Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

betamethasone-clotrimazole Top 0.05%-1% Crm [CQCH]

Facility

$11.20

Service Code	NDC 16714049602
Hospital Charge Code	105912979
Hospital Revenue Code	251
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna of AZ Commercial	$10.08
Rate for Payer: Aetna of AZ Medicare	$3.14
Rate for Payer: Allwell Medicare	$1.79
Rate for Payer: Amerigroup Medicare	$1.79
Rate for Payer: APIPA Medicare/Medicaid	$4.18
Rate for Payer: AZCH Complete Medicare	$1.79
Rate for Payer: Banner UC Health Medicare	$1.79
Rate for Payer: Bisbee Police All Plans	$2.91
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.62
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cigna of AZ Commercial	$7.28
Rate for Payer: Copperpoint Commercial	$2.77
Rate for Payer: Health Net of AZ Commercial	$6.72
Rate for Payer: Health Net of AZ Medicare	$3.14
Rate for Payer: Humana of AZ Medicare	$1.79
Rate for Payer: Self Pay Self Pay	$8.96
Rate for Payer: TriWest Medicare	$1.79
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.02

betamethasone-clotrimazole Top 0.05%-1% Crm [CQCH]

Facility

$11.20

Service Code	NDC 16714049602
Hospital Charge Code	105912979
Hospital Revenue Code	251
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$10.08
Rate for Payer: Aetna of AZ Commercial	$10.08
Rate for Payer: Bisbee Police All Plans	$2.91
Rate for Payer: Cash Price	$8.96
Rate for Payer: Self Pay Self Pay	$8.96

Bilirubin Direct

Facility

$112.00

Service Code	CPT 82248
Hospital Charge Code	633670
Hospital Revenue Code	301
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Aetna of AZ Medicare	$31.36
Rate for Payer: Allwell Medicare	$17.92
Rate for Payer: Amerigroup Medicare	$17.92
Rate for Payer: APIPA Medicare/Medicaid	$41.83
Rate for Payer: AZCH Complete Medicare	$17.92
Rate for Payer: Banner UC Health Medicare	$17.92
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$76.16
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$27.72
Rate for Payer: Health Net of AZ Commercial	$67.20
Rate for Payer: Health Net of AZ Medicare	$31.36
Rate for Payer: Humana of AZ Medicare	$17.92
Rate for Payer: Self Pay Self Pay	$89.60
Rate for Payer: TriWest Medicare	$17.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$65.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.16

Bilirubin Direct

Facility

$112.00

Service Code	CPT 82248
Hospital Charge Code	633670
Hospital Revenue Code	301
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Cash Price	$89.60
Rate for Payer: Self Pay Self Pay	$89.60

Bilirubin Total

Facility

$112.00

Service Code	CPT 82247
Hospital Charge Code	633672
Hospital Revenue Code	301
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Cash Price	$89.60
Rate for Payer: Self Pay Self Pay	$89.60

Bilirubin Total

Facility

$112.00

Service Code	CPT 82247
Hospital Charge Code	633672
Hospital Revenue Code	301
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Aetna of AZ Medicare	$31.36
Rate for Payer: Allwell Medicare	$17.92
Rate for Payer: Amerigroup Medicare	$17.92
Rate for Payer: APIPA Medicare/Medicaid	$41.83
Rate for Payer: AZCH Complete Medicare	$17.92
Rate for Payer: Banner UC Health Medicare	$17.92
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$76.16
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$27.72
Rate for Payer: Health Net of AZ Commercial	$67.20
Rate for Payer: Health Net of AZ Medicare	$31.36
Rate for Payer: Humana of AZ Medicare	$17.92
Rate for Payer: Self Pay Self Pay	$89.60
Rate for Payer: TriWest Medicare	$17.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$65.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.16

Bill 602503 Johnson Grass

Facility

$39.00

Service Code	CPT 86003
Hospital Charge Code	23143910
Hospital Revenue Code	301
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

Bill 602503 Johnson Grass

Facility

$39.00

Service Code	CPT 86003
Hospital Charge Code	23143910
Hospital Revenue Code	301
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: Allwell Medicare	$6.24
Rate for Payer: Amerigroup Medicare	$6.24
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicare	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$25.35
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

Bill 602872 Rye Grass

Facility

$39.00

Service Code	CPT 86003
Hospital Charge Code	23143911
Hospital Revenue Code	301
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: Allwell Medicare	$6.24
Rate for Payer: Amerigroup Medicare	$6.24
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicare	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$25.35
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

Bill 602872 Rye Grass

Facility

$39.00

Service Code	CPT 86003
Hospital Charge Code	23143911
Hospital Revenue Code	301
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

Bill 602931 Mimosa/acacia

Facility

$39.00

Service Code	CPT 86003
Hospital Charge Code	23143912
Hospital Revenue Code	301
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

Bill 602931 Mimosa/acacia

Facility

$39.00

Service Code	CPT 86003
Hospital Charge Code	23143912
Hospital Revenue Code	301
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: Allwell Medicare	$6.24
Rate for Payer: Amerigroup Medicare	$6.24
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicare	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$25.35
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

Bill ABID

Facility

$246.00

Service Code	CPT 86870
Hospital Charge Code	12537756
Hospital Revenue Code	302
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Aetna of AZ Medicare	$68.88
Rate for Payer: Allwell Medicare	$39.36
Rate for Payer: Amerigroup Medicare	$39.36
Rate for Payer: APIPA Medicare/Medicaid	$91.88
Rate for Payer: AZCH Complete Medicare	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$167.28
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$159.90
Rate for Payer: Copperpoint Commercial	$60.88
Rate for Payer: Health Net of AZ Commercial	$147.60
Rate for Payer: Health Net of AZ Medicare	$68.88
Rate for Payer: Humana of AZ Medicare	$39.36
Rate for Payer: Self Pay Self Pay	$196.80
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$143.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.28

Bill ABID

Facility

$246.00

Service Code	CPT 86870
Hospital Charge Code	12537756
Hospital Revenue Code	302
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Cash Price	$196.80
Rate for Payer: Self Pay Self Pay	$196.80

Bill ABID/each panel media

Facility

$237.00

Service Code	CPT 86870
Hospital Charge Code	2465092
Hospital Revenue Code	300
Min. Negotiated Rate	$37.92
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Aetna of AZ Medicare	$66.36
Rate for Payer: Allwell Medicare	$37.92
Rate for Payer: Amerigroup Medicare	$37.92
Rate for Payer: APIPA Medicare/Medicaid	$88.52
Rate for Payer: AZCH Complete Medicare	$37.92
Rate for Payer: Banner UC Health Medicare	$37.92
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Copperpoint Commercial	$58.66
Rate for Payer: Health Net of AZ Commercial	$142.20
Rate for Payer: Health Net of AZ Medicare	$66.36
Rate for Payer: Humana of AZ Medicare	$37.92
Rate for Payer: Self Pay Self Pay	$189.60
Rate for Payer: TriWest Medicare	$37.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.66

Bill ABID/each panel media

Facility

$237.00

Service Code	CPT 86870
Hospital Charge Code	2465092
Hospital Revenue Code	300
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Cash Price	$189.60
Rate for Payer: Self Pay Self Pay	$189.60

Bill Allergen Test

Facility

$145.00

Service Code	CPT 86003
Hospital Charge Code	23568451
Hospital Revenue Code	301
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of AZ Commercial	$130.50
Rate for Payer: Aetna of AZ Medicare	$40.60
Rate for Payer: Allwell Medicare	$23.20
Rate for Payer: Amerigroup Medicare	$23.20
Rate for Payer: APIPA Medicare/Medicaid	$54.16
Rate for Payer: AZCH Complete Medicare	$23.20
Rate for Payer: Banner UC Health Medicare	$23.20
Rate for Payer: Bisbee Police All Plans	$37.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$98.60
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cigna of AZ Commercial	$94.25
Rate for Payer: Copperpoint Commercial	$35.89
Rate for Payer: Health Net of AZ Commercial	$87.00
Rate for Payer: Health Net of AZ Medicare	$40.60
Rate for Payer: Humana of AZ Medicare	$23.20
Rate for Payer: Self Pay Self Pay	$116.00
Rate for Payer: TriWest Medicare	$23.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$84.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.10

Bill Allergen Test

Facility

$145.00

Service Code	CPT 86003
Hospital Charge Code	23568451
Hospital Revenue Code	301
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of AZ Commercial	$130.50
Rate for Payer: Bisbee Police All Plans	$37.70
Rate for Payer: Cash Price	$116.00
Rate for Payer: Self Pay Self Pay	$116.00

Bill Anti gbm

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	23568532
Hospital Revenue Code	301
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Aetna of AZ Medicare	$397.60
Rate for Payer: Allwell Medicare	$227.20
Rate for Payer: Amerigroup Medicare	$227.20
Rate for Payer: APIPA Medicare/Medicaid	$530.37
Rate for Payer: AZCH Complete Medicare	$227.20
Rate for Payer: Banner UC Health Medicare	$227.20
Rate for Payer: Bisbee Police All Plans	$369.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$965.60
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cigna of AZ Commercial	$923.00
Rate for Payer: Copperpoint Commercial	$351.45
Rate for Payer: Health Net of AZ Commercial	$852.00
Rate for Payer: Health Net of AZ Medicare	$397.60
Rate for Payer: Humana of AZ Medicare	$227.20
Rate for Payer: Self Pay Self Pay	$1,136.00
Rate for Payer: TriWest Medicare	$227.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$827.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$255.60

Bill Anti gbm

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	23568532
Hospital Revenue Code	301
Min. Negotiated Rate	$369.20
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Bisbee Police All Plans	$369.20
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Self Pay Self Pay	$1,136.00

Bill Anti-mullerian hormone

Facility

$374.00

Service Code	CPT 82397
Hospital Charge Code	23217725
Hospital Revenue Code	301
Min. Negotiated Rate	$59.84
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Aetna of AZ Medicare	$104.72
Rate for Payer: Allwell Medicare	$59.84
Rate for Payer: Amerigroup Medicare	$59.84
Rate for Payer: APIPA Medicare/Medicaid	$139.69
Rate for Payer: AZCH Complete Medicare	$59.84
Rate for Payer: Banner UC Health Medicare	$59.84
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$254.32
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cigna of AZ Commercial	$243.10
Rate for Payer: Copperpoint Commercial	$92.56
Rate for Payer: Health Net of AZ Commercial	$224.40
Rate for Payer: Health Net of AZ Medicare	$104.72
Rate for Payer: Humana of AZ Medicare	$59.84
Rate for Payer: Self Pay Self Pay	$299.20
Rate for Payer: TriWest Medicare	$59.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$218.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$67.32

Bill Anti-mullerian hormone

Facility

$374.00

Service Code	CPT 82397
Hospital Charge Code	23217725
Hospital Revenue Code	301
Min. Negotiated Rate	$97.24
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Cash Price	$299.20
Rate for Payer: Self Pay Self Pay	$299.20

Bill BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMM

Facility

$99.00

Service Code	CPT 82274
Hospital Charge Code	23621407
Hospital Revenue Code	301
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	$64.35
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

Bill BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMM

Facility

$99.00

Service Code	CPT 82274
Hospital Charge Code	23621407
Hospital Revenue Code	301
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

Bill BRCAssure Comp

Facility

$5,269.00

Hospital Charge Code	23568393
Hospital Revenue Code	301
Min. Negotiated Rate	$843.04
Max. Negotiated Rate	$4,742.10
Rate for Payer: Aetna of AZ Commercial	$4,742.10
Rate for Payer: Aetna of AZ Medicare	$1,475.32
Rate for Payer: Allwell Medicare	$843.04
Rate for Payer: Amerigroup Medicare	$843.04
Rate for Payer: APIPA Medicare/Medicaid	$1,967.97
Rate for Payer: AZCH Complete Medicare	$843.04
Rate for Payer: Banner UC Health Medicare	$843.04
Rate for Payer: Bisbee Police All Plans	$1,369.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,582.92
Rate for Payer: Cash Price	$4,215.20
Rate for Payer: Cigna of AZ Commercial	$3,424.85
Rate for Payer: Copperpoint Commercial	$1,304.08
Rate for Payer: Health Net of AZ Commercial	$3,161.40
Rate for Payer: Health Net of AZ Medicare	$1,475.32
Rate for Payer: Humana of AZ Medicare	$843.04
Rate for Payer: Self Pay Self Pay	$4,215.20
Rate for Payer: TriWest Medicare	$843.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,071.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$948.42

Know your out-of-pocket cost for care.

All Charges