Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

benzocaine Top 20% mucous membrane spray [CQCH]

Facility

$0.04

Service Code	NDC 283067902
Hospital Charge Code	105912709
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.03

Benzodiazepines

Facility

$104.00

Service Code	CPT 80347
Hospital Charge Code	23090938
Hospital Revenue Code	301
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

Benzodiazepines

Facility

$104.00

Service Code	CPT 80347
Hospital Charge Code	23090938
Hospital Revenue Code	301
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$16.64
Rate for Payer: Amerigroup Medicare	$16.64
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$67.60
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

benzonatate 100 mg Cap [CQCH]

Facility

$0.36

Service Code	NDC 904656461
Hospital Charge Code	105912774
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.24
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.22
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.29
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

benzonatate 100 mg Cap [CQCH]

Facility

$0.36

Service Code	NDC 904656461
Hospital Charge Code	105912774
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.28
Rate for Payer: Self Pay Self Pay	$0.29

benztropine 1 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 60687036801
Hospital Charge Code	105912839
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.33
Rate for Payer: Self Pay Self Pay	$0.33

benztropine 1 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 60687036801
Hospital Charge Code	105912839
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.15
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.28
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.25
Rate for Payer: Health Net of AZ Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.33
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

.Beta-2 Glyco I Ab, IgA, Please Note LC

Facility

$302.00

Service Code	CPT 86146
Hospital Charge Code	22311136
Hospital Revenue Code	302
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

.Beta-2 Glyco I Ab, IgA, Please Note LC

Facility

$302.00

Service Code	CPT 86146
Hospital Charge Code	22311136
Hospital Revenue Code	302
Min. Negotiated Rate	$48.32
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$48.32
Rate for Payer: Amerigroup Medicare	$48.32
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$48.32
Rate for Payer: Banner UC Health Medicare	$48.32
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$196.30
Rate for Payer: Copperpoint Commercial	$74.75
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$48.32
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$48.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

.Beta-2 Glyco I Ab, IgG, Please Note LC

Facility

$302.00

Service Code	CPT 86146
Hospital Charge Code	22311137
Hospital Revenue Code	302
Min. Negotiated Rate	$48.32
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$48.32
Rate for Payer: Amerigroup Medicare	$48.32
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$48.32
Rate for Payer: Banner UC Health Medicare	$48.32
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$196.30
Rate for Payer: Copperpoint Commercial	$74.75
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$48.32
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$48.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

.Beta-2 Glyco I Ab, IgG, Please Note LC

Facility

$302.00

Service Code	CPT 86146
Hospital Charge Code	22311137
Hospital Revenue Code	302
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

.Beta-2 Glyco I Ab, IgM, Please Note LC

Facility

$317.00

Service Code	CPT 86146
Hospital Charge Code	22311138
Hospital Revenue Code	302
Min. Negotiated Rate	$50.72
Max. Negotiated Rate	$285.30
Rate for Payer: Aetna of AZ Commercial	$285.30
Rate for Payer: Aetna of AZ Medicare	$88.76
Rate for Payer: Allwell Medicare	$50.72
Rate for Payer: Amerigroup Medicare	$50.72
Rate for Payer: APIPA Medicare/Medicaid	$118.40
Rate for Payer: AZCH Complete Medicare	$50.72
Rate for Payer: Banner UC Health Medicare	$50.72
Rate for Payer: Bisbee Police All Plans	$82.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$215.56
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cigna of AZ Commercial	$206.05
Rate for Payer: Copperpoint Commercial	$78.46
Rate for Payer: Health Net of AZ Commercial	$190.20
Rate for Payer: Health Net of AZ Medicare	$88.76
Rate for Payer: Humana of AZ Medicare	$50.72
Rate for Payer: Self Pay Self Pay	$253.60
Rate for Payer: TriWest Medicare	$50.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$184.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.06

.Beta-2 Glyco I Ab, IgM, Please Note LC

Facility

$317.00

Service Code	CPT 86146
Hospital Charge Code	22311138
Hospital Revenue Code	302
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$285.30
Rate for Payer: Aetna of AZ Commercial	$285.30
Rate for Payer: Bisbee Police All Plans	$82.42
Rate for Payer: Cash Price	$253.60
Rate for Payer: Self Pay Self Pay	$253.60

.BETA 2 GLYCOPROTEIN AB, IGA

Facility

$318.00

Service Code	CPT 86146
Hospital Charge Code	22481442
Hospital Revenue Code	302
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Aetna of AZ Medicare	$89.04
Rate for Payer: Allwell Medicare	$50.88
Rate for Payer: Amerigroup Medicare	$50.88
Rate for Payer: APIPA Medicare/Medicaid	$118.77
Rate for Payer: AZCH Complete Medicare	$50.88
Rate for Payer: Banner UC Health Medicare	$50.88
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$216.24
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cigna of AZ Commercial	$206.70
Rate for Payer: Copperpoint Commercial	$78.70
Rate for Payer: Health Net of AZ Commercial	$190.80
Rate for Payer: Health Net of AZ Medicare	$89.04
Rate for Payer: Humana of AZ Medicare	$50.88
Rate for Payer: Self Pay Self Pay	$254.40
Rate for Payer: TriWest Medicare	$50.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$185.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.24

.BETA 2 GLYCOPROTEIN AB, IGA

Facility

$318.00

Service Code	CPT 86146
Hospital Charge Code	22481442
Hospital Revenue Code	302
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Cash Price	$254.40
Rate for Payer: Self Pay Self Pay	$254.40

.BETA 2 GLYCOPROTEIN AB, IGG

Facility

$318.00

Service Code	CPT 86146
Hospital Charge Code	22481443
Hospital Revenue Code	302
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Cash Price	$254.40
Rate for Payer: Self Pay Self Pay	$254.40

.BETA 2 GLYCOPROTEIN AB, IGG

Facility

$318.00

Service Code	CPT 86146
Hospital Charge Code	22481443
Hospital Revenue Code	302
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Aetna of AZ Medicare	$89.04
Rate for Payer: Allwell Medicare	$50.88
Rate for Payer: Amerigroup Medicare	$50.88
Rate for Payer: APIPA Medicare/Medicaid	$118.77
Rate for Payer: AZCH Complete Medicare	$50.88
Rate for Payer: Banner UC Health Medicare	$50.88
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$216.24
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cigna of AZ Commercial	$206.70
Rate for Payer: Copperpoint Commercial	$78.70
Rate for Payer: Health Net of AZ Commercial	$190.80
Rate for Payer: Health Net of AZ Medicare	$89.04
Rate for Payer: Humana of AZ Medicare	$50.88
Rate for Payer: Self Pay Self Pay	$254.40
Rate for Payer: TriWest Medicare	$50.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$185.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.24

BETA 2 GLYCOPROTEIN AB, IGM

Facility

$334.00

Service Code	CPT 86146
Hospital Charge Code	22481464
Hospital Revenue Code	302
Min. Negotiated Rate	$53.44
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Aetna of AZ Medicare	$93.52
Rate for Payer: Allwell Medicare	$53.44
Rate for Payer: Amerigroup Medicare	$53.44
Rate for Payer: APIPA Medicare/Medicaid	$124.75
Rate for Payer: AZCH Complete Medicare	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$227.12
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Copperpoint Commercial	$82.67
Rate for Payer: Health Net of AZ Commercial	$200.40
Rate for Payer: Health Net of AZ Medicare	$93.52
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Self Pay Self Pay	$267.20
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$194.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.12

BETA 2 GLYCOPROTEIN AB, IGM

Facility

$334.00

Service Code	CPT 86146
Hospital Charge Code	22481464
Hospital Revenue Code	302
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Cash Price	$267.20
Rate for Payer: Self Pay Self Pay	$267.20

Beta-2 Glycoprotein I Ab,G,A,M LC

Facility

$302.00

Service Code	CPT 86146
Hospital Charge Code	2029264
Hospital Revenue Code	302
Min. Negotiated Rate	$48.32
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$48.32
Rate for Payer: Amerigroup Medicare	$48.32
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$48.32
Rate for Payer: Banner UC Health Medicare	$48.32
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$196.30
Rate for Payer: Copperpoint Commercial	$74.75
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$48.32
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$48.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

Beta-2 Glycoprotein I Ab,G,A,M LC

Facility

$302.00

Service Code	CPT 86146
Hospital Charge Code	2029264
Hospital Revenue Code	302
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

Beta-2 Microglobulin, Serum LC

Facility

$270.00

Service Code	CPT 82232
Hospital Charge Code	2029101
Hospital Revenue Code	301
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Aetna of AZ Medicare	$75.60
Rate for Payer: Allwell Medicare	$43.20
Rate for Payer: Amerigroup Medicare	$43.20
Rate for Payer: APIPA Medicare/Medicaid	$100.84
Rate for Payer: AZCH Complete Medicare	$43.20
Rate for Payer: Banner UC Health Medicare	$43.20
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$183.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna of AZ Commercial	$175.50
Rate for Payer: Copperpoint Commercial	$66.83
Rate for Payer: Health Net of AZ Commercial	$162.00
Rate for Payer: Health Net of AZ Medicare	$75.60
Rate for Payer: Humana of AZ Medicare	$43.20
Rate for Payer: Self Pay Self Pay	$216.00
Rate for Payer: TriWest Medicare	$43.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$157.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.60

Beta-2 Microglobulin, Serum LC

Facility

$270.00

Service Code	CPT 82232
Hospital Charge Code	2029101
Hospital Revenue Code	301
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Self Pay Self Pay	$216.00

betamethasone 30 mg/ 5 mL Inj [CQCH]

Facility

$7.57

Service Code	HCPCS J0702
Hospital Charge Code	105912906
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$6.81
Rate for Payer: Aetna of AZ Commercial	$6.81
Rate for Payer: Bisbee Police All Plans	$1.97
Rate for Payer: Cash Price	$6.05
Rate for Payer: Self Pay Self Pay	$6.06

betamethasone 30 mg/ 5 mL Inj [CQCH]

Facility

$7.57

Service Code	HCPCS J0702
Hospital Charge Code	105912906
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$6.81
Rate for Payer: Aetna of AZ Commercial	$6.81
Rate for Payer: Aetna of AZ Medicare	$2.12
Rate for Payer: Allwell Medicare	$1.21
Rate for Payer: Amerigroup Medicare	$1.21
Rate for Payer: APIPA Medicare/Medicaid	$2.83
Rate for Payer: AZCH Complete Medicare	$1.21
Rate for Payer: Banner UC Health Medicare	$1.21
Rate for Payer: Bisbee Police All Plans	$1.97
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.15
Rate for Payer: Cash Price	$6.05
Rate for Payer: Cigna of AZ Commercial	$4.92
Rate for Payer: Copperpoint Commercial	$1.87
Rate for Payer: Health Net of AZ Commercial	$4.54
Rate for Payer: Health Net of AZ Medicare	$2.12
Rate for Payer: Humana of AZ Medicare	$1.21
Rate for Payer: Self Pay Self Pay	$6.06
Rate for Payer: TriWest Medicare	$1.21
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.36

Know your out-of-pocket cost for care.

All Charges