Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Heart Failure

Facility

$3,331.65

Service Code	APR-DRG 1941
Hospital Charge Code	APRDRG1942
Min. Negotiated Rate	$3,331.65
Max. Negotiated Rate	$3,331.65
Rate for Payer: AHCCCS Medicaid	$3,331.65
Rate for Payer: Allwell Medicaid	$3,331.65
Rate for Payer: AZCH Complete Medicaid	$3,331.65
Rate for Payer: Banner UC Health Medicaid	$3,331.65
Rate for Payer: Mercy Care Medicaid	$3,331.65

Heart Failure

Facility

$10,411.58

Service Code	APR-DRG 1944
Hospital Charge Code	APRDRG1942
Min. Negotiated Rate	$10,411.58
Max. Negotiated Rate	$10,411.58
Rate for Payer: AHCCCS Medicaid	$10,411.58
Rate for Payer: Allwell Medicaid	$10,411.58
Rate for Payer: AZCH Complete Medicaid	$10,411.58
Rate for Payer: Banner UC Health Medicaid	$10,411.58
Rate for Payer: Mercy Care Medicaid	$10,411.58

Heart Failure

Facility

$4,503.69

Service Code	APR-DRG 1942
Hospital Charge Code	APRDRG1941
Min. Negotiated Rate	$4,503.69
Max. Negotiated Rate	$4,503.69
Rate for Payer: AHCCCS Medicaid	$4,503.69
Rate for Payer: Allwell Medicaid	$4,503.69
Rate for Payer: AZCH Complete Medicaid	$4,503.69
Rate for Payer: Banner UC Health Medicaid	$4,503.69
Rate for Payer: Mercy Care Medicaid	$4,503.69

Heart Failure

Facility

$10,411.58

Service Code	APR-DRG 1944
Hospital Charge Code	APRDRG1941
Min. Negotiated Rate	$10,411.58
Max. Negotiated Rate	$10,411.58
Rate for Payer: AHCCCS Medicaid	$10,411.58
Rate for Payer: Allwell Medicaid	$10,411.58
Rate for Payer: AZCH Complete Medicaid	$10,411.58
Rate for Payer: Banner UC Health Medicaid	$10,411.58
Rate for Payer: Mercy Care Medicaid	$10,411.58

Heart Failure

Facility

$4,503.69

Service Code	APR-DRG 1942
Hospital Charge Code	APRDRG1942
Min. Negotiated Rate	$4,503.69
Max. Negotiated Rate	$4,503.69
Rate for Payer: AHCCCS Medicaid	$4,503.69
Rate for Payer: Allwell Medicaid	$4,503.69
Rate for Payer: AZCH Complete Medicaid	$4,503.69
Rate for Payer: Banner UC Health Medicaid	$4,503.69
Rate for Payer: Mercy Care Medicaid	$4,503.69

Heart Failure

Facility

$6,358.19

Service Code	APR-DRG 1943
Hospital Charge Code	APRDRG1942
Min. Negotiated Rate	$6,358.19
Max. Negotiated Rate	$6,358.19
Rate for Payer: AHCCCS Medicaid	$6,358.19
Rate for Payer: Allwell Medicaid	$6,358.19
Rate for Payer: AZCH Complete Medicaid	$6,358.19
Rate for Payer: Banner UC Health Medicaid	$6,358.19
Rate for Payer: Mercy Care Medicaid	$6,358.19

Heart Failure

Facility

$10,411.58

Service Code	APR-DRG 1944
Hospital Charge Code	APRDRG1944
Min. Negotiated Rate	$10,411.58
Max. Negotiated Rate	$10,411.58
Rate for Payer: AHCCCS Medicaid	$10,411.58
Rate for Payer: Allwell Medicaid	$10,411.58
Rate for Payer: AZCH Complete Medicaid	$10,411.58
Rate for Payer: Banner UC Health Medicaid	$10,411.58
Rate for Payer: Mercy Care Medicaid	$10,411.58

Heart Failure

Facility

$10,411.58

Service Code	APR-DRG 1944
Hospital Charge Code	APRDRG1943
Min. Negotiated Rate	$10,411.58
Max. Negotiated Rate	$10,411.58
Rate for Payer: AHCCCS Medicaid	$10,411.58
Rate for Payer: Allwell Medicaid	$10,411.58
Rate for Payer: AZCH Complete Medicaid	$10,411.58
Rate for Payer: Banner UC Health Medicaid	$10,411.58
Rate for Payer: Mercy Care Medicaid	$10,411.58

Heavy Metal Profile II, LC

Facility

$487.00

Service Code	CPT 82300
Hospital Charge Code	4976987
Hospital Revenue Code	301
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$438.30
Rate for Payer: Aetna of AZ Commercial	$438.30
Rate for Payer: Aetna of AZ Medicare	$136.36
Rate for Payer: AHCCCS Medicaid	$23.64
Rate for Payer: Allwell Medicaid	$23.64
Rate for Payer: Allwell Medicare	$73.05
Rate for Payer: Amerigroup Medicare	$73.05
Rate for Payer: APIPA Medicare/Medicaid	$181.89
Rate for Payer: AZCH Complete Medicaid	$23.64
Rate for Payer: AZCH Complete Medicare	$73.05
Rate for Payer: Banner UC Health Medicaid	$23.64
Rate for Payer: Banner UC Health Medicare	$73.05
Rate for Payer: Bisbee Police All Plans	$126.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.16
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cigna of AZ Commercial	$316.55
Rate for Payer: Copperpoint Commercial	$120.53
Rate for Payer: Health Net of AZ Commercial	$292.20
Rate for Payer: Health Net of AZ Medicare	$136.36
Rate for Payer: Humana of AZ Medicare	$73.05
Rate for Payer: Mercy Care Medicaid	$23.64
Rate for Payer: Self Pay Self Pay	$389.60
Rate for Payer: TriWest Medicare	$73.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$283.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.66

Heavy Metal Profile II, LC

Facility

$487.00

Service Code	CPT 82300
Hospital Charge Code	4976987
Hospital Revenue Code	301
Min. Negotiated Rate	$126.62
Max. Negotiated Rate	$438.30
Rate for Payer: Aetna of AZ Commercial	$438.30
Rate for Payer: Bisbee Police All Plans	$126.62
Rate for Payer: Cash Price	$389.60
Rate for Payer: Self Pay Self Pay	$389.60

HEEL BO S-M-L

Facility

$41.00

Hospital Charge Code	22355141
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

HEEL BO S-M-L

Facility

$41.00

Hospital Charge Code	22355141
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

Helicobacter pylori, IgA LC

Facility

$212.00

Service Code	CPT 86677
Hospital Charge Code	7328629
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Aetna of AZ Medicare	$59.36
Rate for Payer: AHCCCS Medicaid	$16.85
Rate for Payer: Allwell Medicaid	$16.85
Rate for Payer: Allwell Medicare	$31.80
Rate for Payer: Amerigroup Medicare	$31.80
Rate for Payer: APIPA Medicare/Medicaid	$79.18
Rate for Payer: AZCH Complete Medicaid	$16.85
Rate for Payer: AZCH Complete Medicare	$31.80
Rate for Payer: Banner UC Health Medicaid	$16.85
Rate for Payer: Banner UC Health Medicare	$31.80
Rate for Payer: Bisbee Police All Plans	$55.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.16
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cigna of AZ Commercial	$137.80
Rate for Payer: Copperpoint Commercial	$52.47
Rate for Payer: Health Net of AZ Commercial	$127.20
Rate for Payer: Health Net of AZ Medicare	$59.36
Rate for Payer: Humana of AZ Medicare	$31.80
Rate for Payer: Mercy Care Medicaid	$16.85
Rate for Payer: Self Pay Self Pay	$169.60
Rate for Payer: TriWest Medicare	$31.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$123.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.16

Helicobacter pylori, IgA LC

Facility

$212.00

Service Code	CPT 86677
Hospital Charge Code	7328629
Hospital Revenue Code	302
Min. Negotiated Rate	$55.12
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Bisbee Police All Plans	$55.12
Rate for Payer: Cash Price	$169.60
Rate for Payer: Self Pay Self Pay	$169.60

Helper T-Lymph-CD4 LC

Facility

$331.00

Service Code	CPT 86361
Hospital Charge Code	22201913
Hospital Revenue Code	302
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Cash Price	$264.80
Rate for Payer: Self Pay Self Pay	$264.80

Helper T-Lymph-CD4 LC

Facility

$331.00

Service Code	CPT 86361
Hospital Charge Code	22201913
Hospital Revenue Code	302
Min. Negotiated Rate	$26.78
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Medicare	$92.68
Rate for Payer: AHCCCS Medicaid	$26.78
Rate for Payer: Allwell Medicaid	$26.78
Rate for Payer: Allwell Medicare	$49.65
Rate for Payer: Amerigroup Medicare	$49.65
Rate for Payer: APIPA Medicare/Medicaid	$123.63
Rate for Payer: AZCH Complete Medicaid	$26.78
Rate for Payer: AZCH Complete Medicare	$49.65
Rate for Payer: Banner UC Health Medicaid	$26.78
Rate for Payer: Banner UC Health Medicare	$49.65
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.08
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Copperpoint Commercial	$81.92
Rate for Payer: Health Net of AZ Commercial	$198.60
Rate for Payer: Health Net of AZ Medicare	$92.68
Rate for Payer: Humana of AZ Medicare	$49.65
Rate for Payer: Mercy Care Medicaid	$26.78
Rate for Payer: Self Pay Self Pay	$264.80
Rate for Payer: TriWest Medicare	$49.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.58

Hematocrit

Facility

$49.00

Service Code	CPT 85014
Hospital Charge Code	633742
Hospital Revenue Code	305
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Aetna of AZ Medicare	$13.72
Rate for Payer: AHCCCS Medicaid	$2.37
Rate for Payer: Allwell Medicaid	$2.37
Rate for Payer: Allwell Medicare	$7.35
Rate for Payer: Amerigroup Medicare	$7.35
Rate for Payer: APIPA Medicare/Medicaid	$18.30
Rate for Payer: AZCH Complete Medicaid	$2.37
Rate for Payer: AZCH Complete Medicare	$7.35
Rate for Payer: Banner UC Health Medicaid	$2.37
Rate for Payer: Banner UC Health Medicare	$7.35
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$33.32
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$31.85
Rate for Payer: Copperpoint Commercial	$12.13
Rate for Payer: Health Net of AZ Commercial	$29.40
Rate for Payer: Health Net of AZ Medicare	$13.72
Rate for Payer: Humana of AZ Medicare	$7.35
Rate for Payer: Mercy Care Medicaid	$2.37
Rate for Payer: Self Pay Self Pay	$39.20
Rate for Payer: TriWest Medicare	$7.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.82

Hematocrit

Facility

$49.00

Service Code	CPT 85014
Hospital Charge Code	633742
Hospital Revenue Code	305
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Self Pay Self Pay	$39.20

HEMATOCRIT

Facility

$51.00

Service Code	CPT 85014
Hospital Charge Code	22481477
Hospital Revenue Code	305
Min. Negotiated Rate	$2.37
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: AHCCCS Medicaid	$2.37
Rate for Payer: Allwell Medicaid	$2.37
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 Medicaid	$2.37
Rate for Payer: AZCH Complete Medicare	$7.65
Rate for Payer: Banner UC Health Medicaid	$2.37
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: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$33.15
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: Mercy Care Medicaid	$2.37
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

HEMATOCRIT

Facility

$51.00

Service Code	CPT 85014
Hospital Charge Code	22481477
Hospital Revenue Code	305
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

HEMICAP 15MM ARTICULAR COMPONENT DF 1.5MM X 3.5MM

Facility

$4,737.00

Hospital Charge Code	24129931
Hospital Revenue Code	270
Min. Negotiated Rate	$1,231.62
Max. Negotiated Rate	$4,263.30
Rate for Payer: Aetna of AZ Commercial	$4,263.30
Rate for Payer: Bisbee Police All Plans	$1,231.62
Rate for Payer: Cash Price	$3,789.60
Rate for Payer: Self Pay Self Pay	$3,789.60

HEMICAP 15MM ARTICULAR COMPONENT DF 1.5MM X 3.5MM

Facility

$4,737.00

Hospital Charge Code	24129931
Hospital Revenue Code	270
Min. Negotiated Rate	$710.55
Max. Negotiated Rate	$4,263.30
Rate for Payer: Aetna of AZ Commercial	$4,263.30
Rate for Payer: Aetna of AZ Medicare	$1,326.36
Rate for Payer: Allwell Medicare	$710.55
Rate for Payer: Amerigroup Medicare	$710.55
Rate for Payer: APIPA Medicare/Medicaid	$1,769.27
Rate for Payer: AZCH Complete Medicare	$710.55
Rate for Payer: Banner UC Health Medicare	$710.55
Rate for Payer: Bisbee Police All Plans	$1,231.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,221.16
Rate for Payer: Cash Price	$3,789.60
Rate for Payer: Cigna of AZ Commercial	$3,315.90
Rate for Payer: Copperpoint Commercial	$1,172.41
Rate for Payer: Health Net of AZ Commercial	$2,842.20
Rate for Payer: Health Net of AZ Medicare	$1,326.36
Rate for Payer: Humana of AZ Medicare	$710.55
Rate for Payer: Self Pay Self Pay	$3,789.60
Rate for Payer: TriWest Medicare	$710.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,761.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$852.66

HEMICAP 9.5MM TAPER POST

Facility

$983.00

Hospital Charge Code	24129935
Hospital Revenue Code	270
Min. Negotiated Rate	$147.45
Max. Negotiated Rate	$884.70
Rate for Payer: Aetna of AZ Commercial	$884.70
Rate for Payer: Aetna of AZ Medicare	$275.24
Rate for Payer: Allwell Medicare	$147.45
Rate for Payer: Amerigroup Medicare	$147.45
Rate for Payer: APIPA Medicare/Medicaid	$367.15
Rate for Payer: AZCH Complete Medicare	$147.45
Rate for Payer: Banner UC Health Medicare	$147.45
Rate for Payer: Bisbee Police All Plans	$255.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$668.44
Rate for Payer: Cash Price	$786.40
Rate for Payer: Cigna of AZ Commercial	$688.10
Rate for Payer: Copperpoint Commercial	$243.29
Rate for Payer: Health Net of AZ Commercial	$589.80
Rate for Payer: Health Net of AZ Medicare	$275.24
Rate for Payer: Humana of AZ Medicare	$147.45
Rate for Payer: Self Pay Self Pay	$786.40
Rate for Payer: TriWest Medicare	$147.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$573.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$176.94

HEMICAP 9.5MM TAPER POST

Facility

$983.00

Hospital Charge Code	24129935
Hospital Revenue Code	270
Min. Negotiated Rate	$255.58
Max. Negotiated Rate	$884.70
Rate for Payer: Aetna of AZ Commercial	$884.70
Rate for Payer: Bisbee Police All Plans	$255.58
Rate for Payer: Cash Price	$786.40
Rate for Payer: Self Pay Self Pay	$786.40

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE PROXIMAL END

Facility

$1,305.00

Service Code	CPT 28160
Hospital Charge Code	24043273
Hospital Revenue Code	360
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of AZ Commercial	$1,174.50
Rate for Payer: Bisbee Police All Plans	$339.30
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Self Pay Self Pay	$1,044.00

Know your out-of-pocket cost for care.

All Charges