Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

$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

$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

$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	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

$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	$67.20
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: Allwell Medicare	$67.20
Rate for Payer: Amerigroup Medicare	$67.20
Rate for Payer: APIPA Medicare/Medicaid	$156.87
Rate for Payer: AZCH Complete Medicare	$67.20
Rate for Payer: Banner UC Health Medicare	$67.20
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: 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	$67.20
Rate for Payer: Self Pay Self Pay	$336.00
Rate for Payer: TriWest Medicare	$67.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$244.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.60

.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 Genosure Archive

Facility

$1,244.00

Service Code	CPT 87901
Hospital Charge Code	23175970
Hospital Revenue Code	300
Min. Negotiated Rate	$199.04
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: Allwell Medicare	$199.04
Rate for Payer: Amerigroup Medicare	$199.04
Rate for Payer: APIPA Medicare/Medicaid	$464.63
Rate for Payer: AZCH Complete Medicare	$199.04
Rate for Payer: Banner UC Health Medicare	$199.04
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: 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	$199.04
Rate for Payer: Self Pay Self Pay	$995.20
Rate for Payer: TriWest Medicare	$199.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$725.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$223.92

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 4th Gen Screen w Reflex LC

Facility

$300.00

Service Code	CPT 87389
Hospital Charge Code	22305596
Hospital Revenue Code	301
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Bisbee Police All Plans	$78.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Self Pay Self Pay	$240.00

HIV 4th Gen Screen w Reflex LC

Facility

$300.00

Service Code	CPT 87389
Hospital Charge Code	22305596
Hospital Revenue Code	301
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Aetna of AZ Medicare	$84.00
Rate for Payer: Allwell Medicare	$48.00
Rate for Payer: Amerigroup Medicare	$48.00
Rate for Payer: APIPA Medicare/Medicaid	$112.05
Rate for Payer: AZCH Complete Medicare	$48.00
Rate for Payer: Banner UC Health Medicare	$48.00
Rate for Payer: Bisbee Police All Plans	$78.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$204.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cigna of AZ Commercial	$195.00
Rate for Payer: Copperpoint Commercial	$74.25
Rate for Payer: Health Net of AZ Commercial	$180.00
Rate for Payer: Health Net of AZ Medicare	$84.00
Rate for Payer: Humana of AZ Medicare	$48.00
Rate for Payer: Self Pay Self Pay	$240.00
Rate for Payer: TriWest Medicare	$48.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.00

.HIV GenoSure(R) MG LC

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	23173793
Hospital Revenue Code	306
Min. Negotiated Rate	$240.32
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Aetna of AZ Medicare	$420.56
Rate for Payer: Allwell Medicare	$240.32
Rate for Payer: Amerigroup Medicare	$240.32
Rate for Payer: APIPA Medicare/Medicaid	$561.00
Rate for Payer: AZCH Complete Medicare	$240.32
Rate for Payer: Banner UC Health Medicare	$240.32
Rate for Payer: Bisbee Police All Plans	$390.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,021.36
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cigna of AZ Commercial	$976.30
Rate for Payer: Copperpoint Commercial	$371.75
Rate for Payer: Health Net of AZ Commercial	$901.20
Rate for Payer: Health Net of AZ Medicare	$420.56
Rate for Payer: Humana of AZ Medicare	$240.32
Rate for Payer: Self Pay Self Pay	$1,201.60
Rate for Payer: TriWest Medicare	$240.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$875.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$270.36

.HIV GenoSure(R) MG LC

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	22311150
Hospital Revenue Code	306
Min. Negotiated Rate	$240.32
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Aetna of AZ Medicare	$420.56
Rate for Payer: Allwell Medicare	$240.32
Rate for Payer: Amerigroup Medicare	$240.32
Rate for Payer: APIPA Medicare/Medicaid	$561.00
Rate for Payer: AZCH Complete Medicare	$240.32
Rate for Payer: Banner UC Health Medicare	$240.32
Rate for Payer: Bisbee Police All Plans	$390.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,021.36
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cigna of AZ Commercial	$976.30
Rate for Payer: Copperpoint Commercial	$371.75
Rate for Payer: Health Net of AZ Commercial	$901.20
Rate for Payer: Health Net of AZ Medicare	$420.56
Rate for Payer: Humana of AZ Medicare	$240.32
Rate for Payer: Self Pay Self Pay	$1,201.60
Rate for Payer: TriWest Medicare	$240.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$875.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$270.36

.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

.HIV GenoSure(R) MG LC

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	23173793
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

HIV Quant, LC

Facility

$1,005.00

Service Code	CPT 87536
Hospital Charge Code	2269440
Hospital Revenue Code	306
Min. Negotiated Rate	$160.80
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna of AZ Commercial	$904.50
Rate for Payer: Aetna of AZ Medicare	$281.40
Rate for Payer: Allwell Medicare	$160.80
Rate for Payer: Amerigroup Medicare	$160.80
Rate for Payer: APIPA Medicare/Medicaid	$375.37
Rate for Payer: AZCH Complete Medicare	$160.80
Rate for Payer: Banner UC Health Medicare	$160.80
Rate for Payer: Bisbee Police All Plans	$261.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$683.40
Rate for Payer: Cash Price	$804.00
Rate for Payer: Cigna of AZ Commercial	$653.25
Rate for Payer: Copperpoint Commercial	$248.74
Rate for Payer: Health Net of AZ Commercial	$603.00
Rate for Payer: Health Net of AZ Medicare	$281.40
Rate for Payer: Humana of AZ Medicare	$160.80
Rate for Payer: Self Pay Self Pay	$804.00
Rate for Payer: TriWest Medicare	$160.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$585.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$180.90

HIV Quant, LC

Facility

$1,005.00

Service Code	CPT 87536
Hospital Charge Code	2269440
Hospital Revenue Code	306
Min. Negotiated Rate	$261.30
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna of AZ Commercial	$904.50
Rate for Payer: Bisbee Police All Plans	$261.30
Rate for Payer: Cash Price	$804.00
Rate for Payer: Self Pay Self Pay	$804.00

HIV RNA, PCR (Graph) rfx/Geno LC

Facility

$1,005.00

Service Code	CPT 87536
Hospital Charge Code	22240940
Hospital Revenue Code	301
Min. Negotiated Rate	$160.80
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna of AZ Commercial	$904.50
Rate for Payer: Aetna of AZ Medicare	$281.40
Rate for Payer: Allwell Medicare	$160.80
Rate for Payer: Amerigroup Medicare	$160.80
Rate for Payer: APIPA Medicare/Medicaid	$375.37
Rate for Payer: AZCH Complete Medicare	$160.80
Rate for Payer: Banner UC Health Medicare	$160.80
Rate for Payer: Bisbee Police All Plans	$261.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$683.40
Rate for Payer: Cash Price	$804.00
Rate for Payer: Cigna of AZ Commercial	$653.25
Rate for Payer: Copperpoint Commercial	$248.74
Rate for Payer: Health Net of AZ Commercial	$603.00
Rate for Payer: Health Net of AZ Medicare	$281.40
Rate for Payer: Humana of AZ Medicare	$160.80
Rate for Payer: Self Pay Self Pay	$804.00
Rate for Payer: TriWest Medicare	$160.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$585.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$180.90

HIV RNA, PCR (Graph) rfx/Geno LC

Facility

$1,005.00

Service Code	CPT 87536
Hospital Charge Code	22240940
Hospital Revenue Code	301
Min. Negotiated Rate	$261.30
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna of AZ Commercial	$904.50
Rate for Payer: Bisbee Police All Plans	$261.30
Rate for Payer: Cash Price	$804.00
Rate for Payer: Self Pay Self Pay	$804.00

.HIV RNA Ql LC

Facility

$533.00

Service Code	CPT 87535
Hospital Charge Code	22530964
Hospital Revenue Code	301
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$479.70
Rate for Payer: Aetna of AZ Commercial	$479.70
Rate for Payer: Aetna of AZ Medicare	$149.24
Rate for Payer: Allwell Medicare	$85.28
Rate for Payer: Amerigroup Medicare	$85.28
Rate for Payer: APIPA Medicare/Medicaid	$199.08
Rate for Payer: AZCH Complete Medicare	$85.28
Rate for Payer: Banner UC Health Medicare	$85.28
Rate for Payer: Bisbee Police All Plans	$138.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$362.44
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cigna of AZ Commercial	$346.45
Rate for Payer: Copperpoint Commercial	$131.92
Rate for Payer: Health Net of AZ Commercial	$319.80
Rate for Payer: Health Net of AZ Medicare	$149.24
Rate for Payer: Humana of AZ Medicare	$85.28
Rate for Payer: Self Pay Self Pay	$426.40
Rate for Payer: TriWest Medicare	$85.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$310.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$95.94

.HIV RNA Ql LC

Facility

$533.00

Service Code	CPT 87535
Hospital Charge Code	22530964
Hospital Revenue Code	301
Min. Negotiated Rate	$138.58
Max. Negotiated Rate	$479.70
Rate for Payer: Aetna of AZ Commercial	$479.70
Rate for Payer: Bisbee Police All Plans	$138.58
Rate for Payer: Cash Price	$426.40
Rate for Payer: Self Pay Self Pay	$426.40

.HIV RNA Qual LC

Facility

$506.00

Service Code	CPT 87535
Hospital Charge Code	22305598
Hospital Revenue Code	306
Min. Negotiated Rate	$80.96
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Aetna of AZ Medicare	$141.68
Rate for Payer: Allwell Medicare	$80.96
Rate for Payer: Amerigroup Medicare	$80.96
Rate for Payer: APIPA Medicare/Medicaid	$188.99
Rate for Payer: AZCH Complete Medicare	$80.96
Rate for Payer: Banner UC Health Medicare	$80.96
Rate for Payer: Bisbee Police All Plans	$131.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$344.08
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cigna of AZ Commercial	$328.90
Rate for Payer: Copperpoint Commercial	$125.23
Rate for Payer: Health Net of AZ Commercial	$303.60
Rate for Payer: Health Net of AZ Medicare	$141.68
Rate for Payer: Humana of AZ Medicare	$80.96
Rate for Payer: Self Pay Self Pay	$404.80
Rate for Payer: TriWest Medicare	$80.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$295.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$91.08

.HIV RNA Qual LC

Facility

$506.00

Service Code	CPT 87535
Hospital Charge Code	22305598
Hospital Revenue Code	306
Min. Negotiated Rate	$131.56
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Bisbee Police All Plans	$131.56
Rate for Payer: Cash Price	$404.80
Rate for Payer: Self Pay Self Pay	$404.80

Hiv With Major Hiv Related Condition

Facility

$13,882.81

Service Code	APR-DRG 8924
Hospital Charge Code	APRDRG8924
Min. Negotiated Rate	$13,882.81
Max. Negotiated Rate	$13,882.81
Rate for Payer: AHCCCS Medicaid	$13,882.81
Rate for Payer: Allwell Medicaid	$13,882.81
Rate for Payer: AZCH Complete Medicaid	$13,882.81
Rate for Payer: Banner UC Health Medicaid	$13,882.81
Rate for Payer: Mercy Care Medicaid	$13,882.81

Know your out-of-pocket cost for care.

All Charges