Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

REF RBC OTHER THAN ABO

Facility

$237.00

Service Code	CPT 86905
Hospital Charge Code	22373722
Hospital Revenue Code	302
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Cash Price	$189.60
Rate for Payer: Self Pay Self Pay	$189.60

REF RBC PHENOTYPING

Facility

$249.00

Service Code	CPT 86906
Hospital Charge Code	1676008
Hospital Revenue Code	302
Min. Negotiated Rate	$64.74
Max. Negotiated Rate	$224.10
Rate for Payer: Aetna of AZ Commercial	$224.10
Rate for Payer: Bisbee Police All Plans	$64.74
Rate for Payer: Cash Price	$199.20
Rate for Payer: Self Pay Self Pay	$199.20

REF RBC PHENOTYPING

Facility

$249.00

Service Code	CPT 86906
Hospital Charge Code	1676008
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$224.10
Rate for Payer: Aetna of AZ Commercial	$224.10
Rate for Payer: Aetna of AZ Medicare	$69.72
Rate for Payer: AHCCCS Medicaid	$7.75
Rate for Payer: Allwell Medicaid	$7.75
Rate for Payer: Allwell Medicare	$37.35
Rate for Payer: Amerigroup Medicare	$37.35
Rate for Payer: APIPA Medicare/Medicaid	$93.00
Rate for Payer: AZCH Complete Medicaid	$7.75
Rate for Payer: AZCH Complete Medicare	$37.35
Rate for Payer: Banner UC Health Medicaid	$7.75
Rate for Payer: Banner UC Health Medicare	$37.35
Rate for Payer: Bisbee Police All Plans	$64.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$169.32
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cigna of AZ Commercial	$161.85
Rate for Payer: Copperpoint Commercial	$61.63
Rate for Payer: Health Net of AZ Commercial	$149.40
Rate for Payer: Health Net of AZ Medicare	$69.72
Rate for Payer: Humana of AZ Medicare	$37.35
Rate for Payer: Mercy Care Medicaid	$7.75
Rate for Payer: Self Pay Self Pay	$199.20
Rate for Payer: TriWest Medicare	$37.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$145.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.82

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: AHCCCS Medicaid	$12,529.81
Rate for Payer: Allwell Medicaid	$12,529.81
Rate for Payer: AZCH Complete Medicaid	$12,529.81
Rate for Payer: Banner UC Health Medicaid	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: AHCCCS Medicaid	$12,529.81
Rate for Payer: Allwell Medicaid	$12,529.81
Rate for Payer: AZCH Complete Medicaid	$12,529.81
Rate for Payer: Banner UC Health Medicaid	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: AHCCCS Medicaid	$12,529.81
Rate for Payer: Allwell Medicaid	$12,529.81
Rate for Payer: AZCH Complete Medicaid	$12,529.81
Rate for Payer: Banner UC Health Medicaid	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: AHCCCS Medicaid	$12,529.81
Rate for Payer: Allwell Medicaid	$12,529.81
Rate for Payer: AZCH Complete Medicaid	$12,529.81
Rate for Payer: Banner UC Health Medicaid	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

Facility

$1,737.00

Service Code	CPT 28035
Hospital Charge Code	24043317
Hospital Revenue Code	360
Min. Negotiated Rate	$451.62
Max. Negotiated Rate	$1,563.30
Rate for Payer: Aetna of AZ Commercial	$1,563.30
Rate for Payer: Bisbee Police All Plans	$451.62
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Self Pay Self Pay	$1,389.60

RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

Facility

$1,737.00

Service Code	CPT 28035
Hospital Charge Code	24043317
Hospital Revenue Code	360
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,563.30
Rate for Payer: Aetna of AZ Medicare	$486.36
Rate for Payer: AHCCCS Medicaid	$2,543.86
Rate for Payer: Allwell Medicaid	$2,543.86
Rate for Payer: Allwell Medicare	$260.55
Rate for Payer: Amerigroup Medicare	$260.55
Rate for Payer: APIPA Medicare/Medicaid	$648.77
Rate for Payer: AZCH Complete Medicaid	$2,543.86
Rate for Payer: AZCH Complete Medicare	$260.55
Rate for Payer: Banner UC Health Medicaid	$2,543.86
Rate for Payer: Banner UC Health Medicare	$260.55
Rate for Payer: Bisbee Police All Plans	$451.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,181.16
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cigna of AZ Commercial	$868.50
Rate for Payer: Copperpoint Commercial	$429.91
Rate for Payer: Health Net of AZ Commercial	$1,042.20
Rate for Payer: Health Net of AZ Medicare	$486.36
Rate for Payer: Humana of AZ Medicare	$260.55
Rate for Payer: Mercy Care Medicaid	$2,543.86
Rate for Payer: Self Pay Self Pay	$1,389.60
Rate for Payer: TriWest Medicare	$260.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$312.66

Remdesivir injection 100 mg/20 ml Inj [CQCH]

Facility

$520.00

Service Code	NDC 61958290210
Hospital Charge Code	168146661
Hospital Revenue Code	250
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Aetna of AZ Medicare	$145.60
Rate for Payer: Allwell Medicare	$78.00
Rate for Payer: Amerigroup Medicare	$78.00
Rate for Payer: APIPA Medicare/Medicaid	$194.22
Rate for Payer: AZCH Complete Medicare	$78.00
Rate for Payer: Banner UC Health Medicare	$78.00
Rate for Payer: Bisbee Police All Plans	$135.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$353.60
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cigna of AZ Commercial	$338.00
Rate for Payer: Copperpoint Commercial	$128.70
Rate for Payer: Health Net of AZ Commercial	$312.00
Rate for Payer: Health Net of AZ Medicare	$145.60
Rate for Payer: Humana of AZ Medicare	$78.00
Rate for Payer: Self Pay Self Pay	$416.00
Rate for Payer: TriWest Medicare	$78.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$303.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$93.60

Remdesivir injection 100 mg/20 ml Inj [CQCH]

Facility

$520.00

Service Code	NDC 61958290210
Hospital Charge Code	168146661
Hospital Revenue Code	250
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Bisbee Police All Plans	$135.20
Rate for Payer: Cash Price	$416.00
Rate for Payer: Self Pay Self Pay	$416.00

REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P

Facility

$1,520.00

Service Code	CPT 54406
Hospital Charge Code	23173229
Hospital Revenue Code	982
Min. Negotiated Rate	$395.20
Max. Negotiated Rate	$1,368.00
Rate for Payer: Aetna of AZ Commercial	$1,368.00
Rate for Payer: Bisbee Police All Plans	$395.20
Rate for Payer: Cash Price	$1,216.00
Rate for Payer: Self Pay Self Pay	$1,216.00

REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P

Facility

$1,520.00

Service Code	CPT 54406
Hospital Charge Code	23173229
Hospital Revenue Code	982
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$4,460.70
Rate for Payer: Aetna of AZ Commercial	$1,368.00
Rate for Payer: Aetna of AZ Medicare	$425.60
Rate for Payer: AHCCCS Medicaid	$4,460.70
Rate for Payer: Allwell Medicaid	$4,460.70
Rate for Payer: Allwell Medicare	$228.00
Rate for Payer: Amerigroup Medicare	$228.00
Rate for Payer: APIPA Medicare/Medicaid	$567.72
Rate for Payer: AZCH Complete Medicaid	$4,460.70
Rate for Payer: AZCH Complete Medicare	$228.00
Rate for Payer: Banner UC Health Medicaid	$4,460.70
Rate for Payer: Banner UC Health Medicare	$228.00
Rate for Payer: Bisbee Police All Plans	$395.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,033.60
Rate for Payer: Cash Price	$1,216.00
Rate for Payer: Cash Price	$1,216.00
Rate for Payer: Cigna of AZ Commercial	$1,064.00
Rate for Payer: Copperpoint Commercial	$376.20
Rate for Payer: Health Net of AZ Commercial	$912.00
Rate for Payer: Health Net of AZ Medicare	$425.60
Rate for Payer: Humana of AZ Medicare	$228.00
Rate for Payer: Mercy Care Medicaid	$4,460.70
Rate for Payer: Self Pay Self Pay	$1,216.00
Rate for Payer: TriWest Medicare	$228.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$273.60

Know your out-of-pocket cost for care.

All Charges