Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

AFP, Serum, Tumor Marker LC

Facility

$331.00

Service Code	CPT 82105
Hospital Charge Code	1905887
Hospital Revenue Code	301
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Cash Price	$264.80
Rate for Payer: Self Pay Self Pay	$264.80

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

AIRSPIRAL BREATHING TUBE AND CHAMBER

Facility

$231.00

Hospital Charge Code	24154229
Hospital Revenue Code	270
Min. Negotiated Rate	$36.96
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	$36.96
Rate for Payer: Amerigroup Medicare	$36.96
Rate for Payer: APIPA Medicare/Medicaid	$86.28
Rate for Payer: AZCH Complete Medicare	$36.96
Rate for Payer: Banner UC Health Medicare	$36.96
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	$36.96
Rate for Payer: Self Pay Self Pay	$184.80
Rate for Payer: TriWest Medicare	$36.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.58

Alanine Aminotransferase

Facility

$124.00

Service Code	CPT 84460
Hospital Charge Code	633632
Hospital Revenue Code	301
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Cash Price	$99.20
Rate for Payer: Self Pay Self Pay	$99.20

Alanine Aminotransferase

Facility

$124.00

Service Code	CPT 84460
Hospital Charge Code	633632
Hospital Revenue Code	301
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Aetna of AZ Medicare	$34.72
Rate for Payer: Allwell Medicare	$19.84
Rate for Payer: Amerigroup Medicare	$19.84
Rate for Payer: APIPA Medicare/Medicaid	$46.31
Rate for Payer: AZCH Complete Medicare	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$84.32
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Copperpoint Commercial	$30.69
Rate for Payer: Health Net of AZ Commercial	$74.40
Rate for Payer: Health Net of AZ Medicare	$34.72
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Self Pay Self Pay	$99.20
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.32

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$130.00

Service Code	CPT 82043
Hospital Charge Code	23294369
Hospital Revenue Code	301
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Self Pay Self Pay	$104.00

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$130.00

Service Code	CPT 82043
Hospital Charge Code	23294369
Hospital Revenue Code	301
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Aetna of AZ Medicare	$36.40
Rate for Payer: Allwell Medicare	$20.80
Rate for Payer: Amerigroup Medicare	$20.80
Rate for Payer: APIPA Medicare/Medicaid	$48.55
Rate for Payer: AZCH Complete Medicare	$20.80
Rate for Payer: Banner UC Health Medicare	$20.80
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$88.40
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.17
Rate for Payer: Health Net of AZ Commercial	$78.00
Rate for Payer: Health Net of AZ Medicare	$36.40
Rate for Payer: Humana of AZ Medicare	$20.80
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$20.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$124.00

Service Code	CPT 82043
Hospital Charge Code	16875114
Hospital Revenue Code	301
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Aetna of AZ Medicare	$34.72
Rate for Payer: Allwell Medicare	$19.84
Rate for Payer: Amerigroup Medicare	$19.84
Rate for Payer: APIPA Medicare/Medicaid	$46.31
Rate for Payer: AZCH Complete Medicare	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$84.32
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Copperpoint Commercial	$30.69
Rate for Payer: Health Net of AZ Commercial	$74.40
Rate for Payer: Health Net of AZ Medicare	$34.72
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Self Pay Self Pay	$99.20
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.32

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$124.00

Service Code	CPT 82043
Hospital Charge Code	16875114
Hospital Revenue Code	301
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Cash Price	$99.20
Rate for Payer: Self Pay Self Pay	$99.20

albumin human 5% Sol[CQCH]

Facility

$0.16

Service Code	HCPCS P9045
Hospital Charge Code	195848457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.11
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

albumin human 5% Sol[CQCH]

Facility

$0.16

Service Code	HCPCS P9045
Hospital Charge Code	195848457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.12
Rate for Payer: Self Pay Self Pay	$0.13

Albumin Level

Facility

$62.00

Service Code	CPT 82040
Hospital Charge Code	633634
Hospital Revenue Code	301
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

Albumin Level

Facility

$62.00

Service Code	CPT 82040
Hospital Charge Code	633634
Hospital Revenue Code	301
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

albuterol 0.083% Inh Sol 3 mL [CQCH]

Facility

$0.06

Service Code	HCPCS J7609
Hospital Charge Code	105909534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

albuterol 0.083% Inh Sol 3 mL [CQCH]

Facility

$0.06

Service Code	HCPCS J7609
Hospital Charge Code	105909534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
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	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

albuterol 0.5% Inh Sol 0.5 mL [CQCH]

Facility

$0.68

Service Code	HCPCS J7609
Hospital Charge Code	105909609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of AZ Commercial	$0.61
Rate for Payer: Aetna of AZ Medicare	$0.19
Rate for Payer: Allwell Medicare	$0.11
Rate for Payer: Amerigroup Medicare	$0.11
Rate for Payer: APIPA Medicare/Medicaid	$0.25
Rate for Payer: AZCH Complete Medicare	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Bisbee Police All Plans	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.46
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of AZ Commercial	$0.44
Rate for Payer: Copperpoint Commercial	$0.17
Rate for Payer: Health Net of AZ Commercial	$0.41
Rate for Payer: Health Net of AZ Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Self Pay Self Pay	$0.54
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.12

albuterol 0.5% Inh Sol 0.5 mL [CQCH]

Facility

$0.68

Service Code	HCPCS J7609
Hospital Charge Code	105909609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of AZ Commercial	$0.61
Rate for Payer: Bisbee Police All Plans	$0.18
Rate for Payer: Cash Price	$0.54
Rate for Payer: Self Pay Self Pay	$0.54

albuterol-ipratropium Inh Sol 3 mL [CQCH]

Facility

$0.18

Service Code	HCPCS J7609
Hospital Charge Code	105909698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Aetna of AZ Medicare	$0.05
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	$0.12
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.11
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

albuterol-ipratropium Inh Sol 3 mL [CQCH]

Facility

$0.18

Service Code	HCPCS J7609
Hospital Charge Code	105909698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.15
Rate for Payer: Self Pay Self Pay	$0.14

albuterol MDI-90 mcg/inh 8 gm [CQCH]

Facility

$60.34

Service Code	NDC 59310057922
Hospital Charge Code	105909469
Hospital Revenue Code	251
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna of AZ Commercial	$54.31
Rate for Payer: Bisbee Police All Plans	$15.69
Rate for Payer: Cash Price	$48.27
Rate for Payer: Self Pay Self Pay	$48.27

albuterol MDI-90 mcg/inh 8 gm [CQCH]

Facility

$60.34

Service Code	NDC 59310057922
Hospital Charge Code	105909469
Hospital Revenue Code	251
Min. Negotiated Rate	$9.65
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna of AZ Commercial	$54.31
Rate for Payer: Aetna of AZ Medicare	$16.90
Rate for Payer: Allwell Medicare	$9.65
Rate for Payer: Amerigroup Medicare	$9.65
Rate for Payer: APIPA Medicare/Medicaid	$22.54
Rate for Payer: AZCH Complete Medicare	$9.65
Rate for Payer: Banner UC Health Medicare	$9.65
Rate for Payer: Bisbee Police All Plans	$15.69
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$41.03
Rate for Payer: Cash Price	$48.27
Rate for Payer: Cigna of AZ Commercial	$39.22
Rate for Payer: Copperpoint Commercial	$14.93
Rate for Payer: Health Net of AZ Commercial	$36.20
Rate for Payer: Health Net of AZ Medicare	$16.90
Rate for Payer: Humana of AZ Medicare	$9.65
Rate for Payer: Self Pay Self Pay	$48.27
Rate for Payer: TriWest Medicare	$9.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$35.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.86

Alcohol Abuse And Dependence

Facility

$2,454.20

Service Code	APR-DRG 7751
Hospital Charge Code	APRDRG7751
Min. Negotiated Rate	$2,454.20
Max. Negotiated Rate	$2,454.20
Rate for Payer: AHCCCS Medicaid	$2,454.20
Rate for Payer: Allwell Medicaid	$2,454.20
Rate for Payer: AZCH Complete Medicaid	$2,454.20
Rate for Payer: Banner UC Health Medicaid	$2,454.20
Rate for Payer: Mercy Care Medicaid	$2,454.20

Alcohol Abuse And Dependence

Facility

$15,554.25

Service Code	APR-DRG 7754
Hospital Charge Code	APRDRG7751
Min. Negotiated Rate	$15,554.25
Max. Negotiated Rate	$15,554.25
Rate for Payer: AHCCCS Medicaid	$15,554.25
Rate for Payer: Allwell Medicaid	$15,554.25
Rate for Payer: AZCH Complete Medicaid	$15,554.25
Rate for Payer: Banner UC Health Medicaid	$15,554.25
Rate for Payer: Mercy Care Medicaid	$15,554.25

Alcohol Abuse And Dependence

Facility

$6,181.44

Service Code	APR-DRG 7753
Hospital Charge Code	APRDRG7753
Min. Negotiated Rate	$6,181.44
Max. Negotiated Rate	$6,181.44
Rate for Payer: AHCCCS Medicaid	$6,181.44
Rate for Payer: Allwell Medicaid	$6,181.44
Rate for Payer: AZCH Complete Medicaid	$6,181.44
Rate for Payer: Banner UC Health Medicaid	$6,181.44
Rate for Payer: Mercy Care Medicaid	$6,181.44

Alcohol Abuse And Dependence

Facility

$6,181.44

Service Code	APR-DRG 7753
Hospital Charge Code	APRDRG7752
Min. Negotiated Rate	$6,181.44
Max. Negotiated Rate	$6,181.44
Rate for Payer: AHCCCS Medicaid	$6,181.44
Rate for Payer: Allwell Medicaid	$6,181.44
Rate for Payer: AZCH Complete Medicaid	$6,181.44
Rate for Payer: Banner UC Health Medicaid	$6,181.44
Rate for Payer: Mercy Care Medicaid	$6,181.44

Know your out-of-pocket cost for care.

All Charges