Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

00140 ANES EYE PROCEDURE ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406078
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00140 ANES EYE PROCEDURE ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406078
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00140 ANES EYE PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406079
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00140 ANES EYE PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406079
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00164 ANES NOSE SINUS BIOPSY ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00164
Hospital Charge Code	22406081
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00164 ANES NOSE SINUS BIOPSY ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00164
Hospital Charge Code	22406081
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00164 ANES NOSE SINUS BIOPSY ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00164
Hospital Charge Code	22406082
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00164 ANES NOSE SINUS BIOPSY ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00164
Hospital Charge Code	22406082
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00300 ANES HEAD NECK POSTERIOR PROC ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00300
Hospital Charge Code	22406217
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00300 ANES HEAD NECK POSTERIOR PROC ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00300
Hospital Charge Code	22406217
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00300 ANES HEAD NECK POSTERIOR PROC ADDNL 30 CHARGE

Facility

$298.00

Service Code	CPT 00300
Hospital Charge Code	22406218
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00300 ANES HEAD NECK POSTERIOR PROC ADDNL 30 CHARGE

Facility

$298.00

Service Code	CPT 00300
Hospital Charge Code	22406218
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00300 ANES HEAD NECK POSTERIOR PROCEDURE BASE CHG AND 1ST MI

Facility

$490.00

Service Code	CPT 00300
Hospital Charge Code	22406215
Hospital Revenue Code	964
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Aetna of AZ Medicare	$137.20
Rate for Payer: Allwell Medicare	$78.40
Rate for Payer: Amerigroup Medicare	$78.40
Rate for Payer: APIPA Medicare/Medicaid	$183.01
Rate for Payer: AZCH Complete Medicare	$78.40
Rate for Payer: Banner UC Health Medicare	$78.40
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$333.20
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cigna of AZ Commercial	$343.00
Rate for Payer: Copperpoint Commercial	$121.28
Rate for Payer: Health Net of AZ Commercial	$294.00
Rate for Payer: Health Net of AZ Medicare	$137.20
Rate for Payer: Humana of AZ Medicare	$78.40
Rate for Payer: Self Pay Self Pay	$392.00
Rate for Payer: TriWest Medicare	$78.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$285.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.20

00300 ANES HEAD NECK POSTERIOR PROCEDURE BASE CHG AND 1ST MI

Facility

$490.00

Service Code	CPT 00300
Hospital Charge Code	22406215
Hospital Revenue Code	964
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Cash Price	$392.00
Rate for Payer: Self Pay Self Pay	$392.00

00400 ANES INTEGUMENTARY SYSTEM ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00400
Hospital Charge Code	22406084
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00400 ANES INTEGUMENTARY SYSTEM ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00400
Hospital Charge Code	22406084
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00400 ANES INTEGUMENTARY SYSTEM ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00400
Hospital Charge Code	22406085
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00400 ANES INTEGUMENTARY SYSTEM ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00400
Hospital Charge Code	22406085
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

007012 Lacosamide

Facility

$1,041.00

Service Code	CPT 80339
Hospital Charge Code	23173817
Hospital Revenue Code	301
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$936.90
Rate for Payer: Aetna of AZ Commercial	$936.90
Rate for Payer: Bisbee Police All Plans	$270.66
Rate for Payer: Cash Price	$832.80
Rate for Payer: Self Pay Self Pay	$832.80

007012 Lacosamide

Facility

$1,041.00

Service Code	CPT 80339
Hospital Charge Code	23173817
Hospital Revenue Code	301
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$936.90
Rate for Payer: Aetna of AZ Commercial	$936.90
Rate for Payer: Aetna of AZ Medicare	$291.48
Rate for Payer: Allwell Medicare	$166.56
Rate for Payer: Amerigroup Medicare	$166.56
Rate for Payer: APIPA Medicare/Medicaid	$388.81
Rate for Payer: AZCH Complete Medicare	$166.56
Rate for Payer: Banner UC Health Medicare	$166.56
Rate for Payer: Bisbee Police All Plans	$270.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$707.88
Rate for Payer: Cash Price	$832.80
Rate for Payer: Cigna of AZ Commercial	$676.65
Rate for Payer: Copperpoint Commercial	$257.65
Rate for Payer: Health Net of AZ Commercial	$624.60
Rate for Payer: Health Net of AZ Medicare	$291.48
Rate for Payer: Humana of AZ Medicare	$166.56
Rate for Payer: Self Pay Self Pay	$832.80
Rate for Payer: TriWest Medicare	$166.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$606.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$187.38

00731 ANES UPPER GASTRO ENDO ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00731
Hospital Charge Code	22406087
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00731 ANES UPPER GASTRO ENDO ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00731
Hospital Charge Code	22406087
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00731 ANES UPPER GASTRO ENDO ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00731
Hospital Charge Code	22406088
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00731 ANES UPPER GASTRO ENDO ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00731
Hospital Charge Code	22406088
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00790 ANES INTRAPER UPPER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406094
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

Know your out-of-pocket cost for care.

All Charges