Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Reverse T3 LC

Facility

$359.00

Service Code	CPT 84482
Hospital Charge Code	2087649
Hospital Revenue Code	301
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$323.10
Rate for Payer: Aetna of AZ Commercial	$323.10
Rate for Payer: Bisbee Police All Plans	$93.34
Rate for Payer: Cash Price	$287.20
Rate for Payer: Self Pay Self Pay	$287.20

RF Qualitative

Facility

$135.00

Service Code	CPT 86430
Hospital Charge Code	1051519
Hospital Revenue Code	302
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

RF Qualitative

Facility

$135.00

Service Code	CPT 86430
Hospital Charge Code	1051519
Hospital Revenue Code	302
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

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22308645
Hospital Revenue Code	302
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Cash Price	$79.20
Rate for Payer: Self Pay Self Pay	$79.20

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22308645
Hospital Revenue Code	302
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Aetna of AZ Medicare	$27.72
Rate for Payer: Allwell Medicare	$15.84
Rate for Payer: Amerigroup Medicare	$15.84
Rate for Payer: APIPA Medicare/Medicaid	$36.98
Rate for Payer: AZCH Complete Medicare	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$67.32
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Copperpoint Commercial	$24.50
Rate for Payer: Health Net of AZ Commercial	$59.40
Rate for Payer: Health Net of AZ Medicare	$27.72
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Self Pay Self Pay	$79.20
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.82

Rheumatoid Arthritis Factor LC

Facility

$142.00

Service Code	CPT 86430
Hospital Charge Code	1285583
Hospital Revenue Code	302
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

Rheumatoid Arthritis Factor LC

Facility

$142.00

Service Code	CPT 86430
Hospital Charge Code	1285583
Hospital Revenue Code	302
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: Allwell Medicare	$22.72
Rate for Payer: Amerigroup Medicare	$22.72
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicare	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Copperpoint Commercial	$35.15
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

RHo (D) immune globulin 300 mcg Sol[CQCH]

Facility

$126.14

Service Code	HCPCS J2790
Hospital Charge Code	132649818
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$113.53
Rate for Payer: Aetna of AZ Commercial	$113.53
Rate for Payer: Aetna of AZ Medicare	$35.32
Rate for Payer: Allwell Medicare	$20.18
Rate for Payer: Amerigroup Medicare	$20.18
Rate for Payer: APIPA Medicare/Medicaid	$47.11
Rate for Payer: AZCH Complete Medicare	$20.18
Rate for Payer: Banner UC Health Medicare	$20.18
Rate for Payer: Bisbee Police All Plans	$32.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$85.78
Rate for Payer: Cash Price	$100.91
Rate for Payer: Cigna of AZ Commercial	$81.99
Rate for Payer: Copperpoint Commercial	$31.22
Rate for Payer: Health Net of AZ Commercial	$75.68
Rate for Payer: Health Net of AZ Medicare	$35.32
Rate for Payer: Humana of AZ Medicare	$20.18
Rate for Payer: Self Pay Self Pay	$100.91
Rate for Payer: TriWest Medicare	$20.18
Rate for Payer: UnitedHealth Group of AZ Commercial	$73.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.71

RHo (D) immune globulin 300 mcg Sol[CQCH]

Facility

$126.14

Service Code	HCPCS J2790
Hospital Charge Code	132649818
Hospital Revenue Code	250
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$113.53
Rate for Payer: Aetna of AZ Commercial	$113.53
Rate for Payer: Bisbee Police All Plans	$32.80
Rate for Payer: Cash Price	$100.91
Rate for Payer: Self Pay Self Pay	$100.91

rifAMPin 600 mg REC[CQCH]

Facility

$73.42

Service Code	NDC 68059701
Hospital Charge Code	127193752
Hospital Revenue Code	250
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$66.08
Rate for Payer: Aetna of AZ Commercial	$66.08
Rate for Payer: Bisbee Police All Plans	$19.09
Rate for Payer: Cash Price	$58.74
Rate for Payer: Self Pay Self Pay	$58.74

rifAMPin 600 mg REC[CQCH]

Facility

$73.42

Service Code	NDC 68059701
Hospital Charge Code	127193752
Hospital Revenue Code	250
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$66.08
Rate for Payer: Aetna of AZ Commercial	$66.08
Rate for Payer: Aetna of AZ Medicare	$20.56
Rate for Payer: Allwell Medicare	$11.75
Rate for Payer: Amerigroup Medicare	$11.75
Rate for Payer: APIPA Medicare/Medicaid	$27.42
Rate for Payer: AZCH Complete Medicare	$11.75
Rate for Payer: Banner UC Health Medicare	$11.75
Rate for Payer: Bisbee Police All Plans	$19.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$49.93
Rate for Payer: Cash Price	$58.74
Rate for Payer: Cigna of AZ Commercial	$47.72
Rate for Payer: Copperpoint Commercial	$18.17
Rate for Payer: Health Net of AZ Commercial	$44.05
Rate for Payer: Health Net of AZ Medicare	$20.56
Rate for Payer: Humana of AZ Medicare	$11.75
Rate for Payer: Self Pay Self Pay	$58.74
Rate for Payer: TriWest Medicare	$11.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$42.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.22

rifaximin 200 mg Tab [CQCH]

Facility

$20.78

Service Code	NDC 65649030103
Hospital Charge Code	105939447
Hospital Revenue Code	251
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna of AZ Commercial	$18.70
Rate for Payer: Bisbee Police All Plans	$5.40
Rate for Payer: Cash Price	$16.62
Rate for Payer: Self Pay Self Pay	$16.62

rifaximin 200 mg Tab [CQCH]

Facility

$20.78

Service Code	NDC 65649030103
Hospital Charge Code	105939447
Hospital Revenue Code	251
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna of AZ Commercial	$18.70
Rate for Payer: Aetna of AZ Medicare	$5.82
Rate for Payer: Allwell Medicare	$3.32
Rate for Payer: Amerigroup Medicare	$3.32
Rate for Payer: APIPA Medicare/Medicaid	$7.76
Rate for Payer: AZCH Complete Medicare	$3.32
Rate for Payer: Banner UC Health Medicare	$3.32
Rate for Payer: Bisbee Police All Plans	$5.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.13
Rate for Payer: Cash Price	$16.62
Rate for Payer: Cigna of AZ Commercial	$13.51
Rate for Payer: Copperpoint Commercial	$5.14
Rate for Payer: Health Net of AZ Commercial	$12.47
Rate for Payer: Health Net of AZ Medicare	$5.82
Rate for Payer: Humana of AZ Medicare	$3.32
Rate for Payer: Self Pay Self Pay	$16.62
Rate for Payer: TriWest Medicare	$3.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.74

RIGID SINGLE USE STYLET MEDIUM

Facility

$57.00

Hospital Charge Code	27728098
Hospital Revenue Code	270
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

RIGID SINGLE USE STYLET MEDIUM

Facility

$57.00

Hospital Charge Code	27728098
Hospital Revenue Code	270
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$9.12
Rate for Payer: Amerigroup Medicare	$9.12
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$9.12
Rate for Payer: Banner UC Health Medicare	$9.12
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$9.12
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$9.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

RIGID SINGLE USE STYLET SMALL

Facility

$33.00

Hospital Charge Code	27728092
Hospital Revenue Code	270
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

RIGID SINGLE USE STYLET SMALL

Facility

$33.00

Hospital Charge Code	27728092
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

risankizumab rzaa 60 mg/mL Sol[CQCH]

Facility

$921.80

Service Code	HCPCS J2327
Hospital Charge Code	222641743
Hospital Revenue Code	250
Min. Negotiated Rate	$147.49
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna of AZ Commercial	$829.62
Rate for Payer: Aetna of AZ Medicare	$258.10
Rate for Payer: Allwell Medicare	$147.49
Rate for Payer: Amerigroup Medicare	$147.49
Rate for Payer: APIPA Medicare/Medicaid	$344.29
Rate for Payer: AZCH Complete Medicare	$147.49
Rate for Payer: Banner UC Health Medicare	$147.49
Rate for Payer: Bisbee Police All Plans	$239.67
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$626.82
Rate for Payer: Cash Price	$737.44
Rate for Payer: Cigna of AZ Commercial	$599.17
Rate for Payer: Copperpoint Commercial	$228.15
Rate for Payer: Health Net of AZ Commercial	$553.08
Rate for Payer: Health Net of AZ Medicare	$258.10
Rate for Payer: Humana of AZ Medicare	$147.49
Rate for Payer: Self Pay Self Pay	$737.44
Rate for Payer: TriWest Medicare	$147.49
Rate for Payer: UnitedHealth Group of AZ Commercial	$537.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$165.92

risankizumab rzaa 60 mg/mL Sol[CQCH]

Facility

$921.80

Service Code	HCPCS J2327
Hospital Charge Code	222641743
Hospital Revenue Code	250
Min. Negotiated Rate	$239.67
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna of AZ Commercial	$829.62
Rate for Payer: Bisbee Police All Plans	$239.67
Rate for Payer: Cash Price	$737.44
Rate for Payer: Self Pay Self Pay	$737.44

risperiDONE 0.5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 904635861
Hospital Charge Code	105939512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.16

risperiDONE 0.5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 904635861
Hospital Charge Code	105939512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.14
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.12
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.16
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

rivaroxaban 10 mg Tab [CQCH]

Facility

$12.04

Service Code	NDC 50458058010
Hospital Charge Code	105939709
Hospital Revenue Code	251
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna of AZ Commercial	$10.84
Rate for Payer: Bisbee Police All Plans	$3.13
Rate for Payer: Cash Price	$9.63
Rate for Payer: Self Pay Self Pay	$9.63

rivaroxaban 10 mg Tab [CQCH]

Facility

$12.04

Service Code	NDC 50458058010
Hospital Charge Code	105939709
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna of AZ Commercial	$10.84
Rate for Payer: Aetna of AZ Medicare	$3.37
Rate for Payer: Allwell Medicare	$1.93
Rate for Payer: Amerigroup Medicare	$1.93
Rate for Payer: APIPA Medicare/Medicaid	$4.50
Rate for Payer: AZCH Complete Medicare	$1.93
Rate for Payer: Banner UC Health Medicare	$1.93
Rate for Payer: Bisbee Police All Plans	$3.13
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.19
Rate for Payer: Cash Price	$9.63
Rate for Payer: Cigna of AZ Commercial	$7.83
Rate for Payer: Copperpoint Commercial	$2.98
Rate for Payer: Health Net of AZ Commercial	$7.22
Rate for Payer: Health Net of AZ Medicare	$3.37
Rate for Payer: Humana of AZ Medicare	$1.93
Rate for Payer: Self Pay Self Pay	$9.63
Rate for Payer: TriWest Medicare	$1.93
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.17

rivaroxaban 15 mg Tab [CQCH]

Facility

$11.81

Service Code	NDC 50458057810
Hospital Charge Code	105939642
Hospital Revenue Code	251
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of AZ Commercial	$10.63
Rate for Payer: Bisbee Police All Plans	$3.07
Rate for Payer: Cash Price	$9.45
Rate for Payer: Self Pay Self Pay	$9.45

rivaroxaban 15 mg Tab [CQCH]

Facility

$11.81

Service Code	NDC 50458057810
Hospital Charge Code	105939642
Hospital Revenue Code	251
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of AZ Commercial	$10.63
Rate for Payer: Aetna of AZ Medicare	$3.31
Rate for Payer: Allwell Medicare	$1.89
Rate for Payer: Amerigroup Medicare	$1.89
Rate for Payer: APIPA Medicare/Medicaid	$4.41
Rate for Payer: AZCH Complete Medicare	$1.89
Rate for Payer: Banner UC Health Medicare	$1.89
Rate for Payer: Bisbee Police All Plans	$3.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.03
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cigna of AZ Commercial	$7.68
Rate for Payer: Copperpoint Commercial	$2.92
Rate for Payer: Health Net of AZ Commercial	$7.09
Rate for Payer: Health Net of AZ Medicare	$3.31
Rate for Payer: Humana of AZ Medicare	$1.89
Rate for Payer: Self Pay Self Pay	$9.45
Rate for Payer: TriWest Medicare	$1.89
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.13

Know your out-of-pocket cost for care.

All Charges