Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION INCLUDES INTERNAL FIXATION

Facility

$1,960.00

Service Code	CPT 28675
Hospital Charge Code	24043327
Hospital Revenue Code	360
Min. Negotiated Rate	$313.60
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,764.00
Rate for Payer: Aetna of AZ Medicare	$548.80
Rate for Payer: AHCCCS Medicaid	$2,052.04
Rate for Payer: Allwell Medicaid	$2,052.04
Rate for Payer: Allwell Medicare	$313.60
Rate for Payer: Amerigroup Medicare	$313.60
Rate for Payer: APIPA Medicare/Medicaid	$732.06
Rate for Payer: AZCH Complete Medicaid	$2,052.04
Rate for Payer: AZCH Complete Medicare	$313.60
Rate for Payer: Banner UC Health Medicaid	$2,052.04
Rate for Payer: Banner UC Health Medicare	$313.60
Rate for Payer: Bisbee Police All Plans	$509.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,332.80
Rate for Payer: Cash Price	$1,568.00
Rate for Payer: Cash Price	$1,568.00
Rate for Payer: Cigna of AZ Commercial	$980.00
Rate for Payer: Copperpoint Commercial	$485.10
Rate for Payer: Health Net of AZ Commercial	$1,176.00
Rate for Payer: Health Net of AZ Medicare	$548.80
Rate for Payer: Humana of AZ Medicare	$313.60
Rate for Payer: Mercy Care Medicaid	$2,052.04
Rate for Payer: Self Pay Self Pay	$1,568.00
Rate for Payer: TriWest Medicare	$313.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$352.80

OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION INCLUDES INTERNAL FIXATION

Facility

$1,960.00

Service Code	CPT 28675
Hospital Charge Code	24043327
Hospital Revenue Code	360
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$1,764.00
Rate for Payer: Aetna of AZ Commercial	$1,764.00
Rate for Payer: Bisbee Police All Plans	$509.60
Rate for Payer: Cash Price	$1,568.00
Rate for Payer: Self Pay Self Pay	$1,568.00

OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE INCLUDES INTERNAL FIXATION

Facility

$2,938.00

Service Code	CPT 27766
Hospital Charge Code	24043288
Hospital Revenue Code	360
Min. Negotiated Rate	$470.08
Max. Negotiated Rate	$4,542.09
Rate for Payer: Aetna of AZ Commercial	$2,644.20
Rate for Payer: Aetna of AZ Medicare	$822.64
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$470.08
Rate for Payer: Amerigroup Medicare	$470.08
Rate for Payer: APIPA Medicare/Medicaid	$1,097.34
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$470.08
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$470.08
Rate for Payer: Bisbee Police All Plans	$763.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,997.84
Rate for Payer: Cash Price	$2,350.40
Rate for Payer: Cash Price	$2,350.40
Rate for Payer: Cigna of AZ Commercial	$1,469.00
Rate for Payer: Copperpoint Commercial	$727.15
Rate for Payer: Health Net of AZ Commercial	$1,762.80
Rate for Payer: Health Net of AZ Medicare	$822.64
Rate for Payer: Humana of AZ Medicare	$470.08
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$2,350.40
Rate for Payer: TriWest Medicare	$470.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,712.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$528.84

OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE INCLUDES INTERNAL FIXATION

Facility

$2,938.00

Service Code	CPT 27766
Hospital Charge Code	24043288
Hospital Revenue Code	360
Min. Negotiated Rate	$763.88
Max. Negotiated Rate	$2,644.20
Rate for Payer: Aetna of AZ Commercial	$2,644.20
Rate for Payer: Bisbee Police All Plans	$763.88
Rate for Payer: Cash Price	$2,350.40
Rate for Payer: Self Pay Self Pay	$2,350.40

OPEN TREATMENT OF METATARSAL FRACTURE INCLUDES INTERNAL FIXATION WHEN PERFORME

Facility

$2,648.00

Service Code	CPT 28485
Hospital Charge Code	24043332
Hospital Revenue Code	360
Min. Negotiated Rate	$688.48
Max. Negotiated Rate	$2,383.20
Rate for Payer: Aetna of AZ Commercial	$2,383.20
Rate for Payer: Bisbee Police All Plans	$688.48
Rate for Payer: Cash Price	$2,118.40
Rate for Payer: Self Pay Self Pay	$2,118.40

OPEN TREATMENT OF METATARSAL FRACTURE INCLUDES INTERNAL FIXATION WHEN PERFORME

Facility

$2,648.00

Service Code	CPT 28485
Hospital Charge Code	24043332
Hospital Revenue Code	360
Min. Negotiated Rate	$423.68
Max. Negotiated Rate	$5,265.00
Rate for Payer: Aetna of AZ Commercial	$2,383.20
Rate for Payer: Aetna of AZ Medicare	$741.44
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$423.68
Rate for Payer: Amerigroup Medicare	$423.68
Rate for Payer: APIPA Medicare/Medicaid	$989.03
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$423.68
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$423.68
Rate for Payer: Bisbee Police All Plans	$688.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,800.64
Rate for Payer: Cash Price	$2,118.40
Rate for Payer: Cash Price	$2,118.40
Rate for Payer: Cigna of AZ Commercial	$1,324.00
Rate for Payer: Copperpoint Commercial	$655.38
Rate for Payer: Health Net of AZ Commercial	$1,588.80
Rate for Payer: Health Net of AZ Medicare	$741.44
Rate for Payer: Humana of AZ Medicare	$423.68
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$2,118.40
Rate for Payer: TriWest Medicare	$423.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$476.64

OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION INCLUDES INTERNAL FIXAT

Facility

$2,370.00

Service Code	CPT 28645
Hospital Charge Code	24043325
Hospital Revenue Code	360
Min. Negotiated Rate	$379.20
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$2,133.00
Rate for Payer: Aetna of AZ Medicare	$663.60
Rate for Payer: AHCCCS Medicaid	$2,052.04
Rate for Payer: Allwell Medicaid	$2,052.04
Rate for Payer: Allwell Medicare	$379.20
Rate for Payer: Amerigroup Medicare	$379.20
Rate for Payer: APIPA Medicare/Medicaid	$885.20
Rate for Payer: AZCH Complete Medicaid	$2,052.04
Rate for Payer: AZCH Complete Medicare	$379.20
Rate for Payer: Banner UC Health Medicaid	$2,052.04
Rate for Payer: Banner UC Health Medicare	$379.20
Rate for Payer: Bisbee Police All Plans	$616.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,611.60
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Cigna of AZ Commercial	$1,185.00
Rate for Payer: Copperpoint Commercial	$586.58
Rate for Payer: Health Net of AZ Commercial	$1,422.00
Rate for Payer: Health Net of AZ Medicare	$663.60
Rate for Payer: Humana of AZ Medicare	$379.20
Rate for Payer: Mercy Care Medicaid	$2,052.04
Rate for Payer: Self Pay Self Pay	$1,896.00
Rate for Payer: TriWest Medicare	$379.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$426.60

OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION INCLUDES INTERNAL FIXAT

Facility

$2,370.00

Service Code	CPT 28645
Hospital Charge Code	24043325
Hospital Revenue Code	360
Min. Negotiated Rate	$616.20
Max. Negotiated Rate	$2,133.00
Rate for Payer: Aetna of AZ Commercial	$2,133.00
Rate for Payer: Bisbee Police All Plans	$616.20
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Self Pay Self Pay	$1,896.00

OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION INCLUDES INTERNAL FIXATION WHEN

Facility

$3,167.00

Service Code	CPT 28585
Hospital Charge Code	24043321
Hospital Revenue Code	360
Min. Negotiated Rate	$823.42
Max. Negotiated Rate	$2,850.30
Rate for Payer: Aetna of AZ Commercial	$2,850.30
Rate for Payer: Bisbee Police All Plans	$823.42
Rate for Payer: Cash Price	$2,533.60
Rate for Payer: Self Pay Self Pay	$2,533.60

OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION INCLUDES INTERNAL FIXATION WHEN

Facility

$3,167.00

Service Code	CPT 28585
Hospital Charge Code	24043321
Hospital Revenue Code	360
Min. Negotiated Rate	$506.72
Max. Negotiated Rate	$4,542.09
Rate for Payer: Aetna of AZ Commercial	$2,850.30
Rate for Payer: Aetna of AZ Medicare	$886.76
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$506.72
Rate for Payer: Amerigroup Medicare	$506.72
Rate for Payer: APIPA Medicare/Medicaid	$1,182.87
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$506.72
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$506.72
Rate for Payer: Bisbee Police All Plans	$823.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,153.56
Rate for Payer: Cash Price	$2,533.60
Rate for Payer: Cash Price	$2,533.60
Rate for Payer: Cigna of AZ Commercial	$1,583.50
Rate for Payer: Copperpoint Commercial	$783.83
Rate for Payer: Health Net of AZ Commercial	$1,900.20
Rate for Payer: Health Net of AZ Medicare	$886.76
Rate for Payer: Humana of AZ Medicare	$506.72
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$2,533.60
Rate for Payer: TriWest Medicare	$506.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$570.06

Opiates

Facility

$296.00

Service Code	CPT 80307
Hospital Charge Code	23090934
Hospital Revenue Code	301
Min. Negotiated Rate	$76.96
Max. Negotiated Rate	$266.40
Rate for Payer: Aetna of AZ Commercial	$266.40
Rate for Payer: Bisbee Police All Plans	$76.96
Rate for Payer: Cash Price	$236.80
Rate for Payer: Self Pay Self Pay	$236.80

Opiates

Facility

$296.00

Service Code	CPT 80307
Hospital Charge Code	23090934
Hospital Revenue Code	301
Min. Negotiated Rate	$47.36
Max. Negotiated Rate	$266.40
Rate for Payer: Aetna of AZ Commercial	$266.40
Rate for Payer: Aetna of AZ Medicare	$82.88
Rate for Payer: Allwell Medicare	$47.36
Rate for Payer: Amerigroup Medicare	$47.36
Rate for Payer: APIPA Medicare/Medicaid	$110.56
Rate for Payer: AZCH Complete Medicare	$47.36
Rate for Payer: Banner UC Health Medicare	$47.36
Rate for Payer: Bisbee Police All Plans	$76.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$201.28
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cigna of AZ Commercial	$192.40
Rate for Payer: Copperpoint Commercial	$73.26
Rate for Payer: Health Net of AZ Commercial	$177.60
Rate for Payer: Health Net of AZ Medicare	$82.88
Rate for Payer: Humana of AZ Medicare	$47.36
Rate for Payer: Self Pay Self Pay	$236.80
Rate for Payer: TriWest Medicare	$47.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$172.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.28

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: AHCCCS Medicaid	$12,557.16
Rate for Payer: Allwell Medicaid	$12,557.16
Rate for Payer: AZCH Complete Medicaid	$12,557.16
Rate for Payer: Banner UC Health Medicaid	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: AHCCCS Medicaid	$2,570.63
Rate for Payer: Allwell Medicaid	$2,570.63
Rate for Payer: AZCH Complete Medicaid	$2,570.63
Rate for Payer: Banner UC Health Medicaid	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: AHCCCS Medicaid	$4,880.34
Rate for Payer: Allwell Medicaid	$4,880.34
Rate for Payer: AZCH Complete Medicaid	$4,880.34
Rate for Payer: Banner UC Health Medicaid	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: AHCCCS Medicaid	$1,828.55
Rate for Payer: Allwell Medicaid	$1,828.55
Rate for Payer: AZCH Complete Medicaid	$1,828.55
Rate for Payer: Banner UC Health Medicaid	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: AHCCCS Medicaid	$1,828.55
Rate for Payer: Allwell Medicaid	$1,828.55
Rate for Payer: AZCH Complete Medicaid	$1,828.55
Rate for Payer: Banner UC Health Medicaid	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: AHCCCS Medicaid	$2,570.63
Rate for Payer: Allwell Medicaid	$2,570.63
Rate for Payer: AZCH Complete Medicaid	$2,570.63
Rate for Payer: Banner UC Health Medicaid	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: AHCCCS Medicaid	$4,880.34
Rate for Payer: Allwell Medicaid	$4,880.34
Rate for Payer: AZCH Complete Medicaid	$4,880.34
Rate for Payer: Banner UC Health Medicaid	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: AHCCCS Medicaid	$12,557.16
Rate for Payer: Allwell Medicaid	$12,557.16
Rate for Payer: AZCH Complete Medicaid	$12,557.16
Rate for Payer: Banner UC Health Medicaid	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: AHCCCS Medicaid	$12,557.16
Rate for Payer: Allwell Medicaid	$12,557.16
Rate for Payer: AZCH Complete Medicaid	$12,557.16
Rate for Payer: Banner UC Health Medicaid	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: AHCCCS Medicaid	$4,880.34
Rate for Payer: Allwell Medicaid	$4,880.34
Rate for Payer: AZCH Complete Medicaid	$4,880.34
Rate for Payer: Banner UC Health Medicaid	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: AHCCCS Medicaid	$1,828.55
Rate for Payer: Allwell Medicaid	$1,828.55
Rate for Payer: AZCH Complete Medicaid	$1,828.55
Rate for Payer: Banner UC Health Medicaid	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: AHCCCS Medicaid	$2,570.63
Rate for Payer: Allwell Medicaid	$2,570.63
Rate for Payer: AZCH Complete Medicaid	$2,570.63
Rate for Payer: Banner UC Health Medicaid	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: AHCCCS Medicaid	$1,828.55
Rate for Payer: Allwell Medicaid	$1,828.55
Rate for Payer: AZCH Complete Medicaid	$1,828.55
Rate for Payer: Banner UC Health Medicaid	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55

Know your out-of-pocket cost for care.

All Charges