Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

GYRUS ACMI SUR CATCH NT BASKET 2.2FR

Facility

$823.00

Hospital Charge Code	22354137
Hospital Revenue Code	270
Min. Negotiated Rate	$213.98
Max. Negotiated Rate	$740.70
Rate for Payer: Aetna of AZ Commercial	$740.70
Rate for Payer: Bisbee Police All Plans	$213.98
Rate for Payer: Cash Price	$658.40
Rate for Payer: Self Pay Self Pay	$658.40

GYRUS CUTTING FORCEPS 10MM

Facility

$2,409.00

Hospital Charge Code	22354831
Hospital Revenue Code	270
Min. Negotiated Rate	$626.34
Max. Negotiated Rate	$2,168.10
Rate for Payer: Aetna of AZ Commercial	$2,168.10
Rate for Payer: Bisbee Police All Plans	$626.34
Rate for Payer: Cash Price	$1,927.20
Rate for Payer: Self Pay Self Pay	$1,927.20

GYRUS CUTTING FORCEPS 10MM

Facility

$2,409.00

Hospital Charge Code	22354831
Hospital Revenue Code	270
Min. Negotiated Rate	$385.44
Max. Negotiated Rate	$2,168.10
Rate for Payer: Aetna of AZ Commercial	$2,168.10
Rate for Payer: Aetna of AZ Medicare	$674.52
Rate for Payer: Allwell Medicare	$385.44
Rate for Payer: Amerigroup Medicare	$385.44
Rate for Payer: APIPA Medicare/Medicaid	$899.76
Rate for Payer: AZCH Complete Medicare	$385.44
Rate for Payer: Banner UC Health Medicare	$385.44
Rate for Payer: Bisbee Police All Plans	$626.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,638.12
Rate for Payer: Cash Price	$1,927.20
Rate for Payer: Cigna of AZ Commercial	$1,686.30
Rate for Payer: Copperpoint Commercial	$596.23
Rate for Payer: Health Net of AZ Commercial	$1,445.40
Rate for Payer: Health Net of AZ Medicare	$674.52
Rate for Payer: Humana of AZ Medicare	$385.44
Rate for Payer: Self Pay Self Pay	$1,927.20
Rate for Payer: TriWest Medicare	$385.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,404.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$433.62

GYRUS CUTTING FORCEPS 5MM

Facility

$1,665.00

Hospital Charge Code	22354830
Hospital Revenue Code	270
Min. Negotiated Rate	$266.40
Max. Negotiated Rate	$1,498.50
Rate for Payer: Aetna of AZ Commercial	$1,498.50
Rate for Payer: Aetna of AZ Medicare	$466.20
Rate for Payer: Allwell Medicare	$266.40
Rate for Payer: Amerigroup Medicare	$266.40
Rate for Payer: APIPA Medicare/Medicaid	$621.88
Rate for Payer: AZCH Complete Medicare	$266.40
Rate for Payer: Banner UC Health Medicare	$266.40
Rate for Payer: Bisbee Police All Plans	$432.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,132.20
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Cigna of AZ Commercial	$1,165.50
Rate for Payer: Copperpoint Commercial	$412.09
Rate for Payer: Health Net of AZ Commercial	$999.00
Rate for Payer: Health Net of AZ Medicare	$466.20
Rate for Payer: Humana of AZ Medicare	$266.40
Rate for Payer: Self Pay Self Pay	$1,332.00
Rate for Payer: TriWest Medicare	$266.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$970.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$299.70

GYRUS CUTTING FORCEPS 5MM

Facility

$1,665.00

Hospital Charge Code	22354830
Hospital Revenue Code	270
Min. Negotiated Rate	$432.90
Max. Negotiated Rate	$1,498.50
Rate for Payer: Aetna of AZ Commercial	$1,498.50
Rate for Payer: Bisbee Police All Plans	$432.90
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Self Pay Self Pay	$1,332.00

GYRUS LAP SPATULA

Facility

$981.00

Hospital Charge Code	22354817
Hospital Revenue Code	270
Min. Negotiated Rate	$156.96
Max. Negotiated Rate	$882.90
Rate for Payer: Aetna of AZ Commercial	$882.90
Rate for Payer: Aetna of AZ Medicare	$274.68
Rate for Payer: Allwell Medicare	$156.96
Rate for Payer: Amerigroup Medicare	$156.96
Rate for Payer: APIPA Medicare/Medicaid	$366.40
Rate for Payer: AZCH Complete Medicare	$156.96
Rate for Payer: Banner UC Health Medicare	$156.96
Rate for Payer: Bisbee Police All Plans	$255.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$667.08
Rate for Payer: Cash Price	$784.80
Rate for Payer: Cigna of AZ Commercial	$686.70
Rate for Payer: Copperpoint Commercial	$242.80
Rate for Payer: Health Net of AZ Commercial	$588.60
Rate for Payer: Health Net of AZ Medicare	$274.68
Rate for Payer: Humana of AZ Medicare	$156.96
Rate for Payer: Self Pay Self Pay	$784.80
Rate for Payer: TriWest Medicare	$156.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$571.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$176.58

GYRUS LAP SPATULA

Facility

$981.00

Hospital Charge Code	22354817
Hospital Revenue Code	270
Min. Negotiated Rate	$255.06
Max. Negotiated Rate	$882.90
Rate for Payer: Aetna of AZ Commercial	$882.90
Rate for Payer: Bisbee Police All Plans	$255.06
Rate for Payer: Cash Price	$784.80
Rate for Payer: Self Pay Self Pay	$784.80

GYRUS SUPERLOOP

Facility

$1,686.00

Hospital Charge Code	22354814
Hospital Revenue Code	270
Min. Negotiated Rate	$438.36
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Bisbee Police All Plans	$438.36
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Self Pay Self Pay	$1,348.80

GYRUS SUPERLOOP

Facility

$1,686.00

Hospital Charge Code	22354814
Hospital Revenue Code	270
Min. Negotiated Rate	$269.76
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Aetna of AZ Medicare	$472.08
Rate for Payer: Allwell Medicare	$269.76
Rate for Payer: Amerigroup Medicare	$269.76
Rate for Payer: APIPA Medicare/Medicaid	$629.72
Rate for Payer: AZCH Complete Medicare	$269.76
Rate for Payer: Banner UC Health Medicare	$269.76
Rate for Payer: Bisbee Police All Plans	$438.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,146.48
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Cigna of AZ Commercial	$1,180.20
Rate for Payer: Copperpoint Commercial	$417.29
Rate for Payer: Health Net of AZ Commercial	$1,011.60
Rate for Payer: Health Net of AZ Medicare	$472.08
Rate for Payer: Humana of AZ Medicare	$269.76
Rate for Payer: Self Pay Self Pay	$1,348.80
Rate for Payer: TriWest Medicare	$269.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$982.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$303.48

GYRUS SUPERSECT

Facility

$1,681.00

Hospital Charge Code	22354816
Hospital Revenue Code	270
Min. Negotiated Rate	$437.06
Max. Negotiated Rate	$1,512.90
Rate for Payer: Aetna of AZ Commercial	$1,512.90
Rate for Payer: Bisbee Police All Plans	$437.06
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Self Pay Self Pay	$1,344.80

GYRUS SUPERSECT

Facility

$1,681.00

Hospital Charge Code	22354816
Hospital Revenue Code	270
Min. Negotiated Rate	$268.96
Max. Negotiated Rate	$1,512.90
Rate for Payer: Aetna of AZ Commercial	$1,512.90
Rate for Payer: Aetna of AZ Medicare	$470.68
Rate for Payer: Allwell Medicare	$268.96
Rate for Payer: Amerigroup Medicare	$268.96
Rate for Payer: APIPA Medicare/Medicaid	$627.85
Rate for Payer: AZCH Complete Medicare	$268.96
Rate for Payer: Banner UC Health Medicare	$268.96
Rate for Payer: Bisbee Police All Plans	$437.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,143.08
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cigna of AZ Commercial	$1,176.70
Rate for Payer: Copperpoint Commercial	$416.05
Rate for Payer: Health Net of AZ Commercial	$1,008.60
Rate for Payer: Health Net of AZ Medicare	$470.68
Rate for Payer: Humana of AZ Medicare	$268.96
Rate for Payer: Self Pay Self Pay	$1,344.80
Rate for Payer: TriWest Medicare	$268.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$980.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$302.58

HALLU LOCK C PLACE SIZE 2 RIGHT

Facility

$8,175.00

Hospital Charge Code	27595621
Hospital Revenue Code	270
Min. Negotiated Rate	$1,308.00
Max. Negotiated Rate	$7,357.50
Rate for Payer: Aetna of AZ Commercial	$7,357.50
Rate for Payer: Aetna of AZ Medicare	$2,289.00
Rate for Payer: Allwell Medicare	$1,308.00
Rate for Payer: Amerigroup Medicare	$1,308.00
Rate for Payer: APIPA Medicare/Medicaid	$3,053.36
Rate for Payer: AZCH Complete Medicare	$1,308.00
Rate for Payer: Banner UC Health Medicare	$1,308.00
Rate for Payer: Bisbee Police All Plans	$2,125.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5,559.00
Rate for Payer: Cash Price	$6,540.00
Rate for Payer: Cigna of AZ Commercial	$5,722.50
Rate for Payer: Copperpoint Commercial	$2,023.31
Rate for Payer: Health Net of AZ Commercial	$4,905.00
Rate for Payer: Health Net of AZ Medicare	$2,289.00
Rate for Payer: Humana of AZ Medicare	$1,308.00
Rate for Payer: Self Pay Self Pay	$6,540.00
Rate for Payer: TriWest Medicare	$1,308.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,766.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,471.50

HALLU LOCK C PLACE SIZE 2 RIGHT

Facility

$8,175.00

Hospital Charge Code	27595621
Hospital Revenue Code	270
Min. Negotiated Rate	$2,125.50
Max. Negotiated Rate	$7,357.50
Rate for Payer: Aetna of AZ Commercial	$7,357.50
Rate for Payer: Bisbee Police All Plans	$2,125.50
Rate for Payer: Cash Price	$6,540.00
Rate for Payer: Self Pay Self Pay	$6,540.00

HALLULOCK R S PLATE 5 DEGREE

Facility

$8,997.00

Hospital Charge Code	27663803
Hospital Revenue Code	270
Min. Negotiated Rate	$1,439.52
Max. Negotiated Rate	$8,097.30
Rate for Payer: Aetna of AZ Commercial	$8,097.30
Rate for Payer: Aetna of AZ Medicare	$2,519.16
Rate for Payer: Allwell Medicare	$1,439.52
Rate for Payer: Amerigroup Medicare	$1,439.52
Rate for Payer: APIPA Medicare/Medicaid	$3,360.38
Rate for Payer: AZCH Complete Medicare	$1,439.52
Rate for Payer: Banner UC Health Medicare	$1,439.52
Rate for Payer: Bisbee Police All Plans	$2,339.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6,117.96
Rate for Payer: Cash Price	$7,197.60
Rate for Payer: Cigna of AZ Commercial	$6,297.90
Rate for Payer: Copperpoint Commercial	$2,226.76
Rate for Payer: Health Net of AZ Commercial	$5,398.20
Rate for Payer: Health Net of AZ Medicare	$2,519.16
Rate for Payer: Humana of AZ Medicare	$1,439.52
Rate for Payer: Self Pay Self Pay	$7,197.60
Rate for Payer: TriWest Medicare	$1,439.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,245.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,619.46

HALLULOCK R S PLATE 5 DEGREE

Facility

$8,997.00

Hospital Charge Code	27663803
Hospital Revenue Code	270
Min. Negotiated Rate	$2,339.22
Max. Negotiated Rate	$8,097.30
Rate for Payer: Aetna of AZ Commercial	$8,097.30
Rate for Payer: Bisbee Police All Plans	$2,339.22
Rate for Payer: Cash Price	$7,197.60
Rate for Payer: Self Pay Self Pay	$7,197.60

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF

Facility

$2,242.00

Service Code	CPT 28291
Hospital Charge Code	24043295
Hospital Revenue Code	360
Min. Negotiated Rate	$358.72
Max. Negotiated Rate	$4,542.09
Rate for Payer: Aetna of AZ Commercial	$2,017.80
Rate for Payer: Aetna of AZ Medicare	$627.76
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$358.72
Rate for Payer: Amerigroup Medicare	$358.72
Rate for Payer: APIPA Medicare/Medicaid	$837.39
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$358.72
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$358.72
Rate for Payer: Bisbee Police All Plans	$582.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,524.56
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cigna of AZ Commercial	$1,121.00
Rate for Payer: Copperpoint Commercial	$554.89
Rate for Payer: Health Net of AZ Commercial	$1,345.20
Rate for Payer: Health Net of AZ Medicare	$627.76
Rate for Payer: Humana of AZ Medicare	$358.72
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$1,793.60
Rate for Payer: TriWest Medicare	$358.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,307.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$403.56

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF

Facility

$2,242.00

Service Code	CPT 28291
Hospital Charge Code	24043295
Hospital Revenue Code	360
Min. Negotiated Rate	$582.92
Max. Negotiated Rate	$2,017.80
Rate for Payer: Aetna of AZ Commercial	$2,017.80
Rate for Payer: Bisbee Police All Plans	$582.92
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Self Pay Self Pay	$1,793.60

haloperidol 1 mg Tab [CQCH]

Facility

$0.46

Service Code	NDC 51079073420
Hospital Charge Code	105925162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Aetna of AZ Medicare	$0.13
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.17
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.31
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.30
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.28
Rate for Payer: Health Net of AZ Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.37
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

haloperidol 1 mg Tab [CQCH]

Facility

$0.46

Service Code	NDC 51079073420
Hospital Charge Code	105925162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Cash Price	$0.36
Rate for Payer: Self Pay Self Pay	$0.37

haloperidol 5 mg/mL Inj Sol [CQCH]

Facility

$0.63

Service Code	HCPCS J1630
Hospital Charge Code	105925093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Aetna of AZ Medicare	$0.18
Rate for Payer: Allwell Medicare	$0.10
Rate for Payer: Amerigroup Medicare	$0.10
Rate for Payer: APIPA Medicare/Medicaid	$0.24
Rate for Payer: AZCH Complete Medicare	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.43
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.41
Rate for Payer: Copperpoint Commercial	$0.16
Rate for Payer: Health Net of AZ Commercial	$0.38
Rate for Payer: Health Net of AZ Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

haloperidol 5 mg/mL Inj Sol [CQCH]

Facility

$0.63

Service Code	HCPCS J1630
Hospital Charge Code	105925093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.50
Rate for Payer: Self Pay Self Pay	$0.50

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3163
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$23,327.16
Max. Negotiated Rate	$23,327.16
Rate for Payer: AHCCCS Medicaid	$23,327.16
Rate for Payer: Allwell Medicaid	$23,327.16
Rate for Payer: AZCH Complete Medicaid	$23,327.16
Rate for Payer: Banner UC Health Medicaid	$23,327.16
Rate for Payer: Mercy Care Medicaid	$23,327.16

Know your out-of-pocket cost for care.

All Charges