Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

99292 - ED Critical Care, each 30 min

Facility

$1,822.00

Service Code	CPT 99292
Hospital Charge Code	22283181
Hospital Revenue Code	450
Min. Negotiated Rate	$473.72
Max. Negotiated Rate	$1,639.80
Rate for Payer: Aetna of AZ Commercial	$1,639.80
Rate for Payer: Bisbee Police All Plans	$473.72
Rate for Payer: Cash Price	$1,457.60
Rate for Payer: Self Pay Self Pay	$1,457.60

99292 - ED Critical Care, each 30 min

Facility

$1,822.00

Service Code	CPT 99292
Hospital Charge Code	22283181
Hospital Revenue Code	450
Min. Negotiated Rate	$291.52
Max. Negotiated Rate	$1,639.80
Rate for Payer: Aetna of AZ Commercial	$1,639.80
Rate for Payer: Aetna of AZ Medicare	$510.16
Rate for Payer: Allwell Medicare	$291.52
Rate for Payer: Amerigroup Medicare	$291.52
Rate for Payer: APIPA Medicare/Medicaid	$680.52
Rate for Payer: AZCH Complete Medicare	$291.52
Rate for Payer: Banner UC Health Medicare	$291.52
Rate for Payer: Bisbee Police All Plans	$473.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,238.96
Rate for Payer: Cash Price	$1,457.60
Rate for Payer: Cigna of AZ Commercial	$1,275.40
Rate for Payer: Copperpoint Commercial	$450.94
Rate for Payer: Health Net of AZ Commercial	$1,093.20
Rate for Payer: Health Net of AZ Medicare	$510.16
Rate for Payer: Humana of AZ Medicare	$291.52
Rate for Payer: Self Pay Self Pay	$1,457.60
Rate for Payer: TriWest Medicare	$291.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,062.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$327.96

99455 CDL Physical

Facility

$160.00

Service Code	CPT 99455
Hospital Charge Code	22245603
Hospital Revenue Code	983
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Aetna of AZ Medicare	$44.80
Rate for Payer: Allwell Medicare	$25.60
Rate for Payer: Amerigroup Medicare	$25.60
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicare	$25.60
Rate for Payer: Banner UC Health Medicare	$25.60
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.80
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cigna of AZ Commercial	$112.00
Rate for Payer: Copperpoint Commercial	$39.60
Rate for Payer: Health Net of AZ Commercial	$96.00
Rate for Payer: Health Net of AZ Medicare	$44.80
Rate for Payer: Humana of AZ Medicare	$25.60
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$25.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.80

99455 CDL Physical

Facility

$160.00

Service Code	CPT 99455
Hospital Charge Code	22245603
Hospital Revenue Code	983
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Self Pay Self Pay	$128.00

abatacept 250 mg REC [CQCH]

Facility

$1,338.50

Service Code	HCPCS J0129
Hospital Charge Code	220821185
Hospital Revenue Code	250
Min. Negotiated Rate	$214.16
Max. Negotiated Rate	$1,204.65
Rate for Payer: Aetna of AZ Commercial	$1,204.65
Rate for Payer: Aetna of AZ Medicare	$374.78
Rate for Payer: Allwell Medicare	$214.16
Rate for Payer: Amerigroup Medicare	$214.16
Rate for Payer: APIPA Medicare/Medicaid	$499.93
Rate for Payer: AZCH Complete Medicare	$214.16
Rate for Payer: Banner UC Health Medicare	$214.16
Rate for Payer: Bisbee Police All Plans	$348.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$910.18
Rate for Payer: Cash Price	$1,070.80
Rate for Payer: Cigna of AZ Commercial	$870.02
Rate for Payer: Copperpoint Commercial	$331.28
Rate for Payer: Health Net of AZ Commercial	$803.10
Rate for Payer: Health Net of AZ Medicare	$374.78
Rate for Payer: Humana of AZ Medicare	$214.16
Rate for Payer: Self Pay Self Pay	$1,070.80
Rate for Payer: TriWest Medicare	$214.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$780.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$240.93

abatacept 250 mg REC [CQCH]

Facility

$1,338.50

Service Code	HCPCS J0129
Hospital Charge Code	220821185
Hospital Revenue Code	250
Min. Negotiated Rate	$348.01
Max. Negotiated Rate	$1,204.65
Rate for Payer: Aetna of AZ Commercial	$1,204.65
Rate for Payer: Bisbee Police All Plans	$348.01
Rate for Payer: Cash Price	$1,070.80
Rate for Payer: Self Pay Self Pay	$1,070.80

Abdominal Pain

Facility

$10,527.31

Service Code	APR-DRG 2514
Hospital Charge Code	APRDRG2512
Min. Negotiated Rate	$10,527.31
Max. Negotiated Rate	$10,527.31
Rate for Payer: AHCCCS Medicaid	$10,527.31
Rate for Payer: Allwell Medicaid	$10,527.31
Rate for Payer: AZCH Complete Medicaid	$10,527.31
Rate for Payer: Banner UC Health Medicaid	$10,527.31
Rate for Payer: Mercy Care Medicaid	$10,527.31

Abdominal Pain

Facility

$10,527.31

Service Code	APR-DRG 2514
Hospital Charge Code	APRDRG2513
Min. Negotiated Rate	$10,527.31
Max. Negotiated Rate	$10,527.31
Rate for Payer: AHCCCS Medicaid	$10,527.31
Rate for Payer: Allwell Medicaid	$10,527.31
Rate for Payer: AZCH Complete Medicaid	$10,527.31
Rate for Payer: Banner UC Health Medicaid	$10,527.31
Rate for Payer: Mercy Care Medicaid	$10,527.31

Abdominal Pain

Facility

$5,578.94

Service Code	APR-DRG 2513
Hospital Charge Code	APRDRG2512
Min. Negotiated Rate	$5,578.94
Max. Negotiated Rate	$5,578.94
Rate for Payer: AHCCCS Medicaid	$5,578.94
Rate for Payer: Allwell Medicaid	$5,578.94
Rate for Payer: AZCH Complete Medicaid	$5,578.94
Rate for Payer: Banner UC Health Medicaid	$5,578.94
Rate for Payer: Mercy Care Medicaid	$5,578.94

Abdominal Pain

Facility

$5,578.94

Service Code	APR-DRG 2513
Hospital Charge Code	APRDRG2513
Min. Negotiated Rate	$5,578.94
Max. Negotiated Rate	$5,578.94
Rate for Payer: AHCCCS Medicaid	$5,578.94
Rate for Payer: Allwell Medicaid	$5,578.94
Rate for Payer: AZCH Complete Medicaid	$5,578.94
Rate for Payer: Banner UC Health Medicaid	$5,578.94
Rate for Payer: Mercy Care Medicaid	$5,578.94

Abdominal Pain

Facility

$5,578.94

Service Code	APR-DRG 2513
Hospital Charge Code	APRDRG2514
Min. Negotiated Rate	$5,578.94
Max. Negotiated Rate	$5,578.94
Rate for Payer: AHCCCS Medicaid	$5,578.94
Rate for Payer: Allwell Medicaid	$5,578.94
Rate for Payer: AZCH Complete Medicaid	$5,578.94
Rate for Payer: Banner UC Health Medicaid	$5,578.94
Rate for Payer: Mercy Care Medicaid	$5,578.94

Abdominal Pain

Facility

$3,504.19

Service Code	APR-DRG 2511
Hospital Charge Code	APRDRG2511
Min. Negotiated Rate	$3,504.19
Max. Negotiated Rate	$3,504.19
Rate for Payer: AHCCCS Medicaid	$3,504.19
Rate for Payer: Allwell Medicaid	$3,504.19
Rate for Payer: AZCH Complete Medicaid	$3,504.19
Rate for Payer: Banner UC Health Medicaid	$3,504.19
Rate for Payer: Mercy Care Medicaid	$3,504.19

Abdominal Pain

Facility

$3,504.19

Service Code	APR-DRG 2511
Hospital Charge Code	APRDRG2514
Min. Negotiated Rate	$3,504.19
Max. Negotiated Rate	$3,504.19
Rate for Payer: AHCCCS Medicaid	$3,504.19
Rate for Payer: Allwell Medicaid	$3,504.19
Rate for Payer: AZCH Complete Medicaid	$3,504.19
Rate for Payer: Banner UC Health Medicaid	$3,504.19
Rate for Payer: Mercy Care Medicaid	$3,504.19

Abdominal Pain

Facility

$4,198.58

Service Code	APR-DRG 2512
Hospital Charge Code	APRDRG2514
Min. Negotiated Rate	$4,198.58
Max. Negotiated Rate	$4,198.58
Rate for Payer: AHCCCS Medicaid	$4,198.58
Rate for Payer: Allwell Medicaid	$4,198.58
Rate for Payer: AZCH Complete Medicaid	$4,198.58
Rate for Payer: Banner UC Health Medicaid	$4,198.58
Rate for Payer: Mercy Care Medicaid	$4,198.58

Abdominal Pain

Facility

$5,578.94

Service Code	APR-DRG 2513
Hospital Charge Code	APRDRG2511
Min. Negotiated Rate	$5,578.94
Max. Negotiated Rate	$5,578.94
Rate for Payer: AHCCCS Medicaid	$5,578.94
Rate for Payer: Allwell Medicaid	$5,578.94
Rate for Payer: AZCH Complete Medicaid	$5,578.94
Rate for Payer: Banner UC Health Medicaid	$5,578.94
Rate for Payer: Mercy Care Medicaid	$5,578.94

Abdominal Pain

Facility

$4,198.58

Service Code	APR-DRG 2512
Hospital Charge Code	APRDRG2512
Min. Negotiated Rate	$4,198.58
Max. Negotiated Rate	$4,198.58
Rate for Payer: AHCCCS Medicaid	$4,198.58
Rate for Payer: Allwell Medicaid	$4,198.58
Rate for Payer: AZCH Complete Medicaid	$4,198.58
Rate for Payer: Banner UC Health Medicaid	$4,198.58
Rate for Payer: Mercy Care Medicaid	$4,198.58

Abdominal Pain

Facility

$3,504.19

Service Code	APR-DRG 2511
Hospital Charge Code	APRDRG2513
Min. Negotiated Rate	$3,504.19
Max. Negotiated Rate	$3,504.19
Rate for Payer: AHCCCS Medicaid	$3,504.19
Rate for Payer: Allwell Medicaid	$3,504.19
Rate for Payer: AZCH Complete Medicaid	$3,504.19
Rate for Payer: Banner UC Health Medicaid	$3,504.19
Rate for Payer: Mercy Care Medicaid	$3,504.19

Abdominal Pain

Facility

$4,198.58

Service Code	APR-DRG 2512
Hospital Charge Code	APRDRG2511
Min. Negotiated Rate	$4,198.58
Max. Negotiated Rate	$4,198.58
Rate for Payer: AHCCCS Medicaid	$4,198.58
Rate for Payer: Allwell Medicaid	$4,198.58
Rate for Payer: AZCH Complete Medicaid	$4,198.58
Rate for Payer: Banner UC Health Medicaid	$4,198.58
Rate for Payer: Mercy Care Medicaid	$4,198.58

Abdominal Pain

Facility

$10,527.31

Service Code	APR-DRG 2514
Hospital Charge Code	APRDRG2514
Min. Negotiated Rate	$10,527.31
Max. Negotiated Rate	$10,527.31
Rate for Payer: AHCCCS Medicaid	$10,527.31
Rate for Payer: Allwell Medicaid	$10,527.31
Rate for Payer: AZCH Complete Medicaid	$10,527.31
Rate for Payer: Banner UC Health Medicaid	$10,527.31
Rate for Payer: Mercy Care Medicaid	$10,527.31

Abdominal Pain

Facility

$3,504.19

Service Code	APR-DRG 2511
Hospital Charge Code	APRDRG2512
Min. Negotiated Rate	$3,504.19
Max. Negotiated Rate	$3,504.19
Rate for Payer: AHCCCS Medicaid	$3,504.19
Rate for Payer: Allwell Medicaid	$3,504.19
Rate for Payer: AZCH Complete Medicaid	$3,504.19
Rate for Payer: Banner UC Health Medicaid	$3,504.19
Rate for Payer: Mercy Care Medicaid	$3,504.19

Abdominal Pain

Facility

$4,198.58

Service Code	APR-DRG 2512
Hospital Charge Code	APRDRG2513
Min. Negotiated Rate	$4,198.58
Max. Negotiated Rate	$4,198.58
Rate for Payer: AHCCCS Medicaid	$4,198.58
Rate for Payer: Allwell Medicaid	$4,198.58
Rate for Payer: AZCH Complete Medicaid	$4,198.58
Rate for Payer: Banner UC Health Medicaid	$4,198.58
Rate for Payer: Mercy Care Medicaid	$4,198.58

Abdominal Pain

Facility

$10,527.31

Service Code	APR-DRG 2514
Hospital Charge Code	APRDRG2511
Min. Negotiated Rate	$10,527.31
Max. Negotiated Rate	$10,527.31
Rate for Payer: AHCCCS Medicaid	$10,527.31
Rate for Payer: Allwell Medicaid	$10,527.31
Rate for Payer: AZCH Complete Medicaid	$10,527.31
Rate for Payer: Banner UC Health Medicaid	$10,527.31
Rate for Payer: Mercy Care Medicaid	$10,527.31

ABG STICK

Facility

$347.00

Service Code	CPT 36600
Hospital Charge Code	2280035
Hospital Revenue Code	460
Min. Negotiated Rate	$55.52
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$312.30
Rate for Payer: Aetna of AZ Medicare	$97.16
Rate for Payer: Allwell Medicare	$55.52
Rate for Payer: Amerigroup Medicare	$55.52
Rate for Payer: APIPA Medicare/Medicaid	$129.60
Rate for Payer: AZCH Complete Medicare	$55.52
Rate for Payer: Banner UC Health Medicare	$55.52
Rate for Payer: Bisbee Police All Plans	$90.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$235.96
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cigna of AZ Commercial	$242.90
Rate for Payer: Copperpoint Commercial	$85.88
Rate for Payer: Health Net of AZ Commercial	$208.20
Rate for Payer: Health Net of AZ Medicare	$97.16
Rate for Payer: Humana of AZ Medicare	$55.52
Rate for Payer: Self Pay Self Pay	$277.60
Rate for Payer: TriWest Medicare	$55.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$62.46

ABG STICK

Facility

$347.00

Service Code	CPT 36600
Hospital Charge Code	2280035
Hospital Revenue Code	460
Min. Negotiated Rate	$90.22
Max. Negotiated Rate	$312.30
Rate for Payer: Aetna of AZ Commercial	$312.30
Rate for Payer: Bisbee Police All Plans	$90.22
Rate for Payer: Cash Price	$277.60
Rate for Payer: Self Pay Self Pay	$277.60

ABORh

Facility

$89.00

Service Code	CPT 86900
Hospital Charge Code	1481849
Hospital Revenue Code	302
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Aetna of AZ Medicare	$24.92
Rate for Payer: Allwell Medicare	$14.24
Rate for Payer: Amerigroup Medicare	$14.24
Rate for Payer: APIPA Medicare/Medicaid	$33.24
Rate for Payer: AZCH Complete Medicare	$14.24
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$60.52
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$57.85
Rate for Payer: Copperpoint Commercial	$22.03
Rate for Payer: Health Net of AZ Commercial	$53.40
Rate for Payer: Health Net of AZ Medicare	$24.92
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Self Pay Self Pay	$71.20
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.02

Know your out-of-pocket cost for care.

All Charges