Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

STORZ MILLER 1

Facility

$104.00

Hospital Charge Code	22834572
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$15.60
Rate for Payer: Amerigroup Medicare	$15.60
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$15.60
Rate for Payer: Banner UC Health Medicare	$15.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$15.60
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$15.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

STORZ MILLER 1

Facility

$104.00

Hospital Charge Code	22834572
Hospital Revenue Code	272
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

STRAP CLAVICLE ADULT

Facility

$66.00

Hospital Charge Code	22354243
Hospital Revenue Code	270
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Cash Price	$52.80
Rate for Payer: Self Pay Self Pay	$52.80

STRAP CLAVICLE ADULT

Facility

$66.00

Hospital Charge Code	22354243
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Aetna of AZ Medicare	$18.48
Rate for Payer: Allwell Medicare	$9.90
Rate for Payer: Amerigroup Medicare	$9.90
Rate for Payer: APIPA Medicare/Medicaid	$24.65
Rate for Payer: AZCH Complete Medicare	$9.90
Rate for Payer: Banner UC Health Medicare	$9.90
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$46.20
Rate for Payer: Copperpoint Commercial	$16.34
Rate for Payer: Health Net of AZ Commercial	$39.60
Rate for Payer: Health Net of AZ Medicare	$18.48
Rate for Payer: Humana of AZ Medicare	$9.90
Rate for Payer: Self Pay Self Pay	$52.80
Rate for Payer: TriWest Medicare	$9.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$38.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.88

STRAP CLAVICLE CHILD

Facility

$104.00

Hospital Charge Code	22354245
Hospital Revenue Code	270
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

STRAP CLAVICLE CHILD

Facility

$104.00

Hospital Charge Code	22354245
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$15.60
Rate for Payer: Amerigroup Medicare	$15.60
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$15.60
Rate for Payer: Banner UC Health Medicare	$15.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$15.60
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$15.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

STRAP CLAVICLE YOUTH

Facility

$45.00

Hospital Charge Code	22354260
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Cash Price	$36.00
Rate for Payer: Self Pay Self Pay	$36.00

STRAP CLAVICLE YOUTH

Facility

$45.00

Hospital Charge Code	22354260
Hospital Revenue Code	270
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Aetna of AZ Medicare	$12.60
Rate for Payer: Allwell Medicare	$6.75
Rate for Payer: Amerigroup Medicare	$6.75
Rate for Payer: APIPA Medicare/Medicaid	$16.81
Rate for Payer: AZCH Complete Medicare	$6.75
Rate for Payer: Banner UC Health Medicare	$6.75
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Copperpoint Commercial	$11.14
Rate for Payer: Health Net of AZ Commercial	$27.00
Rate for Payer: Health Net of AZ Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$6.75
Rate for Payer: Self Pay Self Pay	$36.00
Rate for Payer: TriWest Medicare	$6.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.10

STRAPPING; TOES - Tech

Facility

$55.00

Service Code	CPT 29550
Hospital Charge Code	24043305
Hospital Revenue Code	360
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: AHCCCS Medicaid	$80.70
Rate for Payer: Allwell Medicaid	$80.70
Rate for Payer: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicaid	$80.70
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicaid	$80.70
Rate for Payer: Banner UC Health Medicare	$8.25
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$27.50
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.25
Rate for Payer: Mercy Care Medicaid	$80.70
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

STRAPPING; TOES - Tech

Facility

$55.00

Service Code	CPT 29550
Hospital Charge Code	24043305
Hospital Revenue Code	360
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

STRAPPING; UNNA - Tech

Facility

$131.00

Service Code	CPT 29580
Hospital Charge Code	24043306
Hospital Revenue Code	360
Min. Negotiated Rate	$34.06
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Bisbee Police All Plans	$34.06
Rate for Payer: Cash Price	$104.80
Rate for Payer: Self Pay Self Pay	$104.80

STRAPPING; UNNA - Tech

Facility

$131.00

Service Code	CPT 29580
Hospital Charge Code	24043306
Hospital Revenue Code	360
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Aetna of AZ Medicare	$36.68
Rate for Payer: AHCCCS Medicaid	$204.72
Rate for Payer: Allwell Medicaid	$204.72
Rate for Payer: Allwell Medicare	$19.65
Rate for Payer: Amerigroup Medicare	$19.65
Rate for Payer: APIPA Medicare/Medicaid	$48.93
Rate for Payer: AZCH Complete Medicaid	$204.72
Rate for Payer: AZCH Complete Medicare	$19.65
Rate for Payer: Banner UC Health Medicaid	$204.72
Rate for Payer: Banner UC Health Medicare	$19.65
Rate for Payer: Bisbee Police All Plans	$34.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$89.08
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cigna of AZ Commercial	$65.50
Rate for Payer: Copperpoint Commercial	$32.42
Rate for Payer: Health Net of AZ Commercial	$78.60
Rate for Payer: Health Net of AZ Medicare	$36.68
Rate for Payer: Humana of AZ Medicare	$19.65
Rate for Payer: Mercy Care Medicaid	$204.72
Rate for Payer: Self Pay Self Pay	$104.80
Rate for Payer: TriWest Medicare	$19.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.58

Strep A Rapid Screen

Facility

$206.00

Service Code	CPT 87880
Hospital Charge Code	5850971
Hospital Revenue Code	306
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Bisbee Police All Plans	$53.56
Rate for Payer: Cash Price	$164.80
Rate for Payer: Self Pay Self Pay	$164.80

Strep A Rapid Screen

Facility

$206.00

Service Code	CPT 87880
Hospital Charge Code	5850971
Hospital Revenue Code	306
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Aetna of AZ Medicare	$57.68
Rate for Payer: AHCCCS Medicaid	$16.53
Rate for Payer: Allwell Medicaid	$16.53
Rate for Payer: Allwell Medicare	$30.90
Rate for Payer: Amerigroup Medicare	$30.90
Rate for Payer: APIPA Medicare/Medicaid	$76.94
Rate for Payer: AZCH Complete Medicaid	$16.53
Rate for Payer: AZCH Complete Medicare	$30.90
Rate for Payer: Banner UC Health Medicaid	$16.53
Rate for Payer: Banner UC Health Medicare	$30.90
Rate for Payer: Bisbee Police All Plans	$53.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$140.08
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cigna of AZ Commercial	$133.90
Rate for Payer: Copperpoint Commercial	$50.98
Rate for Payer: Health Net of AZ Commercial	$123.60
Rate for Payer: Health Net of AZ Medicare	$57.68
Rate for Payer: Humana of AZ Medicare	$30.90
Rate for Payer: Mercy Care Medicaid	$16.53
Rate for Payer: Self Pay Self Pay	$164.80
Rate for Payer: TriWest Medicare	$30.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$120.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.08

Strep Confirmation

Facility

$182.00

Service Code	CPT 87081
Hospital Charge Code	853207
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna of AZ Commercial	$163.80
Rate for Payer: Aetna of AZ Medicare	$50.96
Rate for Payer: AHCCCS Medicaid	$6.63
Rate for Payer: Allwell Medicaid	$6.63
Rate for Payer: Allwell Medicare	$27.30
Rate for Payer: Amerigroup Medicare	$27.30
Rate for Payer: APIPA Medicare/Medicaid	$67.98
Rate for Payer: AZCH Complete Medicaid	$6.63
Rate for Payer: AZCH Complete Medicare	$27.30
Rate for Payer: Banner UC Health Medicaid	$6.63
Rate for Payer: Banner UC Health Medicare	$27.30
Rate for Payer: Bisbee Police All Plans	$47.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.76
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cigna of AZ Commercial	$118.30
Rate for Payer: Copperpoint Commercial	$45.04
Rate for Payer: Health Net of AZ Commercial	$109.20
Rate for Payer: Health Net of AZ Medicare	$50.96
Rate for Payer: Humana of AZ Medicare	$27.30
Rate for Payer: Mercy Care Medicaid	$6.63
Rate for Payer: Self Pay Self Pay	$145.60
Rate for Payer: TriWest Medicare	$27.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$106.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.76

Strep Confirmation

Facility

$182.00

Service Code	CPT 87081
Hospital Charge Code	853207
Hospital Revenue Code	306
Min. Negotiated Rate	$47.32
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna of AZ Commercial	$163.80
Rate for Payer: Bisbee Police All Plans	$47.32
Rate for Payer: Cash Price	$145.60
Rate for Payer: Self Pay Self Pay	$145.60

Strep Test POC

Facility

$25.00

Service Code	CPT 87880 QW
Hospital Charge Code	23799747
Hospital Revenue Code	521
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Cash Price	$20.00
Rate for Payer: Self Pay Self Pay	$20.00

Strep Test POC

Facility

$25.00

Service Code	CPT 87880 QW
Hospital Charge Code	23799747
Hospital Revenue Code	521
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Aetna of AZ Medicare	$3.75
Rate for Payer: Allwell Medicare	$3.75
Rate for Payer: Amerigroup Medicare	$3.75
Rate for Payer: APIPA Medicare/Medicaid	$9.34
Rate for Payer: AZCH Complete Medicare	$3.75
Rate for Payer: Banner UC Health Medicare	$3.75
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cigna of AZ Commercial	$17.50
Rate for Payer: Copperpoint Commercial	$6.19
Rate for Payer: Health Net of AZ Commercial	$15.00
Rate for Payer: Health Net of AZ Medicare	$7.00
Rate for Payer: Humana of AZ Medicare	$3.75
Rate for Payer: Self Pay Self Pay	$20.00
Rate for Payer: TriWest Medicare	$3.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.50

STRIP T'S STERILE ADHESIVE ORGANIZER

Facility

$50.00

Hospital Charge Code	22561786
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of AZ Commercial	$45.00
Rate for Payer: Bisbee Police All Plans	$13.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Self Pay Self Pay	$40.00

STRIP T'S STERILE ADHESIVE ORGANIZER

Facility

$50.00

Hospital Charge Code	22561786
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of AZ Commercial	$45.00
Rate for Payer: Aetna of AZ Medicare	$14.00
Rate for Payer: Allwell Medicare	$7.50
Rate for Payer: Amerigroup Medicare	$7.50
Rate for Payer: APIPA Medicare/Medicaid	$18.68
Rate for Payer: AZCH Complete Medicare	$7.50
Rate for Payer: Banner UC Health Medicare	$7.50
Rate for Payer: Bisbee Police All Plans	$13.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cigna of AZ Commercial	$35.00
Rate for Payer: Copperpoint Commercial	$12.38
Rate for Payer: Health Net of AZ Commercial	$30.00
Rate for Payer: Health Net of AZ Medicare	$14.00
Rate for Payer: Humana of AZ Medicare	$7.50
Rate for Payer: Self Pay Self Pay	$40.00
Rate for Payer: TriWest Medicare	$7.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.00

STYLETTE ET

Facility

$202.00

Hospital Charge Code	22560511
Hospital Revenue Code	272
Min. Negotiated Rate	$30.30
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of AZ Commercial	$181.80
Rate for Payer: Aetna of AZ Medicare	$56.56
Rate for Payer: Allwell Medicare	$30.30
Rate for Payer: Amerigroup Medicare	$30.30
Rate for Payer: APIPA Medicare/Medicaid	$75.45
Rate for Payer: AZCH Complete Medicare	$30.30
Rate for Payer: Banner UC Health Medicare	$30.30
Rate for Payer: Bisbee Police All Plans	$52.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$137.36
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cigna of AZ Commercial	$141.40
Rate for Payer: Copperpoint Commercial	$50.00
Rate for Payer: Health Net of AZ Commercial	$121.20
Rate for Payer: Health Net of AZ Medicare	$56.56
Rate for Payer: Humana of AZ Medicare	$30.30
Rate for Payer: Self Pay Self Pay	$161.60
Rate for Payer: TriWest Medicare	$30.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$117.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.36

STYLETTE ET

Facility

$202.00

Hospital Charge Code	22560511
Hospital Revenue Code	272
Min. Negotiated Rate	$52.52
Max. Negotiated Rate	$181.80
Rate for Payer: Aetna of AZ Commercial	$181.80
Rate for Payer: Bisbee Police All Plans	$52.52
Rate for Payer: Cash Price	$161.60
Rate for Payer: Self Pay Self Pay	$161.60

succinylcholine 200 mg/ 10 mL Inj Sol [CQCH]

Facility

$0.81

Service Code	HCPCS J0330
Hospital Charge Code	105942505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna of AZ Commercial	$0.73
Rate for Payer: Aetna of AZ Medicare	$0.23
Rate for Payer: AHCCCS Medicaid	$1.30
Rate for Payer: Allwell Medicaid	$1.30
Rate for Payer: Allwell Medicare	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.30
Rate for Payer: AZCH Complete Medicaid	$1.30
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicaid	$1.30
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Bisbee Police All Plans	$0.21
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.55
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cigna of AZ Commercial	$0.53
Rate for Payer: Copperpoint Commercial	$0.20
Rate for Payer: Health Net of AZ Commercial	$0.49
Rate for Payer: Health Net of AZ Medicare	$0.23
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Mercy Care Medicaid	$1.30
Rate for Payer: Self Pay Self Pay	$0.65
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

succinylcholine 200 mg/ 10 mL Inj Sol [CQCH]

Facility

$0.81

Service Code	HCPCS J0330
Hospital Charge Code	105942505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.73
Rate for Payer: Aetna of AZ Commercial	$0.73
Rate for Payer: Bisbee Police All Plans	$0.21
Rate for Payer: Cash Price	$0.65
Rate for Payer: Self Pay Self Pay	$0.65

sucralfate 1 g Tab [CQCH]

Facility

$0.24

Service Code	NDC 63739094310
Hospital Charge Code	105942580
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.19
Rate for Payer: Self Pay Self Pay	$0.19

Know your out-of-pocket cost for care.

All Charges