Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

HIGHFLOW NASAL CANNULA

Facility

$16.00

Hospital Charge Code	24153385
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

HIGHFLOW NASAL CANNULA

Facility

$16.00

Hospital Charge Code	24153385
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Cash Price	$12.80
Rate for Payer: Self Pay Self Pay	$12.80

Hip And Femur Fracture Repair

Facility

$19,971.66

Service Code	APR-DRG 3084
Hospital Charge Code	APRDRG3082
Min. Negotiated Rate	$19,971.66
Max. Negotiated Rate	$19,971.66
Rate for Payer: AHCCCS Medicaid	$19,971.66
Rate for Payer: Allwell Medicaid	$19,971.66
Rate for Payer: AZCH Complete Medicaid	$19,971.66
Rate for Payer: Banner UC Health Medicaid	$19,971.66
Rate for Payer: Mercy Care Medicaid	$19,971.66

Hip And Femur Fracture Repair

Facility

$8,388.74

Service Code	APR-DRG 3081
Hospital Charge Code	APRDRG3084
Min. Negotiated Rate	$8,388.74
Max. Negotiated Rate	$8,388.74
Rate for Payer: AHCCCS Medicaid	$8,388.74
Rate for Payer: Allwell Medicaid	$8,388.74
Rate for Payer: AZCH Complete Medicaid	$8,388.74
Rate for Payer: Banner UC Health Medicaid	$8,388.74
Rate for Payer: Mercy Care Medicaid	$8,388.74

Hip And Femur Fracture Repair

Facility

$9,774.71

Service Code	APR-DRG 3082
Hospital Charge Code	APRDRG3084
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Hip And Femur Fracture Repair

Facility

$9,774.71

Service Code	APR-DRG 3082
Hospital Charge Code	APRDRG3083
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Hip And Femur Fracture Repair

Facility

$19,971.66

Service Code	APR-DRG 3084
Hospital Charge Code	APRDRG3081
Min. Negotiated Rate	$19,971.66
Max. Negotiated Rate	$19,971.66
Rate for Payer: AHCCCS Medicaid	$19,971.66
Rate for Payer: Allwell Medicaid	$19,971.66
Rate for Payer: AZCH Complete Medicaid	$19,971.66
Rate for Payer: Banner UC Health Medicaid	$19,971.66
Rate for Payer: Mercy Care Medicaid	$19,971.66

Hip And Femur Fracture Repair

Facility

$19,971.66

Service Code	APR-DRG 3084
Hospital Charge Code	APRDRG3084
Min. Negotiated Rate	$19,971.66
Max. Negotiated Rate	$19,971.66
Rate for Payer: AHCCCS Medicaid	$19,971.66
Rate for Payer: Allwell Medicaid	$19,971.66
Rate for Payer: AZCH Complete Medicaid	$19,971.66
Rate for Payer: Banner UC Health Medicaid	$19,971.66
Rate for Payer: Mercy Care Medicaid	$19,971.66

Hip And Femur Fracture Repair

Facility

$13,332.91

Service Code	APR-DRG 3083
Hospital Charge Code	APRDRG3084
Min. Negotiated Rate	$13,332.91
Max. Negotiated Rate	$13,332.91
Rate for Payer: AHCCCS Medicaid	$13,332.91
Rate for Payer: Allwell Medicaid	$13,332.91
Rate for Payer: AZCH Complete Medicaid	$13,332.91
Rate for Payer: Banner UC Health Medicaid	$13,332.91
Rate for Payer: Mercy Care Medicaid	$13,332.91

Hip And Femur Fracture Repair

Facility

$13,332.91

Service Code	APR-DRG 3083
Hospital Charge Code	APRDRG3081
Min. Negotiated Rate	$13,332.91
Max. Negotiated Rate	$13,332.91
Rate for Payer: AHCCCS Medicaid	$13,332.91
Rate for Payer: Allwell Medicaid	$13,332.91
Rate for Payer: AZCH Complete Medicaid	$13,332.91
Rate for Payer: Banner UC Health Medicaid	$13,332.91
Rate for Payer: Mercy Care Medicaid	$13,332.91

Hip And Femur Fracture Repair

Facility

$8,388.74

Service Code	APR-DRG 3081
Hospital Charge Code	APRDRG3083
Min. Negotiated Rate	$8,388.74
Max. Negotiated Rate	$8,388.74
Rate for Payer: AHCCCS Medicaid	$8,388.74
Rate for Payer: Allwell Medicaid	$8,388.74
Rate for Payer: AZCH Complete Medicaid	$8,388.74
Rate for Payer: Banner UC Health Medicaid	$8,388.74
Rate for Payer: Mercy Care Medicaid	$8,388.74

Hip And Femur Fracture Repair

Facility

$9,774.71

Service Code	APR-DRG 3082
Hospital Charge Code	APRDRG3081
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Hip And Femur Fracture Repair

Facility

$13,332.91

Service Code	APR-DRG 3083
Hospital Charge Code	APRDRG3082
Min. Negotiated Rate	$13,332.91
Max. Negotiated Rate	$13,332.91
Rate for Payer: AHCCCS Medicaid	$13,332.91
Rate for Payer: Allwell Medicaid	$13,332.91
Rate for Payer: AZCH Complete Medicaid	$13,332.91
Rate for Payer: Banner UC Health Medicaid	$13,332.91
Rate for Payer: Mercy Care Medicaid	$13,332.91

Hip And Femur Fracture Repair

Facility

$13,332.91

Service Code	APR-DRG 3083
Hospital Charge Code	APRDRG3083
Min. Negotiated Rate	$13,332.91
Max. Negotiated Rate	$13,332.91
Rate for Payer: AHCCCS Medicaid	$13,332.91
Rate for Payer: Allwell Medicaid	$13,332.91
Rate for Payer: AZCH Complete Medicaid	$13,332.91
Rate for Payer: Banner UC Health Medicaid	$13,332.91
Rate for Payer: Mercy Care Medicaid	$13,332.91

Hip And Femur Fracture Repair

Facility

$9,774.71

Service Code	APR-DRG 3082
Hospital Charge Code	APRDRG3082
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Hip And Femur Fracture Repair

Facility

$8,388.74

Service Code	APR-DRG 3081
Hospital Charge Code	APRDRG3082
Min. Negotiated Rate	$8,388.74
Max. Negotiated Rate	$8,388.74
Rate for Payer: AHCCCS Medicaid	$8,388.74
Rate for Payer: Allwell Medicaid	$8,388.74
Rate for Payer: AZCH Complete Medicaid	$8,388.74
Rate for Payer: Banner UC Health Medicaid	$8,388.74
Rate for Payer: Mercy Care Medicaid	$8,388.74

Hip And Femur Fracture Repair

Facility

$19,971.66

Service Code	APR-DRG 3084
Hospital Charge Code	APRDRG3083
Min. Negotiated Rate	$19,971.66
Max. Negotiated Rate	$19,971.66
Rate for Payer: AHCCCS Medicaid	$19,971.66
Rate for Payer: Allwell Medicaid	$19,971.66
Rate for Payer: AZCH Complete Medicaid	$19,971.66
Rate for Payer: Banner UC Health Medicaid	$19,971.66
Rate for Payer: Mercy Care Medicaid	$19,971.66

Hip And Femur Fracture Repair

Facility

$8,388.74

Service Code	APR-DRG 3081
Hospital Charge Code	APRDRG3081
Min. Negotiated Rate	$8,388.74
Max. Negotiated Rate	$8,388.74
Rate for Payer: AHCCCS Medicaid	$8,388.74
Rate for Payer: Allwell Medicaid	$8,388.74
Rate for Payer: AZCH Complete Medicaid	$8,388.74
Rate for Payer: Banner UC Health Medicaid	$8,388.74
Rate for Payer: Mercy Care Medicaid	$8,388.74

.HIV 1/2 Supplemental Ab Test LC

Facility

$420.00

Service Code	CPT 86701
Hospital Charge Code	11067502
Hospital Revenue Code	302
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna of AZ Commercial	$378.00
Rate for Payer: Bisbee Police All Plans	$109.20
Rate for Payer: Cash Price	$336.00
Rate for Payer: Self Pay Self Pay	$336.00

.HIV 1/2 Supplemental Ab Test LC

Facility

$420.00

Service Code	CPT 86701
Hospital Charge Code	11067502
Hospital Revenue Code	302
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna of AZ Commercial	$378.00
Rate for Payer: Aetna of AZ Medicare	$117.60
Rate for Payer: AHCCCS Medicaid	$8.89
Rate for Payer: Allwell Medicaid	$8.89
Rate for Payer: Allwell Medicare	$63.00
Rate for Payer: Amerigroup Medicare	$63.00
Rate for Payer: APIPA Medicare/Medicaid	$156.87
Rate for Payer: AZCH Complete Medicaid	$8.89
Rate for Payer: AZCH Complete Medicare	$63.00
Rate for Payer: Banner UC Health Medicaid	$8.89
Rate for Payer: Banner UC Health Medicare	$63.00
Rate for Payer: Bisbee Police All Plans	$109.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$285.60
Rate for Payer: Cash Price	$336.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Cigna of AZ Commercial	$273.00
Rate for Payer: Copperpoint Commercial	$103.95
Rate for Payer: Health Net of AZ Commercial	$252.00
Rate for Payer: Health Net of AZ Medicare	$117.60
Rate for Payer: Humana of AZ Medicare	$63.00
Rate for Payer: Mercy Care Medicaid	$8.89
Rate for Payer: Self Pay Self Pay	$336.00
Rate for Payer: TriWest Medicare	$63.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$244.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.60

HIV-1 Genosure Archive

Facility

$1,244.00

Service Code	CPT 87901
Hospital Charge Code	23175970
Hospital Revenue Code	300
Min. Negotiated Rate	$323.44
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Bisbee Police All Plans	$323.44
Rate for Payer: Cash Price	$995.20
Rate for Payer: Self Pay Self Pay	$995.20

HIV-1 Genosure Archive

Facility

$1,244.00

Service Code	CPT 87901
Hospital Charge Code	23175970
Hospital Revenue Code	300
Min. Negotiated Rate	$186.60
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Aetna of AZ Medicare	$348.32
Rate for Payer: AHCCCS Medicaid	$257.45
Rate for Payer: Allwell Medicaid	$257.45
Rate for Payer: Allwell Medicare	$186.60
Rate for Payer: Amerigroup Medicare	$186.60
Rate for Payer: APIPA Medicare/Medicaid	$464.63
Rate for Payer: AZCH Complete Medicaid	$257.45
Rate for Payer: AZCH Complete Medicare	$186.60
Rate for Payer: Banner UC Health Medicaid	$257.45
Rate for Payer: Banner UC Health Medicare	$186.60
Rate for Payer: Bisbee Police All Plans	$323.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$845.92
Rate for Payer: Cash Price	$995.20
Rate for Payer: Cash Price	$995.20
Rate for Payer: Cigna of AZ Commercial	$808.60
Rate for Payer: Copperpoint Commercial	$307.89
Rate for Payer: Health Net of AZ Commercial	$746.40
Rate for Payer: Health Net of AZ Medicare	$348.32
Rate for Payer: Humana of AZ Medicare	$186.60
Rate for Payer: Mercy Care Medicaid	$257.45
Rate for Payer: Self Pay Self Pay	$995.20
Rate for Payer: TriWest Medicare	$186.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$725.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$223.92

HIV 4th Gen Screen w Reflex LC

Facility

$316.00

Service Code	CPT 87389
Hospital Charge Code	22305596
Hospital Revenue Code	301
Min. Negotiated Rate	$82.16
Max. Negotiated Rate	$284.40
Rate for Payer: Aetna of AZ Commercial	$284.40
Rate for Payer: Bisbee Police All Plans	$82.16
Rate for Payer: Cash Price	$252.80
Rate for Payer: Self Pay Self Pay	$252.80

HIV 4th Gen Screen w Reflex LC

Facility

$316.00

Service Code	CPT 87389
Hospital Charge Code	22305596
Hospital Revenue Code	301
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$284.40
Rate for Payer: Aetna of AZ Commercial	$284.40
Rate for Payer: Aetna of AZ Medicare	$88.48
Rate for Payer: AHCCCS Medicaid	$24.08
Rate for Payer: Allwell Medicaid	$24.08
Rate for Payer: Allwell Medicare	$47.40
Rate for Payer: Amerigroup Medicare	$47.40
Rate for Payer: APIPA Medicare/Medicaid	$118.03
Rate for Payer: AZCH Complete Medicaid	$24.08
Rate for Payer: AZCH Complete Medicare	$47.40
Rate for Payer: Banner UC Health Medicaid	$24.08
Rate for Payer: Banner UC Health Medicare	$47.40
Rate for Payer: Bisbee Police All Plans	$82.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$214.88
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cigna of AZ Commercial	$205.40
Rate for Payer: Copperpoint Commercial	$78.21
Rate for Payer: Health Net of AZ Commercial	$189.60
Rate for Payer: Health Net of AZ Medicare	$88.48
Rate for Payer: Humana of AZ Medicare	$47.40
Rate for Payer: Mercy Care Medicaid	$24.08
Rate for Payer: Self Pay Self Pay	$252.80
Rate for Payer: TriWest Medicare	$47.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$184.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$56.88

.HIV GenoSure(R) MG LC

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	22311150
Hospital Revenue Code	306
Min. Negotiated Rate	$390.52
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Bisbee Police All Plans	$390.52
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Self Pay Self Pay	$1,201.60

Know your out-of-pocket cost for care.

All Charges