Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

warfarin 7.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 56017375
Hospital Charge Code	105945332
Hospital Revenue Code	251
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

WARMER SCOPE BLUE HEAT SINGLE USE

Facility

$99.00

Hospital Charge Code	22354936
Hospital Revenue Code	270
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Aetna of AZ Medicare	$27.72
Rate for Payer: Allwell Medicare	$15.84
Rate for Payer: Amerigroup Medicare	$15.84
Rate for Payer: APIPA Medicare/Medicaid	$36.98
Rate for Payer: AZCH Complete Medicare	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$67.32
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$69.30
Rate for Payer: Copperpoint Commercial	$24.50
Rate for Payer: Health Net of AZ Commercial	$59.40
Rate for Payer: Health Net of AZ Medicare	$27.72
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Self Pay Self Pay	$79.20
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.82

WARMER SCOPE BLUE HEAT SINGLE USE

Facility

$99.00

Hospital Charge Code	22354936
Hospital Revenue Code	270
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Cash Price	$79.20
Rate for Payer: Self Pay Self Pay	$79.20

WATER STERILE 750 ML RESP THERAPY

Facility

$20.00

Hospital Charge Code	22355211
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

WATER STERILE 750 ML RESP THERAPY

Facility

$20.00

Hospital Charge Code	22355211
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

West Nile Virus LC

Facility

$383.00

Service Code	CPT 86788
Hospital Charge Code	3508632
Hospital Revenue Code	302
Min. Negotiated Rate	$99.58
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Bisbee Police All Plans	$99.58
Rate for Payer: Cash Price	$306.40
Rate for Payer: Self Pay Self Pay	$306.40

West Nile Virus LC

Facility

$383.00

Service Code	CPT 86788
Hospital Charge Code	3508632
Hospital Revenue Code	302
Min. Negotiated Rate	$61.28
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Aetna of AZ Medicare	$107.24
Rate for Payer: Allwell Medicare	$61.28
Rate for Payer: Amerigroup Medicare	$61.28
Rate for Payer: APIPA Medicare/Medicaid	$143.05
Rate for Payer: AZCH Complete Medicare	$61.28
Rate for Payer: Banner UC Health Medicare	$61.28
Rate for Payer: Bisbee Police All Plans	$99.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$260.44
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cigna of AZ Commercial	$248.95
Rate for Payer: Copperpoint Commercial	$94.79
Rate for Payer: Health Net of AZ Commercial	$229.80
Rate for Payer: Health Net of AZ Medicare	$107.24
Rate for Payer: Humana of AZ Medicare	$61.28
Rate for Payer: Self Pay Self Pay	$306.40
Rate for Payer: TriWest Medicare	$61.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$223.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.94

Wet Prep

Facility

$132.00

Service Code	CPT 87210
Hospital Charge Code	1657611
Hospital Revenue Code	306
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Aetna of AZ Medicare	$36.96
Rate for Payer: Allwell Medicare	$21.12
Rate for Payer: Amerigroup Medicare	$21.12
Rate for Payer: APIPA Medicare/Medicaid	$49.30
Rate for Payer: AZCH Complete Medicare	$21.12
Rate for Payer: Banner UC Health Medicare	$21.12
Rate for Payer: Bisbee Police All Plans	$34.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$89.76
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cigna of AZ Commercial	$85.80
Rate for Payer: Copperpoint Commercial	$32.67
Rate for Payer: Health Net of AZ Commercial	$79.20
Rate for Payer: Health Net of AZ Medicare	$36.96
Rate for Payer: Humana of AZ Medicare	$21.12
Rate for Payer: Self Pay Self Pay	$105.60
Rate for Payer: TriWest Medicare	$21.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$76.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.76

Wet Prep

Facility

$132.00

Service Code	CPT 87210
Hospital Charge Code	1657611
Hospital Revenue Code	306
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Bisbee Police All Plans	$34.32
Rate for Payer: Cash Price	$105.60
Rate for Payer: Self Pay Self Pay	$105.60

Wet Prep 5

Facility

$132.00

Service Code	CPT 87210
Hospital Charge Code	10495297
Hospital Revenue Code	306
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Bisbee Police All Plans	$34.32
Rate for Payer: Cash Price	$105.60
Rate for Payer: Self Pay Self Pay	$105.60

Wet Prep 5

Facility

$132.00

Service Code	CPT 87210
Hospital Charge Code	10495297
Hospital Revenue Code	306
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Aetna of AZ Medicare	$36.96
Rate for Payer: Allwell Medicare	$21.12
Rate for Payer: Amerigroup Medicare	$21.12
Rate for Payer: APIPA Medicare/Medicaid	$49.30
Rate for Payer: AZCH Complete Medicare	$21.12
Rate for Payer: Banner UC Health Medicare	$21.12
Rate for Payer: Bisbee Police All Plans	$34.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$89.76
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cigna of AZ Commercial	$85.80
Rate for Payer: Copperpoint Commercial	$32.67
Rate for Payer: Health Net of AZ Commercial	$79.20
Rate for Payer: Health Net of AZ Medicare	$36.96
Rate for Payer: Humana of AZ Medicare	$21.12
Rate for Payer: Self Pay Self Pay	$105.60
Rate for Payer: TriWest Medicare	$21.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$76.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.76

WHISPER SWIVEL VALVE

Facility

$298.00

Hospital Charge Code	27733113
Hospital Revenue Code	270
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

WHISPER SWIVEL VALVE

Facility

$298.00

Hospital Charge Code	27733113
Hospital Revenue Code	270
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$208.60
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

White Blood Count

Facility

$92.00

Service Code	CPT 85048
Hospital Charge Code	633873
Hospital Revenue Code	305
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Aetna of AZ Medicare	$25.76
Rate for Payer: Allwell Medicare	$14.72
Rate for Payer: Amerigroup Medicare	$14.72
Rate for Payer: APIPA Medicare/Medicaid	$34.36
Rate for Payer: AZCH Complete Medicare	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.56
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$59.80
Rate for Payer: Copperpoint Commercial	$22.77
Rate for Payer: Health Net of AZ Commercial	$55.20
Rate for Payer: Health Net of AZ Medicare	$25.76
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Self Pay Self Pay	$73.60
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.56

White Blood Count

Facility

$92.00

Service Code	CPT 85048
Hospital Charge Code	633873
Hospital Revenue Code	305
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Cash Price	$73.60
Rate for Payer: Self Pay Self Pay	$73.60

Work Related Or Medical Disability Exam or Sports Physical

Facility

$116.00

Service Code	CPT 99455
Hospital Charge Code	1303643
Hospital Revenue Code	983
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	$81.20
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

Work Related Or Medical Disability Exam or Sports Physical

Facility

$116.00

Service Code	CPT 99455
Hospital Charge Code	1303643
Hospital Revenue Code	983
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

Wound Culture

Facility

$310.00

Service Code	CPT 87070
Hospital Charge Code	858007
Hospital Revenue Code	306
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Bisbee Police All Plans	$80.60
Rate for Payer: Cash Price	$248.00
Rate for Payer: Self Pay Self Pay	$248.00

Wound Culture

Facility

$310.00

Service Code	CPT 87070
Hospital Charge Code	858007
Hospital Revenue Code	306
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Aetna of AZ Medicare	$86.80
Rate for Payer: Allwell Medicare	$49.60
Rate for Payer: Amerigroup Medicare	$49.60
Rate for Payer: APIPA Medicare/Medicaid	$115.78
Rate for Payer: AZCH Complete Medicare	$49.60
Rate for Payer: Banner UC Health Medicare	$49.60
Rate for Payer: Bisbee Police All Plans	$80.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.80
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cigna of AZ Commercial	$201.50
Rate for Payer: Copperpoint Commercial	$76.72
Rate for Payer: Health Net of AZ Commercial	$186.00
Rate for Payer: Health Net of AZ Medicare	$86.80
Rate for Payer: Humana of AZ Medicare	$49.60
Rate for Payer: Self Pay Self Pay	$248.00
Rate for Payer: TriWest Medicare	$49.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$180.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.80

Woven Ureteral Catheter Cone Tip 10Fr

Facility

$525.00

Hospital Charge Code	22926427
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

Woven Ureteral Catheter Cone Tip 10Fr

Facility

$525.00

Hospital Charge Code	22926427
Hospital Revenue Code	272
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

Woven Ureteral Catheter Cone Tip 8Fr

Facility

$525.00

Hospital Charge Code	22926428
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

Woven Ureteral Catheter Cone Tip 8Fr

Facility

$525.00

Hospital Charge Code	22926428
Hospital Revenue Code	272
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

WRIST SPLINT COCKUP

Facility

$34.00

Hospital Charge Code	22354262
Hospital Revenue Code	270
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Bisbee Police All Plans	$8.84
Rate for Payer: Cash Price	$27.20
Rate for Payer: Self Pay Self Pay	$27.20

WRIST SPLINT COCKUP

Facility

$34.00

Hospital Charge Code	22354262
Hospital Revenue Code	270
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Aetna of AZ Medicare	$9.52
Rate for Payer: Allwell Medicare	$5.44
Rate for Payer: Amerigroup Medicare	$5.44
Rate for Payer: APIPA Medicare/Medicaid	$12.70
Rate for Payer: AZCH Complete Medicare	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Bisbee Police All Plans	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.12
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$23.80
Rate for Payer: Copperpoint Commercial	$8.41
Rate for Payer: Health Net of AZ Commercial	$20.40
Rate for Payer: Health Net of AZ Medicare	$9.52
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Self Pay Self Pay	$27.20
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.12

Know your out-of-pocket cost for care.

All Charges