Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CALR Mutation Analysis LC

Facility

$701.00

Service Code	CPT 81219
Hospital Charge Code	22311181
Hospital Revenue Code	302
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$630.90
Rate for Payer: Aetna of AZ Commercial	$630.90
Rate for Payer: Bisbee Police All Plans	$182.26
Rate for Payer: Cash Price	$560.80
Rate for Payer: Self Pay Self Pay	$560.80

CAMPYLOBACTER AG

Facility

$187.00

Service Code	CPT 87899
Hospital Charge Code	22422554
Hospital Revenue Code	306
Min. Negotiated Rate	$29.92
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Aetna of AZ Medicare	$52.36
Rate for Payer: Allwell Medicare	$29.92
Rate for Payer: Amerigroup Medicare	$29.92
Rate for Payer: APIPA Medicare/Medicaid	$69.84
Rate for Payer: AZCH Complete Medicare	$29.92
Rate for Payer: Banner UC Health Medicare	$29.92
Rate for Payer: Bisbee Police All Plans	$48.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$127.16
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cigna of AZ Commercial	$121.55
Rate for Payer: Copperpoint Commercial	$46.28
Rate for Payer: Health Net of AZ Commercial	$112.20
Rate for Payer: Health Net of AZ Medicare	$52.36
Rate for Payer: Humana of AZ Medicare	$29.92
Rate for Payer: Self Pay Self Pay	$149.60
Rate for Payer: TriWest Medicare	$29.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$109.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.66

CAMPYLOBACTER AG

Facility

$187.00

Service Code	CPT 87899
Hospital Charge Code	22422554
Hospital Revenue Code	306
Min. Negotiated Rate	$48.62
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Bisbee Police All Plans	$48.62
Rate for Payer: Cash Price	$149.60
Rate for Payer: Self Pay Self Pay	$149.60

.Campylobacter Cult Result LC

Facility

$83.00

Service Code	CPT 87899
Hospital Charge Code	1294563
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Cash Price	$66.40
Rate for Payer: Self Pay Self Pay	$66.40

.Campylobacter Cult Result LC

Facility

$83.00

Service Code	CPT 87899
Hospital Charge Code	1294563
Hospital Revenue Code	301
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Aetna of AZ Medicare	$23.24
Rate for Payer: Allwell Medicare	$13.28
Rate for Payer: Amerigroup Medicare	$13.28
Rate for Payer: APIPA Medicare/Medicaid	$31.00
Rate for Payer: AZCH Complete Medicare	$13.28
Rate for Payer: Banner UC Health Medicare	$13.28
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$56.44
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Copperpoint Commercial	$20.54
Rate for Payer: Health Net of AZ Commercial	$49.80
Rate for Payer: Health Net of AZ Medicare	$23.24
Rate for Payer: Humana of AZ Medicare	$13.28
Rate for Payer: Self Pay Self Pay	$66.40
Rate for Payer: TriWest Medicare	$13.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.94

Cancer Antigen (CA) 125 LC

Facility

$649.00

Service Code	CPT 86304
Hospital Charge Code	1285563
Hospital Revenue Code	302
Min. Negotiated Rate	$103.84
Max. Negotiated Rate	$584.10
Rate for Payer: Aetna of AZ Commercial	$584.10
Rate for Payer: Aetna of AZ Medicare	$181.72
Rate for Payer: Allwell Medicare	$103.84
Rate for Payer: Amerigroup Medicare	$103.84
Rate for Payer: APIPA Medicare/Medicaid	$242.40
Rate for Payer: AZCH Complete Medicare	$103.84
Rate for Payer: Banner UC Health Medicare	$103.84
Rate for Payer: Bisbee Police All Plans	$168.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$441.32
Rate for Payer: Cash Price	$519.20
Rate for Payer: Cigna of AZ Commercial	$421.85
Rate for Payer: Copperpoint Commercial	$160.63
Rate for Payer: Health Net of AZ Commercial	$389.40
Rate for Payer: Health Net of AZ Medicare	$181.72
Rate for Payer: Humana of AZ Medicare	$103.84
Rate for Payer: Self Pay Self Pay	$519.20
Rate for Payer: TriWest Medicare	$103.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$378.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$116.82

Cancer Antigen (CA) 125 LC

Facility

$649.00

Service Code	CPT 86304
Hospital Charge Code	1285563
Hospital Revenue Code	302
Min. Negotiated Rate	$168.74
Max. Negotiated Rate	$584.10
Rate for Payer: Aetna of AZ Commercial	$584.10
Rate for Payer: Bisbee Police All Plans	$168.74
Rate for Payer: Cash Price	$519.20
Rate for Payer: Self Pay Self Pay	$519.20

CANDIDA AB IGG, IGA, IGM, ELISA

Facility

$268.00

Service Code	CPT 86628
Hospital Charge Code	23294373
Hospital Revenue Code	301
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Cash Price	$214.40
Rate for Payer: Self Pay Self Pay	$214.40

CANDIDA AB IGG, IGA, IGM, ELISA

Facility

$268.00

Service Code	CPT 86628
Hospital Charge Code	23294373
Hospital Revenue Code	301
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Aetna of AZ Medicare	$75.04
Rate for Payer: Allwell Medicare	$42.88
Rate for Payer: Amerigroup Medicare	$42.88
Rate for Payer: APIPA Medicare/Medicaid	$100.10
Rate for Payer: AZCH Complete Medicare	$42.88
Rate for Payer: Banner UC Health Medicare	$42.88
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$182.24
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cigna of AZ Commercial	$174.20
Rate for Payer: Copperpoint Commercial	$66.33
Rate for Payer: Health Net of AZ Commercial	$160.80
Rate for Payer: Health Net of AZ Medicare	$75.04
Rate for Payer: Humana of AZ Medicare	$42.88
Rate for Payer: Self Pay Self Pay	$214.40
Rate for Payer: TriWest Medicare	$42.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$156.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.24

Candida Abs Ql LC

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	6780771
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

Candida Abs Ql LC

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	6780771
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

CANISTER STRYKER REF#502-100-000

Facility

$55.00

Hospital Charge Code	22355508
Hospital Revenue Code	270
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

CANISTER STRYKER REF#502-100-000

Facility

$55.00

Hospital Charge Code	22355508
Hospital Revenue Code	270
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.80
Rate for Payer: Amerigroup Medicare	$8.80
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

CANNULA NASAL ADULT

Facility

$5.00

Service Code	CPT A7034
Hospital Charge Code	22355589
Hospital Revenue Code	270
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Cash Price	$4.00
Rate for Payer: Self Pay Self Pay	$4.00

CANNULA NASAL ADULT

Facility

$5.00

Service Code	CPT A7034
Hospital Charge Code	22355589
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Aetna of AZ Medicare	$1.40
Rate for Payer: Allwell Medicare	$0.80
Rate for Payer: Amerigroup Medicare	$0.80
Rate for Payer: APIPA Medicare/Medicaid	$1.87
Rate for Payer: AZCH Complete Medicare	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.40
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Copperpoint Commercial	$1.24
Rate for Payer: Health Net of AZ Commercial	$3.00
Rate for Payer: Health Net of AZ Medicare	$1.40
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Self Pay Self Pay	$4.00
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.90

CANNULATED DRILL BIT FS3010

Facility

$2,452.00

Hospital Charge Code	27565273
Hospital Revenue Code	270
Min. Negotiated Rate	$392.32
Max. Negotiated Rate	$2,206.80
Rate for Payer: Aetna of AZ Commercial	$2,206.80
Rate for Payer: Aetna of AZ Medicare	$686.56
Rate for Payer: Allwell Medicare	$392.32
Rate for Payer: Amerigroup Medicare	$392.32
Rate for Payer: APIPA Medicare/Medicaid	$915.82
Rate for Payer: AZCH Complete Medicare	$392.32
Rate for Payer: Banner UC Health Medicare	$392.32
Rate for Payer: Bisbee Police All Plans	$637.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,667.36
Rate for Payer: Cash Price	$1,961.60
Rate for Payer: Cigna of AZ Commercial	$1,716.40
Rate for Payer: Copperpoint Commercial	$606.87
Rate for Payer: Health Net of AZ Commercial	$1,471.20
Rate for Payer: Health Net of AZ Medicare	$686.56
Rate for Payer: Humana of AZ Medicare	$392.32
Rate for Payer: Self Pay Self Pay	$1,961.60
Rate for Payer: TriWest Medicare	$392.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,429.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$441.36

CANNULATED DRILL BIT FS3010

Facility

$2,452.00

Hospital Charge Code	27565273
Hospital Revenue Code	270
Min. Negotiated Rate	$637.52
Max. Negotiated Rate	$2,206.80
Rate for Payer: Aetna of AZ Commercial	$2,206.80
Rate for Payer: Bisbee Police All Plans	$637.52
Rate for Payer: Cash Price	$1,961.60
Rate for Payer: Self Pay Self Pay	$1,961.60

CANNULATED DRILL BIT FS4030

Facility

$1,756.00

Hospital Charge Code	27565272
Hospital Revenue Code	270
Min. Negotiated Rate	$456.56
Max. Negotiated Rate	$1,580.40
Rate for Payer: Aetna of AZ Commercial	$1,580.40
Rate for Payer: Bisbee Police All Plans	$456.56
Rate for Payer: Cash Price	$1,404.80
Rate for Payer: Self Pay Self Pay	$1,404.80

CANNULATED DRILL BIT FS4030

Facility

$1,756.00

Hospital Charge Code	27565272
Hospital Revenue Code	270
Min. Negotiated Rate	$280.96
Max. Negotiated Rate	$1,580.40
Rate for Payer: Aetna of AZ Commercial	$1,580.40
Rate for Payer: Aetna of AZ Medicare	$491.68
Rate for Payer: Allwell Medicare	$280.96
Rate for Payer: Amerigroup Medicare	$280.96
Rate for Payer: APIPA Medicare/Medicaid	$655.87
Rate for Payer: AZCH Complete Medicare	$280.96
Rate for Payer: Banner UC Health Medicare	$280.96
Rate for Payer: Bisbee Police All Plans	$456.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,194.08
Rate for Payer: Cash Price	$1,404.80
Rate for Payer: Cigna of AZ Commercial	$1,229.20
Rate for Payer: Copperpoint Commercial	$434.61
Rate for Payer: Health Net of AZ Commercial	$1,053.60
Rate for Payer: Health Net of AZ Medicare	$491.68
Rate for Payer: Humana of AZ Medicare	$280.96
Rate for Payer: Self Pay Self Pay	$1,404.80
Rate for Payer: TriWest Medicare	$280.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,023.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$316.08

Ca+PTH Intact LC

Facility

$78.00

Service Code	CPT 82310
Hospital Charge Code	2269455
Hospital Revenue Code	301
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

Ca+PTH Intact LC

Facility

$78.00

Service Code	CPT 82310
Hospital Charge Code	2269455
Hospital Revenue Code	301
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: Allwell Medicare	$12.48
Rate for Payer: Amerigroup Medicare	$12.48
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicare	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

CAPTIVATOR COLD SNARE

Facility

$72.00

Hospital Charge Code	23833620
Hospital Revenue Code	270
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Aetna of AZ Medicare	$20.16
Rate for Payer: Allwell Medicare	$11.52
Rate for Payer: Amerigroup Medicare	$11.52
Rate for Payer: APIPA Medicare/Medicaid	$26.89
Rate for Payer: AZCH Complete Medicare	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Copperpoint Commercial	$17.82
Rate for Payer: Health Net of AZ Commercial	$43.20
Rate for Payer: Health Net of AZ Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Self Pay Self Pay	$57.60
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.96

CAPTIVATOR COLD SNARE

Facility

$72.00

Hospital Charge Code	23833620
Hospital Revenue Code	270
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Cash Price	$57.60
Rate for Payer: Self Pay Self Pay	$57.60

captopril 25 mg Tab [CQCH]

Facility

$0.83

Service Code	NDC 51079086420
Hospital Charge Code	105914325
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of AZ Commercial	$0.75
Rate for Payer: Aetna of AZ Medicare	$0.23
Rate for Payer: Allwell Medicare	$0.13
Rate for Payer: Amerigroup Medicare	$0.13
Rate for Payer: APIPA Medicare/Medicaid	$0.31
Rate for Payer: AZCH Complete Medicare	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.56
Rate for Payer: Cash Price	$0.66
Rate for Payer: Cigna of AZ Commercial	$0.54
Rate for Payer: Copperpoint Commercial	$0.21
Rate for Payer: Health Net of AZ Commercial	$0.50
Rate for Payer: Health Net of AZ Medicare	$0.23
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Self Pay Self Pay	$0.66
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

captopril 25 mg Tab [CQCH]

Facility

$0.83

Service Code	NDC 51079086420
Hospital Charge Code	105914325
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of AZ Commercial	$0.75
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Cash Price	$0.66
Rate for Payer: Self Pay Self Pay	$0.66

Know your out-of-pocket cost for care.

All Charges