Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Partial Thickness Burns Without Skin Graft

Facility

$3,100.89

Service Code	APR-DRG 8441
Hospital Charge Code	APRDRG8442
Min. Negotiated Rate	$3,100.89
Max. Negotiated Rate	$3,100.89
Rate for Payer: AHCCCS Medicaid	$3,100.89
Rate for Payer: Allwell Medicaid	$3,100.89
Rate for Payer: AZCH Complete Medicaid	$3,100.89
Rate for Payer: Banner UC Health Medicaid	$3,100.89
Rate for Payer: Mercy Care Medicaid	$3,100.89

Partial Thromboplastin Time

Facility

$135.00

Service Code	CPT 85730
Hospital Charge Code	633794
Hospital Revenue Code	305
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Aetna of AZ Medicare	$37.80
Rate for Payer: Allwell Medicare	$21.60
Rate for Payer: Amerigroup Medicare	$21.60
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicare	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$87.75
Rate for Payer: Copperpoint Commercial	$33.41
Rate for Payer: Health Net of AZ Commercial	$81.00
Rate for Payer: Health Net of AZ Medicare	$37.80
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.30

Partial Thromboplastin Time

Facility

$135.00

Service Code	CPT 85730
Hospital Charge Code	633794
Hospital Revenue Code	305
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Cash Price	$108.00
Rate for Payer: Self Pay Self Pay	$108.00

.PARVOVIR IGM

Facility

$176.00

Service Code	CPT 86747
Hospital Charge Code	22481449
Hospital Revenue Code	302
Min. Negotiated Rate	$28.16
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Aetna of AZ Medicare	$49.28
Rate for Payer: Allwell Medicare	$28.16
Rate for Payer: Amerigroup Medicare	$28.16
Rate for Payer: APIPA Medicare/Medicaid	$65.74
Rate for Payer: AZCH Complete Medicare	$28.16
Rate for Payer: Banner UC Health Medicare	$28.16
Rate for Payer: Bisbee Police All Plans	$45.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$119.68
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cigna of AZ Commercial	$114.40
Rate for Payer: Copperpoint Commercial	$43.56
Rate for Payer: Health Net of AZ Commercial	$105.60
Rate for Payer: Health Net of AZ Medicare	$49.28
Rate for Payer: Humana of AZ Medicare	$28.16
Rate for Payer: Self Pay Self Pay	$140.80
Rate for Payer: TriWest Medicare	$28.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$102.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.68

.PARVOVIR IGM

Facility

$176.00

Service Code	CPT 86747
Hospital Charge Code	22481449
Hospital Revenue Code	302
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Bisbee Police All Plans	$45.76
Rate for Payer: Cash Price	$140.80
Rate for Payer: Self Pay Self Pay	$140.80

Parvovirus B19, Human, IgG/IgM LC

Facility

$184.00

Service Code	CPT 86747
Hospital Charge Code	2269428
Hospital Revenue Code	302
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Bisbee Police All Plans	$47.84
Rate for Payer: Cash Price	$147.20
Rate for Payer: Self Pay Self Pay	$147.20

Parvovirus B19, Human, IgG/IgM LC

Facility

$184.00

Service Code	CPT 86747
Hospital Charge Code	2269428
Hospital Revenue Code	302
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Aetna of AZ Medicare	$51.52
Rate for Payer: Allwell Medicare	$29.44
Rate for Payer: Amerigroup Medicare	$29.44
Rate for Payer: APIPA Medicare/Medicaid	$68.72
Rate for Payer: AZCH Complete Medicare	$29.44
Rate for Payer: Banner UC Health Medicare	$29.44
Rate for Payer: Bisbee Police All Plans	$47.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.12
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cigna of AZ Commercial	$119.60
Rate for Payer: Copperpoint Commercial	$45.54
Rate for Payer: Health Net of AZ Commercial	$110.40
Rate for Payer: Health Net of AZ Medicare	$51.52
Rate for Payer: Humana of AZ Medicare	$29.44
Rate for Payer: Self Pay Self Pay	$147.20
Rate for Payer: TriWest Medicare	$29.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.12

PATH CONSULT INTRAOP 1 BLOCK

Facility

$185.00

Service Code	CPT 88331
Hospital Charge Code	22545722
Hospital Revenue Code	310
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Aetna of AZ Medicare	$51.80
Rate for Payer: Allwell Medicare	$29.60
Rate for Payer: Amerigroup Medicare	$29.60
Rate for Payer: APIPA Medicare/Medicaid	$69.10
Rate for Payer: AZCH Complete Medicare	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.80
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$120.25
Rate for Payer: Copperpoint Commercial	$45.79
Rate for Payer: Health Net of AZ Commercial	$111.00
Rate for Payer: Health Net of AZ Medicare	$51.80
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Self Pay Self Pay	$148.00
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.30

PATH CONSULT INTRAOP 1 BLOCK

Facility

$185.00

Service Code	CPT 88331
Hospital Charge Code	22545722
Hospital Revenue Code	310
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Cash Price	$148.00
Rate for Payer: Self Pay Self Pay	$148.00

PATH CONSULT INTRAOP EA ADDL

Facility

$29.00

Service Code	CPT 88332
Hospital Charge Code	22545724
Hospital Revenue Code	310
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Aetna of AZ Medicare	$8.12
Rate for Payer: Allwell Medicare	$4.64
Rate for Payer: Amerigroup Medicare	$4.64
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.64
Rate for Payer: Banner UC Health Medicare	$4.64
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$18.85
Rate for Payer: Copperpoint Commercial	$7.18
Rate for Payer: Health Net of AZ Commercial	$17.40
Rate for Payer: Health Net of AZ Medicare	$8.12
Rate for Payer: Humana of AZ Medicare	$4.64
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.22

PATH CONSULT INTRAOP EA ADDL

Facility

$29.00

Service Code	CPT 88332
Hospital Charge Code	22545724
Hospital Revenue Code	310
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

PATIENT MUG

Facility

$15.00

Hospital Charge Code	22355587
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Cash Price	$12.00
Rate for Payer: Self Pay Self Pay	$12.00

PATIENT MUG

Facility

$15.00

Hospital Charge Code	22355587
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Aetna of AZ Medicare	$4.20
Rate for Payer: Allwell Medicare	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.60
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of AZ Commercial	$10.50
Rate for Payer: Copperpoint Commercial	$3.71
Rate for Payer: Health Net of AZ Commercial	$9.00
Rate for Payer: Health Net of AZ Medicare	$4.20
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Self Pay Self Pay	$12.00
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.70

PATIENT PROGRAMER

Facility

$6,823.00

Service Code	CPT C1787
Hospital Charge Code	22354563
Hospital Revenue Code	270
Min. Negotiated Rate	$1,773.98
Max. Negotiated Rate	$6,140.70
Rate for Payer: Aetna of AZ Commercial	$6,140.70
Rate for Payer: Bisbee Police All Plans	$1,773.98
Rate for Payer: Cash Price	$5,458.40
Rate for Payer: Self Pay Self Pay	$5,458.40

PATIENT PROGRAMER

Facility

$6,823.00

Service Code	CPT C1787
Hospital Charge Code	22354563
Hospital Revenue Code	270
Min. Negotiated Rate	$1,091.68
Max. Negotiated Rate	$6,140.70
Rate for Payer: Aetna of AZ Commercial	$6,140.70
Rate for Payer: Aetna of AZ Medicare	$1,910.44
Rate for Payer: Allwell Medicare	$1,091.68
Rate for Payer: Amerigroup Medicare	$1,091.68
Rate for Payer: APIPA Medicare/Medicaid	$2,548.39
Rate for Payer: AZCH Complete Medicare	$1,091.68
Rate for Payer: Banner UC Health Medicare	$1,091.68
Rate for Payer: Bisbee Police All Plans	$1,773.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,639.64
Rate for Payer: Cash Price	$5,458.40
Rate for Payer: Cigna of AZ Commercial	$4,776.10
Rate for Payer: Copperpoint Commercial	$1,688.69
Rate for Payer: Health Net of AZ Commercial	$4,093.80
Rate for Payer: Health Net of AZ Medicare	$1,910.44
Rate for Payer: Humana of AZ Medicare	$1,091.68
Rate for Payer: Self Pay Self Pay	$5,458.40
Rate for Payer: TriWest Medicare	$1,091.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,977.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,228.14

PEDIALYTE 1 LITER BOTTLE

Facility

$60.00

Hospital Charge Code	22354906
Hospital Revenue Code	270
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	$42.00
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

PEDIALYTE 1 LITER BOTTLE

Facility

$60.00

Hospital Charge Code	22354906
Hospital Revenue Code	270
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

pedialyte oral electrolyte pwder pkt [CQCH]

Facility

$1.00

Service Code	NDC 70074056091
Hospital Charge Code	105955114
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of AZ Commercial	$0.90
Rate for Payer: Aetna of AZ Medicare	$0.28
Rate for Payer: Allwell Medicare	$0.16
Rate for Payer: Amerigroup Medicare	$0.16
Rate for Payer: APIPA Medicare/Medicaid	$0.37
Rate for Payer: AZCH Complete Medicare	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.68
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cigna of AZ Commercial	$0.65
Rate for Payer: Copperpoint Commercial	$0.25
Rate for Payer: Health Net of AZ Commercial	$0.60
Rate for Payer: Health Net of AZ Medicare	$0.28
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Self Pay Self Pay	$0.80
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.18

pedialyte oral electrolyte pwder pkt [CQCH]

Facility

$1.00

Service Code	NDC 70074056091
Hospital Charge Code	105955114
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of AZ Commercial	$0.90
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Cash Price	$0.80
Rate for Payer: Self Pay Self Pay	$0.80

PEDINEB PACIFIER NEBULIZERS

Facility

$55.00

Hospital Charge Code	27728002
Hospital Revenue Code	270
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.80
Rate for Payer: Amerigroup Medicare	$8.80
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

PEDINEB PACIFIER NEBULIZERS

Facility

$55.00

Hospital Charge Code	27728002
Hospital Revenue Code	270
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: AHCCCS Medicaid	$10,957.27
Rate for Payer: Allwell Medicaid	$10,957.27
Rate for Payer: AZCH Complete Medicaid	$10,957.27
Rate for Payer: Banner UC Health Medicaid	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: AHCCCS Medicaid	$34,134.33
Rate for Payer: Allwell Medicaid	$34,134.33
Rate for Payer: AZCH Complete Medicaid	$34,134.33
Rate for Payer: Banner UC Health Medicaid	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

$8,637.04

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$8,637.04
Max. Negotiated Rate	$8,637.04
Rate for Payer: AHCCCS Medicaid	$8,637.04
Rate for Payer: Allwell Medicaid	$8,637.04
Rate for Payer: AZCH Complete Medicaid	$8,637.04
Rate for Payer: Banner UC Health Medicaid	$8,637.04
Rate for Payer: Mercy Care Medicaid	$8,637.04

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: AHCCCS Medicaid	$16,580.39
Rate for Payer: Allwell Medicaid	$16,580.39
Rate for Payer: AZCH Complete Medicaid	$16,580.39
Rate for Payer: Banner UC Health Medicaid	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39

Know your out-of-pocket cost for care.

All Charges