Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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 Metabolic Panel Standard

Facility

$129.00

Service Code	CPT 80048 QW
Hospital Charge Code	22141043
Hospital Revenue Code	301
Min. Negotiated Rate	$20.64
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	$20.64
Rate for Payer: Amerigroup Medicare	$20.64
Rate for Payer: APIPA Medicare/Medicaid	$48.18
Rate for Payer: AZCH Complete Medicare	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
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	$83.85
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	$20.64
Rate for Payer: Self Pay Self Pay	$103.20
Rate for Payer: TriWest Medicare	$20.64
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

$129.00

Service Code	CPT 80048 QW
Hospital Charge Code	22141043
Hospital Revenue Code	301
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

BASIN WASH

Facility

$8.00

Hospital Charge Code	22355559
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Cash Price	$6.40
Rate for Payer: Self Pay Self Pay	$6.40

BASIN WASH

Facility

$8.00

Hospital Charge Code	22355559
Hospital Revenue Code	270
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Aetna of AZ Medicare	$2.24
Rate for Payer: Allwell Medicare	$1.28
Rate for Payer: Amerigroup Medicare	$1.28
Rate for Payer: APIPA Medicare/Medicaid	$2.99
Rate for Payer: AZCH Complete Medicare	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.44
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Copperpoint Commercial	$1.98
Rate for Payer: Health Net of AZ Commercial	$4.80
Rate for Payer: Health Net of AZ Medicare	$2.24
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Self Pay Self Pay	$6.40
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.44

BATH JOEY WIPE

Facility

$5.35

Hospital Charge Code	22355371
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna of AZ Commercial	$4.82
Rate for Payer: Bisbee Police All Plans	$1.39
Rate for Payer: Cash Price	$4.28
Rate for Payer: Self Pay Self Pay	$4.28

BATH JOEY WIPE

Facility

$5.35

Hospital Charge Code	22355371
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna of AZ Commercial	$4.82
Rate for Payer: Aetna of AZ Medicare	$1.50
Rate for Payer: Allwell Medicare	$0.86
Rate for Payer: Amerigroup Medicare	$0.86
Rate for Payer: APIPA Medicare/Medicaid	$2.00
Rate for Payer: AZCH Complete Medicare	$0.86
Rate for Payer: Banner UC Health Medicare	$0.86
Rate for Payer: Bisbee Police All Plans	$1.39
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.64
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna of AZ Commercial	$3.75
Rate for Payer: Copperpoint Commercial	$1.32
Rate for Payer: Health Net of AZ Commercial	$3.21
Rate for Payer: Health Net of AZ Medicare	$1.50
Rate for Payer: Humana of AZ Medicare	$0.86
Rate for Payer: Self Pay Self Pay	$4.28
Rate for Payer: TriWest Medicare	$0.86
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.96

BAYER MIRENA IUD 52MG

Facility

$2,925.00

Hospital Charge Code	27567258
Hospital Revenue Code	270
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$2,632.50
Rate for Payer: Aetna of AZ Commercial	$2,632.50
Rate for Payer: Bisbee Police All Plans	$760.50
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Self Pay Self Pay	$2,340.00

BAYER MIRENA IUD 52MG

Facility

$2,925.00

Hospital Charge Code	27567258
Hospital Revenue Code	270
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$2,632.50
Rate for Payer: Aetna of AZ Commercial	$2,632.50
Rate for Payer: Aetna of AZ Medicare	$819.00
Rate for Payer: Allwell Medicare	$468.00
Rate for Payer: Amerigroup Medicare	$468.00
Rate for Payer: APIPA Medicare/Medicaid	$1,092.49
Rate for Payer: AZCH Complete Medicare	$468.00
Rate for Payer: Banner UC Health Medicare	$468.00
Rate for Payer: Bisbee Police All Plans	$760.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,989.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Cigna of AZ Commercial	$2,047.50
Rate for Payer: Copperpoint Commercial	$723.94
Rate for Payer: Health Net of AZ Commercial	$1,755.00
Rate for Payer: Health Net of AZ Medicare	$819.00
Rate for Payer: Humana of AZ Medicare	$468.00
Rate for Payer: Self Pay Self Pay	$2,340.00
Rate for Payer: TriWest Medicare	$468.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,705.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$526.50

BB ABO/RH/AB SCREEN

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	1165544
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Aetna of AZ Medicare	$23.80
Rate for Payer: Allwell Medicare	$13.60
Rate for Payer: Amerigroup Medicare	$13.60
Rate for Payer: APIPA Medicare/Medicaid	$31.75
Rate for Payer: AZCH Complete Medicare	$13.60
Rate for Payer: Banner UC Health Medicare	$13.60
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.80
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cigna of AZ Commercial	$55.25
Rate for Payer: Copperpoint Commercial	$21.04
Rate for Payer: Health Net of AZ Commercial	$51.00
Rate for Payer: Health Net of AZ Medicare	$23.80
Rate for Payer: Humana of AZ Medicare	$13.60
Rate for Payer: Self Pay Self Pay	$68.00
Rate for Payer: TriWest Medicare	$13.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$49.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.30

BB ABO/RH/AB SCREEN

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	1165544
Hospital Revenue Code	302
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Cash Price	$68.00
Rate for Payer: Self Pay Self Pay	$68.00

BB ANTIBODY SCREEN

Facility

$108.00

Service Code	CPT 86850
Hospital Charge Code	1422360
Hospital Revenue Code	302
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Aetna of AZ Medicare	$30.24
Rate for Payer: Allwell Medicare	$17.28
Rate for Payer: Amerigroup Medicare	$17.28
Rate for Payer: APIPA Medicare/Medicaid	$40.34
Rate for Payer: AZCH Complete Medicare	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$73.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$70.20
Rate for Payer: Copperpoint Commercial	$26.73
Rate for Payer: Health Net of AZ Commercial	$64.80
Rate for Payer: Health Net of AZ Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Self Pay Self Pay	$86.40
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.44

BB ANTIBODY SCREEN

Facility

$108.00

Service Code	CPT 86850
Hospital Charge Code	1422360
Hospital Revenue Code	302
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Cash Price	$86.40
Rate for Payer: Self Pay Self Pay	$86.40

BB RED CELL ANTIGEN TYPING

Facility

$107.00

Service Code	CPT 86905
Hospital Charge Code	1481864
Hospital Revenue Code	302
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Cash Price	$85.60
Rate for Payer: Self Pay Self Pay	$85.60

BB RED CELL ANTIGEN TYPING

Facility

$107.00

Service Code	CPT 86905
Hospital Charge Code	1481864
Hospital Revenue Code	302
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Aetna of AZ Medicare	$29.96
Rate for Payer: Allwell Medicare	$17.12
Rate for Payer: Amerigroup Medicare	$17.12
Rate for Payer: APIPA Medicare/Medicaid	$39.96
Rate for Payer: AZCH Complete Medicare	$17.12
Rate for Payer: Banner UC Health Medicare	$17.12
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.76
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$69.55
Rate for Payer: Copperpoint Commercial	$26.48
Rate for Payer: Health Net of AZ Commercial	$64.20
Rate for Payer: Health Net of AZ Medicare	$29.96
Rate for Payer: Humana of AZ Medicare	$17.12
Rate for Payer: Self Pay Self Pay	$85.60
Rate for Payer: TriWest Medicare	$17.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.26

BCR-ABL (M-TH only) LC

Facility

$2,033.00

Service Code	CPT 81206
Hospital Charge Code	2769565
Hospital Revenue Code	301
Min. Negotiated Rate	$325.28
Max. Negotiated Rate	$1,829.70
Rate for Payer: Aetna of AZ Commercial	$1,829.70
Rate for Payer: Aetna of AZ Medicare	$569.24
Rate for Payer: Allwell Medicare	$325.28
Rate for Payer: Amerigroup Medicare	$325.28
Rate for Payer: APIPA Medicare/Medicaid	$759.33
Rate for Payer: AZCH Complete Medicare	$325.28
Rate for Payer: Banner UC Health Medicare	$325.28
Rate for Payer: Bisbee Police All Plans	$528.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,382.44
Rate for Payer: Cash Price	$1,626.40
Rate for Payer: Cigna of AZ Commercial	$1,321.45
Rate for Payer: Copperpoint Commercial	$503.17
Rate for Payer: Health Net of AZ Commercial	$1,219.80
Rate for Payer: Health Net of AZ Medicare	$569.24
Rate for Payer: Humana of AZ Medicare	$325.28
Rate for Payer: Self Pay Self Pay	$1,626.40
Rate for Payer: TriWest Medicare	$325.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,185.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$365.94

BCR-ABL (M-TH only) LC

Facility

$2,033.00

Service Code	CPT 81206
Hospital Charge Code	2769565
Hospital Revenue Code	301
Min. Negotiated Rate	$528.58
Max. Negotiated Rate	$1,829.70
Rate for Payer: Aetna of AZ Commercial	$1,829.70
Rate for Payer: Bisbee Police All Plans	$528.58
Rate for Payer: Cash Price	$1,626.40
Rate for Payer: Self Pay Self Pay	$1,626.40

BD Bone Density DEXA Study

Facility

$739.00

Service Code	CPT 77080
Hospital Charge Code	1284605
Hospital Revenue Code	320
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$665.10
Rate for Payer: Aetna of AZ Commercial	$665.10
Rate for Payer: Aetna of AZ Medicare	$206.92
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$118.24
Rate for Payer: Amerigroup Medicare	$118.24
Rate for Payer: APIPA Medicare/Medicaid	$276.02
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$118.24
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$118.24
Rate for Payer: Bisbee Police All Plans	$192.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$502.52
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cigna of AZ Commercial	$480.35
Rate for Payer: Copperpoint Commercial	$182.90
Rate for Payer: Health Net of AZ Commercial	$443.40
Rate for Payer: Health Net of AZ Medicare	$206.92
Rate for Payer: Humana of AZ Medicare	$118.24
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$591.20
Rate for Payer: TriWest Medicare	$118.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$430.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$133.02

BD Bone Density DEXA Study

Facility

$739.00

Service Code	CPT 77080
Hospital Charge Code	1284605
Hospital Revenue Code	320
Min. Negotiated Rate	$192.14
Max. Negotiated Rate	$665.10
Rate for Payer: Aetna of AZ Commercial	$665.10
Rate for Payer: Bisbee Police All Plans	$192.14
Rate for Payer: Cash Price	$591.20
Rate for Payer: Self Pay Self Pay	$591.20

BD Dexa Appendicular

Facility

$119.00

Service Code	CPT 77081
Hospital Charge Code	1005095
Hospital Revenue Code	320
Min. Negotiated Rate	$30.94
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of AZ Commercial	$107.10
Rate for Payer: Bisbee Police All Plans	$30.94
Rate for Payer: Cash Price	$95.20
Rate for Payer: Self Pay Self Pay	$95.20

BD Dexa Appendicular

Facility

$119.00

Service Code	CPT 77081
Hospital Charge Code	1005095
Hospital Revenue Code	320
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of AZ Commercial	$107.10
Rate for Payer: Aetna of AZ Medicare	$33.32
Rate for Payer: AHCCCS Medicaid	$58.65
Rate for Payer: Allwell Medicaid	$58.65
Rate for Payer: Allwell Medicare	$19.04
Rate for Payer: Amerigroup Medicare	$19.04
Rate for Payer: APIPA Medicare/Medicaid	$44.45
Rate for Payer: AZCH Complete Medicaid	$58.65
Rate for Payer: AZCH Complete Medicare	$19.04
Rate for Payer: Banner UC Health Medicaid	$58.65
Rate for Payer: Banner UC Health Medicare	$19.04
Rate for Payer: Bisbee Police All Plans	$30.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$80.92
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cigna of AZ Commercial	$77.35
Rate for Payer: Copperpoint Commercial	$29.45
Rate for Payer: Health Net of AZ Commercial	$71.40
Rate for Payer: Health Net of AZ Medicare	$33.32
Rate for Payer: Humana of AZ Medicare	$19.04
Rate for Payer: Mercy Care Medicaid	$58.65
Rate for Payer: Self Pay Self Pay	$95.20
Rate for Payer: TriWest Medicare	$19.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.42

bebtelovimab 175 mg/2 mL Sol[CQCH]

Facility

$1,050.00

Service Code	NDC 2758901
Hospital Charge Code	198470404
Hospital Revenue Code	250
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna of AZ Commercial	$945.00
Rate for Payer: Aetna of AZ Medicare	$294.00
Rate for Payer: Allwell Medicare	$168.00
Rate for Payer: Amerigroup Medicare	$168.00
Rate for Payer: APIPA Medicare/Medicaid	$392.18
Rate for Payer: AZCH Complete Medicare	$168.00
Rate for Payer: Banner UC Health Medicare	$168.00
Rate for Payer: Bisbee Police All Plans	$273.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$714.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Cigna of AZ Commercial	$682.50
Rate for Payer: Copperpoint Commercial	$259.88
Rate for Payer: Health Net of AZ Commercial	$630.00
Rate for Payer: Health Net of AZ Medicare	$294.00
Rate for Payer: Humana of AZ Medicare	$168.00
Rate for Payer: Self Pay Self Pay	$840.00
Rate for Payer: TriWest Medicare	$168.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$612.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$189.00

bebtelovimab 175 mg/2 mL Sol[CQCH]

Facility

$1,050.00

Service Code	NDC 2758901
Hospital Charge Code	198470404
Hospital Revenue Code	250
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna of AZ Commercial	$945.00
Rate for Payer: Bisbee Police All Plans	$273.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Self Pay Self Pay	$840.00

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: AHCCCS Medicaid	$2,675.14
Rate for Payer: Allwell Medicaid	$2,675.14
Rate for Payer: AZCH Complete Medicaid	$2,675.14
Rate for Payer: Banner UC Health Medicaid	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: AHCCCS Medicaid	$6,018.71
Rate for Payer: Allwell Medicaid	$6,018.71
Rate for Payer: AZCH Complete Medicaid	$6,018.71
Rate for Payer: Banner UC Health Medicaid	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71

Know your out-of-pocket cost for care.

All Charges