	$0.77
Rate for Payer: Amerigroup Medicare	$0.77
Rate for Payer: APIPA Medicare/Medicaid	$1.79
Rate for Payer: AZCH Complete Medicare	$0.77
Rate for Payer: Banner UC Health Medicare	$0.77
Rate for Payer: Bisbee Police All Plans	$1.25
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.26
Rate for Payer: Cash Price	$3.84
Rate for Payer: Cigna of AZ Commercial	$3.12
Rate for Payer: Copperpoint Commercial	$1.19
Rate for Payer: Health Net of AZ Commercial	$2.88
Rate for Payer: Health Net of AZ Medicare	$1.34
Rate for Payer: Humana of AZ Medicare	$0.77
Rate for Payer: Self Pay Self Pay	$3.84
Rate for Payer: TriWest Medicare	$0.77
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.86

ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLA

Facility

$1,182.00

Service Code	CPT J7307
Hospital Charge Code	22758888
Hospital Revenue Code	278
Min. Negotiated Rate	$189.12
Max. Negotiated Rate	$1,063.80
Rate for Payer: Aetna of AZ Commercial	$1,063.80
Rate for Payer: Aetna of AZ Medicare	$330.96
Rate for Payer: Allwell Medicare	$189.12
Rate for Payer: Amerigroup Medicare	$189.12
Rate for Payer: APIPA Medicare/Medicaid	$441.48
Rate for Payer: AZCH Complete Medicare	$189.12
Rate for Payer: Banner UC Health Medicare	$189.12
Rate for Payer: Bisbee Police All Plans	$307.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$803.76
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cigna of AZ Commercial	$591.00
Rate for Payer: Copperpoint Commercial	$292.55
Rate for Payer: Health Net of AZ Commercial	$709.20
Rate for Payer: Health Net of AZ Medicare	$330.96
Rate for Payer: Humana of AZ Medicare	$189.12
Rate for Payer: Self Pay Self Pay	$945.60
Rate for Payer: TriWest Medicare	$189.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$689.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$212.76

ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLA

Facility

$1,182.00

Service Code	CPT J7307
Hospital Charge Code	22758888
Hospital Revenue Code	278
Min. Negotiated Rate	$307.32
Max. Negotiated Rate	$1,063.80
Rate for Payer: Aetna of AZ Commercial	$1,063.80
Rate for Payer: Bisbee Police All Plans	$307.32
Rate for Payer: Cash Price	$945.60
Rate for Payer: Self Pay Self Pay	$945.60

Know your out-of-pocket cost for care.

All Charges