Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7731
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	APRDRG7733
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	APRDRG7734
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

OPTICELL AG+ SILVER ANTIBACTERIAL WOUND DRESSING

Facility

$23.00

Hospital Charge Code	27567554
Hospital Revenue Code	270
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Cash Price	$18.40
Rate for Payer: Self Pay Self Pay	$18.40

OPTICELL AG+ SILVER ANTIBACTERIAL WOUND DRESSING

Facility

$23.00

Hospital Charge Code	27567554
Hospital Revenue Code	270
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Aetna of AZ Medicare	$6.44
Rate for Payer: Allwell Medicare	$3.68
Rate for Payer: Amerigroup Medicare	$3.68
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.64
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Copperpoint Commercial	$5.69
Rate for Payer: Health Net of AZ Commercial	$13.80
Rate for Payer: Health Net of AZ Medicare	$6.44
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.14

OPTIFLOW JUNIOR 2 NASAL CANNUAL SIZE XXL

Facility

$185.00

Hospital Charge Code	24154235
Hospital Revenue Code	270
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Aetna of AZ Medicare	$51.80
Rate for Payer: Allwell Medicare	$29.60
Rate for Payer: Amerigroup Medicare	$29.60
Rate for Payer: APIPA Medicare/Medicaid	$69.10
Rate for Payer: AZCH Complete Medicare	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.80
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$129.50
Rate for Payer: Copperpoint Commercial	$45.79
Rate for Payer: Health Net of AZ Commercial	$111.00
Rate for Payer: Health Net of AZ Medicare	$51.80
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Self Pay Self Pay	$148.00
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.30

OPTIFLOW JUNIOR 2 NASAL CANNUAL SIZE XXL

Facility

$185.00

Hospital Charge Code	24154235
Hospital Revenue Code	270
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Cash Price	$148.00
Rate for Payer: Self Pay Self Pay	$148.00

OPTIFLOW PLUS CANNULA SIZE L

Facility

$97.00

Hospital Charge Code	24154232
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

OPTIFLOW PLUS CANNULA SIZE L

Facility

$97.00

Hospital Charge Code	24154232
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

OPTIFLOW PLUS CANNULA SIZE M

Facility

$97.00

Hospital Charge Code	24154231
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

OPTIFLOW PLUS CANNULA SIZE M

Facility

$97.00

Hospital Charge Code	24154231
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

OPTIFLOW PULS CANNULA SIZE S

Facility

$97.00

Hospital Charge Code	24154230
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

OPTIFLOW PULS CANNULA SIZE S

Facility

$97.00

Hospital Charge Code	24154230
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

OPTIFOAM GENTLE AG SA BORDERED 6X6

Facility

$32.00

Hospital Charge Code	27569983
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Cash Price	$25.60
Rate for Payer: Self Pay Self Pay	$25.60

OPTIFOAM GENTLE AG SA BORDERED 6X6

Facility

$32.00

Hospital Charge Code	27569983
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Aetna of AZ Medicare	$8.96
Rate for Payer: Allwell Medicare	$5.12
Rate for Payer: Amerigroup Medicare	$5.12
Rate for Payer: APIPA Medicare/Medicaid	$11.95
Rate for Payer: AZCH Complete Medicare	$5.12
Rate for Payer: Banner UC Health Medicare	$5.12
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21.76
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$22.40
Rate for Payer: Copperpoint Commercial	$7.92
Rate for Payer: Health Net of AZ Commercial	$19.20
Rate for Payer: Health Net of AZ Medicare	$8.96
Rate for Payer: Humana of AZ Medicare	$5.12
Rate for Payer: Self Pay Self Pay	$25.60
Rate for Payer: TriWest Medicare	$5.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$18.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.76

Optilite Holmium Fiber 150 micron

Facility

$1,274.00

Hospital Charge Code	22926479
Hospital Revenue Code	272
Min. Negotiated Rate	$331.24
Max. Negotiated Rate	$1,146.60
Rate for Payer: Aetna of AZ Commercial	$1,146.60
Rate for Payer: Bisbee Police All Plans	$331.24
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Self Pay Self Pay	$1,019.20

Optilite Holmium Fiber 150 micron

Facility

$1,274.00

Hospital Charge Code	22926479
Hospital Revenue Code	272
Min. Negotiated Rate	$203.84
Max. Negotiated Rate	$1,146.60
Rate for Payer: Aetna of AZ Commercial	$1,146.60
Rate for Payer: Aetna of AZ Medicare	$356.72
Rate for Payer: Allwell Medicare	$203.84
Rate for Payer: Amerigroup Medicare	$203.84
Rate for Payer: APIPA Medicare/Medicaid	$475.84
Rate for Payer: AZCH Complete Medicare	$203.84
Rate for Payer: Banner UC Health Medicare	$203.84
Rate for Payer: Bisbee Police All Plans	$331.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$866.32
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Cigna of AZ Commercial	$891.80
Rate for Payer: Copperpoint Commercial	$315.31
Rate for Payer: Health Net of AZ Commercial	$764.40
Rate for Payer: Health Net of AZ Medicare	$356.72
Rate for Payer: Humana of AZ Medicare	$203.84
Rate for Payer: Self Pay Self Pay	$1,019.20
Rate for Payer: TriWest Medicare	$203.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$742.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$229.32

Orbit And Eye Procedures

Facility

$15,146.73

Service Code	APR-DRG 0733
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$15,146.73
Max. Negotiated Rate	$15,146.73
Rate for Payer: AHCCCS Medicaid	$15,146.73
Rate for Payer: Allwell Medicaid	$15,146.73
Rate for Payer: AZCH Complete Medicaid	$15,146.73
Rate for Payer: Banner UC Health Medicaid	$15,146.73
Rate for Payer: Mercy Care Medicaid	$15,146.73

Orbit And Eye Procedures

Facility

$8,902.17

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$8,902.17
Max. Negotiated Rate	$8,902.17
Rate for Payer: AHCCCS Medicaid	$8,902.17
Rate for Payer: Allwell Medicaid	$8,902.17
Rate for Payer: AZCH Complete Medicaid	$8,902.17
Rate for Payer: Banner UC Health Medicaid	$8,902.17
Rate for Payer: Mercy Care Medicaid	$8,902.17

Orbit And Eye Procedures

Facility

$8,902.17

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$8,902.17
Max. Negotiated Rate	$8,902.17
Rate for Payer: AHCCCS Medicaid	$8,902.17
Rate for Payer: Allwell Medicaid	$8,902.17
Rate for Payer: AZCH Complete Medicaid	$8,902.17
Rate for Payer: Banner UC Health Medicaid	$8,902.17
Rate for Payer: Mercy Care Medicaid	$8,902.17

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Orbit And Eye Procedures

Facility

$28,755.30

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG0733
Min. Negotiated Rate	$28,755.30
Max. Negotiated Rate	$28,755.30
Rate for Payer: AHCCCS Medicaid	$28,755.30
Rate for Payer: Allwell Medicaid	$28,755.30
Rate for Payer: AZCH Complete Medicaid	$28,755.30
Rate for Payer: Banner UC Health Medicaid	$28,755.30
Rate for Payer: Mercy Care Medicaid	$28,755.30

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0732
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Orbit And Eye Procedures

Facility

$28,755.30

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$28,755.30
Max. Negotiated Rate	$28,755.30
Rate for Payer: AHCCCS Medicaid	$28,755.30
Rate for Payer: Allwell Medicaid	$28,755.30
Rate for Payer: AZCH Complete Medicaid	$28,755.30
Rate for Payer: Banner UC Health Medicaid	$28,755.30
Rate for Payer: Mercy Care Medicaid	$28,755.30

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Know your out-of-pocket cost for care.

All Charges