Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Folic Acid(FOLATE)

Facility

$181.00

Service Code	CPT 82746
Hospital Charge Code	22540594
Hospital Revenue Code	301
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

Food Allergy Profile LC

Facility

$1,118.00

Service Code	CPT 86003
Hospital Charge Code	22201915
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$1,006.20
Rate for Payer: Aetna of AZ Commercial	$1,006.20
Rate for Payer: Aetna of AZ Medicare	$313.04
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$167.70
Rate for Payer: Amerigroup Medicare	$167.70
Rate for Payer: APIPA Medicare/Medicaid	$417.57
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$167.70
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$167.70
Rate for Payer: Bisbee Police All Plans	$290.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$760.24
Rate for Payer: Cash Price	$894.40
Rate for Payer: Cash Price	$894.40
Rate for Payer: Cigna of AZ Commercial	$726.70
Rate for Payer: Copperpoint Commercial	$276.70
Rate for Payer: Health Net of AZ Commercial	$670.80
Rate for Payer: Health Net of AZ Medicare	$313.04
Rate for Payer: Humana of AZ Medicare	$167.70
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$894.40
Rate for Payer: TriWest Medicare	$167.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$651.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$201.24

Food Allergy Profile LC

Facility

$1,118.00

Service Code	CPT 86003
Hospital Charge Code	22201915
Hospital Revenue Code	302
Min. Negotiated Rate	$290.68
Max. Negotiated Rate	$1,006.20
Rate for Payer: Aetna of AZ Commercial	$1,006.20
Rate for Payer: Bisbee Police All Plans	$290.68
Rate for Payer: Cash Price	$894.40
Rate for Payer: Self Pay Self Pay	$894.40

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: AHCCCS Medicaid	$11,056.87
Rate for Payer: Allwell Medicaid	$11,056.87
Rate for Payer: AZCH Complete Medicaid	$11,056.87
Rate for Payer: Banner UC Health Medicaid	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: AHCCCS Medicaid	$11,056.87
Rate for Payer: Allwell Medicaid	$11,056.87
Rate for Payer: AZCH Complete Medicaid	$11,056.87
Rate for Payer: Banner UC Health Medicaid	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: AHCCCS Medicaid	$7,850.07
Rate for Payer: Allwell Medicaid	$7,850.07
Rate for Payer: AZCH Complete Medicaid	$7,850.07
Rate for Payer: Banner UC Health Medicaid	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: AHCCCS Medicaid	$7,850.07
Rate for Payer: Allwell Medicaid	$7,850.07
Rate for Payer: AZCH Complete Medicaid	$7,850.07
Rate for Payer: Banner UC Health Medicaid	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: AHCCCS Medicaid	$21,326.77
Rate for Payer: Allwell Medicaid	$21,326.77
Rate for Payer: AZCH Complete Medicaid	$21,326.77
Rate for Payer: Banner UC Health Medicaid	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3144
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: AHCCCS Medicaid	$21,326.77
Rate for Payer: Allwell Medicaid	$21,326.77
Rate for Payer: AZCH Complete Medicaid	$21,326.77
Rate for Payer: Banner UC Health Medicaid	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: AHCCCS Medicaid	$11,056.87
Rate for Payer: Allwell Medicaid	$11,056.87
Rate for Payer: AZCH Complete Medicaid	$11,056.87
Rate for Payer: Banner UC Health Medicaid	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87

Foot And Toe Procedures

Facility

$7,268.61

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$7,268.61
Max. Negotiated Rate	$7,268.61
Rate for Payer: AHCCCS Medicaid	$7,268.61
Rate for Payer: Allwell Medicaid	$7,268.61
Rate for Payer: AZCH Complete Medicaid	$7,268.61
Rate for Payer: Banner UC Health Medicaid	$7,268.61
Rate for Payer: Mercy Care Medicaid	$7,268.61

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3144
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: AHCCCS Medicaid	$7,850.07
Rate for Payer: Allwell Medicaid	$7,850.07
Rate for Payer: AZCH Complete Medicaid	$7,850.07
Rate for Payer: Banner UC Health Medicaid	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07

Foot And Toe Procedures

Facility

$7,268.61

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$7,268.61
Max. Negotiated Rate	$7,268.61
Rate for Payer: AHCCCS Medicaid	$7,268.61
Rate for Payer: Allwell Medicaid	$7,268.61
Rate for Payer: AZCH Complete Medicaid	$7,268.61
Rate for Payer: Banner UC Health Medicaid	$7,268.61
Rate for Payer: Mercy Care Medicaid	$7,268.61

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3144
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: AHCCCS Medicaid	$11,056.87
Rate for Payer: Allwell Medicaid	$11,056.87
Rate for Payer: AZCH Complete Medicaid	$11,056.87
Rate for Payer: Banner UC Health Medicaid	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: AHCCCS Medicaid	$7,850.07
Rate for Payer: Allwell Medicaid	$7,850.07
Rate for Payer: AZCH Complete Medicaid	$7,850.07
Rate for Payer: Banner UC Health Medicaid	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07

Foot And Toe Procedures

Facility

$7,268.61

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG3144
Min. Negotiated Rate	$7,268.61
Max. Negotiated Rate	$7,268.61
Rate for Payer: AHCCCS Medicaid	$7,268.61
Rate for Payer: Allwell Medicaid	$7,268.61
Rate for Payer: AZCH Complete Medicaid	$7,268.61
Rate for Payer: Banner UC Health Medicaid	$7,268.61
Rate for Payer: Mercy Care Medicaid	$7,268.61

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: AHCCCS Medicaid	$21,326.77
Rate for Payer: Allwell Medicaid	$21,326.77
Rate for Payer: AZCH Complete Medicaid	$21,326.77
Rate for Payer: Banner UC Health Medicaid	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: AHCCCS Medicaid	$21,326.77
Rate for Payer: Allwell Medicaid	$21,326.77
Rate for Payer: AZCH Complete Medicaid	$21,326.77
Rate for Payer: Banner UC Health Medicaid	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77

Foot And Toe Procedures

Facility

$7,268.61

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$7,268.61
Max. Negotiated Rate	$7,268.61
Rate for Payer: AHCCCS Medicaid	$7,268.61
Rate for Payer: Allwell Medicaid	$7,268.61
Rate for Payer: AZCH Complete Medicaid	$7,268.61
Rate for Payer: Banner UC Health Medicaid	$7,268.61
Rate for Payer: Mercy Care Medicaid	$7,268.61

FORCEP BIOPSY RADIAL JAW 4 W/INDL 2.8MM STANDARD

Facility

$35.18

Hospital Charge Code	23589473
Hospital Revenue Code	272
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$31.66
Rate for Payer: Aetna of AZ Commercial	$31.66
Rate for Payer: Bisbee Police All Plans	$9.15
Rate for Payer: Cash Price	$28.14
Rate for Payer: Self Pay Self Pay	$28.14

FORCEP BIOPSY RADIAL JAW 4 W/INDL 2.8MM STANDARD

Facility

$35.18

Hospital Charge Code	23589473
Hospital Revenue Code	272
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$31.66
Rate for Payer: Aetna of AZ Commercial	$31.66
Rate for Payer: Aetna of AZ Medicare	$9.85
Rate for Payer: Allwell Medicare	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$13.14
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Bisbee Police All Plans	$9.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.92
Rate for Payer: Cash Price	$28.14
Rate for Payer: Cigna of AZ Commercial	$24.63
Rate for Payer: Copperpoint Commercial	$8.71
Rate for Payer: Health Net of AZ Commercial	$21.11
Rate for Payer: Health Net of AZ Medicare	$9.85
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Self Pay Self Pay	$28.14
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.33

FORCEP BIOPSY RADIAL JAW 4 W/NDL 2.8MM

Facility

$51.00

Hospital Charge Code	22354836
Hospital Revenue Code	270
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Bisbee Police All Plans	$13.26
Rate for Payer: Cash Price	$40.80
Rate for Payer: Self Pay Self Pay	$40.80

FORCEP BIOPSY RADIAL JAW 4 W/NDL 2.8MM

Facility

$51.00

Hospital Charge Code	22354836
Hospital Revenue Code	270
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Aetna of AZ Medicare	$14.28
Rate for Payer: Allwell Medicare	$7.65
Rate for Payer: Amerigroup Medicare	$7.65
Rate for Payer: APIPA Medicare/Medicaid	$19.05
Rate for Payer: AZCH Complete Medicare	$7.65
Rate for Payer: Banner UC Health Medicare	$7.65
Rate for Payer: Bisbee Police All Plans	$13.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$35.70
Rate for Payer: Copperpoint Commercial	$12.62
Rate for Payer: Health Net of AZ Commercial	$30.60
Rate for Payer: Health Net of AZ Medicare	$14.28
Rate for Payer: Humana of AZ Medicare	$7.65
Rate for Payer: Self Pay Self Pay	$40.80
Rate for Payer: TriWest Medicare	$7.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.18

FORCEP BIOPSY RADIAL JAW WITH NEEDLE

Facility

$246.00

Hospital Charge Code	22354837
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Aetna of AZ Medicare	$68.88
Rate for Payer: Allwell Medicare	$36.90
Rate for Payer: Amerigroup Medicare	$36.90
Rate for Payer: APIPA Medicare/Medicaid	$91.88
Rate for Payer: AZCH Complete Medicare	$36.90
Rate for Payer: Banner UC Health Medicare	$36.90
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$167.28
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$172.20
Rate for Payer: Copperpoint Commercial	$60.88
Rate for Payer: Health Net of AZ Commercial	$147.60
Rate for Payer: Health Net of AZ Medicare	$68.88
Rate for Payer: Humana of AZ Medicare	$36.90
Rate for Payer: Self Pay Self Pay	$196.80
Rate for Payer: TriWest Medicare	$36.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$143.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.28

FORCEP BIOPSY RADIAL JAW WITH NEEDLE

Facility

$246.00

Hospital Charge Code	22354837
Hospital Revenue Code	270
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Cash Price	$196.80
Rate for Payer: Self Pay Self Pay	$196.80

Know your out-of-pocket cost for care.

All Charges