Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: AHCCCS Medicaid	$3,955.90
Rate for Payer: Allwell Medicaid	$3,955.90
Rate for Payer: AZCH Complete Medicaid	$3,955.90
Rate for Payer: Banner UC Health Medicaid	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: AHCCCS Medicaid	$9,069.80
Rate for Payer: Allwell Medicaid	$9,069.80
Rate for Payer: AZCH Complete Medicaid	$9,069.80
Rate for Payer: Banner UC Health Medicaid	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: AHCCCS Medicaid	$4,438.46
Rate for Payer: Allwell Medicaid	$4,438.46
Rate for Payer: AZCH Complete Medicaid	$4,438.46
Rate for Payer: Banner UC Health Medicaid	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46

Syncope And Collapse

Facility

$5,625.23

Service Code	APR-DRG 2043
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$5,625.23
Max. Negotiated Rate	$5,625.23
Rate for Payer: AHCCCS Medicaid	$5,625.23
Rate for Payer: Allwell Medicaid	$5,625.23
Rate for Payer: AZCH Complete Medicaid	$5,625.23
Rate for Payer: Banner UC Health Medicaid	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23

Synovial Fluid Cell Count Standard

Facility

$95.00

Service Code	CPT 89051
Hospital Charge Code	22309857
Hospital Revenue Code	309
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Cash Price	$76.00
Rate for Payer: Self Pay Self Pay	$76.00

Synovial Fluid Cell Count Standard

Facility

$95.00

Service Code	CPT 89051
Hospital Charge Code	22309857
Hospital Revenue Code	309
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Aetna of AZ Medicare	$26.60
Rate for Payer: Allwell Medicare	$15.20
Rate for Payer: Amerigroup Medicare	$15.20
Rate for Payer: APIPA Medicare/Medicaid	$35.48
Rate for Payer: AZCH Complete Medicare	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$64.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$61.75
Rate for Payer: Copperpoint Commercial	$23.51
Rate for Payer: Health Net of AZ Commercial	$57.00
Rate for Payer: Health Net of AZ Medicare	$26.60
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Self Pay Self Pay	$76.00
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.10

SYR ASEPTO

Facility

$7.00

Service Code	CPT A4322
Hospital Charge Code	22354240
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Aetna of AZ Medicare	$1.96
Rate for Payer: Allwell Medicare	$1.12
Rate for Payer: Amerigroup Medicare	$1.12
Rate for Payer: APIPA Medicare/Medicaid	$2.61
Rate for Payer: AZCH Complete Medicare	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Bisbee Police All Plans	$1.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.76
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cigna of AZ Commercial	$4.90
Rate for Payer: Copperpoint Commercial	$1.73
Rate for Payer: Health Net of AZ Commercial	$4.20
Rate for Payer: Health Net of AZ Medicare	$1.96
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Self Pay Self Pay	$5.60
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.26

SYR ASEPTO

Facility

$7.00

Service Code	CPT A4322
Hospital Charge Code	22354240
Hospital Revenue Code	270
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Bisbee Police All Plans	$1.82
Rate for Payer: Cash Price	$5.60
Rate for Payer: Self Pay Self Pay	$5.60

.T3Free LC

Facility

$475.00

Service Code	CPT 84481
Hospital Charge Code	22531069
Hospital Revenue Code	302
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Bisbee Police All Plans	$123.50
Rate for Payer: Cash Price	$380.00
Rate for Payer: Self Pay Self Pay	$380.00

.T3Free LC

Facility

$475.00

Service Code	CPT 84481
Hospital Charge Code	22531069
Hospital Revenue Code	302
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Aetna of AZ Medicare	$133.00
Rate for Payer: Allwell Medicare	$76.00
Rate for Payer: Amerigroup Medicare	$76.00
Rate for Payer: APIPA Medicare/Medicaid	$177.41
Rate for Payer: AZCH Complete Medicare	$76.00
Rate for Payer: Banner UC Health Medicare	$76.00
Rate for Payer: Bisbee Police All Plans	$123.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$323.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cigna of AZ Commercial	$308.75
Rate for Payer: Copperpoint Commercial	$117.56
Rate for Payer: Health Net of AZ Commercial	$285.00
Rate for Payer: Health Net of AZ Medicare	$133.00
Rate for Payer: Humana of AZ Medicare	$76.00
Rate for Payer: Self Pay Self Pay	$380.00
Rate for Payer: TriWest Medicare	$76.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$276.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$85.50

T3, Total

Facility

$245.00

Service Code	CPT 84480
Hospital Charge Code	1281222
Hospital Revenue Code	301
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Bisbee Police All Plans	$63.70
Rate for Payer: Cash Price	$196.00
Rate for Payer: Self Pay Self Pay	$196.00

T3, Total

Facility

$245.00

Service Code	CPT 84480
Hospital Charge Code	1281222
Hospital Revenue Code	301
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Aetna of AZ Medicare	$68.60
Rate for Payer: Allwell Medicare	$39.20
Rate for Payer: Amerigroup Medicare	$39.20
Rate for Payer: APIPA Medicare/Medicaid	$91.51
Rate for Payer: AZCH Complete Medicare	$39.20
Rate for Payer: Banner UC Health Medicare	$39.20
Rate for Payer: Bisbee Police All Plans	$63.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$166.60
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cigna of AZ Commercial	$159.25
Rate for Payer: Copperpoint Commercial	$60.64
Rate for Payer: Health Net of AZ Commercial	$147.00
Rate for Payer: Health Net of AZ Medicare	$68.60
Rate for Payer: Humana of AZ Medicare	$39.20
Rate for Payer: Self Pay Self Pay	$196.00
Rate for Payer: TriWest Medicare	$39.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$142.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.10

T3 Uptake LC

Facility

$124.00

Service Code	CPT 84479
Hospital Charge Code	1285538
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

T3 Uptake LC

Facility

$124.00

Service Code	CPT 84479
Hospital Charge Code	1285538
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

T4, Total

Facility

$116.00

Service Code	CPT 84436
Hospital Charge Code	1281223
Hospital Revenue Code	301
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Aetna of AZ Medicare	$32.48
Rate for Payer: Allwell Medicare	$18.56
Rate for Payer: Amerigroup Medicare	$18.56
Rate for Payer: APIPA Medicare/Medicaid	$43.33
Rate for Payer: AZCH Complete Medicare	$18.56
Rate for Payer: Banner UC Health Medicare	$18.56
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.88
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$75.40
Rate for Payer: Copperpoint Commercial	$28.71
Rate for Payer: Health Net of AZ Commercial	$69.60
Rate for Payer: Health Net of AZ Medicare	$32.48
Rate for Payer: Humana of AZ Medicare	$18.56
Rate for Payer: Self Pay Self Pay	$92.80
Rate for Payer: TriWest Medicare	$18.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.88

T4, Total

Facility

$116.00

Service Code	CPT 84436
Hospital Charge Code	1281223
Hospital Revenue Code	301
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Cash Price	$92.80
Rate for Payer: Self Pay Self Pay	$92.80

Tacrolimus (FK506), Blood LC

Facility

$357.00

Service Code	CPT 80197
Hospital Charge Code	1902306
Hospital Revenue Code	301
Min. Negotiated Rate	$57.12
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Aetna of AZ Medicare	$99.96
Rate for Payer: Allwell Medicare	$57.12
Rate for Payer: Amerigroup Medicare	$57.12
Rate for Payer: APIPA Medicare/Medicaid	$133.34
Rate for Payer: AZCH Complete Medicare	$57.12
Rate for Payer: Banner UC Health Medicare	$57.12
Rate for Payer: Bisbee Police All Plans	$92.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$242.76
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cigna of AZ Commercial	$232.05
Rate for Payer: Copperpoint Commercial	$88.36
Rate for Payer: Health Net of AZ Commercial	$214.20
Rate for Payer: Health Net of AZ Medicare	$99.96
Rate for Payer: Humana of AZ Medicare	$57.12
Rate for Payer: Self Pay Self Pay	$285.60
Rate for Payer: TriWest Medicare	$57.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$208.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.26

Tacrolimus (FK506), Blood LC

Facility

$357.00

Service Code	CPT 80197
Hospital Charge Code	1902306
Hospital Revenue Code	301
Min. Negotiated Rate	$92.82
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Bisbee Police All Plans	$92.82
Rate for Payer: Cash Price	$285.60
Rate for Payer: Self Pay Self Pay	$285.60

TAH with Burch

Facility

$6,767.00

Service Code	CPT 58152
Hospital Charge Code	27291786
Hospital Revenue Code	360
Min. Negotiated Rate	$1,759.42
Max. Negotiated Rate	$6,090.30
Rate for Payer: Aetna of AZ Commercial	$6,090.30
Rate for Payer: Bisbee Police All Plans	$1,759.42
Rate for Payer: Cash Price	$5,413.60
Rate for Payer: Self Pay Self Pay	$5,413.60

TAH with Burch

Facility

$6,767.00

Service Code	CPT 58152
Hospital Charge Code	27291786
Hospital Revenue Code	360
Min. Negotiated Rate	$1,082.72
Max. Negotiated Rate	$6,090.30
Rate for Payer: Aetna of AZ Commercial	$6,090.30
Rate for Payer: Aetna of AZ Medicare	$1,894.76
Rate for Payer: Allwell Medicare	$1,082.72
Rate for Payer: Amerigroup Medicare	$1,082.72
Rate for Payer: APIPA Medicare/Medicaid	$2,527.47
Rate for Payer: AZCH Complete Medicare	$1,082.72
Rate for Payer: Banner UC Health Medicare	$1,082.72
Rate for Payer: Bisbee Police All Plans	$1,759.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,601.56
Rate for Payer: Cash Price	$5,413.60
Rate for Payer: Cash Price	$5,413.60
Rate for Payer: Cigna of AZ Commercial	$3,383.50
Rate for Payer: Copperpoint Commercial	$1,674.83
Rate for Payer: Health Net of AZ Commercial	$4,060.20
Rate for Payer: Health Net of AZ Medicare	$1,894.76
Rate for Payer: Humana of AZ Medicare	$1,082.72
Rate for Payer: Self Pay Self Pay	$5,413.60
Rate for Payer: TriWest Medicare	$1,082.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,218.06

tamsulosin 0.4 mg Oral Cap [CQCH]

Facility

$0.34

Service Code	NDC 904640161
Hospital Charge Code	105943045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of AZ Commercial	$0.31
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.23
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of AZ Commercial	$0.22
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.20
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.27
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

tamsulosin 0.4 mg Oral Cap [CQCH]

Facility

$0.34

Service Code	NDC 904640161
Hospital Charge Code	105943045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of AZ Commercial	$0.31
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.27
Rate for Payer: Self Pay Self Pay	$0.27

TAPER POST BOSS 10MM

Facility

$2,221.00

Hospital Charge Code	27745953
Hospital Revenue Code	270
Min. Negotiated Rate	$355.36
Max. Negotiated Rate	$1,998.90
Rate for Payer: Aetna of AZ Commercial	$1,998.90
Rate for Payer: Aetna of AZ Medicare	$621.88
Rate for Payer: Allwell Medicare	$355.36
Rate for Payer: Amerigroup Medicare	$355.36
Rate for Payer: APIPA Medicare/Medicaid	$829.54
Rate for Payer: AZCH Complete Medicare	$355.36
Rate for Payer: Banner UC Health Medicare	$355.36
Rate for Payer: Bisbee Police All Plans	$577.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,510.28
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cigna of AZ Commercial	$1,554.70
Rate for Payer: Copperpoint Commercial	$549.70
Rate for Payer: Health Net of AZ Commercial	$1,332.60
Rate for Payer: Health Net of AZ Medicare	$621.88
Rate for Payer: Humana of AZ Medicare	$355.36
Rate for Payer: Self Pay Self Pay	$1,776.80
Rate for Payer: TriWest Medicare	$355.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,294.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$399.78

TAPER POST BOSS 10MM

Facility

$2,221.00

Hospital Charge Code	27745953
Hospital Revenue Code	270
Min. Negotiated Rate	$577.46
Max. Negotiated Rate	$1,998.90
Rate for Payer: Aetna of AZ Commercial	$1,998.90
Rate for Payer: Bisbee Police All Plans	$577.46
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Self Pay Self Pay	$1,776.80

TC 3.0/4.0 OVERDRILL

Facility

$945.00

Hospital Charge Code	24127774
Hospital Revenue Code	270
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of AZ Commercial	$850.50
Rate for Payer: Bisbee Police All Plans	$245.70
Rate for Payer: Cash Price	$756.00
Rate for Payer: Self Pay Self Pay	$756.00

Know your out-of-pocket cost for care.

All Charges