Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

CLIENT ABG STICK

Facility

$171.00

Service Code	CPT 36600
Hospital Charge Code	22331130
Hospital Revenue Code	460
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Aetna of AZ Medicare	$47.88
Rate for Payer: Allwell Medicare	$27.36
Rate for Payer: Amerigroup Medicare	$27.36
Rate for Payer: APIPA Medicare/Medicaid	$63.87
Rate for Payer: AZCH Complete Medicare	$27.36
Rate for Payer: Banner UC Health Medicare	$27.36
Rate for Payer: Bisbee Police All Plans	$44.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.28
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna of AZ Commercial	$119.70
Rate for Payer: Copperpoint Commercial	$42.32
Rate for Payer: Health Net of AZ Commercial	$102.60
Rate for Payer: Health Net of AZ Medicare	$47.88
Rate for Payer: Humana of AZ Medicare	$27.36
Rate for Payer: Self Pay Self Pay	$136.80
Rate for Payer: TriWest Medicare	$27.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.78

CLIENT ABG STICK

Facility

$171.00

Service Code	CPT 36600
Hospital Charge Code	22331130
Hospital Revenue Code	460
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Bisbee Police All Plans	$44.46
Rate for Payer: Cash Price	$136.80
Rate for Payer: Self Pay Self Pay	$136.80

CLIENT ALCOHOL BREATH

Facility

$28.00

Service Code	CPT 82075
Hospital Charge Code	22331138
Hospital Revenue Code	301
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of AZ Commercial	$25.20
Rate for Payer: Aetna of AZ Medicare	$7.84
Rate for Payer: Allwell Medicare	$4.48
Rate for Payer: Amerigroup Medicare	$4.48
Rate for Payer: APIPA Medicare/Medicaid	$10.46
Rate for Payer: AZCH Complete Medicare	$4.48
Rate for Payer: Banner UC Health Medicare	$4.48
Rate for Payer: Bisbee Police All Plans	$7.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.04
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.93
Rate for Payer: Health Net of AZ Commercial	$16.80
Rate for Payer: Health Net of AZ Medicare	$7.84
Rate for Payer: Humana of AZ Medicare	$4.48
Rate for Payer: Self Pay Self Pay	$22.40
Rate for Payer: TriWest Medicare	$4.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.04

CLIENT ALCOHOL BREATH

Facility

$28.00

Service Code	CPT 82075
Hospital Charge Code	22331138
Hospital Revenue Code	301
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of AZ Commercial	$25.20
Rate for Payer: Bisbee Police All Plans	$7.28
Rate for Payer: Cash Price	$22.40
Rate for Payer: Self Pay Self Pay	$22.40

CLIENT AMYLASE

Facility

$20.00

Service Code	CPT 82150
Hospital Charge Code	22331142
Hospital Revenue Code	301
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

CLIENT AMYLASE

Facility

$20.00

Service Code	CPT 82150
Hospital Charge Code	22331142
Hospital Revenue Code	301
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$13.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

CLIENT AUDIOMETRY

Facility

$22.00

Hospital Charge Code	22331153
Hospital Revenue Code	301
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Aetna of AZ Medicare	$6.16
Rate for Payer: Allwell Medicare	$3.52
Rate for Payer: Amerigroup Medicare	$3.52
Rate for Payer: APIPA Medicare/Medicaid	$8.22
Rate for Payer: AZCH Complete Medicare	$3.52
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.96
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$14.30
Rate for Payer: Copperpoint Commercial	$5.45
Rate for Payer: Health Net of AZ Commercial	$13.20
Rate for Payer: Health Net of AZ Medicare	$6.16
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Self Pay Self Pay	$17.60
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.96

CLIENT AUDIOMETRY

Facility

$22.00

Hospital Charge Code	22331153
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Cash Price	$17.60
Rate for Payer: Self Pay Self Pay	$17.60

CLIENT BASIC PHYSICAL EXAM

Facility

$55.00

Hospital Charge Code	22331158
Hospital Revenue Code	301
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

CLIENT BASIC PHYSICAL EXAM

Facility

$55.00

Hospital Charge Code	22331158
Hospital Revenue Code	301
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	$35.75
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

CLIENT BLOOD COLLECTION

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331170
Hospital Revenue Code	300
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CLIENT BLOOD COLLECTION

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331170
Hospital Revenue Code	300
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.92
Rate for Payer: Amerigroup Medicare	$1.92
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$7.80
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CLIENT BLOOD COLLECT LC

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331168
Hospital Revenue Code	300
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.92
Rate for Payer: Amerigroup Medicare	$1.92
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$7.80
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CLIENT BLOOD COLLECT LC

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331168
Hospital Revenue Code	300
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CLIENT BLOOD COLLECT SQ

Facility

$13.00

Service Code	CPT 36415
Hospital Charge Code	22331169
Hospital Revenue Code	300
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

CLIENT BLOOD COLLECT SQ

Facility

$13.00

Service Code	CPT 36415
Hospital Charge Code	22331169
Hospital Revenue Code	300
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$8.45
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

CLIENT CARTRIDGE RESPIRATOR FIT TEST

Facility

$48.00

Hospital Charge Code	22331178
Hospital Revenue Code	999
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CLIENT CARTRIDGE RESPIRATOR FIT TEST

Facility

$48.00

Hospital Charge Code	22331178
Hospital Revenue Code	999
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.68
Rate for Payer: Amerigroup Medicare	$7.68
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CLIENT CATH URETHRA COMPLEX

Facility

$315.00

Service Code	CPT 51703
Hospital Charge Code	22331180
Hospital Revenue Code	450
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$283.50
Rate for Payer: Aetna of AZ Medicare	$88.20
Rate for Payer: AHCCCS Medicaid	$101.17
Rate for Payer: Allwell Medicaid	$101.17
Rate for Payer: Allwell Medicare	$50.40
Rate for Payer: Amerigroup Medicare	$50.40
Rate for Payer: APIPA Medicare/Medicaid	$117.65
Rate for Payer: AZCH Complete Medicaid	$101.17
Rate for Payer: AZCH Complete Medicare	$50.40
Rate for Payer: Banner UC Health Medicaid	$101.17
Rate for Payer: Banner UC Health Medicare	$50.40
Rate for Payer: Bisbee Police All Plans	$81.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$214.20
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cigna of AZ Commercial	$220.50
Rate for Payer: Copperpoint Commercial	$77.96
Rate for Payer: Health Net of AZ Commercial	$189.00
Rate for Payer: Health Net of AZ Medicare	$88.20
Rate for Payer: Humana of AZ Medicare	$50.40
Rate for Payer: Mercy Care Medicaid	$101.17
Rate for Payer: Self Pay Self Pay	$252.00
Rate for Payer: TriWest Medicare	$50.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$56.70

CLIENT CATH URETHRA COMPLEX

Facility

$315.00

Service Code	CPT 51703
Hospital Charge Code	22331180
Hospital Revenue Code	450
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna of AZ Commercial	$283.50
Rate for Payer: Bisbee Police All Plans	$81.90
Rate for Payer: Cash Price	$252.00
Rate for Payer: Self Pay Self Pay	$252.00

CLIENT CATH URETHRA SIMPLE

Facility

$106.00

Service Code	CPT 51701
Hospital Charge Code	22331181
Hospital Revenue Code	450
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$16.96
Rate for Payer: Amerigroup Medicare	$16.96
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$74.20
Rate for Payer: Copperpoint Commercial	$26.23
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

CLIENT CATH URETHRA SIMPLE

Facility

$106.00

Service Code	CPT 51701
Hospital Charge Code	22331181
Hospital Revenue Code	450
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

Know your out-of-pocket cost for care.

All Charges