Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Bill BRCAssure Comp

Facility

$5,269.00

Hospital Charge Code	23568393
Hospital Revenue Code	301
Min. Negotiated Rate	$1,369.94
Max. Negotiated Rate	$4,742.10
Rate for Payer: Aetna of AZ Commercial	$4,742.10
Rate for Payer: Bisbee Police All Plans	$1,369.94
Rate for Payer: Cash Price	$4,215.20
Rate for Payer: Self Pay Self Pay	$4,215.20

Bill Capillary Draw

Facility

$34.00

Service Code	CPT 36416
Hospital Charge Code	10443835
Hospital Revenue Code	300
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	$22.10
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

Bill Capillary Draw

Facility

$34.00

Service Code	CPT 36416
Hospital Charge Code	10443835
Hospital Revenue Code	300
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

Bill CMV Quant DNA PCR

Facility

$320.00

Service Code	CPT 87497
Hospital Charge Code	23568396
Hospital Revenue Code	301
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna of AZ Commercial	$288.00
Rate for Payer: Aetna of AZ Medicare	$89.60
Rate for Payer: Allwell Medicare	$51.20
Rate for Payer: Amerigroup Medicare	$51.20
Rate for Payer: APIPA Medicare/Medicaid	$119.52
Rate for Payer: AZCH Complete Medicare	$51.20
Rate for Payer: Banner UC Health Medicare	$51.20
Rate for Payer: Bisbee Police All Plans	$83.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$217.60
Rate for Payer: Cash Price	$256.00
Rate for Payer: Cigna of AZ Commercial	$208.00
Rate for Payer: Copperpoint Commercial	$79.20
Rate for Payer: Health Net of AZ Commercial	$192.00
Rate for Payer: Health Net of AZ Medicare	$89.60
Rate for Payer: Humana of AZ Medicare	$51.20
Rate for Payer: Self Pay Self Pay	$256.00
Rate for Payer: TriWest Medicare	$51.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$186.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.60

Bill CMV Quant DNA PCR

Facility

$320.00

Service Code	CPT 87497
Hospital Charge Code	23568396
Hospital Revenue Code	301
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna of AZ Commercial	$288.00
Rate for Payer: Bisbee Police All Plans	$83.20
Rate for Payer: Cash Price	$256.00
Rate for Payer: Self Pay Self Pay	$256.00

Bill Cryo Prep/Thaw

Facility

$177.00

Service Code	CPT 86931
Hospital Charge Code	22248792
Hospital Revenue Code	302
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

Bill Cryo Prep/Thaw

Facility

$177.00

Service Code	CPT 86931
Hospital Charge Code	22248792
Hospital Revenue Code	302
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

Bill Culture ID Aerobie Confirm

Facility

$138.00

Service Code	CPT 87077
Hospital Charge Code	22374498
Hospital Revenue Code	306
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Bisbee Police All Plans	$35.88
Rate for Payer: Cash Price	$110.40
Rate for Payer: Self Pay Self Pay	$110.40

Bill Culture ID Aerobie Confirm

Facility

$138.00

Service Code	CPT 87077
Hospital Charge Code	22374498
Hospital Revenue Code	306
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Aetna of AZ Medicare	$38.64
Rate for Payer: Allwell Medicare	$22.08
Rate for Payer: Amerigroup Medicare	$22.08
Rate for Payer: APIPA Medicare/Medicaid	$51.54
Rate for Payer: AZCH Complete Medicare	$22.08
Rate for Payer: Banner UC Health Medicare	$22.08
Rate for Payer: Bisbee Police All Plans	$35.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$93.84
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cigna of AZ Commercial	$89.70
Rate for Payer: Copperpoint Commercial	$34.16
Rate for Payer: Health Net of AZ Commercial	$82.80
Rate for Payer: Health Net of AZ Medicare	$38.64
Rate for Payer: Humana of AZ Medicare	$22.08
Rate for Payer: Self Pay Self Pay	$110.40
Rate for Payer: TriWest Medicare	$22.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$80.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.84

Bill Culture Stool, Vibrio Only

Facility

$88.00

Service Code	CPT 87046
Hospital Charge Code	22374496
Hospital Revenue Code	306
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Aetna of AZ Medicare	$24.64
Rate for Payer: Allwell Medicare	$14.08
Rate for Payer: Amerigroup Medicare	$14.08
Rate for Payer: APIPA Medicare/Medicaid	$32.87
Rate for Payer: AZCH Complete Medicare	$14.08
Rate for Payer: Banner UC Health Medicare	$14.08
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$57.20
Rate for Payer: Copperpoint Commercial	$21.78
Rate for Payer: Health Net of AZ Commercial	$52.80
Rate for Payer: Health Net of AZ Medicare	$24.64
Rate for Payer: Humana of AZ Medicare	$14.08
Rate for Payer: Self Pay Self Pay	$70.40
Rate for Payer: TriWest Medicare	$14.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.84

Bill Culture Stool, Vibrio Only

Facility

$88.00

Service Code	CPT 87046
Hospital Charge Code	22374496
Hospital Revenue Code	306
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Cash Price	$70.40
Rate for Payer: Self Pay Self Pay	$70.40

BILL CULTURE STOOL, YERSINIA ONLY

Facility

$116.00

Service Code	CPT 87046
Hospital Charge Code	22374494
Hospital Revenue Code	306
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

BILL CULTURE STOOL, YERSINIA ONLY

Facility

$116.00

Service Code	CPT 87046
Hospital Charge Code	22374494
Hospital Revenue Code	306
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	$75.40
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

Bill Cystic Fibrosis Profile

Facility

$252.00

Service Code	CPT 81220
Hospital Charge Code	23568394
Hospital Revenue Code	301
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of AZ Commercial	$226.80
Rate for Payer: Bisbee Police All Plans	$65.52
Rate for Payer: Cash Price	$201.60
Rate for Payer: Self Pay Self Pay	$201.60

Bill Cystic Fibrosis Profile

Facility

$252.00

Service Code	CPT 81220
Hospital Charge Code	23568394
Hospital Revenue Code	301
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of AZ Commercial	$226.80
Rate for Payer: Aetna of AZ Medicare	$70.56
Rate for Payer: Allwell Medicare	$40.32
Rate for Payer: Amerigroup Medicare	$40.32
Rate for Payer: APIPA Medicare/Medicaid	$94.12
Rate for Payer: AZCH Complete Medicare	$40.32
Rate for Payer: Banner UC Health Medicare	$40.32
Rate for Payer: Bisbee Police All Plans	$65.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$171.36
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cigna of AZ Commercial	$163.80
Rate for Payer: Copperpoint Commercial	$62.37
Rate for Payer: Health Net of AZ Commercial	$151.20
Rate for Payer: Health Net of AZ Medicare	$70.56
Rate for Payer: Humana of AZ Medicare	$40.32
Rate for Payer: Self Pay Self Pay	$201.60
Rate for Payer: TriWest Medicare	$40.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$146.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.36

Bill FFP Prep/Thaw

Facility

$255.00

Service Code	CPT 86927
Hospital Charge Code	22248793
Hospital Revenue Code	302
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Cash Price	$204.00
Rate for Payer: Self Pay Self Pay	$204.00

Bill FFP Prep/Thaw

Facility

$255.00

Service Code	CPT 86927
Hospital Charge Code	22248793
Hospital Revenue Code	302
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Aetna of AZ Medicare	$71.40
Rate for Payer: Allwell Medicare	$40.80
Rate for Payer: Amerigroup Medicare	$40.80
Rate for Payer: APIPA Medicare/Medicaid	$95.24
Rate for Payer: AZCH Complete Medicare	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$173.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Copperpoint Commercial	$63.11
Rate for Payer: Health Net of AZ Commercial	$153.00
Rate for Payer: Health Net of AZ Medicare	$71.40
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Self Pay Self Pay	$204.00
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.90

Bill Hep b dna quant

Facility

$1,416.00

Service Code	CPT 87912
Hospital Charge Code	23568533
Hospital Revenue Code	301
Min. Negotiated Rate	$226.56
Max. Negotiated Rate	$1,274.40
Rate for Payer: Aetna of AZ Commercial	$1,274.40
Rate for Payer: Aetna of AZ Medicare	$396.48
Rate for Payer: Allwell Medicare	$226.56
Rate for Payer: Amerigroup Medicare	$226.56
Rate for Payer: APIPA Medicare/Medicaid	$528.88
Rate for Payer: AZCH Complete Medicare	$226.56
Rate for Payer: Banner UC Health Medicare	$226.56
Rate for Payer: Bisbee Police All Plans	$368.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$962.88
Rate for Payer: Cash Price	$1,132.80
Rate for Payer: Cigna of AZ Commercial	$920.40
Rate for Payer: Copperpoint Commercial	$350.46
Rate for Payer: Health Net of AZ Commercial	$849.60
Rate for Payer: Health Net of AZ Medicare	$396.48
Rate for Payer: Humana of AZ Medicare	$226.56
Rate for Payer: Self Pay Self Pay	$1,132.80
Rate for Payer: TriWest Medicare	$226.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$825.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$254.88

Bill Hep b dna quant

Facility

$1,416.00

Service Code	CPT 87912
Hospital Charge Code	23568533
Hospital Revenue Code	301
Min. Negotiated Rate	$368.16
Max. Negotiated Rate	$1,274.40
Rate for Payer: Aetna of AZ Commercial	$1,274.40
Rate for Payer: Bisbee Police All Plans	$368.16
Rate for Payer: Cash Price	$1,132.80
Rate for Payer: Self Pay Self Pay	$1,132.80

Bill Hep b genotype

Facility

$546.00

Service Code	CPT 87912
Hospital Charge Code	23568534
Hospital Revenue Code	301
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Aetna of AZ Medicare	$152.88
Rate for Payer: Allwell Medicare	$87.36
Rate for Payer: Amerigroup Medicare	$87.36
Rate for Payer: APIPA Medicare/Medicaid	$203.93
Rate for Payer: AZCH Complete Medicare	$87.36
Rate for Payer: Banner UC Health Medicare	$87.36
Rate for Payer: Bisbee Police All Plans	$141.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$371.28
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cigna of AZ Commercial	$354.90
Rate for Payer: Copperpoint Commercial	$135.13
Rate for Payer: Health Net of AZ Commercial	$327.60
Rate for Payer: Health Net of AZ Medicare	$152.88
Rate for Payer: Humana of AZ Medicare	$87.36
Rate for Payer: Self Pay Self Pay	$436.80
Rate for Payer: TriWest Medicare	$87.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$318.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$98.28

Bill Hep b genotype

Facility

$546.00

Service Code	CPT 87912
Hospital Charge Code	23568534
Hospital Revenue Code	301
Min. Negotiated Rate	$141.96
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Bisbee Police All Plans	$141.96
Rate for Payer: Cash Price	$436.80
Rate for Payer: Self Pay Self Pay	$436.80

Bill HIV-1 RNA

Facility

$653.00

Service Code	CPT 87536
Hospital Charge Code	22985134
Hospital Revenue Code	306
Min. Negotiated Rate	$169.78
Max. Negotiated Rate	$587.70
Rate for Payer: Aetna of AZ Commercial	$587.70
Rate for Payer: Bisbee Police All Plans	$169.78
Rate for Payer: Cash Price	$522.40
Rate for Payer: Self Pay Self Pay	$522.40

Bill HIV-1 RNA

Facility

$653.00

Service Code	CPT 87536
Hospital Charge Code	22985134
Hospital Revenue Code	306
Min. Negotiated Rate	$104.48
Max. Negotiated Rate	$587.70
Rate for Payer: Aetna of AZ Commercial	$587.70
Rate for Payer: Aetna of AZ Medicare	$182.84
Rate for Payer: Allwell Medicare	$104.48
Rate for Payer: Amerigroup Medicare	$104.48
Rate for Payer: APIPA Medicare/Medicaid	$243.90
Rate for Payer: AZCH Complete Medicare	$104.48
Rate for Payer: Banner UC Health Medicare	$104.48
Rate for Payer: Bisbee Police All Plans	$169.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$444.04
Rate for Payer: Cash Price	$522.40
Rate for Payer: Cigna of AZ Commercial	$424.45
Rate for Payer: Copperpoint Commercial	$161.62
Rate for Payer: Health Net of AZ Commercial	$391.80
Rate for Payer: Health Net of AZ Medicare	$182.84
Rate for Payer: Humana of AZ Medicare	$104.48
Rate for Payer: Self Pay Self Pay	$522.40
Rate for Payer: TriWest Medicare	$104.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$380.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$117.54

Bill Ige Dog dander

Facility

$76.00

Service Code	CPT 86003
Hospital Charge Code	23217726
Hospital Revenue Code	301
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

Bill Ige Dog dander

Facility

$76.00

Service Code	CPT 86003
Hospital Charge Code	23217726
Hospital Revenue Code	301
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$12.16
Rate for Payer: Amerigroup Medicare	$12.16
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

Know your out-of-pocket cost for care.

All Charges