Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MASK AMBU INFANT

Facility

$131.00

Hospital Charge Code	22355208
Hospital Revenue Code	270
Min. Negotiated Rate	$34.06
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Bisbee Police All Plans	$34.06
Rate for Payer: Cash Price	$104.80
Rate for Payer: Self Pay Self Pay	$104.80

MASK AMBU INFANT

Facility

$131.00

Hospital Charge Code	22355208
Hospital Revenue Code	270
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Aetna of AZ Medicare	$36.68
Rate for Payer: Allwell Medicare	$19.65
Rate for Payer: Amerigroup Medicare	$19.65
Rate for Payer: APIPA Medicare/Medicaid	$48.93
Rate for Payer: AZCH Complete Medicare	$19.65
Rate for Payer: Banner UC Health Medicare	$19.65
Rate for Payer: Bisbee Police All Plans	$34.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$89.08
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cigna of AZ Commercial	$91.70
Rate for Payer: Copperpoint Commercial	$32.42
Rate for Payer: Health Net of AZ Commercial	$78.60
Rate for Payer: Health Net of AZ Medicare	$36.68
Rate for Payer: Humana of AZ Medicare	$19.65
Rate for Payer: Self Pay Self Pay	$104.80
Rate for Payer: TriWest Medicare	$19.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$76.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.58

MASK AMBU NEONATE

Facility

$149.00

Hospital Charge Code	22355207
Hospital Revenue Code	270
Min. Negotiated Rate	$38.74
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of AZ Commercial	$134.10
Rate for Payer: Bisbee Police All Plans	$38.74
Rate for Payer: Cash Price	$119.20
Rate for Payer: Self Pay Self Pay	$119.20

MASK AMBU NEONATE

Facility

$149.00

Hospital Charge Code	22355207
Hospital Revenue Code	270
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna of AZ Commercial	$134.10
Rate for Payer: Aetna of AZ Medicare	$41.72
Rate for Payer: Allwell Medicare	$22.35
Rate for Payer: Amerigroup Medicare	$22.35
Rate for Payer: APIPA Medicare/Medicaid	$55.65
Rate for Payer: AZCH Complete Medicare	$22.35
Rate for Payer: Banner UC Health Medicare	$22.35
Rate for Payer: Bisbee Police All Plans	$38.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$101.32
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cigna of AZ Commercial	$104.30
Rate for Payer: Copperpoint Commercial	$36.88
Rate for Payer: Health Net of AZ Commercial	$89.40
Rate for Payer: Health Net of AZ Medicare	$41.72
Rate for Payer: Humana of AZ Medicare	$22.35
Rate for Payer: Self Pay Self Pay	$119.20
Rate for Payer: TriWest Medicare	$22.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.82

MASK BIPAP FULL FACE LARGE

Facility

$120.00

Hospital Charge Code	22354321
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

MASK BIPAP FULL FACE LARGE

Facility

$120.00

Hospital Charge Code	22354321
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$18.00
Rate for Payer: Amerigroup Medicare	$18.00
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$18.00
Rate for Payer: Banner UC Health Medicare	$18.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$84.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$18.00
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$18.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

MASK BIPAP FULL FACE MED

Facility

$120.00

Hospital Charge Code	22354319
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

MASK BIPAP FULL FACE MED

Facility

$120.00

Hospital Charge Code	22354319
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$18.00
Rate for Payer: Amerigroup Medicare	$18.00
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$18.00
Rate for Payer: Banner UC Health Medicare	$18.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$84.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$18.00
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$18.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

MASK BIPAP FULL FACE SMALL

Facility

$120.00

Hospital Charge Code	22354320
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$18.00
Rate for Payer: Amerigroup Medicare	$18.00
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$18.00
Rate for Payer: Banner UC Health Medicare	$18.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$84.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$18.00
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$18.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

MASK BIPAP FULL FACE SMALL

Facility

$120.00

Hospital Charge Code	22354320
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

MASK BIPAP NASAL LARGE

Facility

$167.00

Hospital Charge Code	22354760
Hospital Revenue Code	272
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$150.30
Rate for Payer: Aetna of AZ Commercial	$150.30
Rate for Payer: Aetna of AZ Medicare	$46.76
Rate for Payer: Allwell Medicare	$25.05
Rate for Payer: Amerigroup Medicare	$25.05
Rate for Payer: APIPA Medicare/Medicaid	$62.37
Rate for Payer: AZCH Complete Medicare	$25.05
Rate for Payer: Banner UC Health Medicare	$25.05
Rate for Payer: Bisbee Police All Plans	$43.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$113.56
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cigna of AZ Commercial	$116.90
Rate for Payer: Copperpoint Commercial	$41.33
Rate for Payer: Health Net of AZ Commercial	$100.20
Rate for Payer: Health Net of AZ Medicare	$46.76
Rate for Payer: Humana of AZ Medicare	$25.05
Rate for Payer: Self Pay Self Pay	$133.60
Rate for Payer: TriWest Medicare	$25.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$97.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.06

MASK BIPAP NASAL LARGE

Facility

$167.00

Hospital Charge Code	22354760
Hospital Revenue Code	272
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$150.30
Rate for Payer: Aetna of AZ Commercial	$150.30
Rate for Payer: Bisbee Police All Plans	$43.42
Rate for Payer: Cash Price	$133.60
Rate for Payer: Self Pay Self Pay	$133.60

MASK BIPAP NASAL MEDIUM

Facility

$161.00

Hospital Charge Code	22354759
Hospital Revenue Code	272
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Bisbee Police All Plans	$41.86
Rate for Payer: Cash Price	$128.80
Rate for Payer: Self Pay Self Pay	$128.80

MASK BIPAP NASAL MEDIUM

Facility

$161.00

Hospital Charge Code	22354759
Hospital Revenue Code	272
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Aetna of AZ Medicare	$45.08
Rate for Payer: Allwell Medicare	$24.15
Rate for Payer: Amerigroup Medicare	$24.15
Rate for Payer: APIPA Medicare/Medicaid	$60.13
Rate for Payer: AZCH Complete Medicare	$24.15
Rate for Payer: Banner UC Health Medicare	$24.15
Rate for Payer: Bisbee Police All Plans	$41.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$109.48
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cigna of AZ Commercial	$112.70
Rate for Payer: Copperpoint Commercial	$39.85
Rate for Payer: Health Net of AZ Commercial	$96.60
Rate for Payer: Health Net of AZ Medicare	$45.08
Rate for Payer: Humana of AZ Medicare	$24.15
Rate for Payer: Self Pay Self Pay	$128.80
Rate for Payer: TriWest Medicare	$24.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.98

MASK BIPAP NASAL SMALL

Facility

$161.00

Hospital Charge Code	22354758
Hospital Revenue Code	272
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Aetna of AZ Medicare	$45.08
Rate for Payer: Allwell Medicare	$24.15
Rate for Payer: Amerigroup Medicare	$24.15
Rate for Payer: APIPA Medicare/Medicaid	$60.13
Rate for Payer: AZCH Complete Medicare	$24.15
Rate for Payer: Banner UC Health Medicare	$24.15
Rate for Payer: Bisbee Police All Plans	$41.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$109.48
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cigna of AZ Commercial	$112.70
Rate for Payer: Copperpoint Commercial	$39.85
Rate for Payer: Health Net of AZ Commercial	$96.60
Rate for Payer: Health Net of AZ Medicare	$45.08
Rate for Payer: Humana of AZ Medicare	$24.15
Rate for Payer: Self Pay Self Pay	$128.80
Rate for Payer: TriWest Medicare	$24.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.98

MASK BIPAP NASAL SMALL

Facility

$161.00

Hospital Charge Code	22354758
Hospital Revenue Code	272
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Bisbee Police All Plans	$41.86
Rate for Payer: Cash Price	$128.80
Rate for Payer: Self Pay Self Pay	$128.80

MASK LARYNGEAL #2 DISPOSABLE

Facility

$44.00

Hospital Charge Code	22570783
Hospital Revenue Code	272
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

MASK LARYNGEAL #2 DISPOSABLE

Facility

$44.00

Hospital Charge Code	22570783
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$6.60
Rate for Payer: Amerigroup Medicare	$6.60
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$6.60
Rate for Payer: Banner UC Health Medicare	$6.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$6.60
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$6.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

MASK LARYNGEAL NO. 1 DISPOSABLE

Facility

$41.00

Hospital Charge Code	22570781
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

MASK LARYNGEAL NO. 1 DISPOSABLE

Facility

$41.00

Hospital Charge Code	22570781
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

MASK LARYNGEAL NO.3 DISPOSABLE

Facility

$65.00

Hospital Charge Code	22354933
Hospital Revenue Code	270
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

MASK LARYNGEAL NO.3 DISPOSABLE

Facility

$65.00

Hospital Charge Code	22354933
Hospital Revenue Code	270
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

MASK LARYNGEAL NO.4 DISPOSABLE

Facility

$76.00

Hospital Charge Code	22354934
Hospital Revenue Code	270
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

MASK LARYNGEAL NO.4 DISPOSABLE

Facility

$76.00

Hospital Charge Code	22354934
Hospital Revenue Code	270
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$11.40
Rate for Payer: Amerigroup Medicare	$11.40
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$11.40
Rate for Payer: Banner UC Health Medicare	$11.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$53.20
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$11.40
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$11.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

MASK LARYNGEAL NO.5 DISPOSABLE

Facility

$67.00

Hospital Charge Code	22354935
Hospital Revenue Code	270
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

Know your out-of-pocket cost for care.

All Charges