Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Rubella Antibodies, IgG LC

Facility

$172.00

Service Code	CPT 86762
Hospital Charge Code	2029257
Hospital Revenue Code	302
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: Allwell Medicare	$27.52
Rate for Payer: Amerigroup Medicare	$27.52
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

Rubella Antibodies, IgG LC

Facility

$172.00

Service Code	CPT 86762
Hospital Charge Code	2029257
Hospital Revenue Code	302
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

Rubella Antibody, IgM LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2446665
Hospital Revenue Code	302
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

Rubella Antibody, IgM LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2446665
Hospital Revenue Code	302
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

RUBELLA IGG

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	22481502
Hospital Revenue Code	302
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

RUBELLA IGG

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	22481502
Hospital Revenue Code	302
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

Rubeola Antibodies, IgG LC

Facility

$219.00

Service Code	CPT 86765
Hospital Charge Code	22201672
Hospital Revenue Code	302
Min. Negotiated Rate	$35.04
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Aetna of AZ Medicare	$61.32
Rate for Payer: Allwell Medicare	$35.04
Rate for Payer: Amerigroup Medicare	$35.04
Rate for Payer: APIPA Medicare/Medicaid	$81.80
Rate for Payer: AZCH Complete Medicare	$35.04
Rate for Payer: Banner UC Health Medicare	$35.04
Rate for Payer: Bisbee Police All Plans	$56.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$148.92
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cigna of AZ Commercial	$142.35
Rate for Payer: Copperpoint Commercial	$54.20
Rate for Payer: Health Net of AZ Commercial	$131.40
Rate for Payer: Health Net of AZ Medicare	$61.32
Rate for Payer: Humana of AZ Medicare	$35.04
Rate for Payer: Self Pay Self Pay	$175.20
Rate for Payer: TriWest Medicare	$35.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$127.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.42

Rubeola Antibodies, IgG LC

Facility

$219.00

Service Code	CPT 86765
Hospital Charge Code	22201672
Hospital Revenue Code	302
Min. Negotiated Rate	$56.94
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Bisbee Police All Plans	$56.94
Rate for Payer: Cash Price	$175.20
Rate for Payer: Self Pay Self Pay	$175.20

RUBEOLA IGG

Facility

$230.00

Service Code	CPT 86765
Hospital Charge Code	22481503
Hospital Revenue Code	302
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Cash Price	$184.00
Rate for Payer: Self Pay Self Pay	$184.00

RUBEOLA IGG

Facility

$230.00

Service Code	CPT 86765
Hospital Charge Code	22481503
Hospital Revenue Code	302
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Aetna of AZ Medicare	$64.40
Rate for Payer: Allwell Medicare	$36.80
Rate for Payer: Amerigroup Medicare	$36.80
Rate for Payer: APIPA Medicare/Medicaid	$85.91
Rate for Payer: AZCH Complete Medicare	$36.80
Rate for Payer: Banner UC Health Medicare	$36.80
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$156.40
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna of AZ Commercial	$149.50
Rate for Payer: Copperpoint Commercial	$56.92
Rate for Payer: Health Net of AZ Commercial	$138.00
Rate for Payer: Health Net of AZ Medicare	$64.40
Rate for Payer: Humana of AZ Medicare	$36.80
Rate for Payer: Self Pay Self Pay	$184.00
Rate for Payer: TriWest Medicare	$36.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.40

Rubeola IgM LC

Facility

$242.00

Service Code	CPT 86765
Hospital Charge Code	6780983
Hospital Revenue Code	302
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Cash Price	$193.60
Rate for Payer: Self Pay Self Pay	$193.60

Rubeola IgM LC

Facility

$242.00

Service Code	CPT 86765
Hospital Charge Code	6780983
Hospital Revenue Code	302
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Medicare	$67.76
Rate for Payer: Allwell Medicare	$38.72
Rate for Payer: Amerigroup Medicare	$38.72
Rate for Payer: APIPA Medicare/Medicaid	$90.39
Rate for Payer: AZCH Complete Medicare	$38.72
Rate for Payer: Banner UC Health Medicare	$38.72
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$164.56
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$157.30
Rate for Payer: Copperpoint Commercial	$59.90
Rate for Payer: Health Net of AZ Commercial	$145.20
Rate for Payer: Health Net of AZ Medicare	$67.76
Rate for Payer: Humana of AZ Medicare	$38.72
Rate for Payer: Self Pay Self Pay	$193.60
Rate for Payer: TriWest Medicare	$38.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.56

Sacrospinous ligament fixaton

Facility

$3,595.00

Service Code	CPT 57282
Hospital Charge Code	27267823
Hospital Revenue Code	360
Min. Negotiated Rate	$575.20
Max. Negotiated Rate	$4,925.87
Rate for Payer: Aetna of AZ Commercial	$3,235.50
Rate for Payer: Aetna of AZ Medicare	$1,006.60
Rate for Payer: AHCCCS Medicaid	$4,925.87
Rate for Payer: Allwell Medicaid	$4,925.87
Rate for Payer: Allwell Medicare	$575.20
Rate for Payer: Amerigroup Medicare	$575.20
Rate for Payer: APIPA Medicare/Medicaid	$1,342.73
Rate for Payer: AZCH Complete Medicaid	$4,925.87
Rate for Payer: AZCH Complete Medicare	$575.20
Rate for Payer: Banner UC Health Medicaid	$4,925.87
Rate for Payer: Banner UC Health Medicare	$575.20
Rate for Payer: Bisbee Police All Plans	$934.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,444.60
Rate for Payer: Cash Price	$2,876.00
Rate for Payer: Cash Price	$2,876.00
Rate for Payer: Cigna of AZ Commercial	$1,797.50
Rate for Payer: Copperpoint Commercial	$889.76
Rate for Payer: Health Net of AZ Commercial	$2,157.00
Rate for Payer: Health Net of AZ Medicare	$1,006.60
Rate for Payer: Humana of AZ Medicare	$575.20
Rate for Payer: Mercy Care Medicaid	$4,925.87
Rate for Payer: Self Pay Self Pay	$2,876.00
Rate for Payer: TriWest Medicare	$575.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,095.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$647.10

Sacrospinous ligament fixaton

Facility

$3,595.00

Service Code	CPT 57282
Hospital Charge Code	27267823
Hospital Revenue Code	360
Min. Negotiated Rate	$934.70
Max. Negotiated Rate	$3,235.50
Rate for Payer: Aetna of AZ Commercial	$3,235.50
Rate for Payer: Bisbee Police All Plans	$934.70
Rate for Payer: Cash Price	$2,876.00
Rate for Payer: Self Pay Self Pay	$2,876.00

Salicylate Level

Facility

$180.00

Service Code	CPT G0480
Hospital Charge Code	633829
Hospital Revenue Code	301
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

Salicylate Level

Facility

$180.00

Service Code	CPT G0480
Hospital Charge Code	633829
Hospital Revenue Code	301
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$28.80
Rate for Payer: Amerigroup Medicare	$28.80
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$117.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

SALINE FLUSH 10 ML

Facility

$4.00

Hospital Charge Code	22354289
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of AZ Commercial	$3.60
Rate for Payer: Bisbee Police All Plans	$1.04
Rate for Payer: Cash Price	$3.20
Rate for Payer: Self Pay Self Pay	$3.20

SALINE FLUSH 10 ML

Facility

$4.00

Hospital Charge Code	22354289
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of AZ Commercial	$3.60
Rate for Payer: Aetna of AZ Medicare	$1.12
Rate for Payer: Allwell Medicare	$0.64
Rate for Payer: Amerigroup Medicare	$0.64
Rate for Payer: APIPA Medicare/Medicaid	$1.49
Rate for Payer: AZCH Complete Medicare	$0.64
Rate for Payer: Banner UC Health Medicare	$0.64
Rate for Payer: Bisbee Police All Plans	$1.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.72
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cigna of AZ Commercial	$2.80
Rate for Payer: Copperpoint Commercial	$0.99
Rate for Payer: Health Net of AZ Commercial	$2.40
Rate for Payer: Health Net of AZ Medicare	$1.12
Rate for Payer: Humana of AZ Medicare	$0.64
Rate for Payer: Self Pay Self Pay	$3.20
Rate for Payer: TriWest Medicare	$0.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.72

SALINE FLUSH 10 ML SYRINGE

Facility

$4.00

Hospital Charge Code	27569984
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of AZ Commercial	$3.60
Rate for Payer: Bisbee Police All Plans	$1.04
Rate for Payer: Cash Price	$3.20
Rate for Payer: Self Pay Self Pay	$3.20

SALINE FLUSH 10 ML SYRINGE

Facility

$4.00

Hospital Charge Code	27569984
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna of AZ Commercial	$3.60
Rate for Payer: Aetna of AZ Medicare	$1.12
Rate for Payer: Allwell Medicare	$0.64
Rate for Payer: Amerigroup Medicare	$0.64
Rate for Payer: APIPA Medicare/Medicaid	$1.49
Rate for Payer: AZCH Complete Medicare	$0.64
Rate for Payer: Banner UC Health Medicare	$0.64
Rate for Payer: Bisbee Police All Plans	$1.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.72
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cigna of AZ Commercial	$2.80
Rate for Payer: Copperpoint Commercial	$0.99
Rate for Payer: Health Net of AZ Commercial	$2.40
Rate for Payer: Health Net of AZ Medicare	$1.12
Rate for Payer: Humana of AZ Medicare	$0.64
Rate for Payer: Self Pay Self Pay	$3.20
Rate for Payer: TriWest Medicare	$0.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.72

saline nasal moisturizing spray [CQCH]

Facility

$0.02

Service Code	NDC 49348035684
Hospital Charge Code	105942039
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

saline nasal moisturizing spray [CQCH]

Facility

$0.02

Service Code	NDC 49348035684
Hospital Charge Code	105942039
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Salpingectomy complete/partial

Facility

$4,120.00

Service Code	CPT 58700
Hospital Charge Code	27281891
Hospital Revenue Code	360
Min. Negotiated Rate	$1,071.20
Max. Negotiated Rate	$3,708.00
Rate for Payer: Aetna of AZ Commercial	$3,708.00
Rate for Payer: Bisbee Police All Plans	$1,071.20
Rate for Payer: Cash Price	$3,296.00
Rate for Payer: Self Pay Self Pay	$3,296.00

Salpingectomy complete/partial

Facility

$4,120.00

Service Code	CPT 58700
Hospital Charge Code	27281891
Hospital Revenue Code	360
Min. Negotiated Rate	$659.20
Max. Negotiated Rate	$3,708.00
Rate for Payer: Aetna of AZ Commercial	$3,708.00
Rate for Payer: Aetna of AZ Medicare	$1,153.60
Rate for Payer: Allwell Medicare	$659.20
Rate for Payer: Amerigroup Medicare	$659.20
Rate for Payer: APIPA Medicare/Medicaid	$1,538.82
Rate for Payer: AZCH Complete Medicare	$659.20
Rate for Payer: Banner UC Health Medicare	$659.20
Rate for Payer: Bisbee Police All Plans	$1,071.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,801.60
Rate for Payer: Cash Price	$3,296.00
Rate for Payer: Cigna of AZ Commercial	$2,060.00
Rate for Payer: Copperpoint Commercial	$1,019.70
Rate for Payer: Health Net of AZ Commercial	$2,472.00
Rate for Payer: Health Net of AZ Medicare	$1,153.60
Rate for Payer: Humana of AZ Medicare	$659.20
Rate for Payer: Self Pay Self Pay	$3,296.00
Rate for Payer: TriWest Medicare	$659.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,401.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$741.60

Schizophrenia

Facility

$4,006.40

Service Code	APR-DRG 7501
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$4,006.40
Max. Negotiated Rate	$4,006.40
Rate for Payer: AHCCCS Medicaid	$4,006.40
Rate for Payer: Allwell Medicaid	$4,006.40
Rate for Payer: AZCH Complete Medicaid	$4,006.40
Rate for Payer: Banner UC Health Medicaid	$4,006.40
Rate for Payer: Mercy Care Medicaid	$4,006.40

Know your out-of-pocket cost for care.

All Charges