Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

BITE PROOF BITE BLOCK

Facility

$56.35

Hospital Charge Code	27542969
Hospital Revenue Code	270
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$50.72
Rate for Payer: Aetna of AZ Commercial	$50.72
Rate for Payer: Aetna of AZ Medicare	$15.78
Rate for Payer: Allwell Medicare	$9.02
Rate for Payer: Amerigroup Medicare	$9.02
Rate for Payer: APIPA Medicare/Medicaid	$21.05
Rate for Payer: AZCH Complete Medicare	$9.02
Rate for Payer: Banner UC Health Medicare	$9.02
Rate for Payer: Bisbee Police All Plans	$14.65
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.32
Rate for Payer: Cash Price	$45.08
Rate for Payer: Cigna of AZ Commercial	$39.45
Rate for Payer: Copperpoint Commercial	$13.95
Rate for Payer: Health Net of AZ Commercial	$33.81
Rate for Payer: Health Net of AZ Medicare	$15.78
Rate for Payer: Humana of AZ Medicare	$9.02
Rate for Payer: Self Pay Self Pay	$45.08
Rate for Payer: TriWest Medicare	$9.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.14

BITE PROOF BITE BLOCK

Facility

$56.35

Hospital Charge Code	27542969
Hospital Revenue Code	270
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$50.72
Rate for Payer: Aetna of AZ Commercial	$50.72
Rate for Payer: Bisbee Police All Plans	$14.65
Rate for Payer: Cash Price	$45.08
Rate for Payer: Self Pay Self Pay	$45.08

BK Quant PCR (Plasma/Serum) LC

Facility

$532.00

Service Code	CPT 87799
Hospital Charge Code	2029177
Hospital Revenue Code	306
Min. Negotiated Rate	$85.12
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of AZ Commercial	$478.80
Rate for Payer: Aetna of AZ Medicare	$148.96
Rate for Payer: Allwell Medicare	$85.12
Rate for Payer: Amerigroup Medicare	$85.12
Rate for Payer: APIPA Medicare/Medicaid	$198.70
Rate for Payer: AZCH Complete Medicare	$85.12
Rate for Payer: Banner UC Health Medicare	$85.12
Rate for Payer: Bisbee Police All Plans	$138.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$361.76
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cigna of AZ Commercial	$345.80
Rate for Payer: Copperpoint Commercial	$131.67
Rate for Payer: Health Net of AZ Commercial	$319.20
Rate for Payer: Health Net of AZ Medicare	$148.96
Rate for Payer: Humana of AZ Medicare	$85.12
Rate for Payer: Self Pay Self Pay	$425.60
Rate for Payer: TriWest Medicare	$85.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$310.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$95.76

BK Quant PCR (Plasma/Serum) LC

Facility

$532.00

Service Code	CPT 87799
Hospital Charge Code	2029177
Hospital Revenue Code	306
Min. Negotiated Rate	$138.32
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of AZ Commercial	$478.80
Rate for Payer: Bisbee Police All Plans	$138.32
Rate for Payer: Cash Price	$425.60
Rate for Payer: Self Pay Self Pay	$425.60

Black Silicone Filiform ureteral stent

Facility

$1,159.00

Hospital Charge Code	22926477
Hospital Revenue Code	272
Min. Negotiated Rate	$301.34
Max. Negotiated Rate	$1,043.10
Rate for Payer: Aetna of AZ Commercial	$1,043.10
Rate for Payer: Bisbee Police All Plans	$301.34
Rate for Payer: Cash Price	$927.20
Rate for Payer: Self Pay Self Pay	$927.20

Black Silicone Filiform ureteral stent

Facility

$1,159.00

Hospital Charge Code	22926477
Hospital Revenue Code	272
Min. Negotiated Rate	$185.44
Max. Negotiated Rate	$1,043.10
Rate for Payer: Aetna of AZ Commercial	$1,043.10
Rate for Payer: Aetna of AZ Medicare	$324.52
Rate for Payer: Allwell Medicare	$185.44
Rate for Payer: Amerigroup Medicare	$185.44
Rate for Payer: APIPA Medicare/Medicaid	$432.89
Rate for Payer: AZCH Complete Medicare	$185.44
Rate for Payer: Banner UC Health Medicare	$185.44
Rate for Payer: Bisbee Police All Plans	$301.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$788.12
Rate for Payer: Cash Price	$927.20
Rate for Payer: Cigna of AZ Commercial	$811.30
Rate for Payer: Copperpoint Commercial	$286.85
Rate for Payer: Health Net of AZ Commercial	$695.40
Rate for Payer: Health Net of AZ Medicare	$324.52
Rate for Payer: Humana of AZ Medicare	$185.44
Rate for Payer: Self Pay Self Pay	$927.20
Rate for Payer: TriWest Medicare	$185.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$675.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$208.62

Bladder scan (PVR)

Facility

$53.00

Service Code	CPT 51798
Hospital Charge Code	27267788
Hospital Revenue Code	360
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Cash Price	$42.40
Rate for Payer: Self Pay Self Pay	$42.40

Bladder scan (PVR)

Facility

$53.00

Service Code	CPT 51798
Hospital Charge Code	27267788
Hospital Revenue Code	360
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Aetna of AZ Medicare	$14.84
Rate for Payer: Allwell Medicare	$8.48
Rate for Payer: Amerigroup Medicare	$8.48
Rate for Payer: APIPA Medicare/Medicaid	$19.80
Rate for Payer: AZCH Complete Medicare	$8.48
Rate for Payer: Banner UC Health Medicare	$8.48
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$36.04
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$26.50
Rate for Payer: Copperpoint Commercial	$13.12
Rate for Payer: Health Net of AZ Commercial	$31.80
Rate for Payer: Health Net of AZ Medicare	$14.84
Rate for Payer: Humana of AZ Medicare	$8.48
Rate for Payer: Self Pay Self Pay	$42.40
Rate for Payer: TriWest Medicare	$8.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.54

BLADE CUDA 4.2MM

Facility

$213.00

Hospital Charge Code	22354870
Hospital Revenue Code	270
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Cash Price	$170.40
Rate for Payer: Self Pay Self Pay	$170.40

BLADE CUDA 4.2MM

Facility

$213.00

Hospital Charge Code	22354870
Hospital Revenue Code	270
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Aetna of AZ Medicare	$59.64
Rate for Payer: Allwell Medicare	$34.08
Rate for Payer: Amerigroup Medicare	$34.08
Rate for Payer: APIPA Medicare/Medicaid	$79.56
Rate for Payer: AZCH Complete Medicare	$34.08
Rate for Payer: Banner UC Health Medicare	$34.08
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.84
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cigna of AZ Commercial	$149.10
Rate for Payer: Copperpoint Commercial	$52.72
Rate for Payer: Health Net of AZ Commercial	$127.80
Rate for Payer: Health Net of AZ Medicare	$59.64
Rate for Payer: Humana of AZ Medicare	$34.08
Rate for Payer: Self Pay Self Pay	$170.40
Rate for Payer: TriWest Medicare	$34.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$124.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.34

BLADE GLIDESCOPE GVL 1

Facility

$109.00

Hospital Charge Code	22560418
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

BLADE GLIDESCOPE GVL 1

Facility

$109.00

Hospital Charge Code	22560418
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

BLADE GLIDESCOPE GVL 2

Facility

$109.00

Hospital Charge Code	22561231
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

BLADE GLIDESCOPE GVL 2

Facility

$109.00

Hospital Charge Code	22561231
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

BLADE GLIDESCOPE GVL 3

Facility

$109.00

Hospital Charge Code	22561233
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

BLADE GLIDESCOPE GVL 3

Facility

$109.00

Hospital Charge Code	22561233
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

BLADE GLIDESCOPE GVL 4

Facility

$109.00

Hospital Charge Code	22561235
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

BLADE GLIDESCOPE GVL 4

Facility

$109.00

Hospital Charge Code	22561235
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

BLADE GLIDESCOPE SML

Facility

$109.00

Hospital Charge Code	22354971
Hospital Revenue Code	270
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

BLADE GLIDESCOPE SML

Facility

$109.00

Hospital Charge Code	22354971
Hospital Revenue Code	270
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

BLADE LARYNGASCOPE #3

Facility

$222.00

Hospital Charge Code	22354256
Hospital Revenue Code	270
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Cash Price	$177.60
Rate for Payer: Self Pay Self Pay	$177.60

BLADE LARYNGASCOPE #3

Facility

$222.00

Hospital Charge Code	22354256
Hospital Revenue Code	270
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Aetna of AZ Medicare	$62.16
Rate for Payer: Allwell Medicare	$35.52
Rate for Payer: Amerigroup Medicare	$35.52
Rate for Payer: APIPA Medicare/Medicaid	$82.92
Rate for Payer: AZCH Complete Medicare	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$150.96
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$155.40
Rate for Payer: Copperpoint Commercial	$54.95
Rate for Payer: Health Net of AZ Commercial	$133.20
Rate for Payer: Health Net of AZ Medicare	$62.16
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Self Pay Self Pay	$177.60
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$129.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.96

BLADE SM62 PODIATRY

Facility

$18.00

Hospital Charge Code	22926423
Hospital Revenue Code	272
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.88
Rate for Payer: Amerigroup Medicare	$2.88
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

BLADE SM62 PODIATRY

Facility

$18.00

Hospital Charge Code	22926423
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

Blood Admininstration

Facility

$958.00

Service Code	CPT 36430
Hospital Charge Code	22349429
Hospital Revenue Code	391
Min. Negotiated Rate	$249.08
Max. Negotiated Rate	$862.20
Rate for Payer: Aetna of AZ Commercial	$862.20
Rate for Payer: Bisbee Police All Plans	$249.08
Rate for Payer: Cash Price	$766.40
Rate for Payer: Self Pay Self Pay	$766.40

Know your out-of-pocket cost for care.

All Charges