Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Digestive Malignancy

Facility

$5,198.78

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG2402
Min. Negotiated Rate	$5,198.78
Max. Negotiated Rate	$5,198.78
Rate for Payer: AHCCCS Medicaid	$5,198.78
Rate for Payer: Allwell Medicaid	$5,198.78
Rate for Payer: AZCH Complete Medicaid	$5,198.78
Rate for Payer: Banner UC Health Medicaid	$5,198.78
Rate for Payer: Mercy Care Medicaid	$5,198.78

Digestive Malignancy

Facility

$8,453.27

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG2401
Min. Negotiated Rate	$8,453.27
Max. Negotiated Rate	$8,453.27
Rate for Payer: AHCCCS Medicaid	$8,453.27
Rate for Payer: Allwell Medicaid	$8,453.27
Rate for Payer: AZCH Complete Medicaid	$8,453.27
Rate for Payer: Banner UC Health Medicaid	$8,453.27
Rate for Payer: Mercy Care Medicaid	$8,453.27

Digestive Malignancy

Facility

$15,754.85

Service Code	APR-DRG 2404
Hospital Charge Code	APRDRG2401
Min. Negotiated Rate	$15,754.85
Max. Negotiated Rate	$15,754.85
Rate for Payer: AHCCCS Medicaid	$15,754.85
Rate for Payer: Allwell Medicaid	$15,754.85
Rate for Payer: AZCH Complete Medicaid	$15,754.85
Rate for Payer: Banner UC Health Medicaid	$15,754.85
Rate for Payer: Mercy Care Medicaid	$15,754.85

Digestive Malignancy

Facility

$15,754.85

Service Code	APR-DRG 2404
Hospital Charge Code	APRDRG2403
Min. Negotiated Rate	$15,754.85
Max. Negotiated Rate	$15,754.85
Rate for Payer: AHCCCS Medicaid	$15,754.85
Rate for Payer: Allwell Medicaid	$15,754.85
Rate for Payer: AZCH Complete Medicaid	$15,754.85
Rate for Payer: Banner UC Health Medicaid	$15,754.85
Rate for Payer: Mercy Care Medicaid	$15,754.85

Digestive Malignancy

Facility

$5,986.45

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG2402
Min. Negotiated Rate	$5,986.45
Max. Negotiated Rate	$5,986.45
Rate for Payer: AHCCCS Medicaid	$5,986.45
Rate for Payer: Allwell Medicaid	$5,986.45
Rate for Payer: AZCH Complete Medicaid	$5,986.45
Rate for Payer: Banner UC Health Medicaid	$5,986.45
Rate for Payer: Mercy Care Medicaid	$5,986.45

Digestive Malignancy

Facility

$15,754.85

Service Code	APR-DRG 2404
Hospital Charge Code	APRDRG2402
Min. Negotiated Rate	$15,754.85
Max. Negotiated Rate	$15,754.85
Rate for Payer: AHCCCS Medicaid	$15,754.85
Rate for Payer: Allwell Medicaid	$15,754.85
Rate for Payer: AZCH Complete Medicaid	$15,754.85
Rate for Payer: Banner UC Health Medicaid	$15,754.85
Rate for Payer: Mercy Care Medicaid	$15,754.85

Digestive Malignancy

Facility

$5,986.45

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG2401
Min. Negotiated Rate	$5,986.45
Max. Negotiated Rate	$5,986.45
Rate for Payer: AHCCCS Medicaid	$5,986.45
Rate for Payer: Allwell Medicaid	$5,986.45
Rate for Payer: AZCH Complete Medicaid	$5,986.45
Rate for Payer: Banner UC Health Medicaid	$5,986.45
Rate for Payer: Mercy Care Medicaid	$5,986.45

Digestive Malignancy

Facility

$8,453.27

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$8,453.27
Max. Negotiated Rate	$8,453.27
Rate for Payer: AHCCCS Medicaid	$8,453.27
Rate for Payer: Allwell Medicaid	$8,453.27
Rate for Payer: AZCH Complete Medicaid	$8,453.27
Rate for Payer: Banner UC Health Medicaid	$8,453.27
Rate for Payer: Mercy Care Medicaid	$8,453.27

Digestive Malignancy

Facility

$8,453.27

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG2402
Min. Negotiated Rate	$8,453.27
Max. Negotiated Rate	$8,453.27
Rate for Payer: AHCCCS Medicaid	$8,453.27
Rate for Payer: Allwell Medicaid	$8,453.27
Rate for Payer: AZCH Complete Medicaid	$8,453.27
Rate for Payer: Banner UC Health Medicaid	$8,453.27
Rate for Payer: Mercy Care Medicaid	$8,453.27

Digestive Malignancy

Facility

$5,198.78

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG2403
Min. Negotiated Rate	$5,198.78
Max. Negotiated Rate	$5,198.78
Rate for Payer: AHCCCS Medicaid	$5,198.78
Rate for Payer: Allwell Medicaid	$5,198.78
Rate for Payer: AZCH Complete Medicaid	$5,198.78
Rate for Payer: Banner UC Health Medicaid	$5,198.78
Rate for Payer: Mercy Care Medicaid	$5,198.78

Digestive Malignancy

Facility

$5,986.45

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG2403
Min. Negotiated Rate	$5,986.45
Max. Negotiated Rate	$5,986.45
Rate for Payer: AHCCCS Medicaid	$5,986.45
Rate for Payer: Allwell Medicaid	$5,986.45
Rate for Payer: AZCH Complete Medicaid	$5,986.45
Rate for Payer: Banner UC Health Medicaid	$5,986.45
Rate for Payer: Mercy Care Medicaid	$5,986.45

Digestive Malignancy

Facility

$8,453.27

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG2403
Min. Negotiated Rate	$8,453.27
Max. Negotiated Rate	$8,453.27
Rate for Payer: AHCCCS Medicaid	$8,453.27
Rate for Payer: Allwell Medicaid	$8,453.27
Rate for Payer: AZCH Complete Medicaid	$8,453.27
Rate for Payer: Banner UC Health Medicaid	$8,453.27
Rate for Payer: Mercy Care Medicaid	$8,453.27

DIGIFUSE GUIDE WIRE SMOOTH .80 X 70MM

Facility

$89.00

Hospital Charge Code	24127791
Hospital Revenue Code	270
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Cash Price	$71.20
Rate for Payer: Self Pay Self Pay	$71.20

DIGIFUSE GUIDE WIRE SMOOTH .80 X 70MM

Facility

$89.00

Hospital Charge Code	24127791
Hospital Revenue Code	270
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Aetna of AZ Medicare	$24.92
Rate for Payer: Allwell Medicare	$14.24
Rate for Payer: Amerigroup Medicare	$14.24
Rate for Payer: APIPA Medicare/Medicaid	$33.24
Rate for Payer: AZCH Complete Medicare	$14.24
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$60.52
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$62.30
Rate for Payer: Copperpoint Commercial	$22.03
Rate for Payer: Health Net of AZ Commercial	$53.40
Rate for Payer: Health Net of AZ Medicare	$24.92
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Self Pay Self Pay	$71.20
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.02

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24127789
Hospital Revenue Code	270
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Aetna of AZ Medicare	$1,611.96
Rate for Payer: Allwell Medicare	$921.12
Rate for Payer: Amerigroup Medicare	$921.12
Rate for Payer: APIPA Medicare/Medicaid	$2,150.24
Rate for Payer: AZCH Complete Medicare	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,914.76
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Copperpoint Commercial	$1,424.86
Rate for Payer: Health Net of AZ Commercial	$3,454.20
Rate for Payer: Health Net of AZ Medicare	$1,611.96
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Self Pay Self Pay	$4,605.60
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,356.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,036.26

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24127789
Hospital Revenue Code	270
Min. Negotiated Rate	$1,496.82
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Self Pay Self Pay	$4,605.60

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE MINI BLADE

Facility

$5,757.00

Hospital Charge Code	24127793
Hospital Revenue Code	270
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Aetna of AZ Medicare	$1,611.96
Rate for Payer: Allwell Medicare	$921.12
Rate for Payer: Amerigroup Medicare	$921.12
Rate for Payer: APIPA Medicare/Medicaid	$2,150.24
Rate for Payer: AZCH Complete Medicare	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,914.76
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Copperpoint Commercial	$1,424.86
Rate for Payer: Health Net of AZ Commercial	$3,454.20
Rate for Payer: Health Net of AZ Medicare	$1,611.96
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Self Pay Self Pay	$4,605.60
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,356.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,036.26

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE MINI BLADE

Facility

$5,757.00

Hospital Charge Code	24127793
Hospital Revenue Code	270
Min. Negotiated Rate	$1,496.82
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Self Pay Self Pay	$4,605.60

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE SHORT

Facility

$5,757.00

Hospital Charge Code	24129271
Hospital Revenue Code	270
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Aetna of AZ Medicare	$1,611.96
Rate for Payer: Allwell Medicare	$921.12
Rate for Payer: Amerigroup Medicare	$921.12
Rate for Payer: APIPA Medicare/Medicaid	$2,150.24
Rate for Payer: AZCH Complete Medicare	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,914.76
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Copperpoint Commercial	$1,424.86
Rate for Payer: Health Net of AZ Commercial	$3,454.20
Rate for Payer: Health Net of AZ Medicare	$1,611.96
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Self Pay Self Pay	$4,605.60
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,356.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,036.26

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE SHORT

Facility

$5,757.00

Hospital Charge Code	24129271
Hospital Revenue Code	270
Min. Negotiated Rate	$1,496.82
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Self Pay Self Pay	$4,605.60

DIGIFUSE IMPLANT 2.5MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24129272
Hospital Revenue Code	270
Min. Negotiated Rate	$1,496.82
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Self Pay Self Pay	$4,605.60

DIGIFUSE IMPLANT 2.5MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24129272
Hospital Revenue Code	270
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Aetna of AZ Medicare	$1,611.96
Rate for Payer: Allwell Medicare	$921.12
Rate for Payer: Amerigroup Medicare	$921.12
Rate for Payer: APIPA Medicare/Medicaid	$2,150.24
Rate for Payer: AZCH Complete Medicare	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Bisbee Police All Plans	$1,496.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,914.76
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Copperpoint Commercial	$1,424.86
Rate for Payer: Health Net of AZ Commercial	$3,454.20
Rate for Payer: Health Net of AZ Medicare	$1,611.96
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Self Pay Self Pay	$4,605.60
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,356.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,036.26

DIGITAL SCREW SZ 2MM X 40MM

Facility

$2,180.00

Hospital Charge Code	27595622
Hospital Revenue Code	270
Min. Negotiated Rate	$348.80
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Aetna of AZ Medicare	$610.40
Rate for Payer: Allwell Medicare	$348.80
Rate for Payer: Amerigroup Medicare	$348.80
Rate for Payer: APIPA Medicare/Medicaid	$814.23
Rate for Payer: AZCH Complete Medicare	$348.80
Rate for Payer: Banner UC Health Medicare	$348.80
Rate for Payer: Bisbee Police All Plans	$566.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,482.40
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Cigna of AZ Commercial	$1,526.00
Rate for Payer: Copperpoint Commercial	$539.55
Rate for Payer: Health Net of AZ Commercial	$1,308.00
Rate for Payer: Health Net of AZ Medicare	$610.40
Rate for Payer: Humana of AZ Medicare	$348.80
Rate for Payer: Self Pay Self Pay	$1,744.00
Rate for Payer: TriWest Medicare	$348.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,270.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$392.40

DIGITAL SCREW SZ 2MM X 40MM

Facility

$2,180.00

Hospital Charge Code	27595622
Hospital Revenue Code	270
Min. Negotiated Rate	$566.80
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Bisbee Police All Plans	$566.80
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Self Pay Self Pay	$1,744.00

DIGITAL SCREW SZ 2MM X 44MM

Facility

$2,180.00

Hospital Charge Code	27595623
Hospital Revenue Code	270
Min. Negotiated Rate	$566.80
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Bisbee Police All Plans	$566.80
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Self Pay Self Pay	$1,744.00

Know your out-of-pocket cost for care.

All Charges