Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: AHCCCS Medicaid	$12,529.81
Rate for Payer: Allwell Medicaid	$12,529.81
Rate for Payer: AZCH Complete Medicaid	$12,529.81
Rate for Payer: Banner UC Health Medicaid	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: AHCCCS Medicaid	$15,792.02
Rate for Payer: Allwell Medicaid	$15,792.02
Rate for Payer: AZCH Complete Medicaid	$15,792.02
Rate for Payer: Banner UC Health Medicaid	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: AHCCCS Medicaid	$7,453.78
Rate for Payer: Allwell Medicaid	$7,453.78
Rate for Payer: AZCH Complete Medicaid	$7,453.78
Rate for Payer: Banner UC Health Medicaid	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: AHCCCS Medicaid	$9,792.25
Rate for Payer: Allwell Medicaid	$9,792.25
Rate for Payer: AZCH Complete Medicaid	$9,792.25
Rate for Payer: Banner UC Health Medicaid	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: AHCCCS Medicaid	$12,529.81
Rate for Payer: Allwell Medicaid	$12,529.81
Rate for Payer: AZCH Complete Medicaid	$12,529.81
Rate for Payer: Banner UC Health Medicaid	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81

RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

Facility

$1,737.00

Service Code	CPT 28035
Hospital Charge Code	24043317
Hospital Revenue Code	360
Min. Negotiated Rate	$277.92
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,563.30
Rate for Payer: Aetna of AZ Medicare	$486.36
Rate for Payer: AHCCCS Medicaid	$1,271.93
Rate for Payer: Allwell Medicaid	$1,271.93
Rate for Payer: Allwell Medicare	$277.92
Rate for Payer: Amerigroup Medicare	$277.92
Rate for Payer: APIPA Medicare/Medicaid	$648.77
Rate for Payer: AZCH Complete Medicaid	$1,271.93
Rate for Payer: AZCH Complete Medicare	$277.92
Rate for Payer: Banner UC Health Medicaid	$1,271.93
Rate for Payer: Banner UC Health Medicare	$277.92
Rate for Payer: Bisbee Police All Plans	$451.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,181.16
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cigna of AZ Commercial	$868.50
Rate for Payer: Copperpoint Commercial	$429.91
Rate for Payer: Health Net of AZ Commercial	$1,042.20
Rate for Payer: Health Net of AZ Medicare	$486.36
Rate for Payer: Humana of AZ Medicare	$277.92
Rate for Payer: Mercy Care Medicaid	$1,271.93
Rate for Payer: Self Pay Self Pay	$1,389.60
Rate for Payer: TriWest Medicare	$277.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$312.66

RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

Facility

$1,737.00

Service Code	CPT 28035
Hospital Charge Code	24043317
Hospital Revenue Code	360
Min. Negotiated Rate	$451.62
Max. Negotiated Rate	$1,563.30
Rate for Payer: Aetna of AZ Commercial	$1,563.30
Rate for Payer: Bisbee Police All Plans	$451.62
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Self Pay Self Pay	$1,389.60

Remdesivir injection 100 mg/20 ml Inj [CQCH]

Facility

$520.00

Service Code	NDC 61958290210
Hospital Charge Code	168146661
Hospital Revenue Code	250
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Aetna of AZ Medicare	$145.60
Rate for Payer: Allwell Medicare	$83.20
Rate for Payer: Amerigroup Medicare	$83.20
Rate for Payer: APIPA Medicare/Medicaid	$194.22
Rate for Payer: AZCH Complete Medicare	$83.20
Rate for Payer: Banner UC Health Medicare	$83.20
Rate for Payer: Bisbee Police All Plans	$135.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$353.60
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cigna of AZ Commercial	$338.00
Rate for Payer: Copperpoint Commercial	$128.70
Rate for Payer: Health Net of AZ Commercial	$312.00
Rate for Payer: Health Net of AZ Medicare	$145.60
Rate for Payer: Humana of AZ Medicare	$83.20
Rate for Payer: Self Pay Self Pay	$416.00
Rate for Payer: TriWest Medicare	$83.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$303.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$93.60

Remdesivir injection 100 mg/20 ml Inj [CQCH]

Facility

$520.00

Service Code	NDC 61958290210
Hospital Charge Code	168146661
Hospital Revenue Code	250
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Bisbee Police All Plans	$135.20
Rate for Payer: Cash Price	$416.00
Rate for Payer: Self Pay Self Pay	$416.00

REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P

Facility

$6,340.00

Service Code	CPT 54406
Hospital Charge Code	23173229
Hospital Revenue Code	982
Min. Negotiated Rate	$1,648.40
Max. Negotiated Rate	$5,706.00
Rate for Payer: Aetna of AZ Commercial	$5,706.00
Rate for Payer: Bisbee Police All Plans	$1,648.40
Rate for Payer: Cash Price	$5,072.00
Rate for Payer: Self Pay Self Pay	$5,072.00

REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P

Facility

$6,340.00

Service Code	CPT 54406
Hospital Charge Code	23173229
Hospital Revenue Code	982
Min. Negotiated Rate	$1,014.40
Max. Negotiated Rate	$5,706.00
Rate for Payer: Aetna of AZ Commercial	$5,706.00
Rate for Payer: Aetna of AZ Medicare	$1,775.20
Rate for Payer: AHCCCS Medicaid	$2,230.35
Rate for Payer: Allwell Medicaid	$2,230.35
Rate for Payer: Allwell Medicare	$1,014.40
Rate for Payer: Amerigroup Medicare	$1,014.40
Rate for Payer: APIPA Medicare/Medicaid	$2,367.99
Rate for Payer: AZCH Complete Medicaid	$2,230.35
Rate for Payer: AZCH Complete Medicare	$1,014.40
Rate for Payer: Banner UC Health Medicaid	$2,230.35
Rate for Payer: Banner UC Health Medicare	$1,014.40
Rate for Payer: Bisbee Police All Plans	$1,648.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,311.20
Rate for Payer: Cash Price	$5,072.00
Rate for Payer: Cash Price	$5,072.00
Rate for Payer: Cigna of AZ Commercial	$4,438.00
Rate for Payer: Copperpoint Commercial	$1,569.15
Rate for Payer: Health Net of AZ Commercial	$3,804.00
Rate for Payer: Health Net of AZ Medicare	$1,775.20
Rate for Payer: Humana of AZ Medicare	$1,014.40
Rate for Payer: Mercy Care Medicaid	$2,230.35
Rate for Payer: Self Pay Self Pay	$5,072.00
Rate for Payer: TriWest Medicare	$1,014.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,696.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,141.20

REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D

Facility

$82.00

Service Code	CPT 97602
Hospital Charge Code	24049292
Hospital Revenue Code	360
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D

Facility

$82.00

Service Code	CPT 97602
Hospital Charge Code	24049292
Hospital Revenue Code	360
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$130.17
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$13.12
Rate for Payer: Amerigroup Medicare	$13.12
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$13.12
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$13.12
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$41.00
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$13.12
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$13.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

Removal of lead

Facility

$740.00

Service Code	CPT 64585
Hospital Charge Code	27281907
Hospital Revenue Code	360
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$2,374.59
Rate for Payer: Aetna of AZ Commercial	$666.00
Rate for Payer: Aetna of AZ Medicare	$207.20
Rate for Payer: AHCCCS Medicaid	$2,374.59
Rate for Payer: Allwell Medicaid	$2,374.59
Rate for Payer: Allwell Medicare	$118.40
Rate for Payer: Amerigroup Medicare	$118.40
Rate for Payer: APIPA Medicare/Medicaid	$276.39
Rate for Payer: AZCH Complete Medicaid	$2,374.59
Rate for Payer: AZCH Complete Medicare	$118.40
Rate for Payer: Banner UC Health Medicaid	$2,374.59
Rate for Payer: Banner UC Health Medicare	$118.40
Rate for Payer: Bisbee Police All Plans	$192.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$503.20
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cigna of AZ Commercial	$370.00
Rate for Payer: Copperpoint Commercial	$183.15
Rate for Payer: Health Net of AZ Commercial	$444.00
Rate for Payer: Health Net of AZ Medicare	$207.20
Rate for Payer: Humana of AZ Medicare	$118.40
Rate for Payer: Mercy Care Medicaid	$2,374.59
Rate for Payer: Self Pay Self Pay	$592.00
Rate for Payer: TriWest Medicare	$118.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$431.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$133.20

Removal of lead

Facility

$740.00

Service Code	CPT 64585
Hospital Charge Code	27281907
Hospital Revenue Code	360
Min. Negotiated Rate	$192.40
Max. Negotiated Rate	$666.00
Rate for Payer: Aetna of AZ Commercial	$666.00
Rate for Payer: Bisbee Police All Plans	$192.40
Rate for Payer: Cash Price	$592.00
Rate for Payer: Self Pay Self Pay	$592.00

Removal /revision of generator

Facility

$688.00

Service Code	CPT 64595
Hospital Charge Code	27267840
Hospital Revenue Code	360
Min. Negotiated Rate	$110.08
Max. Negotiated Rate	$2,374.59
Rate for Payer: Aetna of AZ Commercial	$619.20
Rate for Payer: Aetna of AZ Medicare	$192.64
Rate for Payer: AHCCCS Medicaid	$2,374.59
Rate for Payer: Allwell Medicaid	$2,374.59
Rate for Payer: Allwell Medicare	$110.08
Rate for Payer: Amerigroup Medicare	$110.08
Rate for Payer: APIPA Medicare/Medicaid	$256.97
Rate for Payer: AZCH Complete Medicaid	$2,374.59
Rate for Payer: AZCH Complete Medicare	$110.08
Rate for Payer: Banner UC Health Medicaid	$2,374.59
Rate for Payer: Banner UC Health Medicare	$110.08
Rate for Payer: Bisbee Police All Plans	$178.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$467.84
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cigna of AZ Commercial	$344.00
Rate for Payer: Copperpoint Commercial	$170.28
Rate for Payer: Health Net of AZ Commercial	$412.80
Rate for Payer: Health Net of AZ Medicare	$192.64
Rate for Payer: Humana of AZ Medicare	$110.08
Rate for Payer: Mercy Care Medicaid	$2,374.59
Rate for Payer: Self Pay Self Pay	$550.40
Rate for Payer: TriWest Medicare	$110.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$401.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$123.84

Removal /revision of generator

Facility

$688.00

Service Code	CPT 64595
Hospital Charge Code	27267840
Hospital Revenue Code	360
Min. Negotiated Rate	$178.88
Max. Negotiated Rate	$619.20
Rate for Payer: Aetna of AZ Commercial	$619.20
Rate for Payer: Bisbee Police All Plans	$178.88
Rate for Payer: Cash Price	$550.40
Rate for Payer: Self Pay Self Pay	$550.40

REMOVER STAPLE PRECISE 3M

Facility

$16.00

Hospital Charge Code	22540633
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.56
Rate for Payer: Amerigroup Medicare	$2.56
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.56
Rate for Payer: Banner UC Health Medicare	$2.56
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.56
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

REMOVER STAPLE PRECISE 3M

Facility

$16.00

Hospital Charge Code	22540633
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Cash Price	$12.80
Rate for Payer: Self Pay Self Pay	$12.80

Know your out-of-pocket cost for care.

All Charges