Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3162
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

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3163
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

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

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3164
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

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

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

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3163
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

HAPTOGLOBIN

Facility

$205.00

Service Code	CPT 83010
Hospital Charge Code	22481476
Hospital Revenue Code	301
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Cash Price	$164.00
Rate for Payer: Self Pay Self Pay	$164.00

HAPTOGLOBIN

Facility

$205.00

Service Code	CPT 83010
Hospital Charge Code	22481476
Hospital Revenue Code	301
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Aetna of AZ Medicare	$57.40
Rate for Payer: Allwell Medicare	$32.80
Rate for Payer: Amerigroup Medicare	$32.80
Rate for Payer: APIPA Medicare/Medicaid	$76.57
Rate for Payer: AZCH Complete Medicare	$32.80
Rate for Payer: Banner UC Health Medicare	$32.80
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$139.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cigna of AZ Commercial	$133.25
Rate for Payer: Copperpoint Commercial	$50.74
Rate for Payer: Health Net of AZ Commercial	$123.00
Rate for Payer: Health Net of AZ Medicare	$57.40
Rate for Payer: Humana of AZ Medicare	$32.80
Rate for Payer: Self Pay Self Pay	$164.00
Rate for Payer: TriWest Medicare	$32.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$119.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.90

Haptoglobin LC

Facility

$195.00

Service Code	CPT 83010
Hospital Charge Code	1906874
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Aetna of AZ Medicare	$54.60
Rate for Payer: Allwell Medicare	$31.20
Rate for Payer: Amerigroup Medicare	$31.20
Rate for Payer: APIPA Medicare/Medicaid	$72.83
Rate for Payer: AZCH Complete Medicare	$31.20
Rate for Payer: Banner UC Health Medicare	$31.20
Rate for Payer: Bisbee Police All Plans	$50.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$132.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cigna of AZ Commercial	$126.75
Rate for Payer: Copperpoint Commercial	$48.26
Rate for Payer: Health Net of AZ Commercial	$117.00
Rate for Payer: Health Net of AZ Medicare	$54.60
Rate for Payer: Humana of AZ Medicare	$31.20
Rate for Payer: Self Pay Self Pay	$156.00
Rate for Payer: TriWest Medicare	$31.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$113.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.10

Haptoglobin LC

Facility

$195.00

Service Code	CPT 83010
Hospital Charge Code	1906874
Hospital Revenue Code	301
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Bisbee Police All Plans	$50.70
Rate for Payer: Cash Price	$156.00
Rate for Payer: Self Pay Self Pay	$156.00

.HBsAg Confirmation LC

Facility

$293.00

Service Code	CPT 87340
Hospital Charge Code	1285756
Hospital Revenue Code	306
Min. Negotiated Rate	$46.88
Max. Negotiated Rate	$263.70
Rate for Payer: Aetna of AZ Commercial	$263.70
Rate for Payer: Aetna of AZ Medicare	$82.04
Rate for Payer: Allwell Medicare	$46.88
Rate for Payer: Amerigroup Medicare	$46.88
Rate for Payer: APIPA Medicare/Medicaid	$109.44
Rate for Payer: AZCH Complete Medicare	$46.88
Rate for Payer: Banner UC Health Medicare	$46.88
Rate for Payer: Bisbee Police All Plans	$76.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$199.24
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cigna of AZ Commercial	$190.45
Rate for Payer: Copperpoint Commercial	$72.52
Rate for Payer: Health Net of AZ Commercial	$175.80
Rate for Payer: Health Net of AZ Medicare	$82.04
Rate for Payer: Humana of AZ Medicare	$46.88
Rate for Payer: Self Pay Self Pay	$234.40
Rate for Payer: TriWest Medicare	$46.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$170.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.74

.HBsAg Confirmation LC

Facility

$293.00

Service Code	CPT 87340
Hospital Charge Code	1285756
Hospital Revenue Code	306
Min. Negotiated Rate	$76.18
Max. Negotiated Rate	$263.70
Rate for Payer: Aetna of AZ Commercial	$263.70
Rate for Payer: Bisbee Police All Plans	$76.18
Rate for Payer: Cash Price	$234.40
Rate for Payer: Self Pay Self Pay	$234.40

HBsAg Screen LC

Facility

$395.00

Service Code	CPT 87340
Hospital Charge Code	1902150
Hospital Revenue Code	306
Min. Negotiated Rate	$102.70
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Bisbee Police All Plans	$102.70
Rate for Payer: Cash Price	$316.00
Rate for Payer: Self Pay Self Pay	$316.00

HBsAg Screen LC

Facility

$395.00

Service Code	CPT 87340
Hospital Charge Code	1902150
Hospital Revenue Code	306
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Aetna of AZ Medicare	$110.60
Rate for Payer: Allwell Medicare	$63.20
Rate for Payer: Amerigroup Medicare	$63.20
Rate for Payer: APIPA Medicare/Medicaid	$147.53
Rate for Payer: AZCH Complete Medicare	$63.20
Rate for Payer: Banner UC Health Medicare	$63.20
Rate for Payer: Bisbee Police All Plans	$102.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$268.60
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cigna of AZ Commercial	$256.75
Rate for Payer: Copperpoint Commercial	$97.76
Rate for Payer: Health Net of AZ Commercial	$237.00
Rate for Payer: Health Net of AZ Medicare	$110.60
Rate for Payer: Humana of AZ Medicare	$63.20
Rate for Payer: Self Pay Self Pay	$316.00
Rate for Payer: TriWest Medicare	$63.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$230.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.10

HBV Real-Time PCR Qn LC

Facility

$982.00

Service Code	CPT 87517
Hospital Charge Code	6782273
Hospital Revenue Code	306
Min. Negotiated Rate	$255.32
Max. Negotiated Rate	$883.80
Rate for Payer: Aetna of AZ Commercial	$883.80
Rate for Payer: Bisbee Police All Plans	$255.32
Rate for Payer: Cash Price	$785.60
Rate for Payer: Self Pay Self Pay	$785.60

HBV Real-Time PCR Qn LC

Facility

$982.00

Service Code	CPT 87517
Hospital Charge Code	6782273
Hospital Revenue Code	306
Min. Negotiated Rate	$157.12
Max. Negotiated Rate	$883.80
Rate for Payer: Aetna of AZ Commercial	$883.80
Rate for Payer: Aetna of AZ Medicare	$274.96
Rate for Payer: Allwell Medicare	$157.12
Rate for Payer: Amerigroup Medicare	$157.12
Rate for Payer: APIPA Medicare/Medicaid	$366.78
Rate for Payer: AZCH Complete Medicare	$157.12
Rate for Payer: Banner UC Health Medicare	$157.12
Rate for Payer: Bisbee Police All Plans	$255.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$667.76
Rate for Payer: Cash Price	$785.60
Rate for Payer: Cigna of AZ Commercial	$638.30
Rate for Payer: Copperpoint Commercial	$243.04
Rate for Payer: Health Net of AZ Commercial	$589.20
Rate for Payer: Health Net of AZ Medicare	$274.96
Rate for Payer: Humana of AZ Medicare	$157.12
Rate for Payer: Self Pay Self Pay	$785.60
Rate for Payer: TriWest Medicare	$157.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$572.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$176.76

hCG,Beta Subunit, Qnt, Serum LC

Facility

$207.00

Service Code	CPT 84702
Hospital Charge Code	1285573
Hospital Revenue Code	301
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of AZ Commercial	$186.30
Rate for Payer: Bisbee Police All Plans	$53.82
Rate for Payer: Cash Price	$165.60
Rate for Payer: Self Pay Self Pay	$165.60

hCG,Beta Subunit, Qnt, Serum LC

Facility

$207.00

Service Code	CPT 84702
Hospital Charge Code	1285573
Hospital Revenue Code	301
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of AZ Commercial	$186.30
Rate for Payer: Aetna of AZ Medicare	$57.96
Rate for Payer: Allwell Medicare	$33.12
Rate for Payer: Amerigroup Medicare	$33.12
Rate for Payer: APIPA Medicare/Medicaid	$77.31
Rate for Payer: AZCH Complete Medicare	$33.12
Rate for Payer: Banner UC Health Medicare	$33.12
Rate for Payer: Bisbee Police All Plans	$53.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$140.76
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cigna of AZ Commercial	$134.55
Rate for Payer: Copperpoint Commercial	$51.23
Rate for Payer: Health Net of AZ Commercial	$124.20
Rate for Payer: Health Net of AZ Medicare	$57.96
Rate for Payer: Humana of AZ Medicare	$33.12
Rate for Payer: Self Pay Self Pay	$165.60
Rate for Payer: TriWest Medicare	$33.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$120.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.26

hCG Qual w/ Reflex to Beta hCG

Facility

$16.00

Service Code	CPT 84703
Hospital Charge Code	24319555
Hospital Revenue Code	300
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.56
Rate for Payer: Amerigroup Medicare	$2.56
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.56
Rate for Payer: Banner UC Health Medicare	$2.56
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$10.40
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.56
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

Know your out-of-pocket cost for care.

All Charges