Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PACKING NASAL 5.5 RHINO

Facility

$144.00

Hospital Charge Code	22354976
Hospital Revenue Code	270
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Bisbee Police All Plans	$37.44
Rate for Payer: Cash Price	$115.20
Rate for Payer: Self Pay Self Pay	$115.20

PACKING NASAL 5.5 RHINO

Facility

$144.00

Hospital Charge Code	22354976
Hospital Revenue Code	270
Min. Negotiated Rate	$23.04
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Aetna of AZ Medicare	$40.32
Rate for Payer: Allwell Medicare	$23.04
Rate for Payer: Amerigroup Medicare	$23.04
Rate for Payer: APIPA Medicare/Medicaid	$53.78
Rate for Payer: AZCH Complete Medicare	$23.04
Rate for Payer: Banner UC Health Medicare	$23.04
Rate for Payer: Bisbee Police All Plans	$37.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$97.92
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna of AZ Commercial	$100.80
Rate for Payer: Copperpoint Commercial	$35.64
Rate for Payer: Health Net of AZ Commercial	$86.40
Rate for Payer: Health Net of AZ Medicare	$40.32
Rate for Payer: Humana of AZ Medicare	$23.04
Rate for Payer: Self Pay Self Pay	$115.20
Rate for Payer: TriWest Medicare	$23.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$83.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.92

PACKING NASAL 7.5 RHINO

Facility

$159.00

Hospital Charge Code	22354977
Hospital Revenue Code	270
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: Allwell Medicare	$25.44
Rate for Payer: Amerigroup Medicare	$25.44
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$111.30
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

PACKING NASAL 7.5 RHINO

Facility

$159.00

Hospital Charge Code	22354977
Hospital Revenue Code	270
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

PACK ORTHO 5 HIP

Facility

$158.00

Hospital Charge Code	22926426
Hospital Revenue Code	272
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Aetna of AZ Medicare	$44.24
Rate for Payer: Allwell Medicare	$25.28
Rate for Payer: Amerigroup Medicare	$25.28
Rate for Payer: APIPA Medicare/Medicaid	$59.01
Rate for Payer: AZCH Complete Medicare	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$107.44
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$110.60
Rate for Payer: Copperpoint Commercial	$39.10
Rate for Payer: Health Net of AZ Commercial	$94.80
Rate for Payer: Health Net of AZ Medicare	$44.24
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Self Pay Self Pay	$126.40
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.44

PACK ORTHO 5 HIP

Facility

$158.00

Hospital Charge Code	22926426
Hospital Revenue Code	272
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Cash Price	$126.40
Rate for Payer: Self Pay Self Pay	$126.40

PADDED GAIT BELT LG

Facility

$289.00

Hospital Charge Code	27445198
Hospital Revenue Code	270
Min. Negotiated Rate	$75.14
Max. Negotiated Rate	$260.10
Rate for Payer: Aetna of AZ Commercial	$260.10
Rate for Payer: Bisbee Police All Plans	$75.14
Rate for Payer: Cash Price	$231.20
Rate for Payer: Self Pay Self Pay	$231.20

PADDED GAIT BELT LG

Facility

$289.00

Hospital Charge Code	27445198
Hospital Revenue Code	270
Min. Negotiated Rate	$46.24
Max. Negotiated Rate	$260.10
Rate for Payer: Aetna of AZ Commercial	$260.10
Rate for Payer: Aetna of AZ Medicare	$80.92
Rate for Payer: Allwell Medicare	$46.24
Rate for Payer: Amerigroup Medicare	$46.24
Rate for Payer: APIPA Medicare/Medicaid	$107.94
Rate for Payer: AZCH Complete Medicare	$46.24
Rate for Payer: Banner UC Health Medicare	$46.24
Rate for Payer: Bisbee Police All Plans	$75.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$196.52
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cigna of AZ Commercial	$202.30
Rate for Payer: Copperpoint Commercial	$71.53
Rate for Payer: Health Net of AZ Commercial	$173.40
Rate for Payer: Health Net of AZ Medicare	$80.92
Rate for Payer: Humana of AZ Medicare	$46.24
Rate for Payer: Self Pay Self Pay	$231.20
Rate for Payer: TriWest Medicare	$46.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$168.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.02

PADDED GAIT BELT MED

Facility

$279.00

Hospital Charge Code	27446678
Hospital Revenue Code	270
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Bisbee Police All Plans	$72.54
Rate for Payer: Cash Price	$223.20
Rate for Payer: Self Pay Self Pay	$223.20

PADDED GAIT BELT MED

Facility

$279.00

Hospital Charge Code	27446678
Hospital Revenue Code	270
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Aetna of AZ Medicare	$78.12
Rate for Payer: Allwell Medicare	$44.64
Rate for Payer: Amerigroup Medicare	$44.64
Rate for Payer: APIPA Medicare/Medicaid	$104.21
Rate for Payer: AZCH Complete Medicare	$44.64
Rate for Payer: Banner UC Health Medicare	$44.64
Rate for Payer: Bisbee Police All Plans	$72.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$189.72
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna of AZ Commercial	$195.30
Rate for Payer: Copperpoint Commercial	$69.05
Rate for Payer: Health Net of AZ Commercial	$167.40
Rate for Payer: Health Net of AZ Medicare	$78.12
Rate for Payer: Humana of AZ Medicare	$44.64
Rate for Payer: Self Pay Self Pay	$223.20
Rate for Payer: TriWest Medicare	$44.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$162.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.22

PADDED GAIT BELT SM

Facility

$216.00

Hospital Charge Code	27446677
Hospital Revenue Code	270
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Bisbee Police All Plans	$56.16
Rate for Payer: Cash Price	$172.80
Rate for Payer: Self Pay Self Pay	$172.80

PADDED GAIT BELT SM

Facility

$216.00

Hospital Charge Code	27446677
Hospital Revenue Code	270
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Aetna of AZ Medicare	$60.48
Rate for Payer: Allwell Medicare	$34.56
Rate for Payer: Amerigroup Medicare	$34.56
Rate for Payer: APIPA Medicare/Medicaid	$80.68
Rate for Payer: AZCH Complete Medicare	$34.56
Rate for Payer: Banner UC Health Medicare	$34.56
Rate for Payer: Bisbee Police All Plans	$56.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$146.88
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna of AZ Commercial	$151.20
Rate for Payer: Copperpoint Commercial	$53.46
Rate for Payer: Health Net of AZ Commercial	$129.60
Rate for Payer: Health Net of AZ Medicare	$60.48
Rate for Payer: Humana of AZ Medicare	$34.56
Rate for Payer: Self Pay Self Pay	$172.80
Rate for Payer: TriWest Medicare	$34.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$125.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.88

PAD GROUNDING (BOVIE) CONMED

Facility

$18.00

Hospital Charge Code	22355702
Hospital Revenue Code	270
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.88
Rate for Payer: Amerigroup Medicare	$2.88
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

PAD GROUNDING (BOVIE) CONMED

Facility

$18.00

Hospital Charge Code	22355702
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

Pain Management drug screen

Facility

$155.00

Service Code	CPT 80305 QW
Hospital Charge Code	1491676
Hospital Revenue Code	301
Min. Negotiated Rate	$40.30
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Cash Price	$124.00
Rate for Payer: Self Pay Self Pay	$124.00

Pain Management drug screen

Facility

$155.00

Service Code	CPT 80305 QW
Hospital Charge Code	1491676
Hospital Revenue Code	301
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Aetna of AZ Medicare	$43.40
Rate for Payer: Allwell Medicare	$24.80
Rate for Payer: Amerigroup Medicare	$24.80
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$105.40
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$100.75
Rate for Payer: Copperpoint Commercial	$38.36
Rate for Payer: Health Net of AZ Commercial	$93.00
Rate for Payer: Health Net of AZ Medicare	$43.40
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: AHCCCS Medicaid	$58,558.48
Rate for Payer: Allwell Medicaid	$58,558.48
Rate for Payer: AZCH Complete Medicaid	$58,558.48
Rate for Payer: Banner UC Health Medicaid	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: AHCCCS Medicaid	$58,558.48
Rate for Payer: Allwell Medicaid	$58,558.48
Rate for Payer: AZCH Complete Medicaid	$58,558.48
Rate for Payer: Banner UC Health Medicaid	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: AHCCCS Medicaid	$97,322.06
Rate for Payer: Allwell Medicaid	$97,322.06
Rate for Payer: AZCH Complete Medicaid	$97,322.06
Rate for Payer: Banner UC Health Medicaid	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Know your out-of-pocket cost for care.

All Charges