Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY A

Facility

$676.00

Service Code	CPT 55700
Hospital Charge Code	27883521
Hospital Revenue Code	360
Min. Negotiated Rate	$175.76
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Bisbee Police All Plans	$175.76
Rate for Payer: Cash Price	$540.80
Rate for Payer: Self Pay Self Pay	$540.80

BIPAP SET-UP

Facility

$1,987.00

Service Code	CPT 94002
Hospital Charge Code	1886931
Hospital Revenue Code	410
Min. Negotiated Rate	$516.62
Max. Negotiated Rate	$1,788.30
Rate for Payer: Aetna of AZ Commercial	$1,788.30
Rate for Payer: Bisbee Police All Plans	$516.62
Rate for Payer: Cash Price	$1,589.60
Rate for Payer: Self Pay Self Pay	$1,589.60

BIPAP SET-UP

Facility

$1,987.00

Service Code	CPT 94002
Hospital Charge Code	1886931
Hospital Revenue Code	410
Min. Negotiated Rate	$317.92
Max. Negotiated Rate	$1,788.30
Rate for Payer: Aetna of AZ Commercial	$1,788.30
Rate for Payer: Aetna of AZ Medicare	$556.36
Rate for Payer: Allwell Medicare	$317.92
Rate for Payer: Amerigroup Medicare	$317.92
Rate for Payer: APIPA Medicare/Medicaid	$742.14
Rate for Payer: AZCH Complete Medicare	$317.92
Rate for Payer: Banner UC Health Medicare	$317.92
Rate for Payer: Bisbee Police All Plans	$516.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,351.16
Rate for Payer: Cash Price	$1,589.60
Rate for Payer: Cigna of AZ Commercial	$1,390.90
Rate for Payer: Copperpoint Commercial	$491.78
Rate for Payer: Health Net of AZ Commercial	$1,192.20
Rate for Payer: Health Net of AZ Medicare	$556.36
Rate for Payer: Humana of AZ Medicare	$317.92
Rate for Payer: Self Pay Self Pay	$1,589.60
Rate for Payer: TriWest Medicare	$317.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,158.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$357.66

BIPAP SUBSEQUENT DAY

Facility

$1,704.00

Service Code	CPT 94003
Hospital Charge Code	1886932
Hospital Revenue Code	410
Min. Negotiated Rate	$443.04
Max. Negotiated Rate	$1,533.60
Rate for Payer: Aetna of AZ Commercial	$1,533.60
Rate for Payer: Bisbee Police All Plans	$443.04
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Self Pay Self Pay	$1,363.20

BIPAP SUBSEQUENT DAY

Facility

$1,704.00

Service Code	CPT 94003
Hospital Charge Code	1886932
Hospital Revenue Code	410
Min. Negotiated Rate	$272.64
Max. Negotiated Rate	$1,533.60
Rate for Payer: Aetna of AZ Commercial	$1,533.60
Rate for Payer: Aetna of AZ Medicare	$477.12
Rate for Payer: Allwell Medicare	$272.64
Rate for Payer: Amerigroup Medicare	$272.64
Rate for Payer: APIPA Medicare/Medicaid	$636.44
Rate for Payer: AZCH Complete Medicare	$272.64
Rate for Payer: Banner UC Health Medicare	$272.64
Rate for Payer: Bisbee Police All Plans	$443.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,158.72
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cigna of AZ Commercial	$1,192.80
Rate for Payer: Copperpoint Commercial	$421.74
Rate for Payer: Health Net of AZ Commercial	$1,022.40
Rate for Payer: Health Net of AZ Medicare	$477.12
Rate for Payer: Humana of AZ Medicare	$272.64
Rate for Payer: Self Pay Self Pay	$1,363.20
Rate for Payer: TriWest Medicare	$272.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$993.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$306.72

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

bisacodyl 10 mg Supp [CQCH]

Facility

$0.08

Service Code	NDC 713010912
Hospital Charge Code	105913109
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

bisacodyl 10 mg Supp [CQCH]

Facility

$0.08

Service Code	NDC 713010912
Hospital Charge Code	105913109
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

bisacodyl 5 mg EC Tab [CQCH]

Facility

$0.03

Service Code	NDC 904640761
Hospital Charge Code	105913044
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

bisacodyl 5 mg EC Tab [CQCH]

Facility

$0.03

Service Code	NDC 904640761
Hospital Charge Code	105913044
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges