Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PM COCAINE METABOLITE

Facility

$239.00

Service Code	CPT 80353
Hospital Charge Code	23293448
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Cash Price	$191.20
Rate for Payer: Self Pay Self Pay	$191.20

PM COCAINE METABOLITE

Facility

$239.00

Service Code	CPT 80353
Hospital Charge Code	23293448
Hospital Revenue Code	301
Min. Negotiated Rate	$38.24
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Aetna of AZ Medicare	$66.92
Rate for Payer: Allwell Medicare	$38.24
Rate for Payer: Amerigroup Medicare	$38.24
Rate for Payer: APIPA Medicare/Medicaid	$89.27
Rate for Payer: AZCH Complete Medicare	$38.24
Rate for Payer: Banner UC Health Medicare	$38.24
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$162.52
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cigna of AZ Commercial	$155.35
Rate for Payer: Copperpoint Commercial	$59.15
Rate for Payer: Health Net of AZ Commercial	$143.40
Rate for Payer: Health Net of AZ Medicare	$66.92
Rate for Payer: Humana of AZ Medicare	$38.24
Rate for Payer: Self Pay Self Pay	$191.20
Rate for Payer: TriWest Medicare	$38.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.02

PM DOA Screen

Facility

$163.00

Service Code	CPT 80305 QW
Hospital Charge Code	23741289
Hospital Revenue Code	301
Min. Negotiated Rate	$42.38
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Cash Price	$130.40
Rate for Payer: Self Pay Self Pay	$130.40

PM DOA Screen

Facility

$163.00

Service Code	CPT 80305 QW
Hospital Charge Code	23741289
Hospital Revenue Code	301
Min. Negotiated Rate	$26.08
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Aetna of AZ Medicare	$45.64
Rate for Payer: Allwell Medicare	$26.08
Rate for Payer: Amerigroup Medicare	$26.08
Rate for Payer: APIPA Medicare/Medicaid	$60.88
Rate for Payer: AZCH Complete Medicare	$26.08
Rate for Payer: Banner UC Health Medicare	$26.08
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$110.84
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cigna of AZ Commercial	$105.95
Rate for Payer: Copperpoint Commercial	$40.34
Rate for Payer: Health Net of AZ Commercial	$97.80
Rate for Payer: Health Net of AZ Medicare	$45.64
Rate for Payer: Humana of AZ Medicare	$26.08
Rate for Payer: Self Pay Self Pay	$130.40
Rate for Payer: TriWest Medicare	$26.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.34

PM METHADONE

Facility

$228.00

Service Code	CPT 80358
Hospital Charge Code	23293445
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna of AZ Commercial	$205.20
Rate for Payer: Aetna of AZ Medicare	$63.84
Rate for Payer: Allwell Medicare	$36.48
Rate for Payer: Amerigroup Medicare	$36.48
Rate for Payer: APIPA Medicare/Medicaid	$85.16
Rate for Payer: AZCH Complete Medicare	$36.48
Rate for Payer: Banner UC Health Medicare	$36.48
Rate for Payer: Bisbee Police All Plans	$59.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$155.04
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cigna of AZ Commercial	$148.20
Rate for Payer: Copperpoint Commercial	$56.43
Rate for Payer: Health Net of AZ Commercial	$136.80
Rate for Payer: Health Net of AZ Medicare	$63.84
Rate for Payer: Humana of AZ Medicare	$36.48
Rate for Payer: Self Pay Self Pay	$182.40
Rate for Payer: TriWest Medicare	$36.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.04

PM METHADONE

Facility

$228.00

Service Code	CPT 80358
Hospital Charge Code	23293445
Hospital Revenue Code	301
Min. Negotiated Rate	$59.28
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna of AZ Commercial	$205.20
Rate for Payer: Bisbee Police All Plans	$59.28
Rate for Payer: Cash Price	$182.40
Rate for Payer: Self Pay Self Pay	$182.40

PM OPIATES

Facility

$227.00

Service Code	CPT 80361
Hospital Charge Code	23293439
Hospital Revenue Code	301
Min. Negotiated Rate	$36.32
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Aetna of AZ Medicare	$63.56
Rate for Payer: Allwell Medicare	$36.32
Rate for Payer: Amerigroup Medicare	$36.32
Rate for Payer: APIPA Medicare/Medicaid	$84.78
Rate for Payer: AZCH Complete Medicare	$36.32
Rate for Payer: Banner UC Health Medicare	$36.32
Rate for Payer: Bisbee Police All Plans	$59.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$154.36
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cigna of AZ Commercial	$147.55
Rate for Payer: Copperpoint Commercial	$56.18
Rate for Payer: Health Net of AZ Commercial	$136.20
Rate for Payer: Health Net of AZ Medicare	$63.56
Rate for Payer: Humana of AZ Medicare	$36.32
Rate for Payer: Self Pay Self Pay	$181.60
Rate for Payer: TriWest Medicare	$36.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.86

PM OPIATES

Facility

$227.00

Service Code	CPT 80361
Hospital Charge Code	23293439
Hospital Revenue Code	301
Min. Negotiated Rate	$59.02
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Bisbee Police All Plans	$59.02
Rate for Payer: Cash Price	$181.60
Rate for Payer: Self Pay Self Pay	$181.60

PM TRAMADOL

Facility

$239.00

Service Code	CPT 80373
Hospital Charge Code	23293441
Hospital Revenue Code	301
Min. Negotiated Rate	$38.24
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Aetna of AZ Medicare	$66.92
Rate for Payer: Allwell Medicare	$38.24
Rate for Payer: Amerigroup Medicare	$38.24
Rate for Payer: APIPA Medicare/Medicaid	$89.27
Rate for Payer: AZCH Complete Medicare	$38.24
Rate for Payer: Banner UC Health Medicare	$38.24
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$162.52
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cigna of AZ Commercial	$155.35
Rate for Payer: Copperpoint Commercial	$59.15
Rate for Payer: Health Net of AZ Commercial	$143.40
Rate for Payer: Health Net of AZ Medicare	$66.92
Rate for Payer: Humana of AZ Medicare	$38.24
Rate for Payer: Self Pay Self Pay	$191.20
Rate for Payer: TriWest Medicare	$38.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.02

PM TRAMADOL

Facility

$239.00

Service Code	CPT 80373
Hospital Charge Code	23293441
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Cash Price	$191.20
Rate for Payer: Self Pay Self Pay	$191.20

pneumococcal 13 vaccine Prevnar PFS [CQCH]

Facility

$770.66

Service Code	HCPCS 90670
Hospital Charge Code	105937029
Hospital Revenue Code	250
Min. Negotiated Rate	$200.37
Max. Negotiated Rate	$693.59
Rate for Payer: Aetna of AZ Commercial	$693.59
Rate for Payer: Bisbee Police All Plans	$200.37
Rate for Payer: Cash Price	$616.53
Rate for Payer: Self Pay Self Pay	$616.53

pneumococcal 13 vaccine Prevnar PFS [CQCH]

Facility

$770.66

Service Code	HCPCS 90670
Hospital Charge Code	105937029
Hospital Revenue Code	250
Min. Negotiated Rate	$123.31
Max. Negotiated Rate	$693.59
Rate for Payer: Aetna of AZ Commercial	$693.59
Rate for Payer: Aetna of AZ Medicare	$215.78
Rate for Payer: Allwell Medicare	$123.31
Rate for Payer: Amerigroup Medicare	$123.31
Rate for Payer: APIPA Medicare/Medicaid	$287.84
Rate for Payer: AZCH Complete Medicare	$123.31
Rate for Payer: Banner UC Health Medicare	$123.31
Rate for Payer: Bisbee Police All Plans	$200.37
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$524.05
Rate for Payer: Cash Price	$616.53
Rate for Payer: Cigna of AZ Commercial	$500.93
Rate for Payer: Copperpoint Commercial	$190.74
Rate for Payer: Health Net of AZ Commercial	$462.40
Rate for Payer: Health Net of AZ Medicare	$215.78
Rate for Payer: Humana of AZ Medicare	$123.31
Rate for Payer: Self Pay Self Pay	$616.53
Rate for Payer: TriWest Medicare	$123.31
Rate for Payer: UnitedHealth Group of AZ Commercial	$449.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.72

pneumococcal 23 vaccine Inj [CQCH]

Facility

$414.52

Service Code	HCPCS 90732
Hospital Charge Code	105937100
Hospital Revenue Code	250
Min. Negotiated Rate	$66.32
Max. Negotiated Rate	$373.07
Rate for Payer: Aetna of AZ Commercial	$373.07
Rate for Payer: Aetna of AZ Medicare	$116.07
Rate for Payer: Allwell Medicare	$66.32
Rate for Payer: Amerigroup Medicare	$66.32
Rate for Payer: APIPA Medicare/Medicaid	$154.82
Rate for Payer: AZCH Complete Medicare	$66.32
Rate for Payer: Banner UC Health Medicare	$66.32
Rate for Payer: Bisbee Police All Plans	$107.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$281.87
Rate for Payer: Cash Price	$331.62
Rate for Payer: Cigna of AZ Commercial	$269.44
Rate for Payer: Copperpoint Commercial	$102.59
Rate for Payer: Health Net of AZ Commercial	$248.71
Rate for Payer: Health Net of AZ Medicare	$116.07
Rate for Payer: Humana of AZ Medicare	$66.32
Rate for Payer: Self Pay Self Pay	$331.62
Rate for Payer: TriWest Medicare	$66.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$241.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$74.61

pneumococcal 23 vaccine Inj [CQCH]

Facility

$414.52

Service Code	HCPCS 90732
Hospital Charge Code	105937100
Hospital Revenue Code	250
Min. Negotiated Rate	$107.78
Max. Negotiated Rate	$373.07
Rate for Payer: Aetna of AZ Commercial	$373.07
Rate for Payer: Bisbee Police All Plans	$107.78
Rate for Payer: Cash Price	$331.62
Rate for Payer: Self Pay Self Pay	$331.62

Pneumococcal IM (14 Serotype) LC

Facility

$73.00

Service Code	CPT 86317
Hospital Charge Code	22311203
Hospital Revenue Code	302
Min. Negotiated Rate	$11.68
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Aetna of AZ Medicare	$20.44
Rate for Payer: Allwell Medicare	$11.68
Rate for Payer: Amerigroup Medicare	$11.68
Rate for Payer: APIPA Medicare/Medicaid	$27.27
Rate for Payer: AZCH Complete Medicare	$11.68
Rate for Payer: Banner UC Health Medicare	$11.68
Rate for Payer: Bisbee Police All Plans	$18.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$49.64
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cigna of AZ Commercial	$47.45
Rate for Payer: Copperpoint Commercial	$18.07
Rate for Payer: Health Net of AZ Commercial	$43.80
Rate for Payer: Health Net of AZ Medicare	$20.44
Rate for Payer: Humana of AZ Medicare	$11.68
Rate for Payer: Self Pay Self Pay	$58.40
Rate for Payer: TriWest Medicare	$11.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$42.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.14

Pneumococcal IM (14 Serotype) LC

Facility

$73.00

Service Code	CPT 86317
Hospital Charge Code	22311203
Hospital Revenue Code	302
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Bisbee Police All Plans	$18.98
Rate for Payer: Cash Price	$58.40
Rate for Payer: Self Pay Self Pay	$58.40

PNEUMOTHORAX 10FR 29CM CATH KIT

Facility

$821.70

Hospital Charge Code	27987619
Hospital Revenue Code	270
Min. Negotiated Rate	$213.64
Max. Negotiated Rate	$739.53
Rate for Payer: Aetna of AZ Commercial	$739.53
Rate for Payer: Bisbee Police All Plans	$213.64
Rate for Payer: Cash Price	$657.36
Rate for Payer: Self Pay Self Pay	$657.36

PNEUMOTHORAX 10FR 29CM CATH KIT

Facility

$821.70

Hospital Charge Code	27987619
Hospital Revenue Code	270
Min. Negotiated Rate	$131.47
Max. Negotiated Rate	$739.53
Rate for Payer: Aetna of AZ Commercial	$739.53
Rate for Payer: Aetna of AZ Medicare	$230.08
Rate for Payer: Allwell Medicare	$131.47
Rate for Payer: Amerigroup Medicare	$131.47
Rate for Payer: APIPA Medicare/Medicaid	$306.90
Rate for Payer: AZCH Complete Medicare	$131.47
Rate for Payer: Banner UC Health Medicare	$131.47
Rate for Payer: Bisbee Police All Plans	$213.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$558.76
Rate for Payer: Cash Price	$657.36
Rate for Payer: Cigna of AZ Commercial	$575.19
Rate for Payer: Copperpoint Commercial	$203.37
Rate for Payer: Health Net of AZ Commercial	$493.02
Rate for Payer: Health Net of AZ Medicare	$230.08
Rate for Payer: Humana of AZ Medicare	$131.47
Rate for Payer: Self Pay Self Pay	$657.36
Rate for Payer: TriWest Medicare	$131.47
Rate for Payer: UnitedHealth Group of AZ Commercial	$479.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$147.91

PNT 1002836 Drug Screen 10 w/ confirmation

Facility

$282.00

Service Code	CPT 80307
Hospital Charge Code	23090932
Hospital Revenue Code	301
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Aetna of AZ Medicare	$78.96
Rate for Payer: Allwell Medicare	$45.12
Rate for Payer: Amerigroup Medicare	$45.12
Rate for Payer: APIPA Medicare/Medicaid	$105.33
Rate for Payer: AZCH Complete Medicare	$45.12
Rate for Payer: Banner UC Health Medicare	$45.12
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Copperpoint Commercial	$69.80
Rate for Payer: Health Net of AZ Commercial	$169.20
Rate for Payer: Health Net of AZ Medicare	$78.96
Rate for Payer: Humana of AZ Medicare	$45.12
Rate for Payer: Self Pay Self Pay	$225.60
Rate for Payer: TriWest Medicare	$45.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$164.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.76

PNT 1002836 Drug Screen 10 w/ confirmation

Facility

$282.00

Service Code	CPT 80307
Hospital Charge Code	23090932
Hospital Revenue Code	301
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Cash Price	$225.60
Rate for Payer: Self Pay Self Pay	$225.60

PNT 1007757 C Diff Toxin Gene NAA DPT

Facility

$270.00

Service Code	CPT 87493
Hospital Charge Code	23090942
Hospital Revenue Code	301
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Aetna of AZ Medicare	$75.60
Rate for Payer: Allwell Medicare	$43.20
Rate for Payer: Amerigroup Medicare	$43.20
Rate for Payer: APIPA Medicare/Medicaid	$100.84
Rate for Payer: AZCH Complete Medicare	$43.20
Rate for Payer: Banner UC Health Medicare	$43.20
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$183.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna of AZ Commercial	$175.50
Rate for Payer: Copperpoint Commercial	$66.83
Rate for Payer: Health Net of AZ Commercial	$162.00
Rate for Payer: Health Net of AZ Medicare	$75.60
Rate for Payer: Humana of AZ Medicare	$43.20
Rate for Payer: Self Pay Self Pay	$216.00
Rate for Payer: TriWest Medicare	$43.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$157.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.60

PNT 1007757 C Diff Toxin Gene NAA DPT

Facility

$270.00

Service Code	CPT 87493
Hospital Charge Code	23090942
Hospital Revenue Code	301
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Self Pay Self Pay	$216.00

PNT 1011215 Chromium, Unirine

Facility

$299.00

Service Code	CPT 82495
Hospital Charge Code	23090945
Hospital Revenue Code	301
Min. Negotiated Rate	$77.74
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Cash Price	$239.20
Rate for Payer: Self Pay Self Pay	$239.20

PNT 1011215 Chromium, Unirine

Facility

$299.00

Service Code	CPT 82495
Hospital Charge Code	23090945
Hospital Revenue Code	301
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Aetna of AZ Medicare	$83.72
Rate for Payer: Allwell Medicare	$47.84
Rate for Payer: Amerigroup Medicare	$47.84
Rate for Payer: APIPA Medicare/Medicaid	$111.68
Rate for Payer: AZCH Complete Medicare	$47.84
Rate for Payer: Banner UC Health Medicare	$47.84
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$203.32
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cigna of AZ Commercial	$194.35
Rate for Payer: Copperpoint Commercial	$74.00
Rate for Payer: Health Net of AZ Commercial	$179.40
Rate for Payer: Health Net of AZ Medicare	$83.72
Rate for Payer: Humana of AZ Medicare	$47.84
Rate for Payer: Self Pay Self Pay	$239.20
Rate for Payer: TriWest Medicare	$47.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.82

PNT 1209072 Aspergillus AB

Facility

$404.00

Service Code	CPT 86606
Hospital Charge Code	23090944
Hospital Revenue Code	301
Min. Negotiated Rate	$64.64
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Aetna of AZ Medicare	$113.12
Rate for Payer: Allwell Medicare	$64.64
Rate for Payer: Amerigroup Medicare	$64.64
Rate for Payer: APIPA Medicare/Medicaid	$150.89
Rate for Payer: AZCH Complete Medicare	$64.64
Rate for Payer: Banner UC Health Medicare	$64.64
Rate for Payer: Bisbee Police All Plans	$105.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$274.72
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cigna of AZ Commercial	$262.60
Rate for Payer: Copperpoint Commercial	$99.99
Rate for Payer: Health Net of AZ Commercial	$242.40
Rate for Payer: Health Net of AZ Medicare	$113.12
Rate for Payer: Humana of AZ Medicare	$64.64
Rate for Payer: Self Pay Self Pay	$323.20
Rate for Payer: TriWest Medicare	$64.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$235.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.72

Know your out-of-pocket cost for care.

All Charges