Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

MASK LARYNGEAL NO.5 DISPOSABLE

Facility

$67.00

Hospital Charge Code	22354935
Hospital Revenue Code	270
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.72
Rate for Payer: Amerigroup Medicare	$10.72
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.72
Rate for Payer: Banner UC Health Medicare	$10.72
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.72
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

MASK NRB ADULT

Facility

$13.00

Hospital Charge Code	22354318
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

MASK NRB ADULT

Facility

$13.00

Hospital Charge Code	22354318
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

MASK NRB PEDIATRIC NON-REBREATHER

Facility

$12.00

Hospital Charge Code	22562175
Hospital Revenue Code	272
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.92
Rate for Payer: Amerigroup Medicare	$1.92
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

MASK NRB PEDIATRIC NON-REBREATHER

Facility

$12.00

Hospital Charge Code	22562175
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

MASK O2 PED

Facility

$9.00

Hospital Charge Code	22354263
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

MASK O2 PED

Facility

$9.00

Hospital Charge Code	22354263
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

MASK VENTI ADULT

Facility

$47.00

Hospital Charge Code	22355297
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

MASK VENTI ADULT

Facility

$47.00

Hospital Charge Code	22355297
Hospital Revenue Code	270
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Massage Charges (97124)

Facility

$172.00

Service Code	CPT 97124 GP
Hospital Charge Code	1675794
Hospital Revenue Code	420
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

Massage Charges (97124)

Facility

$172.00

Service Code	CPT 97124 GP
Hospital Charge Code	1675794
Hospital Revenue Code	420
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: Allwell Medicare	$27.52
Rate for Payer: Amerigroup Medicare	$27.52
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTO

Facility

$1,877.00

Service Code	CPT 19302
Hospital Charge Code	23390088
Hospital Revenue Code	982
Min. Negotiated Rate	$300.32
Max. Negotiated Rate	$4,012.11
Rate for Payer: Aetna of AZ Commercial	$1,689.30
Rate for Payer: Aetna of AZ Medicare	$525.56
Rate for Payer: AHCCCS Medicaid	$4,012.11
Rate for Payer: Allwell Medicaid	$4,012.11
Rate for Payer: Allwell Medicare	$300.32
Rate for Payer: Amerigroup Medicare	$300.32
Rate for Payer: APIPA Medicare/Medicaid	$701.06
Rate for Payer: AZCH Complete Medicaid	$4,012.11
Rate for Payer: AZCH Complete Medicare	$300.32
Rate for Payer: Banner UC Health Medicaid	$4,012.11
Rate for Payer: Banner UC Health Medicare	$300.32
Rate for Payer: Bisbee Police All Plans	$488.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,276.36
Rate for Payer: Cash Price	$1,501.60
Rate for Payer: Cash Price	$1,501.60
Rate for Payer: Cigna of AZ Commercial	$1,313.90
Rate for Payer: Copperpoint Commercial	$464.56
Rate for Payer: Health Net of AZ Commercial	$1,126.20
Rate for Payer: Health Net of AZ Medicare	$525.56
Rate for Payer: Humana of AZ Medicare	$300.32
Rate for Payer: Mercy Care Medicaid	$4,012.11
Rate for Payer: Self Pay Self Pay	$1,501.60
Rate for Payer: TriWest Medicare	$300.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,094.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$337.86

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTO

Facility

$1,877.00

Service Code	CPT 19302
Hospital Charge Code	23390088
Hospital Revenue Code	982
Min. Negotiated Rate	$488.02
Max. Negotiated Rate	$1,689.30
Rate for Payer: Aetna of AZ Commercial	$1,689.30
Rate for Payer: Bisbee Police All Plans	$488.02
Rate for Payer: Cash Price	$1,501.60
Rate for Payer: Self Pay Self Pay	$1,501.60

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: AHCCCS Medicaid	$17,489.41
Rate for Payer: Allwell Medicaid	$17,489.41
Rate for Payer: AZCH Complete Medicaid	$17,489.41
Rate for Payer: Banner UC Health Medicaid	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3622
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: AHCCCS Medicaid	$14,776.39
Rate for Payer: Allwell Medicaid	$14,776.39
Rate for Payer: AZCH Complete Medicaid	$14,776.39
Rate for Payer: Banner UC Health Medicaid	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: AHCCCS Medicaid	$14,776.39
Rate for Payer: Allwell Medicaid	$14,776.39
Rate for Payer: AZCH Complete Medicaid	$14,776.39
Rate for Payer: Banner UC Health Medicaid	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39

Mastectomy Procedures

Facility

$8,417.50

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG3622
Min. Negotiated Rate	$8,417.50
Max. Negotiated Rate	$8,417.50
Rate for Payer: AHCCCS Medicaid	$8,417.50
Rate for Payer: Allwell Medicaid	$8,417.50
Rate for Payer: AZCH Complete Medicaid	$8,417.50
Rate for Payer: Banner UC Health Medicaid	$8,417.50
Rate for Payer: Mercy Care Medicaid	$8,417.50

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: AHCCCS Medicaid	$14,776.39
Rate for Payer: Allwell Medicaid	$14,776.39
Rate for Payer: AZCH Complete Medicaid	$14,776.39
Rate for Payer: Banner UC Health Medicaid	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3621
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: AHCCCS Medicaid	$11,591.34
Rate for Payer: Allwell Medicaid	$11,591.34
Rate for Payer: AZCH Complete Medicaid	$11,591.34
Rate for Payer: Banner UC Health Medicaid	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: AHCCCS Medicaid	$17,489.41
Rate for Payer: Allwell Medicaid	$17,489.41
Rate for Payer: AZCH Complete Medicaid	$17,489.41
Rate for Payer: Banner UC Health Medicaid	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: AHCCCS Medicaid	$11,591.34
Rate for Payer: Allwell Medicaid	$11,591.34
Rate for Payer: AZCH Complete Medicaid	$11,591.34
Rate for Payer: Banner UC Health Medicaid	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3621
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: AHCCCS Medicaid	$17,489.41
Rate for Payer: Allwell Medicaid	$17,489.41
Rate for Payer: AZCH Complete Medicaid	$17,489.41
Rate for Payer: Banner UC Health Medicaid	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: AHCCCS Medicaid	$11,591.34
Rate for Payer: Allwell Medicaid	$11,591.34
Rate for Payer: AZCH Complete Medicaid	$11,591.34
Rate for Payer: Banner UC Health Medicaid	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34

Mastectomy Procedures

Facility

$8,417.50

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$8,417.50
Max. Negotiated Rate	$8,417.50
Rate for Payer: AHCCCS Medicaid	$8,417.50
Rate for Payer: Allwell Medicaid	$8,417.50
Rate for Payer: AZCH Complete Medicaid	$8,417.50
Rate for Payer: Banner UC Health Medicaid	$8,417.50
Rate for Payer: Mercy Care Medicaid	$8,417.50

Know your out-of-pocket cost for care.

All Charges