Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

BAG PREM LEG DISPOSABLE

Facility

$15.00

Hospital Charge Code	22354156
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Aetna of AZ Medicare	$4.20
Rate for Payer: Allwell Medicare	$2.25
Rate for Payer: Amerigroup Medicare	$2.25
Rate for Payer: APIPA Medicare/Medicaid	$5.60
Rate for Payer: AZCH Complete Medicare	$2.25
Rate for Payer: Banner UC Health Medicare	$2.25
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of AZ Commercial	$10.50
Rate for Payer: Copperpoint Commercial	$3.71
Rate for Payer: Health Net of AZ Commercial	$9.00
Rate for Payer: Health Net of AZ Medicare	$4.20
Rate for Payer: Humana of AZ Medicare	$2.25
Rate for Payer: Self Pay Self Pay	$12.00
Rate for Payer: TriWest Medicare	$2.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.70

BAG PREM LEG DISPOSABLE

Facility

$15.00

Hospital Charge Code	22354156
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Cash Price	$12.00
Rate for Payer: Self Pay Self Pay	$12.00

BAG URINARY LEG

Facility

$15.00

Service Code	CPT A5112
Hospital Charge Code	22355176
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Cash Price	$12.00
Rate for Payer: Self Pay Self Pay	$12.00

BAG URINARY LEG

Facility

$15.00

Service Code	CPT A5112
Hospital Charge Code	22355176
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$62.36
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Aetna of AZ Medicare	$4.20
Rate for Payer: AHCCCS Medicaid	$62.36
Rate for Payer: Allwell Medicaid	$62.36
Rate for Payer: Allwell Medicare	$2.25
Rate for Payer: Amerigroup Medicare	$2.25
Rate for Payer: APIPA Medicare/Medicaid	$5.60
Rate for Payer: AZCH Complete Medicaid	$62.36
Rate for Payer: AZCH Complete Medicare	$2.25
Rate for Payer: Banner UC Health Medicaid	$62.36
Rate for Payer: Banner UC Health Medicare	$2.25
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of AZ Commercial	$10.50
Rate for Payer: Copperpoint Commercial	$3.71
Rate for Payer: Health Net of AZ Commercial	$9.00
Rate for Payer: Health Net of AZ Medicare	$4.20
Rate for Payer: Humana of AZ Medicare	$2.25
Rate for Payer: Mercy Care Medicaid	$62.36
Rate for Payer: Self Pay Self Pay	$12.00
Rate for Payer: TriWest Medicare	$2.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.70

BAIR HUGGER DISPOSABLE BLANKET

Facility

$148.00

Hospital Charge Code	22354968
Hospital Revenue Code	270
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

BAIR HUGGER DISPOSABLE BLANKET

Facility

$148.00

Hospital Charge Code	22354968
Hospital Revenue Code	270
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Aetna of AZ Medicare	$41.44
Rate for Payer: Allwell Medicare	$22.20
Rate for Payer: Amerigroup Medicare	$22.20
Rate for Payer: APIPA Medicare/Medicaid	$55.28
Rate for Payer: AZCH Complete Medicare	$22.20
Rate for Payer: Banner UC Health Medicare	$22.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.64
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$103.60
Rate for Payer: Copperpoint Commercial	$36.63
Rate for Payer: Health Net of AZ Commercial	$88.80
Rate for Payer: Health Net of AZ Medicare	$41.44
Rate for Payer: Humana of AZ Medicare	$22.20
Rate for Payer: Self Pay Self Pay	$118.40
Rate for Payer: TriWest Medicare	$22.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.64

BALL ELECTRODE 5MM CONMED

Facility

$109.00

Hospital Charge Code	22554974
Hospital Revenue Code	272
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$16.35
Rate for Payer: Amerigroup Medicare	$16.35
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$16.35
Rate for Payer: Banner UC Health Medicare	$16.35
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$16.35
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$16.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

BALL ELECTRODE 5MM CONMED

Facility

$109.00

Hospital Charge Code	22554974
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

BANDAID 2X4

Facility

$0.29

Hospital Charge Code	22355607
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Aetna of AZ Medicare	$0.08
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.11
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.20
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of AZ Commercial	$0.20
Rate for Payer: Copperpoint Commercial	$0.07
Rate for Payer: Health Net of AZ Commercial	$0.17
Rate for Payer: Health Net of AZ Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.23
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

BANDAID 2X4

Facility

$0.29

Hospital Charge Code	22355607
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.23
Rate for Payer: Self Pay Self Pay	$0.23

baricitinib 2 mg Tab[CQCH]

Facility

$78.09

Service Code	NDC 2418230
Hospital Charge Code	188268943
Hospital Revenue Code	251
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$70.28
Rate for Payer: Aetna of AZ Commercial	$70.28
Rate for Payer: Bisbee Police All Plans	$20.30
Rate for Payer: Cash Price	$62.47
Rate for Payer: Self Pay Self Pay	$62.47

baricitinib 2 mg Tab[CQCH]

Facility

$78.09

Service Code	NDC 2418230
Hospital Charge Code	188268943
Hospital Revenue Code	251
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$70.28
Rate for Payer: Aetna of AZ Commercial	$70.28
Rate for Payer: Aetna of AZ Medicare	$21.87
Rate for Payer: Allwell Medicare	$11.71
Rate for Payer: Amerigroup Medicare	$11.71
Rate for Payer: APIPA Medicare/Medicaid	$29.17
Rate for Payer: AZCH Complete Medicare	$11.71
Rate for Payer: Banner UC Health Medicare	$11.71
Rate for Payer: Bisbee Police All Plans	$20.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.10
Rate for Payer: Cash Price	$62.47
Rate for Payer: Cigna of AZ Commercial	$50.76
Rate for Payer: Copperpoint Commercial	$19.33
Rate for Payer: Health Net of AZ Commercial	$46.85
Rate for Payer: Health Net of AZ Medicare	$21.87
Rate for Payer: Humana of AZ Medicare	$11.71
Rate for Payer: Self Pay Self Pay	$62.47
Rate for Payer: TriWest Medicare	$11.71
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.06

BARRIER FILM SKINCARE CAVILON ADV 2.7ML

Facility

$67.00

Hospital Charge Code	23362063
Hospital Revenue Code	272
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.05
Rate for Payer: Amerigroup Medicare	$10.05
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.05
Rate for Payer: Banner UC Health Medicare	$10.05
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.05
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

BARRIER FILM SKINCARE CAVILON ADV 2.7ML

Facility

$67.00

Hospital Charge Code	23362063
Hospital Revenue Code	272
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

BARRIER OINTMENT

Facility

$16.00

Hospital Charge Code	22355159
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

BARRIER OINTMENT

Facility

$16.00

Hospital Charge Code	22355159
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Cash Price	$12.80
Rate for Payer: Self Pay Self Pay	$12.80

Bartholins Gland Excision

Facility

$1,625.00

Service Code	CPT 56740
Hospital Charge Code	27291808
Hospital Revenue Code	360
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Bartholins Gland Excision

Facility

$1,625.00

Service Code	CPT 56740
Hospital Charge Code	27291808
Hospital Revenue Code	360
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$3,803.66
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Aetna of AZ Medicare	$455.00
Rate for Payer: AHCCCS Medicaid	$3,803.66
Rate for Payer: Allwell Medicaid	$3,803.66
Rate for Payer: Allwell Medicare	$243.75
Rate for Payer: Amerigroup Medicare	$243.75
Rate for Payer: APIPA Medicare/Medicaid	$606.94
Rate for Payer: AZCH Complete Medicaid	$3,803.66
Rate for Payer: AZCH Complete Medicare	$243.75
Rate for Payer: Banner UC Health Medicaid	$3,803.66
Rate for Payer: Banner UC Health Medicare	$243.75
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,105.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$812.50
Rate for Payer: Copperpoint Commercial	$402.19
Rate for Payer: Health Net of AZ Commercial	$975.00
Rate for Payer: Health Net of AZ Medicare	$455.00
Rate for Payer: Humana of AZ Medicare	$243.75
Rate for Payer: Mercy Care Medicaid	$3,803.66
Rate for Payer: Self Pay Self Pay	$1,300.00
Rate for Payer: TriWest Medicare	$243.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$292.50

Bartonella AB

Facility

$78.00

Service Code	CPT 86611
Hospital Charge Code	22912236
Hospital Revenue Code	301
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: AHCCCS Medicaid	$10.18
Rate for Payer: Allwell Medicaid	$10.18
Rate for Payer: Allwell Medicare	$11.70
Rate for Payer: Amerigroup Medicare	$11.70
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicaid	$10.18
Rate for Payer: AZCH Complete Medicare	$11.70
Rate for Payer: Banner UC Health Medicaid	$10.18
Rate for Payer: Banner UC Health Medicare	$11.70
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$11.70
Rate for Payer: Mercy Care Medicaid	$10.18
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$11.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

Bartonella AB

Facility

$78.00

Service Code	CPT 86611
Hospital Charge Code	22912236
Hospital Revenue Code	301
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

Bartonella Antibody Panel LC

Facility

$125.00

Service Code	CPT 86611
Hospital Charge Code	2029236
Hospital Revenue Code	301
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of AZ Commercial	$112.50
Rate for Payer: Aetna of AZ Medicare	$35.00
Rate for Payer: AHCCCS Medicaid	$10.18
Rate for Payer: Allwell Medicaid	$10.18
Rate for Payer: Allwell Medicare	$18.75
Rate for Payer: Amerigroup Medicare	$18.75
Rate for Payer: APIPA Medicare/Medicaid	$46.69
Rate for Payer: AZCH Complete Medicaid	$10.18
Rate for Payer: AZCH Complete Medicare	$18.75
Rate for Payer: Banner UC Health Medicaid	$10.18
Rate for Payer: Banner UC Health Medicare	$18.75
Rate for Payer: Bisbee Police All Plans	$32.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$85.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cigna of AZ Commercial	$81.25
Rate for Payer: Copperpoint Commercial	$30.94
Rate for Payer: Health Net of AZ Commercial	$75.00
Rate for Payer: Health Net of AZ Medicare	$35.00
Rate for Payer: Humana of AZ Medicare	$18.75
Rate for Payer: Mercy Care Medicaid	$10.18
Rate for Payer: Self Pay Self Pay	$100.00
Rate for Payer: TriWest Medicare	$18.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.50

Bartonella Antibody Panel LC

Facility

$125.00

Service Code	CPT 86611
Hospital Charge Code	2029236
Hospital Revenue Code	301
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of AZ Commercial	$112.50
Rate for Payer: Bisbee Police All Plans	$32.50
Rate for Payer: Cash Price	$100.00
Rate for Payer: Self Pay Self Pay	$100.00

BASIC CYSTOSCOPY TRAY

Facility

$129.00

Hospital Charge Code	27749972
Hospital Revenue Code	270
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Cash Price	$103.20
Rate for Payer: Self Pay Self Pay	$103.20

BASIC CYSTOSCOPY TRAY

Facility

$129.00

Hospital Charge Code	27749972
Hospital Revenue Code	270
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Aetna of AZ Medicare	$36.12
Rate for Payer: Allwell Medicare	$19.35
Rate for Payer: Amerigroup Medicare	$19.35
Rate for Payer: APIPA Medicare/Medicaid	$48.18
Rate for Payer: AZCH Complete Medicare	$19.35
Rate for Payer: Banner UC Health Medicare	$19.35
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.72
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$90.30
Rate for Payer: Copperpoint Commercial	$31.93
Rate for Payer: Health Net of AZ Commercial	$77.40
Rate for Payer: Health Net of AZ Medicare	$36.12
Rate for Payer: Humana of AZ Medicare	$19.35
Rate for Payer: Self Pay Self Pay	$103.20
Rate for Payer: TriWest Medicare	$19.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.22

Basic Metabolic Panel Standard

Facility

$136.00

Service Code	CPT 80048 QW
Hospital Charge Code	22141043
Hospital Revenue Code	301
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of AZ Commercial	$122.40
Rate for Payer: Bisbee Police All Plans	$35.36
Rate for Payer: Cash Price	$108.80
Rate for Payer: Self Pay Self Pay	$108.80

Know your out-of-pocket cost for care.

All Charges