Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ROOM/BED: Swingbed

Facility

$2,500.00

Hospital Charge Code	11805353
Hospital Revenue Code	120
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$4,672.80
Rate for Payer: Aetna of AZ Commercial	$2,250.00
Rate for Payer: Aetna of AZ Medicare	$1,263.00
Rate for Payer: Allwell Medicare	$3,338.00
Rate for Payer: Amerigroup Medicare	$3,338.00
Rate for Payer: APIPA Medicare/Medicaid	$1,022.00
Rate for Payer: AZCH Complete Medicare	$3,338.00
Rate for Payer: Banner UC Health Medicare	$3,338.00
Rate for Payer: Bisbee Police All Plans	$650.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cigna of AZ Commercial	$1,700.00
Rate for Payer: Copperpoint Commercial	$4,672.80
Rate for Payer: Health Net of AZ Commercial	$1,231.00
Rate for Payer: Health Net of AZ Medicare	$1,176.00
Rate for Payer: Humana of AZ Medicare	$3,338.00
Rate for Payer: Self Pay Self Pay	$2,000.00
Rate for Payer: TriWest Medicare	$3,338.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,434.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,751.00

rOPINIRole 0.5 mg Tab [CQCH]

Facility

$0.09

Service Code	NDC 43547026910
Hospital Charge Code	105939910
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.06
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.06
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.07
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

rOPINIRole 0.5 mg Tab [CQCH]

Facility

$0.09

Service Code	NDC 43547026910
Hospital Charge Code	105939910
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.07

ropivacaine HCl, 0.5%, 20 ml

Facility

$4.26

Service Code	NDC 63323028627
Hospital Charge Code	135066287
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna of AZ Commercial	$3.83
Rate for Payer: Bisbee Police All Plans	$1.11
Rate for Payer: Cash Price	$3.41
Rate for Payer: Self Pay Self Pay	$3.41

ropivacaine HCl, 0.5%, 20 ml

Facility

$4.26

Service Code	NDC 63323028627
Hospital Charge Code	135066287
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna of AZ Commercial	$3.83
Rate for Payer: Aetna of AZ Medicare	$1.19
Rate for Payer: Allwell Medicare	$0.68
Rate for Payer: Amerigroup Medicare	$0.68
Rate for Payer: APIPA Medicare/Medicaid	$1.59
Rate for Payer: AZCH Complete Medicare	$0.68
Rate for Payer: Banner UC Health Medicare	$0.68
Rate for Payer: Bisbee Police All Plans	$1.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.90
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cigna of AZ Commercial	$2.77
Rate for Payer: Copperpoint Commercial	$1.05
Rate for Payer: Health Net of AZ Commercial	$2.56
Rate for Payer: Health Net of AZ Medicare	$1.19
Rate for Payer: Humana of AZ Medicare	$0.68
Rate for Payer: Self Pay Self Pay	$3.41
Rate for Payer: TriWest Medicare	$0.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.77

Rotatable Small Oval Snare Medium Stiffness

Facility

$213.00

Hospital Charge Code	22926473
Hospital Revenue Code	272
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Aetna of AZ Medicare	$59.64
Rate for Payer: Allwell Medicare	$34.08
Rate for Payer: Amerigroup Medicare	$34.08
Rate for Payer: APIPA Medicare/Medicaid	$79.56
Rate for Payer: AZCH Complete Medicare	$34.08
Rate for Payer: Banner UC Health Medicare	$34.08
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.84
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cigna of AZ Commercial	$149.10
Rate for Payer: Copperpoint Commercial	$52.72
Rate for Payer: Health Net of AZ Commercial	$127.80
Rate for Payer: Health Net of AZ Medicare	$59.64
Rate for Payer: Humana of AZ Medicare	$34.08
Rate for Payer: Self Pay Self Pay	$170.40
Rate for Payer: TriWest Medicare	$34.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$124.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.34

Rotatable Small Oval Snare Medium Stiffness

Facility

$213.00

Hospital Charge Code	22926473
Hospital Revenue Code	272
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Cash Price	$170.40
Rate for Payer: Self Pay Self Pay	$170.40

ROTATIONS MORCELLATOR 4.8MM WL 355MM

Facility

$5,257.15

Hospital Charge Code	27839759
Hospital Revenue Code	270
Min. Negotiated Rate	$1,366.86
Max. Negotiated Rate	$4,731.44
Rate for Payer: Aetna of AZ Commercial	$4,731.44
Rate for Payer: Bisbee Police All Plans	$1,366.86
Rate for Payer: Cash Price	$4,205.72
Rate for Payer: Self Pay Self Pay	$4,205.72

ROTATIONS MORCELLATOR 4.8MM WL 355MM

Facility

$5,257.15

Hospital Charge Code	27839759
Hospital Revenue Code	270
Min. Negotiated Rate	$841.14
Max. Negotiated Rate	$4,731.44
Rate for Payer: Aetna of AZ Commercial	$4,731.44
Rate for Payer: Aetna of AZ Medicare	$1,472.00
Rate for Payer: Allwell Medicare	$841.14
Rate for Payer: Amerigroup Medicare	$841.14
Rate for Payer: APIPA Medicare/Medicaid	$1,963.55
Rate for Payer: AZCH Complete Medicare	$841.14
Rate for Payer: Banner UC Health Medicare	$841.14
Rate for Payer: Bisbee Police All Plans	$1,366.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,574.86
Rate for Payer: Cash Price	$4,205.72
Rate for Payer: Cigna of AZ Commercial	$3,680.01
Rate for Payer: Copperpoint Commercial	$1,301.14
Rate for Payer: Health Net of AZ Commercial	$3,154.29
Rate for Payer: Health Net of AZ Medicare	$1,472.00
Rate for Payer: Humana of AZ Medicare	$841.14
Rate for Payer: Self Pay Self Pay	$4,205.72
Rate for Payer: TriWest Medicare	$841.14
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,064.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$946.29

ROTH NET

Facility

$440.00

Hospital Charge Code	22354323
Hospital Revenue Code	270
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Aetna of AZ Medicare	$123.20
Rate for Payer: Allwell Medicare	$70.40
Rate for Payer: Amerigroup Medicare	$70.40
Rate for Payer: APIPA Medicare/Medicaid	$164.34
Rate for Payer: AZCH Complete Medicare	$70.40
Rate for Payer: Banner UC Health Medicare	$70.40
Rate for Payer: Bisbee Police All Plans	$114.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$299.20
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cigna of AZ Commercial	$308.00
Rate for Payer: Copperpoint Commercial	$108.90
Rate for Payer: Health Net of AZ Commercial	$264.00
Rate for Payer: Health Net of AZ Medicare	$123.20
Rate for Payer: Humana of AZ Medicare	$70.40
Rate for Payer: Self Pay Self Pay	$352.00
Rate for Payer: TriWest Medicare	$70.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$256.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$79.20

ROTH NET

Facility

$440.00

Hospital Charge Code	22354323
Hospital Revenue Code	270
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Bisbee Police All Plans	$114.40
Rate for Payer: Cash Price	$352.00
Rate for Payer: Self Pay Self Pay	$352.00

RPR LC

Facility

$62.00

Service Code	CPT 86592
Hospital Charge Code	2269415
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

RPR LC

Facility

$62.00

Service Code	CPT 86592
Hospital Charge Code	2269415
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

.RPR Qn+TP Abs LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	22311166
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

.RPR Qn+TP Abs LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	22311166
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

.RPR, Quant LC

Facility

$65.00

Service Code	CPT 86593
Hospital Charge Code	3033479
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

.RPR, Quant LC

Facility

$65.00

Service Code	CPT 86593
Hospital Charge Code	3033479
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

RPR, Rfx Qn RPR/Confirm TP LC

Facility

$64.00

Service Code	CPT 86592
Hospital Charge Code	22201655
Hospital Revenue Code	302
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Aetna of AZ Medicare	$17.92
Rate for Payer: Allwell Medicare	$10.24
Rate for Payer: Amerigroup Medicare	$10.24
Rate for Payer: APIPA Medicare/Medicaid	$23.90
Rate for Payer: AZCH Complete Medicare	$10.24
Rate for Payer: Banner UC Health Medicare	$10.24
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43.52
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cigna of AZ Commercial	$41.60
Rate for Payer: Copperpoint Commercial	$15.84
Rate for Payer: Health Net of AZ Commercial	$38.40
Rate for Payer: Health Net of AZ Medicare	$17.92
Rate for Payer: Humana of AZ Medicare	$10.24
Rate for Payer: Self Pay Self Pay	$51.20
Rate for Payer: TriWest Medicare	$10.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.52

RPR, Rfx Qn RPR/Confirm TP LC

Facility

$64.00

Service Code	CPT 86592
Hospital Charge Code	22201655
Hospital Revenue Code	302
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Cash Price	$51.20
Rate for Payer: Self Pay Self Pay	$51.20

RT Continuous Neb Subsequent Charge

Facility

$321.00

Service Code	CPT 94645
Hospital Charge Code	3230232
Hospital Revenue Code	410
Min. Negotiated Rate	$51.36
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Aetna of AZ Medicare	$89.88
Rate for Payer: Allwell Medicare	$51.36
Rate for Payer: Amerigroup Medicare	$51.36
Rate for Payer: APIPA Medicare/Medicaid	$119.89
Rate for Payer: AZCH Complete Medicare	$51.36
Rate for Payer: Banner UC Health Medicare	$51.36
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$218.28
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$224.70
Rate for Payer: Copperpoint Commercial	$79.45
Rate for Payer: Health Net of AZ Commercial	$192.60
Rate for Payer: Health Net of AZ Medicare	$89.88
Rate for Payer: Humana of AZ Medicare	$51.36
Rate for Payer: Self Pay Self Pay	$256.80
Rate for Payer: TriWest Medicare	$51.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$187.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.78

RT Continuous Neb Subsequent Charge

Facility

$321.00

Service Code	CPT 94645
Hospital Charge Code	3230232
Hospital Revenue Code	410
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Cash Price	$256.80
Rate for Payer: Self Pay Self Pay	$256.80

RT ETC02 Monitoring Charge

Facility

$605.00

Service Code	CPT G0238
Hospital Charge Code	1886873
Hospital Revenue Code	410
Min. Negotiated Rate	$157.30
Max. Negotiated Rate	$544.50
Rate for Payer: Aetna of AZ Commercial	$544.50
Rate for Payer: Bisbee Police All Plans	$157.30
Rate for Payer: Cash Price	$484.00
Rate for Payer: Self Pay Self Pay	$484.00

RT ETC02 Monitoring Charge

Facility

$605.00

Service Code	CPT G0238
Hospital Charge Code	1886873
Hospital Revenue Code	410
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$544.50
Rate for Payer: Aetna of AZ Commercial	$544.50
Rate for Payer: Aetna of AZ Medicare	$169.40
Rate for Payer: Allwell Medicare	$96.80
Rate for Payer: Amerigroup Medicare	$96.80
Rate for Payer: APIPA Medicare/Medicaid	$225.97
Rate for Payer: AZCH Complete Medicare	$96.80
Rate for Payer: Banner UC Health Medicare	$96.80
Rate for Payer: Bisbee Police All Plans	$157.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$411.40
Rate for Payer: Cash Price	$484.00
Rate for Payer: Cigna of AZ Commercial	$423.50
Rate for Payer: Copperpoint Commercial	$149.74
Rate for Payer: Health Net of AZ Commercial	$363.00
Rate for Payer: Health Net of AZ Medicare	$169.40
Rate for Payer: Humana of AZ Medicare	$96.80
Rate for Payer: Self Pay Self Pay	$484.00
Rate for Payer: TriWest Medicare	$96.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$352.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$108.90

RT Ventilator Services - Subs Charge

Facility

$2,715.00

Service Code	CPT 94003
Hospital Charge Code	1886948
Hospital Revenue Code	410
Min. Negotiated Rate	$705.90
Max. Negotiated Rate	$2,443.50
Rate for Payer: Aetna of AZ Commercial	$2,443.50
Rate for Payer: Bisbee Police All Plans	$705.90
Rate for Payer: Cash Price	$2,172.00
Rate for Payer: Self Pay Self Pay	$2,172.00

RT Ventilator Services - Subs Charge

Facility

$2,715.00

Service Code	CPT 94003
Hospital Charge Code	1886948
Hospital Revenue Code	410
Min. Negotiated Rate	$434.40
Max. Negotiated Rate	$2,443.50
Rate for Payer: Aetna of AZ Commercial	$2,443.50
Rate for Payer: Aetna of AZ Medicare	$760.20
Rate for Payer: Allwell Medicare	$434.40
Rate for Payer: Amerigroup Medicare	$434.40
Rate for Payer: APIPA Medicare/Medicaid	$1,014.05
Rate for Payer: AZCH Complete Medicare	$434.40
Rate for Payer: Banner UC Health Medicare	$434.40
Rate for Payer: Bisbee Police All Plans	$705.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,846.20
Rate for Payer: Cash Price	$2,172.00
Rate for Payer: Cigna of AZ Commercial	$1,900.50
Rate for Payer: Copperpoint Commercial	$671.96
Rate for Payer: Health Net of AZ Commercial	$1,629.00
Rate for Payer: Health Net of AZ Medicare	$760.20
Rate for Payer: Humana of AZ Medicare	$434.40
Rate for Payer: Self Pay Self Pay	$2,172.00
Rate for Payer: TriWest Medicare	$434.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,582.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$488.70

Know your out-of-pocket cost for care.

All Charges