Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

D-Dimer 2

Facility

$311.00

Service Code	CPT 85379
Hospital Charge Code	18323368
Hospital Revenue Code	305
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Aetna of AZ Medicare	$87.08
Rate for Payer: AHCCCS Medicaid	$10.18
Rate for Payer: Allwell Medicaid	$10.18
Rate for Payer: Allwell Medicare	$46.65
Rate for Payer: Amerigroup Medicare	$46.65
Rate for Payer: APIPA Medicare/Medicaid	$116.16
Rate for Payer: AZCH Complete Medicaid	$10.18
Rate for Payer: AZCH Complete Medicare	$46.65
Rate for Payer: Banner UC Health Medicaid	$10.18
Rate for Payer: Banner UC Health Medicare	$46.65
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$211.48
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Copperpoint Commercial	$76.97
Rate for Payer: Health Net of AZ Commercial	$186.60
Rate for Payer: Health Net of AZ Medicare	$87.08
Rate for Payer: Humana of AZ Medicare	$46.65
Rate for Payer: Mercy Care Medicaid	$10.18
Rate for Payer: Self Pay Self Pay	$248.80
Rate for Payer: TriWest Medicare	$46.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$181.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.98

D-Dimer 2

Facility

$311.00

Service Code	CPT 85379
Hospital Charge Code	18323368
Hospital Revenue Code	305
Min. Negotiated Rate	$80.86
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Cash Price	$248.80
Rate for Payer: Self Pay Self Pay	$248.80

DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE CQCH

Facility

$71.00

Service Code	CPT 11720
Hospital Charge Code	24049508
Hospital Revenue Code	360
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE CQCH

Facility

$71.00

Service Code	CPT 11720
Hospital Charge Code	24049508
Hospital Revenue Code	360
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: AHCCCS Medicaid	$80.70
Rate for Payer: Allwell Medicaid	$80.70
Rate for Payer: Allwell Medicare	$10.65
Rate for Payer: Amerigroup Medicare	$10.65
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicaid	$80.70
Rate for Payer: AZCH Complete Medicare	$10.65
Rate for Payer: Banner UC Health Medicaid	$80.70
Rate for Payer: Banner UC Health Medicare	$10.65
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$35.50
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$10.65
Rate for Payer: Mercy Care Medicaid	$80.70
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$10.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE CQCH

Facility

$115.00

Service Code	CPT 11721
Hospital Charge Code	24049509
Hospital Revenue Code	360
Min. Negotiated Rate	$29.90
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Cash Price	$92.00
Rate for Payer: Self Pay Self Pay	$92.00

DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE CQCH

Facility

$115.00

Service Code	CPT 11721
Hospital Charge Code	24049509
Hospital Revenue Code	360
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Aetna of AZ Medicare	$32.20
Rate for Payer: AHCCCS Medicaid	$80.70
Rate for Payer: Allwell Medicaid	$80.70
Rate for Payer: Allwell Medicare	$17.25
Rate for Payer: Amerigroup Medicare	$17.25
Rate for Payer: APIPA Medicare/Medicaid	$42.95
Rate for Payer: AZCH Complete Medicaid	$80.70
Rate for Payer: AZCH Complete Medicare	$17.25
Rate for Payer: Banner UC Health Medicaid	$80.70
Rate for Payer: Banner UC Health Medicare	$17.25
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.20
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cigna of AZ Commercial	$57.50
Rate for Payer: Copperpoint Commercial	$28.46
Rate for Payer: Health Net of AZ Commercial	$69.00
Rate for Payer: Health Net of AZ Medicare	$32.20
Rate for Payer: Humana of AZ Medicare	$17.25
Rate for Payer: Mercy Care Medicaid	$80.70
Rate for Payer: Self Pay Self Pay	$92.00
Rate for Payer: TriWest Medicare	$17.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.70

DECALCIFICATION PROCEDURE

Facility

$643.00

Service Code	CPT 88311
Hospital Charge Code	22545717
Hospital Revenue Code	310
Min. Negotiated Rate	$167.18
Max. Negotiated Rate	$578.70
Rate for Payer: Aetna of AZ Commercial	$578.70
Rate for Payer: Bisbee Police All Plans	$167.18
Rate for Payer: Cash Price	$514.40
Rate for Payer: Self Pay Self Pay	$514.40

DECALCIFICATION PROCEDURE

Facility

$643.00

Service Code	CPT 88311
Hospital Charge Code	22545717
Hospital Revenue Code	310
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$578.70
Rate for Payer: Aetna of AZ Commercial	$578.70
Rate for Payer: Aetna of AZ Medicare	$180.04
Rate for Payer: AHCCCS Medicaid	$12.26
Rate for Payer: Allwell Medicaid	$12.26
Rate for Payer: Allwell Medicare	$96.45
Rate for Payer: Amerigroup Medicare	$96.45
Rate for Payer: APIPA Medicare/Medicaid	$240.16
Rate for Payer: AZCH Complete Medicaid	$12.26
Rate for Payer: AZCH Complete Medicare	$96.45
Rate for Payer: Banner UC Health Medicaid	$12.26
Rate for Payer: Banner UC Health Medicare	$96.45
Rate for Payer: Bisbee Police All Plans	$167.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$437.24
Rate for Payer: Cash Price	$514.40
Rate for Payer: Cash Price	$514.40
Rate for Payer: Cigna of AZ Commercial	$417.95
Rate for Payer: Copperpoint Commercial	$159.14
Rate for Payer: Health Net of AZ Commercial	$385.80
Rate for Payer: Health Net of AZ Medicare	$180.04
Rate for Payer: Humana of AZ Medicare	$96.45
Rate for Payer: Mercy Care Medicaid	$12.26
Rate for Payer: Self Pay Self Pay	$514.40
Rate for Payer: TriWest Medicare	$96.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$374.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$115.74

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: AHCCCS Medicaid	$32,110.79
Rate for Payer: Allwell Medicaid	$32,110.79
Rate for Payer: AZCH Complete Medicaid	$32,110.79
Rate for Payer: Banner UC Health Medicaid	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: AHCCCS Medicaid	$43,469.97
Rate for Payer: Allwell Medicaid	$43,469.97
Rate for Payer: AZCH Complete Medicaid	$43,469.97
Rate for Payer: Banner UC Health Medicaid	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: AHCCCS Medicaid	$43,469.97
Rate for Payer: Allwell Medicaid	$43,469.97
Rate for Payer: AZCH Complete Medicaid	$43,469.97
Rate for Payer: Banner UC Health Medicaid	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: AHCCCS Medicaid	$23,301.21
Rate for Payer: Allwell Medicaid	$23,301.21
Rate for Payer: AZCH Complete Medicaid	$23,301.21
Rate for Payer: Banner UC Health Medicaid	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: AHCCCS Medicaid	$23,301.21
Rate for Payer: Allwell Medicaid	$23,301.21
Rate for Payer: AZCH Complete Medicaid	$23,301.21
Rate for Payer: Banner UC Health Medicaid	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: AHCCCS Medicaid	$26,401.40
Rate for Payer: Allwell Medicaid	$26,401.40
Rate for Payer: AZCH Complete Medicaid	$26,401.40
Rate for Payer: Banner UC Health Medicaid	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: AHCCCS Medicaid	$26,401.40
Rate for Payer: Allwell Medicaid	$26,401.40
Rate for Payer: AZCH Complete Medicaid	$26,401.40
Rate for Payer: Banner UC Health Medicaid	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: AHCCCS Medicaid	$26,401.40
Rate for Payer: Allwell Medicaid	$26,401.40
Rate for Payer: AZCH Complete Medicaid	$26,401.40
Rate for Payer: Banner UC Health Medicaid	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: AHCCCS Medicaid	$43,469.97
Rate for Payer: Allwell Medicaid	$43,469.97
Rate for Payer: AZCH Complete Medicaid	$43,469.97
Rate for Payer: Banner UC Health Medicaid	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: AHCCCS Medicaid	$32,110.79
Rate for Payer: Allwell Medicaid	$32,110.79
Rate for Payer: AZCH Complete Medicaid	$32,110.79
Rate for Payer: Banner UC Health Medicaid	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: AHCCCS Medicaid	$26,401.40
Rate for Payer: Allwell Medicaid	$26,401.40
Rate for Payer: AZCH Complete Medicaid	$26,401.40
Rate for Payer: Banner UC Health Medicaid	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: AHCCCS Medicaid	$43,469.97
Rate for Payer: Allwell Medicaid	$43,469.97
Rate for Payer: AZCH Complete Medicaid	$43,469.97
Rate for Payer: Banner UC Health Medicaid	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: AHCCCS Medicaid	$23,301.21
Rate for Payer: Allwell Medicaid	$23,301.21
Rate for Payer: AZCH Complete Medicaid	$23,301.21
Rate for Payer: Banner UC Health Medicaid	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: AHCCCS Medicaid	$32,110.79
Rate for Payer: Allwell Medicaid	$32,110.79
Rate for Payer: AZCH Complete Medicaid	$32,110.79
Rate for Payer: Banner UC Health Medicaid	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: AHCCCS Medicaid	$23,301.21
Rate for Payer: Allwell Medicaid	$23,301.21
Rate for Payer: AZCH Complete Medicaid	$23,301.21
Rate for Payer: Banner UC Health Medicaid	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: AHCCCS Medicaid	$32,110.79
Rate for Payer: Allwell Medicaid	$32,110.79
Rate for Payer: AZCH Complete Medicaid	$32,110.79
Rate for Payer: Banner UC Health Medicaid	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79

DEFOGGER

Facility

$11.00

Hospital Charge Code	22355325
Hospital Revenue Code	272
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Cash Price	$8.80
Rate for Payer: Self Pay Self Pay	$8.80

Know your out-of-pocket cost for care.

All Charges