Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

AFP, Serum, Tumor Marker LC

Facility

$365.00

Service Code	CPT 82105
Hospital Charge Code	1905891
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Aetna of AZ Medicare	$102.20
Rate for Payer: AHCCCS Medicaid	$16.77
Rate for Payer: Allwell Medicaid	$16.77
Rate for Payer: Allwell Medicare	$54.75
Rate for Payer: Amerigroup Medicare	$54.75
Rate for Payer: APIPA Medicare/Medicaid	$136.33
Rate for Payer: AZCH Complete Medicaid	$16.77
Rate for Payer: AZCH Complete Medicare	$54.75
Rate for Payer: Banner UC Health Medicaid	$16.77
Rate for Payer: Banner UC Health Medicare	$54.75
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$248.20
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cigna of AZ Commercial	$237.25
Rate for Payer: Copperpoint Commercial	$90.34
Rate for Payer: Health Net of AZ Commercial	$219.00
Rate for Payer: Health Net of AZ Medicare	$102.20
Rate for Payer: Humana of AZ Medicare	$54.75
Rate for Payer: Mercy Care Medicaid	$16.77
Rate for Payer: Self Pay Self Pay	$292.00
Rate for Payer: TriWest Medicare	$54.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$212.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.70

AFP, Serum, Tumor Marker LC

Facility

$348.00

Service Code	CPT 82105
Hospital Charge Code	1905887
Hospital Revenue Code	301
Min. Negotiated Rate	$90.48
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Bisbee Police All Plans	$90.48
Rate for Payer: Cash Price	$278.40
Rate for Payer: Self Pay Self Pay	$278.40

AFP, Serum, Tumor Marker LC

Facility

$365.00

Service Code	CPT 82105
Hospital Charge Code	1905891
Hospital Revenue Code	301
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Cash Price	$292.00
Rate for Payer: Self Pay Self Pay	$292.00

AIRSPIRAL BREATHING TUBE AND CHAMBER

Facility

$231.00

Hospital Charge Code	24154229
Hospital Revenue Code	270
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Aetna of AZ Medicare	$64.68
Rate for Payer: Allwell Medicare	$34.65
Rate for Payer: Amerigroup Medicare	$34.65
Rate for Payer: APIPA Medicare/Medicaid	$86.28
Rate for Payer: AZCH Complete Medicare	$34.65
Rate for Payer: Banner UC Health Medicare	$34.65
Rate for Payer: Bisbee Police All Plans	$60.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$157.08
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cigna of AZ Commercial	$161.70
Rate for Payer: Copperpoint Commercial	$57.17
Rate for Payer: Health Net of AZ Commercial	$138.60
Rate for Payer: Health Net of AZ Medicare	$64.68
Rate for Payer: Humana of AZ Medicare	$34.65
Rate for Payer: Self Pay Self Pay	$184.80
Rate for Payer: TriWest Medicare	$34.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.58

AIRSPIRAL BREATHING TUBE AND CHAMBER

Facility

$231.00

Hospital Charge Code	24154229
Hospital Revenue Code	270
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Bisbee Police All Plans	$60.06
Rate for Payer: Cash Price	$184.80
Rate for Payer: Self Pay Self Pay	$184.80

AIRWAY NASO 20F

Facility

$13.00

Hospital Charge Code	22354992
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 20F

Facility

$13.00

Hospital Charge Code	22354992
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 22F

Facility

$13.00

Hospital Charge Code	22354993
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 22F

Facility

$13.00

Hospital Charge Code	22354993
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 24F

Facility

$13.00

Hospital Charge Code	22354985
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 24F

Facility

$13.00

Hospital Charge Code	22354985
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 26F

Facility

$13.00

Hospital Charge Code	22354994
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 26F

Facility

$13.00

Hospital Charge Code	22354994
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 28F

Facility

$13.00

Hospital Charge Code	22355050
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 28F

Facility

$13.00

Hospital Charge Code	22355050
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 30F

Facility

$13.00

Hospital Charge Code	22354995
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 30F

Facility

$13.00

Hospital Charge Code	22354995
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 32F

Facility

$13.00

Hospital Charge Code	22354991
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 32F

Facility

$13.00

Hospital Charge Code	22354991
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 34F

Facility

$13.00

Hospital Charge Code	22354996
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY NASO 34F

Facility

$13.00

Hospital Charge Code	22354996
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 36F

Facility

$13.00

Hospital Charge Code	22354997
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

AIRWAY NASO 36F

Facility

$13.00

Hospital Charge Code	22354997
Hospital Revenue Code	279
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

AIRWAY ORAL 90MM

Facility

$6.00

Hospital Charge Code	22355597
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna of AZ Commercial	$5.40
Rate for Payer: Aetna of AZ Medicare	$1.68
Rate for Payer: Allwell Medicare	$0.90
Rate for Payer: Amerigroup Medicare	$0.90
Rate for Payer: APIPA Medicare/Medicaid	$2.24
Rate for Payer: AZCH Complete Medicare	$0.90
Rate for Payer: Banner UC Health Medicare	$0.90
Rate for Payer: Bisbee Police All Plans	$1.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cigna of AZ Commercial	$4.20
Rate for Payer: Copperpoint Commercial	$1.48
Rate for Payer: Health Net of AZ Commercial	$3.60
Rate for Payer: Health Net of AZ Medicare	$1.68
Rate for Payer: Humana of AZ Medicare	$0.90
Rate for Payer: Self Pay Self Pay	$4.80
Rate for Payer: TriWest Medicare	$0.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.08

AIRWAY ORAL 90MM

Facility

$6.00

Hospital Charge Code	22355597
Hospital Revenue Code	270
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna of AZ Commercial	$5.40
Rate for Payer: Bisbee Police All Plans	$1.56
Rate for Payer: Cash Price	$4.80
Rate for Payer: Self Pay Self Pay	$4.80

Know your out-of-pocket cost for care.

All Charges