Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

COOK FLEX PARALLEL URETRL ACCESS SHTH 28

Facility

$534.00

Hospital Charge Code	22354209
Hospital Revenue Code	270
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$480.60
Rate for Payer: Aetna of AZ Commercial	$480.60
Rate for Payer: Aetna of AZ Medicare	$149.52
Rate for Payer: Allwell Medicare	$80.10
Rate for Payer: Amerigroup Medicare	$80.10
Rate for Payer: APIPA Medicare/Medicaid	$199.45
Rate for Payer: AZCH Complete Medicare	$80.10
Rate for Payer: Banner UC Health Medicare	$80.10
Rate for Payer: Bisbee Police All Plans	$138.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$363.12
Rate for Payer: Cash Price	$427.20
Rate for Payer: Cigna of AZ Commercial	$373.80
Rate for Payer: Copperpoint Commercial	$132.16
Rate for Payer: Health Net of AZ Commercial	$320.40
Rate for Payer: Health Net of AZ Medicare	$149.52
Rate for Payer: Humana of AZ Medicare	$80.10
Rate for Payer: Self Pay Self Pay	$427.20
Rate for Payer: TriWest Medicare	$80.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$311.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$96.12

COOK FLEX PARALLEL URETRL ACCESS SHTH 28

Facility

$534.00

Hospital Charge Code	22354209
Hospital Revenue Code	270
Min. Negotiated Rate	$138.84
Max. Negotiated Rate	$480.60
Rate for Payer: Aetna of AZ Commercial	$480.60
Rate for Payer: Bisbee Police All Plans	$138.84
Rate for Payer: Cash Price	$427.20
Rate for Payer: Self Pay Self Pay	$427.20

COOK G14255

Facility

$90.00

Hospital Charge Code	22618969
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

COOK G14255

Facility

$90.00

Hospital Charge Code	22618969
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$13.50
Rate for Payer: Amerigroup Medicare	$13.50
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$13.50
Rate for Payer: Banner UC Health Medicare	$13.50
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$22.28
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$13.50
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$13.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

COOK G14519

Facility

$155.00

Hospital Charge Code	22618967
Hospital Revenue Code	272
Min. Negotiated Rate	$40.30
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Cash Price	$124.00
Rate for Payer: Self Pay Self Pay	$124.00

COOK G14519

Facility

$155.00

Hospital Charge Code	22618967
Hospital Revenue Code	272
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Aetna of AZ Medicare	$43.40
Rate for Payer: Allwell Medicare	$23.25
Rate for Payer: Amerigroup Medicare	$23.25
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$23.25
Rate for Payer: Banner UC Health Medicare	$23.25
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$105.40
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Copperpoint Commercial	$38.36
Rate for Payer: Health Net of AZ Commercial	$93.00
Rate for Payer: Health Net of AZ Medicare	$43.40
Rate for Payer: Humana of AZ Medicare	$23.25
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$23.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

COOK G17976

Facility

$123.00

Hospital Charge Code	22619412
Hospital Revenue Code	272
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$110.70
Rate for Payer: Aetna of AZ Commercial	$110.70
Rate for Payer: Bisbee Police All Plans	$31.98
Rate for Payer: Cash Price	$98.40
Rate for Payer: Self Pay Self Pay	$98.40

COOK G17976

Facility

$123.00

Hospital Charge Code	22619412
Hospital Revenue Code	272
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$110.70
Rate for Payer: Aetna of AZ Commercial	$110.70
Rate for Payer: Aetna of AZ Medicare	$34.44
Rate for Payer: Allwell Medicare	$18.45
Rate for Payer: Amerigroup Medicare	$18.45
Rate for Payer: APIPA Medicare/Medicaid	$45.94
Rate for Payer: AZCH Complete Medicare	$18.45
Rate for Payer: Banner UC Health Medicare	$18.45
Rate for Payer: Bisbee Police All Plans	$31.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$83.64
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cigna of AZ Commercial	$86.10
Rate for Payer: Copperpoint Commercial	$30.44
Rate for Payer: Health Net of AZ Commercial	$73.80
Rate for Payer: Health Net of AZ Medicare	$34.44
Rate for Payer: Humana of AZ Medicare	$18.45
Rate for Payer: Self Pay Self Pay	$98.40
Rate for Payer: TriWest Medicare	$18.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$71.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.14

COOK G18063

Facility

$222.00

Hospital Charge Code	22619410
Hospital Revenue Code	272
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

COOK G18063

Facility

$222.00

Hospital Charge Code	22619410
Hospital Revenue Code	272
Min. Negotiated Rate	$33.30
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	$33.30
Rate for Payer: Amerigroup Medicare	$33.30
Rate for Payer: APIPA Medicare/Medicaid	$82.92
Rate for Payer: AZCH Complete Medicare	$33.30
Rate for Payer: Banner UC Health Medicare	$33.30
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	$54.94
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	$33.30
Rate for Payer: Self Pay Self Pay	$177.60
Rate for Payer: TriWest Medicare	$33.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$129.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.96

COOK G30357

Facility

$948.00

Hospital Charge Code	22619312
Hospital Revenue Code	272
Min. Negotiated Rate	$246.48
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Bisbee Police All Plans	$246.48
Rate for Payer: Cash Price	$758.40
Rate for Payer: Self Pay Self Pay	$758.40

COOK G30357

Facility

$948.00

Hospital Charge Code	22619312
Hospital Revenue Code	272
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Aetna of AZ Medicare	$265.44
Rate for Payer: Allwell Medicare	$142.20
Rate for Payer: Amerigroup Medicare	$142.20
Rate for Payer: APIPA Medicare/Medicaid	$354.08
Rate for Payer: AZCH Complete Medicare	$142.20
Rate for Payer: Banner UC Health Medicare	$142.20
Rate for Payer: Bisbee Police All Plans	$246.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$644.64
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cigna of AZ Commercial	$663.60
Rate for Payer: Copperpoint Commercial	$234.63
Rate for Payer: Health Net of AZ Commercial	$568.80
Rate for Payer: Health Net of AZ Medicare	$265.44
Rate for Payer: Humana of AZ Medicare	$142.20
Rate for Payer: Self Pay Self Pay	$758.40
Rate for Payer: TriWest Medicare	$142.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$552.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$170.64

COOK G34931

Facility

$792.00

Hospital Charge Code	22619414
Hospital Revenue Code	272
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$712.80
Rate for Payer: Aetna of AZ Commercial	$712.80
Rate for Payer: Aetna of AZ Medicare	$221.76
Rate for Payer: Allwell Medicare	$118.80
Rate for Payer: Amerigroup Medicare	$118.80
Rate for Payer: APIPA Medicare/Medicaid	$295.81
Rate for Payer: AZCH Complete Medicare	$118.80
Rate for Payer: Banner UC Health Medicare	$118.80
Rate for Payer: Bisbee Police All Plans	$205.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$538.56
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cigna of AZ Commercial	$554.40
Rate for Payer: Copperpoint Commercial	$196.02
Rate for Payer: Health Net of AZ Commercial	$475.20
Rate for Payer: Health Net of AZ Medicare	$221.76
Rate for Payer: Humana of AZ Medicare	$118.80
Rate for Payer: Self Pay Self Pay	$633.60
Rate for Payer: TriWest Medicare	$118.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$461.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$142.56

COOK G34931

Facility

$792.00

Hospital Charge Code	22619414
Hospital Revenue Code	272
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$712.80
Rate for Payer: Aetna of AZ Commercial	$712.80
Rate for Payer: Bisbee Police All Plans	$205.92
Rate for Payer: Cash Price	$633.60
Rate for Payer: Self Pay Self Pay	$633.60

COOK G53566

Facility

$142.00

Hospital Charge Code	22619314
Hospital Revenue Code	272
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

COOK G53566

Facility

$142.00

Hospital Charge Code	22619314
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: Allwell Medicare	$21.30
Rate for Payer: Amerigroup Medicare	$21.30
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicare	$21.30
Rate for Payer: Banner UC Health Medicare	$21.30
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$99.40
Rate for Payer: Copperpoint Commercial	$35.14
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$21.30
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$21.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

COOK ULTRAXX NEPHROSTOMY BALLOON SET 10M

Facility

$948.00

Hospital Charge Code	22354223
Hospital Revenue Code	270
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Aetna of AZ Medicare	$265.44
Rate for Payer: Allwell Medicare	$142.20
Rate for Payer: Amerigroup Medicare	$142.20
Rate for Payer: APIPA Medicare/Medicaid	$354.08
Rate for Payer: AZCH Complete Medicare	$142.20
Rate for Payer: Banner UC Health Medicare	$142.20
Rate for Payer: Bisbee Police All Plans	$246.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$644.64
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cigna of AZ Commercial	$663.60
Rate for Payer: Copperpoint Commercial	$234.63
Rate for Payer: Health Net of AZ Commercial	$568.80
Rate for Payer: Health Net of AZ Medicare	$265.44
Rate for Payer: Humana of AZ Medicare	$142.20
Rate for Payer: Self Pay Self Pay	$758.40
Rate for Payer: TriWest Medicare	$142.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$552.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$170.64

COOK ULTRAXX NEPHROSTOMY BALLOON SET 10M

Facility

$948.00

Hospital Charge Code	22354223
Hospital Revenue Code	270
Min. Negotiated Rate	$246.48
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Bisbee Police All Plans	$246.48
Rate for Payer: Cash Price	$758.40
Rate for Payer: Self Pay Self Pay	$758.40

Copper Serum LC

Facility

$156.00

Service Code	CPT 82525
Hospital Charge Code	1285554
Hospital Revenue Code	301
Min. Negotiated Rate	$40.56
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Cash Price	$124.80
Rate for Payer: Self Pay Self Pay	$124.80

Copper Serum LC

Facility

$156.00

Service Code	CPT 82525
Hospital Charge Code	1285554
Hospital Revenue Code	301
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Aetna of AZ Medicare	$43.68
Rate for Payer: AHCCCS Medicaid	$12.41
Rate for Payer: Allwell Medicaid	$12.41
Rate for Payer: Allwell Medicare	$23.40
Rate for Payer: Amerigroup Medicare	$23.40
Rate for Payer: APIPA Medicare/Medicaid	$58.27
Rate for Payer: AZCH Complete Medicaid	$12.41
Rate for Payer: AZCH Complete Medicare	$23.40
Rate for Payer: Banner UC Health Medicaid	$12.41
Rate for Payer: Banner UC Health Medicare	$23.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$106.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cigna of AZ Commercial	$101.40
Rate for Payer: Copperpoint Commercial	$38.61
Rate for Payer: Health Net of AZ Commercial	$93.60
Rate for Payer: Health Net of AZ Medicare	$43.68
Rate for Payer: Humana of AZ Medicare	$23.40
Rate for Payer: Mercy Care Medicaid	$12.41
Rate for Payer: Self Pay Self Pay	$124.80
Rate for Payer: TriWest Medicare	$23.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.08

Copper, Urine LC

Facility

$156.00

Service Code	CPT 82525
Hospital Charge Code	2029250
Hospital Revenue Code	301
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Aetna of AZ Medicare	$43.68
Rate for Payer: AHCCCS Medicaid	$12.41
Rate for Payer: Allwell Medicaid	$12.41
Rate for Payer: Allwell Medicare	$23.40
Rate for Payer: Amerigroup Medicare	$23.40
Rate for Payer: APIPA Medicare/Medicaid	$58.27
Rate for Payer: AZCH Complete Medicaid	$12.41
Rate for Payer: AZCH Complete Medicare	$23.40
Rate for Payer: Banner UC Health Medicaid	$12.41
Rate for Payer: Banner UC Health Medicare	$23.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$106.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cigna of AZ Commercial	$101.40
Rate for Payer: Copperpoint Commercial	$38.61
Rate for Payer: Health Net of AZ Commercial	$93.60
Rate for Payer: Health Net of AZ Medicare	$43.68
Rate for Payer: Humana of AZ Medicare	$23.40
Rate for Payer: Mercy Care Medicaid	$12.41
Rate for Payer: Self Pay Self Pay	$124.80
Rate for Payer: TriWest Medicare	$23.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.08

Copper, Urine LC

Facility

$156.00

Service Code	CPT 82525
Hospital Charge Code	2029250
Hospital Revenue Code	301
Min. Negotiated Rate	$40.56
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Cash Price	$124.80
Rate for Payer: Self Pay Self Pay	$124.80

CORD DISPOSABLE KLEPPINGER

Facility

$117.00

Hospital Charge Code	22355015
Hospital Revenue Code	272
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of AZ Commercial	$105.30
Rate for Payer: Bisbee Police All Plans	$30.42
Rate for Payer: Cash Price	$93.60
Rate for Payer: Self Pay Self Pay	$93.60

CORD DISPOSABLE KLEPPINGER

Facility

$117.00

Hospital Charge Code	22355015
Hospital Revenue Code	272
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of AZ Commercial	$105.30
Rate for Payer: Aetna of AZ Medicare	$32.76
Rate for Payer: Allwell Medicare	$17.55
Rate for Payer: Amerigroup Medicare	$17.55
Rate for Payer: APIPA Medicare/Medicaid	$43.70
Rate for Payer: AZCH Complete Medicare	$17.55
Rate for Payer: Banner UC Health Medicare	$17.55
Rate for Payer: Bisbee Police All Plans	$30.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$79.56
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna of AZ Commercial	$81.90
Rate for Payer: Copperpoint Commercial	$28.96
Rate for Payer: Health Net of AZ Commercial	$70.20
Rate for Payer: Health Net of AZ Medicare	$32.76
Rate for Payer: Humana of AZ Medicare	$17.55
Rate for Payer: Self Pay Self Pay	$93.60
Rate for Payer: TriWest Medicare	$17.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.06

Cord Gas Venous 1

Facility

$309.00

Service Code	CPT 82803
Hospital Charge Code	5144987
Hospital Revenue Code	301
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Cash Price	$247.20
Rate for Payer: Self Pay Self Pay	$247.20

Know your out-of-pocket cost for care.

All Charges