Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

FORCEP BIOPSY RADIAL JAW 4 W/NDL 2.8MM

Facility

$51.00

Hospital Charge Code	22354836
Hospital Revenue Code	270
Min. Negotiated Rate	$8.16
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	$8.16
Rate for Payer: Amerigroup Medicare	$8.16
Rate for Payer: APIPA Medicare/Medicaid	$19.05
Rate for Payer: AZCH Complete Medicare	$8.16
Rate for Payer: Banner UC Health Medicare	$8.16
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	$8.16
Rate for Payer: Self Pay Self Pay	$40.80
Rate for Payer: TriWest Medicare	$8.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.18

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 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

FORCEP BIOPSY RADIAL JAW WITH NEEDLE

Facility

$246.00

Hospital Charge Code	22354837
Hospital Revenue Code	270
Min. Negotiated Rate	$39.36
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	$39.36
Rate for Payer: Amerigroup Medicare	$39.36
Rate for Payer: APIPA Medicare/Medicaid	$91.88
Rate for Payer: AZCH Complete Medicare	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
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	$39.36
Rate for Payer: Self Pay Self Pay	$196.80
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$143.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.28

FORCEP BIOPSY W/O NEEDLE

Facility

$1,307.00

Hospital Charge Code	22354311
Hospital Revenue Code	270
Min. Negotiated Rate	$339.82
Max. Negotiated Rate	$1,176.30
Rate for Payer: Aetna of AZ Commercial	$1,176.30
Rate for Payer: Bisbee Police All Plans	$339.82
Rate for Payer: Cash Price	$1,045.60
Rate for Payer: Self Pay Self Pay	$1,045.60

FORCEP BIOPSY W/O NEEDLE

Facility

$1,307.00

Hospital Charge Code	22354311
Hospital Revenue Code	270
Min. Negotiated Rate	$209.12
Max. Negotiated Rate	$1,176.30
Rate for Payer: Aetna of AZ Commercial	$1,176.30
Rate for Payer: Aetna of AZ Medicare	$365.96
Rate for Payer: Allwell Medicare	$209.12
Rate for Payer: Amerigroup Medicare	$209.12
Rate for Payer: APIPA Medicare/Medicaid	$488.16
Rate for Payer: AZCH Complete Medicare	$209.12
Rate for Payer: Banner UC Health Medicare	$209.12
Rate for Payer: Bisbee Police All Plans	$339.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$888.76
Rate for Payer: Cash Price	$1,045.60
Rate for Payer: Cigna of AZ Commercial	$914.90
Rate for Payer: Copperpoint Commercial	$323.48
Rate for Payer: Health Net of AZ Commercial	$784.20
Rate for Payer: Health Net of AZ Medicare	$365.96
Rate for Payer: Humana of AZ Medicare	$209.12
Rate for Payer: Self Pay Self Pay	$1,045.60
Rate for Payer: TriWest Medicare	$209.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$761.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$235.26

FORCEPS GRASPING STONE RETR BSKT 2.8F

Facility

$1,377.00

Hospital Charge Code	22354261
Hospital Revenue Code	270
Min. Negotiated Rate	$358.02
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Bisbee Police All Plans	$358.02
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Self Pay Self Pay	$1,101.60

FORCEPS GRASPING STONE RETR BSKT 2.8F

Facility

$1,377.00

Hospital Charge Code	22354261
Hospital Revenue Code	270
Min. Negotiated Rate	$220.32
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Aetna of AZ Medicare	$385.56
Rate for Payer: Allwell Medicare	$220.32
Rate for Payer: Amerigroup Medicare	$220.32
Rate for Payer: APIPA Medicare/Medicaid	$514.31
Rate for Payer: AZCH Complete Medicare	$220.32
Rate for Payer: Banner UC Health Medicare	$220.32
Rate for Payer: Bisbee Police All Plans	$358.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$936.36
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Cigna of AZ Commercial	$963.90
Rate for Payer: Copperpoint Commercial	$340.81
Rate for Payer: Health Net of AZ Commercial	$826.20
Rate for Payer: Health Net of AZ Medicare	$385.56
Rate for Payer: Humana of AZ Medicare	$220.32
Rate for Payer: Self Pay Self Pay	$1,101.60
Rate for Payer: TriWest Medicare	$220.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$802.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$247.86

FORCEPS GRASPING TRICEP 2.4FR

Facility

$886.00

Hospital Charge Code	22354313
Hospital Revenue Code	270
Min. Negotiated Rate	$230.36
Max. Negotiated Rate	$797.40
Rate for Payer: Aetna of AZ Commercial	$797.40
Rate for Payer: Bisbee Police All Plans	$230.36
Rate for Payer: Cash Price	$708.80
Rate for Payer: Self Pay Self Pay	$708.80

FORCEPS GRASPING TRICEP 2.4FR

Facility

$886.00

Hospital Charge Code	22354313
Hospital Revenue Code	270
Min. Negotiated Rate	$141.76
Max. Negotiated Rate	$797.40
Rate for Payer: Aetna of AZ Commercial	$797.40
Rate for Payer: Aetna of AZ Medicare	$248.08
Rate for Payer: Allwell Medicare	$141.76
Rate for Payer: Amerigroup Medicare	$141.76
Rate for Payer: APIPA Medicare/Medicaid	$330.92
Rate for Payer: AZCH Complete Medicare	$141.76
Rate for Payer: Banner UC Health Medicare	$141.76
Rate for Payer: Bisbee Police All Plans	$230.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$602.48
Rate for Payer: Cash Price	$708.80
Rate for Payer: Cigna of AZ Commercial	$620.20
Rate for Payer: Copperpoint Commercial	$219.28
Rate for Payer: Health Net of AZ Commercial	$531.60
Rate for Payer: Health Net of AZ Medicare	$248.08
Rate for Payer: Humana of AZ Medicare	$141.76
Rate for Payer: Self Pay Self Pay	$708.80
Rate for Payer: TriWest Medicare	$141.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$516.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$159.48

fosphenytoin (PE) 500 mg/10 mL Inj Sol [CQCH]

Facility

$1.41

Service Code	HCPCS Q2009
Hospital Charge Code	105923388
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna of AZ Commercial	$1.27
Rate for Payer: Aetna of AZ Medicare	$0.39
Rate for Payer: Allwell Medicare	$0.23
Rate for Payer: Amerigroup Medicare	$0.23
Rate for Payer: APIPA Medicare/Medicaid	$0.53
Rate for Payer: AZCH Complete Medicare	$0.23
Rate for Payer: Banner UC Health Medicare	$0.23
Rate for Payer: Bisbee Police All Plans	$0.37
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.96
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cigna of AZ Commercial	$0.92
Rate for Payer: Copperpoint Commercial	$0.35
Rate for Payer: Health Net of AZ Commercial	$0.85
Rate for Payer: Health Net of AZ Medicare	$0.39
Rate for Payer: Humana of AZ Medicare	$0.23
Rate for Payer: Self Pay Self Pay	$1.13
Rate for Payer: TriWest Medicare	$0.23
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.25

fosphenytoin (PE) 500 mg/10 mL Inj Sol [CQCH]

Facility

$1.41

Service Code	HCPCS Q2009
Hospital Charge Code	105923388
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna of AZ Commercial	$1.27
Rate for Payer: Bisbee Police All Plans	$0.37
Rate for Payer: Cash Price	$1.13
Rate for Payer: Self Pay Self Pay	$1.13

Fracture Of Femur

Facility

$10,305.67

Service Code	APR-DRG 3404
Hospital Charge Code	APRDRG3402
Min. Negotiated Rate	$10,305.67
Max. Negotiated Rate	$10,305.67
Rate for Payer: AHCCCS Medicaid	$10,305.67
Rate for Payer: Allwell Medicaid	$10,305.67
Rate for Payer: AZCH Complete Medicaid	$10,305.67
Rate for Payer: Banner UC Health Medicaid	$10,305.67
Rate for Payer: Mercy Care Medicaid	$10,305.67

Fracture Of Femur

Facility

$3,143.67

Service Code	APR-DRG 3401
Hospital Charge Code	APRDRG3404
Min. Negotiated Rate	$3,143.67
Max. Negotiated Rate	$3,143.67
Rate for Payer: AHCCCS Medicaid	$3,143.67
Rate for Payer: Allwell Medicaid	$3,143.67
Rate for Payer: AZCH Complete Medicaid	$3,143.67
Rate for Payer: Banner UC Health Medicaid	$3,143.67
Rate for Payer: Mercy Care Medicaid	$3,143.67

Fracture Of Femur

Facility

$3,836.66

Service Code	APR-DRG 3402
Hospital Charge Code	APRDRG3401
Min. Negotiated Rate	$3,836.66
Max. Negotiated Rate	$3,836.66
Rate for Payer: AHCCCS Medicaid	$3,836.66
Rate for Payer: Allwell Medicaid	$3,836.66
Rate for Payer: AZCH Complete Medicaid	$3,836.66
Rate for Payer: Banner UC Health Medicaid	$3,836.66
Rate for Payer: Mercy Care Medicaid	$3,836.66

Fracture Of Femur

Facility

$3,836.66

Service Code	APR-DRG 3402
Hospital Charge Code	APRDRG3402
Min. Negotiated Rate	$3,836.66
Max. Negotiated Rate	$3,836.66
Rate for Payer: AHCCCS Medicaid	$3,836.66
Rate for Payer: Allwell Medicaid	$3,836.66
Rate for Payer: AZCH Complete Medicaid	$3,836.66
Rate for Payer: Banner UC Health Medicaid	$3,836.66
Rate for Payer: Mercy Care Medicaid	$3,836.66

Fracture Of Femur

Facility

$3,143.67

Service Code	APR-DRG 3401
Hospital Charge Code	APRDRG3401
Min. Negotiated Rate	$3,143.67
Max. Negotiated Rate	$3,143.67
Rate for Payer: AHCCCS Medicaid	$3,143.67
Rate for Payer: Allwell Medicaid	$3,143.67
Rate for Payer: AZCH Complete Medicaid	$3,143.67
Rate for Payer: Banner UC Health Medicaid	$3,143.67
Rate for Payer: Mercy Care Medicaid	$3,143.67

Fracture Of Femur

Facility

$3,836.66

Service Code	APR-DRG 3402
Hospital Charge Code	APRDRG3404
Min. Negotiated Rate	$3,836.66
Max. Negotiated Rate	$3,836.66
Rate for Payer: AHCCCS Medicaid	$3,836.66
Rate for Payer: Allwell Medicaid	$3,836.66
Rate for Payer: AZCH Complete Medicaid	$3,836.66
Rate for Payer: Banner UC Health Medicaid	$3,836.66
Rate for Payer: Mercy Care Medicaid	$3,836.66

Fracture Of Femur

Facility

$5,646.27

Service Code	APR-DRG 3403
Hospital Charge Code	APRDRG3401
Min. Negotiated Rate	$5,646.27
Max. Negotiated Rate	$5,646.27
Rate for Payer: AHCCCS Medicaid	$5,646.27
Rate for Payer: Allwell Medicaid	$5,646.27
Rate for Payer: AZCH Complete Medicaid	$5,646.27
Rate for Payer: Banner UC Health Medicaid	$5,646.27
Rate for Payer: Mercy Care Medicaid	$5,646.27

Fracture Of Femur

Facility

$10,305.67

Service Code	APR-DRG 3404
Hospital Charge Code	APRDRG3404
Min. Negotiated Rate	$10,305.67
Max. Negotiated Rate	$10,305.67
Rate for Payer: AHCCCS Medicaid	$10,305.67
Rate for Payer: Allwell Medicaid	$10,305.67
Rate for Payer: AZCH Complete Medicaid	$10,305.67
Rate for Payer: Banner UC Health Medicaid	$10,305.67
Rate for Payer: Mercy Care Medicaid	$10,305.67

Fracture Of Femur

Facility

$3,836.66

Service Code	APR-DRG 3402
Hospital Charge Code	APRDRG3403
Min. Negotiated Rate	$3,836.66
Max. Negotiated Rate	$3,836.66
Rate for Payer: AHCCCS Medicaid	$3,836.66
Rate for Payer: Allwell Medicaid	$3,836.66
Rate for Payer: AZCH Complete Medicaid	$3,836.66
Rate for Payer: Banner UC Health Medicaid	$3,836.66
Rate for Payer: Mercy Care Medicaid	$3,836.66

Fracture Of Femur

Facility

$5,646.27

Service Code	APR-DRG 3403
Hospital Charge Code	APRDRG3403
Min. Negotiated Rate	$5,646.27
Max. Negotiated Rate	$5,646.27
Rate for Payer: AHCCCS Medicaid	$5,646.27
Rate for Payer: Allwell Medicaid	$5,646.27
Rate for Payer: AZCH Complete Medicaid	$5,646.27
Rate for Payer: Banner UC Health Medicaid	$5,646.27
Rate for Payer: Mercy Care Medicaid	$5,646.27

Fracture Of Femur

Facility

$3,143.67

Service Code	APR-DRG 3401
Hospital Charge Code	APRDRG3402
Min. Negotiated Rate	$3,143.67
Max. Negotiated Rate	$3,143.67
Rate for Payer: AHCCCS Medicaid	$3,143.67
Rate for Payer: Allwell Medicaid	$3,143.67
Rate for Payer: AZCH Complete Medicaid	$3,143.67
Rate for Payer: Banner UC Health Medicaid	$3,143.67
Rate for Payer: Mercy Care Medicaid	$3,143.67

Fracture Of Femur

Facility

$10,305.67

Service Code	APR-DRG 3404
Hospital Charge Code	APRDRG3401
Min. Negotiated Rate	$10,305.67
Max. Negotiated Rate	$10,305.67
Rate for Payer: AHCCCS Medicaid	$10,305.67
Rate for Payer: Allwell Medicaid	$10,305.67
Rate for Payer: AZCH Complete Medicaid	$10,305.67
Rate for Payer: Banner UC Health Medicaid	$10,305.67
Rate for Payer: Mercy Care Medicaid	$10,305.67

Fracture Of Femur

Facility

$10,305.67

Service Code	APR-DRG 3404
Hospital Charge Code	APRDRG3403
Min. Negotiated Rate	$10,305.67
Max. Negotiated Rate	$10,305.67
Rate for Payer: AHCCCS Medicaid	$10,305.67
Rate for Payer: Allwell Medicaid	$10,305.67
Rate for Payer: AZCH Complete Medicaid	$10,305.67
Rate for Payer: Banner UC Health Medicaid	$10,305.67
Rate for Payer: Mercy Care Medicaid	$10,305.67

Know your out-of-pocket cost for care.

All Charges