Copper Queen Community Hospital

All Charges

Charge

Type

Price

Shoulder And Elbow Joint Replacement

Facility IP

$10,051.76

Service Code	APRDRG 3221
Hospital Charge Code	APRDRG3221
Min. Negotiated Rate	$10,051.76
Max. Negotiated Rate	$10,051.76
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$10,051.76
Rate for Payer: Arizona Complete Care Health Medicaid	$10,051.76
Rate for Payer: Banner University Family Care Medicaid	$10,051.76
Rate for Payer: Mercy Care Medicaid	$10,051.76

Shoulder And Elbow Joint Replacement

Facility IP

$11,399.15

Service Code	APRDRG 3222
Hospital Charge Code	APRDRG3222
Min. Negotiated Rate	$11,399.15
Max. Negotiated Rate	$11,399.15
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$11,399.15
Rate for Payer: Arizona Complete Care Health Medicaid	$11,399.15
Rate for Payer: Banner University Family Care Medicaid	$11,399.15
Rate for Payer: Mercy Care Medicaid	$11,399.15

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility IP

$29,141.77

Service Code	APRDRG 3154
Hospital Charge Code	APRDRG3154
Min. Negotiated Rate	$29,141.77
Max. Negotiated Rate	$29,141.77
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$29,141.77
Rate for Payer: Arizona Complete Care Health Medicaid	$29,141.77
Rate for Payer: Banner University Family Care Medicaid	$29,141.77
Rate for Payer: Mercy Care Medicaid	$29,141.77

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility IP

$6,777.63

Service Code	APRDRG 3151
Hospital Charge Code	APRDRG3151
Min. Negotiated Rate	$6,777.63
Max. Negotiated Rate	$6,777.63
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$6,777.63
Rate for Payer: Arizona Complete Care Health Medicaid	$6,777.63
Rate for Payer: Banner University Family Care Medicaid	$6,777.63
Rate for Payer: Mercy Care Medicaid	$6,777.63

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility IP

$10,067.90

Service Code	APRDRG 3152
Hospital Charge Code	APRDRG3152
Min. Negotiated Rate	$10,067.90
Max. Negotiated Rate	$10,067.90
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$10,067.90
Rate for Payer: Arizona Complete Care Health Medicaid	$10,067.90
Rate for Payer: Banner University Family Care Medicaid	$10,067.90
Rate for Payer: Mercy Care Medicaid	$10,067.90

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility IP

$15,478.50

Service Code	APRDRG 3153
Hospital Charge Code	APRDRG3153
Min. Negotiated Rate	$15,478.50
Max. Negotiated Rate	$15,478.50
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$15,478.50
Rate for Payer: Arizona Complete Care Health Medicaid	$15,478.50
Rate for Payer: Banner University Family Care Medicaid	$15,478.50
Rate for Payer: Mercy Care Medicaid	$15,478.50

Sickle Cell Anemia Crisis

Facility IP

$4,968.72

Service Code	APRDRG 6622
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$4,968.72
Rate for Payer: Arizona Complete Care Health Medicaid	$4,968.72
Rate for Payer: Banner University Family Care Medicaid	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72

Sickle Cell Anemia Crisis

Facility IP

$3,701.29

Service Code	APRDRG 6621
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$3,701.29
Rate for Payer: Arizona Complete Care Health Medicaid	$3,701.29
Rate for Payer: Banner University Family Care Medicaid	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29

Sickle Cell Anemia Crisis

Facility IP

$16,471.68

Service Code	APRDRG 6624
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$16,471.68
Rate for Payer: Arizona Complete Care Health Medicaid	$16,471.68
Rate for Payer: Banner University Family Care Medicaid	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68

Sickle Cell Anemia Crisis

Facility IP

$7,503.58

Service Code	APRDRG 6623
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$7,503.58
Rate for Payer: Arizona Complete Care Health Medicaid	$7,503.58
Rate for Payer: Banner University Family Care Medicaid	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58

SIGMOIDOSCOPY

Facility IP

$361.00

Service Code	CPT 45330
Hospital Charge Code	1015557
Hospital Revenue Code	750
Min. Negotiated Rate	$61.37
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna POS, PPO, HMO	$324.90
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$61.37
Rate for Payer: Amerigroup Medicare	$61.37
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$61.37
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$61.37
Rate for Payer: City of Bisbee Police Bisbee Police	$93.86
Rate for Payer: Copperpoint	$101.26
Rate for Payer: Humana Medicare	$61.37
Rate for Payer: SELF PAY	$288.80
Rate for Payer: Veterans (Triwest)	$61.37

SIGMOIDOSCOPY

Facility OP

$361.00

Service Code	CPT 45330
Hospital Charge Code	1015557
Hospital Revenue Code	750
Min. Negotiated Rate	$61.37
Max. Negotiated Rate	$1,150.80
Rate for Payer: Aetna POS, PPO, HMO	$324.90
Rate for Payer: Aetna Medicare	$101.08
Rate for Payer: AHCCCS Medicaid	$1,150.80
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$1,150.80
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$61.37
Rate for Payer: Amerigroup Medicare	$61.37
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$134.83
Rate for Payer: Arizona Complete Care Health Medicaid	$1,150.80
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$61.37
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$61.37
Rate for Payer: Banner University Family Care Medicaid	$1,150.80
Rate for Payer: City of Bisbee Police Bisbee Police	$93.86
Rate for Payer: Cigna All Products	$252.70
Rate for Payer: Copperpoint	$101.26
Rate for Payer: HealthNet Commercial	$216.60
Rate for Payer: HealthNet Medicare	$101.08
Rate for Payer: Humana Medicare	$61.37
Rate for Payer: Mercy Care Medicaid	$1,150.80
Rate for Payer: SELF PAY	$288.80
Rate for Payer: Veterans (Triwest)	$61.37
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$210.46
Rate for Payer: United Healthcare Medicare	$64.98

Signs, Symptoms And Other Factors Influencing Health Status

Facility IP

$3,340.07

Service Code	APRDRG 8611
Hospital Charge Code	APRDRG8611
Min. Negotiated Rate	$3,340.07
Max. Negotiated Rate	$3,340.07
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$3,340.07
Rate for Payer: Arizona Complete Care Health Medicaid	$3,340.07
Rate for Payer: Banner University Family Care Medicaid	$3,340.07
Rate for Payer: Mercy Care Medicaid	$3,340.07

Signs, Symptoms And Other Factors Influencing Health Status

Facility IP

$5,985.05

Service Code	APRDRG 8613
Hospital Charge Code	APRDRG8613
Min. Negotiated Rate	$5,985.05
Max. Negotiated Rate	$5,985.05
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$5,985.05
Rate for Payer: Arizona Complete Care Health Medicaid	$5,985.05
Rate for Payer: Banner University Family Care Medicaid	$5,985.05
Rate for Payer: Mercy Care Medicaid	$5,985.05

Signs, Symptoms And Other Factors Influencing Health Status

Facility IP

$9,865.19

Service Code	APRDRG 8614
Hospital Charge Code	APRDRG8614
Min. Negotiated Rate	$9,865.19
Max. Negotiated Rate	$9,865.19
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$9,865.19
Rate for Payer: Arizona Complete Care Health Medicaid	$9,865.19
Rate for Payer: Banner University Family Care Medicaid	$9,865.19
Rate for Payer: Mercy Care Medicaid	$9,865.19

Signs, Symptoms And Other Factors Influencing Health Status

Facility IP

$4,167.02

Service Code	APRDRG 8612
Hospital Charge Code	APRDRG8612
Min. Negotiated Rate	$4,167.02
Max. Negotiated Rate	$4,167.02
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$4,167.02
Rate for Payer: Arizona Complete Care Health Medicaid	$4,167.02
Rate for Payer: Banner University Family Care Medicaid	$4,167.02
Rate for Payer: Mercy Care Medicaid	$4,167.02

SILICONE EPISTAXIS BALLOON

Facility IP

$276.32

Hospital Charge Code	27526363
Hospital Revenue Code	270
Min. Negotiated Rate	$46.97
Max. Negotiated Rate	$248.69
Rate for Payer: Aetna POS, PPO, HMO	$248.69
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$46.97
Rate for Payer: Amerigroup Medicare	$46.97
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$46.97
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$46.97
Rate for Payer: City of Bisbee Police Bisbee Police	$71.84
Rate for Payer: Copperpoint	$77.51
Rate for Payer: Humana Medicare	$46.97
Rate for Payer: SELF PAY	$221.06
Rate for Payer: Veterans (Triwest)	$46.97

SILICONE EPISTAXIS BALLOON

Facility OP

$276.32

Hospital Charge Code	27526363
Hospital Revenue Code	270
Min. Negotiated Rate	$46.97
Max. Negotiated Rate	$248.69
Rate for Payer: Aetna POS, PPO, HMO	$248.69
Rate for Payer: Aetna Medicare	$77.37
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$46.97
Rate for Payer: Amerigroup Medicare	$46.97
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$103.21
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$46.97
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$46.97
Rate for Payer: City of Bisbee Police Bisbee Police	$71.84
Rate for Payer: Cigna All Products	$193.42
Rate for Payer: Copperpoint	$77.51
Rate for Payer: HealthNet Commercial	$165.79
Rate for Payer: HealthNet Medicare	$77.37
Rate for Payer: Humana Medicare	$46.97
Rate for Payer: SELF PAY	$221.06
Rate for Payer: Veterans (Triwest)	$46.97
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$161.09
Rate for Payer: United Healthcare Medicare	$49.74

Simple vulvectomy complete

Facility OP

$3,420.00

Service Code	CPT 56625
Hospital Charge Code	27267830
Hospital Revenue Code	360
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$3,803.66
Rate for Payer: Aetna POS, PPO, HMO	$3,078.00
Rate for Payer: Aetna Medicare	$957.60
Rate for Payer: AHCCCS Medicaid	$3,803.66
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$3,803.66
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$581.40
Rate for Payer: Amerigroup Medicare	$581.40
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$1,277.37
Rate for Payer: Arizona Complete Care Health Medicaid	$3,803.66
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$581.40
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$581.40
Rate for Payer: Banner University Family Care Medicaid	$3,803.66
Rate for Payer: City of Bisbee Police Bisbee Police	$889.20
Rate for Payer: Cigna All Products	$1,710.00
Rate for Payer: Copperpoint	$959.31
Rate for Payer: HealthNet Commercial	$2,052.00
Rate for Payer: HealthNet Medicare	$957.60
Rate for Payer: Humana Medicare	$581.40
Rate for Payer: Mercy Care Medicaid	$3,803.66
Rate for Payer: SELF PAY	$2,736.00
Rate for Payer: Veterans (Triwest)	$581.40
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$1,993.86
Rate for Payer: United Healthcare Medicare	$615.60

Simple vulvectomy complete

Facility IP

$3,157.45

Hospital Charge Code	27341814
Hospital Revenue Code	270
Min. Negotiated Rate	$536.77
Max. Negotiated Rate	$2,841.70
Rate for Payer: Aetna POS, PPO, HMO	$2,841.70
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$536.77
Rate for Payer: Amerigroup Medicare	$536.77
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$536.77
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$536.77
Rate for Payer: City of Bisbee Police Bisbee Police	$820.94
Rate for Payer: Copperpoint	$885.66
Rate for Payer: Humana Medicare	$536.77
Rate for Payer: SELF PAY	$2,525.96
Rate for Payer: Veterans (Triwest)	$536.77

Simple vulvectomy complete

Facility IP

$3,420.00

Service Code	CPT 56625
Hospital Charge Code	27267830
Hospital Revenue Code	360
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$3,078.00
Rate for Payer: Aetna POS, PPO, HMO	$3,078.00
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$581.40
Rate for Payer: Amerigroup Medicare	$581.40
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$581.40
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$581.40
Rate for Payer: City of Bisbee Police Bisbee Police	$889.20
Rate for Payer: Copperpoint	$959.31
Rate for Payer: Humana Medicare	$581.40
Rate for Payer: SELF PAY	$2,736.00
Rate for Payer: Veterans (Triwest)	$581.40

Simple vulvectomy complete

Facility OP

$3,157.45

Hospital Charge Code	27341814
Hospital Revenue Code	270
Min. Negotiated Rate	$536.77
Max. Negotiated Rate	$2,841.70
Rate for Payer: Aetna POS, PPO, HMO	$2,841.70
Rate for Payer: Aetna Medicare	$884.09
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$536.77
Rate for Payer: Amerigroup Medicare	$536.77
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$1,179.31
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$536.77
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$536.77
Rate for Payer: City of Bisbee Police Bisbee Police	$820.94
Rate for Payer: Cigna All Products	$2,210.21
Rate for Payer: Copperpoint	$885.66
Rate for Payer: HealthNet Commercial	$1,894.47
Rate for Payer: HealthNet Medicare	$884.09
Rate for Payer: Humana Medicare	$536.77
Rate for Payer: SELF PAY	$2,525.96
Rate for Payer: Veterans (Triwest)	$536.77
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$1,840.79
Rate for Payer: United Healthcare Medicare	$568.34

SINGLE USE BITE BLOCK

Facility IP

$8.00

Hospital Charge Code	22355557
Hospital Revenue Code	270
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna POS, PPO, HMO	$7.20
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$1.36
Rate for Payer: Amerigroup Medicare	$1.36
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$1.36
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$1.36
Rate for Payer: City of Bisbee Police Bisbee Police	$2.08
Rate for Payer: Copperpoint	$2.24
Rate for Payer: Humana Medicare	$1.36
Rate for Payer: SELF PAY	$6.40
Rate for Payer: Veterans (Triwest)	$1.36

SINGLE USE BITE BLOCK

Facility OP

$8.00

Hospital Charge Code	22355557
Hospital Revenue Code	270
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$7.20
Rate for Payer: SELF PAY	$6.40
Rate for Payer: Aetna POS, PPO, HMO	$7.20
Rate for Payer: Aetna Medicare	$2.24
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$1.36
Rate for Payer: Amerigroup Medicare	$1.36
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$2.99
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$1.36
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$1.36
Rate for Payer: City of Bisbee Police Bisbee Police	$2.08
Rate for Payer: Cigna All Products	$5.60
Rate for Payer: Copperpoint	$2.24
Rate for Payer: HealthNet Commercial	$4.80
Rate for Payer: HealthNet Medicare	$2.24
Rate for Payer: Humana Medicare	$1.36
Rate for Payer: Veterans (Triwest)	$1.36
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$4.66
Rate for Payer: United Healthcare Medicare	$1.44

SIROLIMUS (RAPAMUNE)

Facility IP

$331.00

Service Code	CPT 80195
Hospital Charge Code	23603249
Hospital Revenue Code	301
Min. Negotiated Rate	$56.27
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna POS, PPO, HMO	$297.90
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$56.27
Rate for Payer: Amerigroup Medicare	$56.27
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$56.27
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$56.27
Rate for Payer: City of Bisbee Police Bisbee Police	$86.06
Rate for Payer: Copperpoint	$92.85
Rate for Payer: Humana Medicare	$56.27
Rate for Payer: SELF PAY	$264.80
Rate for Payer: Veterans (Triwest)	$56.27

Copper Queen Community Hospital

Price Transparency.

All Charges