Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

REPAIR OF STRICTURE IN KIDNEY USING AN ENDOSCOPE

Facility

$1,777.00

Service Code	CPT 52343
Hospital Charge Code	28068481
Hospital Revenue Code	360
Min. Negotiated Rate	$462.02
Max. Negotiated Rate	$1,599.30
Rate for Payer: Aetna of AZ Commercial	$1,599.30
Rate for Payer: Bisbee Police All Plans	$462.02
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Self Pay Self Pay	$1,421.60

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,625.00

Service Code	CPT 23412
Hospital Charge Code	27368692
Hospital Revenue Code	360
Min. Negotiated Rate	$740.00
Max. Negotiated Rate	$4,542.09
Rate for Payer: Aetna of AZ Commercial	$4,162.50
Rate for Payer: Aetna of AZ Medicare	$1,295.00
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$740.00
Rate for Payer: Amerigroup Medicare	$740.00
Rate for Payer: APIPA Medicare/Medicaid	$1,727.44
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$740.00
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$740.00
Rate for Payer: Bisbee Police All Plans	$1,202.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,145.00
Rate for Payer: Cash Price	$3,700.00
Rate for Payer: Cash Price	$3,700.00
Rate for Payer: Cigna of AZ Commercial	$2,312.50
Rate for Payer: Copperpoint Commercial	$1,144.69
Rate for Payer: Health Net of AZ Commercial	$2,775.00
Rate for Payer: Health Net of AZ Medicare	$1,295.00
Rate for Payer: Humana of AZ Medicare	$740.00
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$3,700.00
Rate for Payer: TriWest Medicare	$740.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,696.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$832.50

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,452.00

Service Code	CPT 23410
Hospital Charge Code	27371853
Hospital Revenue Code	360
Min. Negotiated Rate	$712.32
Max. Negotiated Rate	$4,542.09
Rate for Payer: Aetna of AZ Commercial	$4,006.80
Rate for Payer: Aetna of AZ Medicare	$1,246.56
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$712.32
Rate for Payer: Amerigroup Medicare	$712.32
Rate for Payer: APIPA Medicare/Medicaid	$1,662.82
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$712.32
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$712.32
Rate for Payer: Bisbee Police All Plans	$1,157.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,027.36
Rate for Payer: Cash Price	$3,561.60
Rate for Payer: Cash Price	$3,561.60
Rate for Payer: Cigna of AZ Commercial	$2,226.00
Rate for Payer: Copperpoint Commercial	$1,101.87
Rate for Payer: Health Net of AZ Commercial	$2,671.20
Rate for Payer: Health Net of AZ Medicare	$1,246.56
Rate for Payer: Humana of AZ Medicare	$712.32
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$3,561.60
Rate for Payer: TriWest Medicare	$712.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,595.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$801.36

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,452.00

Service Code	CPT 23410
Hospital Charge Code	27371853
Hospital Revenue Code	360
Min. Negotiated Rate	$1,157.52
Max. Negotiated Rate	$4,006.80
Rate for Payer: Aetna of AZ Commercial	$4,006.80
Rate for Payer: Bisbee Police All Plans	$1,157.52
Rate for Payer: Cash Price	$3,561.60
Rate for Payer: Self Pay Self Pay	$3,561.60

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,625.00

Service Code	CPT 23412
Hospital Charge Code	27368692
Hospital Revenue Code	360
Min. Negotiated Rate	$1,202.50
Max. Negotiated Rate	$4,162.50
Rate for Payer: Aetna of AZ Commercial	$4,162.50
Rate for Payer: Bisbee Police All Plans	$1,202.50
Rate for Payer: Cash Price	$3,700.00
Rate for Payer: Self Pay Self Pay	$3,700.00

RESCUENET RETRIEVAL NET

Facility

$446.00

Hospital Charge Code	27497393
Hospital Revenue Code	270
Min. Negotiated Rate	$71.36
Max. Negotiated Rate	$401.40
Rate for Payer: Aetna of AZ Commercial	$401.40
Rate for Payer: Aetna of AZ Medicare	$124.88
Rate for Payer: Allwell Medicare	$71.36
Rate for Payer: Amerigroup Medicare	$71.36
Rate for Payer: APIPA Medicare/Medicaid	$166.58
Rate for Payer: AZCH Complete Medicare	$71.36
Rate for Payer: Banner UC Health Medicare	$71.36
Rate for Payer: Bisbee Police All Plans	$115.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$303.28
Rate for Payer: Cash Price	$356.80
Rate for Payer: Cigna of AZ Commercial	$312.20
Rate for Payer: Copperpoint Commercial	$110.39
Rate for Payer: Health Net of AZ Commercial	$267.60
Rate for Payer: Health Net of AZ Medicare	$124.88
Rate for Payer: Humana of AZ Medicare	$71.36
Rate for Payer: Self Pay Self Pay	$356.80
Rate for Payer: TriWest Medicare	$71.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$260.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$80.28

RESCUENET RETRIEVAL NET

Facility

$446.00

Hospital Charge Code	27497393
Hospital Revenue Code	270
Min. Negotiated Rate	$115.96
Max. Negotiated Rate	$401.40
Rate for Payer: Aetna of AZ Commercial	$401.40
Rate for Payer: Bisbee Police All Plans	$115.96
Rate for Payer: Cash Price	$356.80
Rate for Payer: Self Pay Self Pay	$356.80

RESCUENET RETRIEVAL NET

Facility

$349.00

Hospital Charge Code	23839570
Hospital Revenue Code	270
Min. Negotiated Rate	$90.74
Max. Negotiated Rate	$314.10
Rate for Payer: Aetna of AZ Commercial	$314.10
Rate for Payer: Bisbee Police All Plans	$90.74
Rate for Payer: Cash Price	$279.20
Rate for Payer: Self Pay Self Pay	$279.20

RESCUENET RETRIEVAL NET

Facility

$349.00

Hospital Charge Code	23839570
Hospital Revenue Code	270
Min. Negotiated Rate	$55.84
Max. Negotiated Rate	$314.10
Rate for Payer: Aetna of AZ Commercial	$314.10
Rate for Payer: Aetna of AZ Medicare	$97.72
Rate for Payer: Allwell Medicare	$55.84
Rate for Payer: Amerigroup Medicare	$55.84
Rate for Payer: APIPA Medicare/Medicaid	$130.35
Rate for Payer: AZCH Complete Medicare	$55.84
Rate for Payer: Banner UC Health Medicare	$55.84
Rate for Payer: Bisbee Police All Plans	$90.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$237.32
Rate for Payer: Cash Price	$279.20
Rate for Payer: Cigna of AZ Commercial	$244.30
Rate for Payer: Copperpoint Commercial	$86.38
Rate for Payer: Health Net of AZ Commercial	$209.40
Rate for Payer: Health Net of AZ Medicare	$97.72
Rate for Payer: Humana of AZ Medicare	$55.84
Rate for Payer: Self Pay Self Pay	$279.20
Rate for Payer: TriWest Medicare	$55.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$203.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$62.82

RESECTOR SHAVER BLADE 3MM

Facility

$236.00

Hospital Charge Code	25519687
Hospital Revenue Code	270
Min. Negotiated Rate	$61.36
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Cash Price	$188.80
Rate for Payer: Self Pay Self Pay	$188.80

RESECTOR SHAVER BLADE 3MM

Facility

$236.00

Hospital Charge Code	25519687
Hospital Revenue Code	270
Min. Negotiated Rate	$37.76
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Aetna of AZ Medicare	$66.08
Rate for Payer: Allwell Medicare	$37.76
Rate for Payer: Amerigroup Medicare	$37.76
Rate for Payer: APIPA Medicare/Medicaid	$88.15
Rate for Payer: AZCH Complete Medicare	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$160.48
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$165.20
Rate for Payer: Copperpoint Commercial	$58.41
Rate for Payer: Health Net of AZ Commercial	$141.60
Rate for Payer: Health Net of AZ Medicare	$66.08
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Self Pay Self Pay	$188.80
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$137.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.48

RESECTOR SHAVER BLADE 4MM

Facility

$236.00

Hospital Charge Code	25519688
Hospital Revenue Code	270
Min. Negotiated Rate	$61.36
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Cash Price	$188.80
Rate for Payer: Self Pay Self Pay	$188.80

RESECTOR SHAVER BLADE 4MM

Facility

$236.00

Hospital Charge Code	25519688
Hospital Revenue Code	270
Min. Negotiated Rate	$37.76
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Aetna of AZ Medicare	$66.08
Rate for Payer: Allwell Medicare	$37.76
Rate for Payer: Amerigroup Medicare	$37.76
Rate for Payer: APIPA Medicare/Medicaid	$88.15
Rate for Payer: AZCH Complete Medicare	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$160.48
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$165.20
Rate for Payer: Copperpoint Commercial	$58.41
Rate for Payer: Health Net of AZ Commercial	$141.60
Rate for Payer: Health Net of AZ Medicare	$66.08
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Self Pay Self Pay	$188.80
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$137.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.48

Resolution Clip

Facility

$838.00

Hospital Charge Code	22926472
Hospital Revenue Code	272
Min. Negotiated Rate	$134.08
Max. Negotiated Rate	$754.20
Rate for Payer: Aetna of AZ Commercial	$754.20
Rate for Payer: Aetna of AZ Medicare	$234.64
Rate for Payer: Allwell Medicare	$134.08
Rate for Payer: Amerigroup Medicare	$134.08
Rate for Payer: APIPA Medicare/Medicaid	$312.99
Rate for Payer: AZCH Complete Medicare	$134.08
Rate for Payer: Banner UC Health Medicare	$134.08
Rate for Payer: Bisbee Police All Plans	$217.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$569.84
Rate for Payer: Cash Price	$670.40
Rate for Payer: Cigna of AZ Commercial	$586.60
Rate for Payer: Copperpoint Commercial	$207.41
Rate for Payer: Health Net of AZ Commercial	$502.80
Rate for Payer: Health Net of AZ Medicare	$234.64
Rate for Payer: Humana of AZ Medicare	$134.08
Rate for Payer: Self Pay Self Pay	$670.40
Rate for Payer: TriWest Medicare	$134.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$488.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$150.84

Resolution Clip

Facility

$838.00

Hospital Charge Code	22926472
Hospital Revenue Code	272
Min. Negotiated Rate	$217.88
Max. Negotiated Rate	$754.20
Rate for Payer: Aetna of AZ Commercial	$754.20
Rate for Payer: Bisbee Police All Plans	$217.88
Rate for Payer: Cash Price	$670.40
Rate for Payer: Self Pay Self Pay	$670.40

Respiratory Failure

Facility

$12,428.81

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$12,428.81
Max. Negotiated Rate	$12,428.81
Rate for Payer: AHCCCS Medicaid	$12,428.81
Rate for Payer: Allwell Medicaid	$12,428.81
Rate for Payer: AZCH Complete Medicaid	$12,428.81
Rate for Payer: Banner UC Health Medicaid	$12,428.81
Rate for Payer: Mercy Care Medicaid	$12,428.81

Respiratory Failure

Facility

$2,807.70

Service Code	APR-DRG 1331
Hospital Charge Code	APRDRG1333
Min. Negotiated Rate	$2,807.70
Max. Negotiated Rate	$2,807.70
Rate for Payer: AHCCCS Medicaid	$2,807.70
Rate for Payer: Allwell Medicaid	$2,807.70
Rate for Payer: AZCH Complete Medicaid	$2,807.70
Rate for Payer: Banner UC Health Medicaid	$2,807.70
Rate for Payer: Mercy Care Medicaid	$2,807.70

Respiratory Failure

Facility

$2,807.70

Service Code	APR-DRG 1331
Hospital Charge Code	APRDRG1332
Min. Negotiated Rate	$2,807.70
Max. Negotiated Rate	$2,807.70
Rate for Payer: AHCCCS Medicaid	$2,807.70
Rate for Payer: Allwell Medicaid	$2,807.70
Rate for Payer: AZCH Complete Medicaid	$2,807.70
Rate for Payer: Banner UC Health Medicaid	$2,807.70
Rate for Payer: Mercy Care Medicaid	$2,807.70

Respiratory Failure

Facility

$7,082.04

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG1332
Min. Negotiated Rate	$7,082.04
Max. Negotiated Rate	$7,082.04
Rate for Payer: AHCCCS Medicaid	$7,082.04
Rate for Payer: Allwell Medicaid	$7,082.04
Rate for Payer: AZCH Complete Medicaid	$7,082.04
Rate for Payer: Banner UC Health Medicaid	$7,082.04
Rate for Payer: Mercy Care Medicaid	$7,082.04

Respiratory Failure

Facility

$12,428.81

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG1332
Min. Negotiated Rate	$12,428.81
Max. Negotiated Rate	$12,428.81
Rate for Payer: AHCCCS Medicaid	$12,428.81
Rate for Payer: Allwell Medicaid	$12,428.81
Rate for Payer: AZCH Complete Medicaid	$12,428.81
Rate for Payer: Banner UC Health Medicaid	$12,428.81
Rate for Payer: Mercy Care Medicaid	$12,428.81

Respiratory Failure

Facility

$7,082.04

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$7,082.04
Max. Negotiated Rate	$7,082.04
Rate for Payer: AHCCCS Medicaid	$7,082.04
Rate for Payer: Allwell Medicaid	$7,082.04
Rate for Payer: AZCH Complete Medicaid	$7,082.04
Rate for Payer: Banner UC Health Medicaid	$7,082.04
Rate for Payer: Mercy Care Medicaid	$7,082.04

Respiratory Failure

Facility

$7,082.04

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG1331
Min. Negotiated Rate	$7,082.04
Max. Negotiated Rate	$7,082.04
Rate for Payer: AHCCCS Medicaid	$7,082.04
Rate for Payer: Allwell Medicaid	$7,082.04
Rate for Payer: AZCH Complete Medicaid	$7,082.04
Rate for Payer: Banner UC Health Medicaid	$7,082.04
Rate for Payer: Mercy Care Medicaid	$7,082.04

Respiratory Failure

Facility

$4,633.45

Service Code	APR-DRG 1332
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$4,633.45
Max. Negotiated Rate	$4,633.45
Rate for Payer: AHCCCS Medicaid	$4,633.45
Rate for Payer: Allwell Medicaid	$4,633.45
Rate for Payer: AZCH Complete Medicaid	$4,633.45
Rate for Payer: Banner UC Health Medicaid	$4,633.45
Rate for Payer: Mercy Care Medicaid	$4,633.45

Respiratory Failure

Facility

$4,633.45

Service Code	APR-DRG 1332
Hospital Charge Code	APRDRG1331
Min. Negotiated Rate	$4,633.45
Max. Negotiated Rate	$4,633.45
Rate for Payer: AHCCCS Medicaid	$4,633.45
Rate for Payer: Allwell Medicaid	$4,633.45
Rate for Payer: AZCH Complete Medicaid	$4,633.45
Rate for Payer: Banner UC Health Medicaid	$4,633.45
Rate for Payer: Mercy Care Medicaid	$4,633.45

Respiratory Failure

Facility

$12,428.81

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG1333
Min. Negotiated Rate	$12,428.81
Max. Negotiated Rate	$12,428.81
Rate for Payer: AHCCCS Medicaid	$12,428.81
Rate for Payer: Allwell Medicaid	$12,428.81
Rate for Payer: AZCH Complete Medicaid	$12,428.81
Rate for Payer: Banner UC Health Medicaid	$12,428.81
Rate for Payer: Mercy Care Medicaid	$12,428.81

Know your out-of-pocket cost for care.

All Charges