Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SHEATH URETERAL ACCESS DBL LUMEN 12X35

Facility

$534.00

Hospital Charge Code	22354224
Hospital Revenue Code	270
Min. Negotiated Rate	$85.44
Max. Negotiated Rate	$480.60
Rate for Payer: Aetna of AZ Commercial	$480.60
Rate for Payer: Aetna of AZ Medicare	$149.52
Rate for Payer: Allwell Medicare	$85.44
Rate for Payer: Amerigroup Medicare	$85.44
Rate for Payer: APIPA Medicare/Medicaid	$199.45
Rate for Payer: AZCH Complete Medicare	$85.44
Rate for Payer: Banner UC Health Medicare	$85.44
Rate for Payer: Bisbee Police All Plans	$138.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$363.12
Rate for Payer: Cash Price	$427.20
Rate for Payer: Cigna of AZ Commercial	$373.80
Rate for Payer: Copperpoint Commercial	$132.16
Rate for Payer: Health Net of AZ Commercial	$320.40
Rate for Payer: Health Net of AZ Medicare	$149.52
Rate for Payer: Humana of AZ Medicare	$85.44
Rate for Payer: Self Pay Self Pay	$427.20
Rate for Payer: TriWest Medicare	$85.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$311.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$96.12

SHIGA-TOXIN 1 AG

Facility

$83.00

Service Code	CPT 87899
Hospital Charge Code	22272337
Hospital Revenue Code	306
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Aetna of AZ Medicare	$23.24
Rate for Payer: Allwell Medicare	$13.28
Rate for Payer: Amerigroup Medicare	$13.28
Rate for Payer: APIPA Medicare/Medicaid	$31.00
Rate for Payer: AZCH Complete Medicare	$13.28
Rate for Payer: Banner UC Health Medicare	$13.28
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$56.44
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Copperpoint Commercial	$20.54
Rate for Payer: Health Net of AZ Commercial	$49.80
Rate for Payer: Health Net of AZ Medicare	$23.24
Rate for Payer: Humana of AZ Medicare	$13.28
Rate for Payer: Self Pay Self Pay	$66.40
Rate for Payer: TriWest Medicare	$13.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.94

SHIGA-TOXIN 1 AG

Facility

$83.00

Service Code	CPT 87899
Hospital Charge Code	22272337
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Cash Price	$66.40
Rate for Payer: Self Pay Self Pay	$66.40

SHIGA-TOXIN 2 AG

Facility

$87.00

Service Code	CPT 87899
Hospital Charge Code	22272338
Hospital Revenue Code	306
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Cash Price	$69.60
Rate for Payer: Self Pay Self Pay	$69.60

SHIGA-TOXIN 2 AG

Facility

$87.00

Service Code	CPT 87899
Hospital Charge Code	22272338
Hospital Revenue Code	306
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Aetna of AZ Medicare	$24.36
Rate for Payer: Allwell Medicare	$13.92
Rate for Payer: Amerigroup Medicare	$13.92
Rate for Payer: APIPA Medicare/Medicaid	$32.49
Rate for Payer: AZCH Complete Medicare	$13.92
Rate for Payer: Banner UC Health Medicare	$13.92
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.16
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cigna of AZ Commercial	$56.55
Rate for Payer: Copperpoint Commercial	$21.53
Rate for Payer: Health Net of AZ Commercial	$52.20
Rate for Payer: Health Net of AZ Medicare	$24.36
Rate for Payer: Humana of AZ Medicare	$13.92
Rate for Payer: Self Pay Self Pay	$69.60
Rate for Payer: TriWest Medicare	$13.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.66

SHOE POST-OP FEMALE LARGE

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354284
Hospital Revenue Code	270
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Cash Price	$69.60
Rate for Payer: Self Pay Self Pay	$69.60

SHOE POST-OP FEMALE LARGE

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354284
Hospital Revenue Code	270
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Aetna of AZ Medicare	$24.36
Rate for Payer: Allwell Medicare	$13.92
Rate for Payer: Amerigroup Medicare	$13.92
Rate for Payer: APIPA Medicare/Medicaid	$32.49
Rate for Payer: AZCH Complete Medicare	$13.92
Rate for Payer: Banner UC Health Medicare	$13.92
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.16
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cigna of AZ Commercial	$60.90
Rate for Payer: Copperpoint Commercial	$21.53
Rate for Payer: Health Net of AZ Commercial	$52.20
Rate for Payer: Health Net of AZ Medicare	$24.36
Rate for Payer: Humana of AZ Medicare	$13.92
Rate for Payer: Self Pay Self Pay	$69.60
Rate for Payer: TriWest Medicare	$13.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.66

SHOE POST-OP FEMALE MEDIUM

Facility

$63.00

Service Code	CPT L3260
Hospital Charge Code	22354283
Hospital Revenue Code	270
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Aetna of AZ Medicare	$17.64
Rate for Payer: Allwell Medicare	$10.08
Rate for Payer: Amerigroup Medicare	$10.08
Rate for Payer: APIPA Medicare/Medicaid	$23.53
Rate for Payer: AZCH Complete Medicare	$10.08
Rate for Payer: Banner UC Health Medicare	$10.08
Rate for Payer: Bisbee Police All Plans	$16.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.84
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna of AZ Commercial	$44.10
Rate for Payer: Copperpoint Commercial	$15.59
Rate for Payer: Health Net of AZ Commercial	$37.80
Rate for Payer: Health Net of AZ Medicare	$17.64
Rate for Payer: Humana of AZ Medicare	$10.08
Rate for Payer: Self Pay Self Pay	$50.40
Rate for Payer: TriWest Medicare	$10.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.34

SHOE POST-OP FEMALE MEDIUM

Facility

$63.00

Service Code	CPT L3260
Hospital Charge Code	22354283
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Bisbee Police All Plans	$16.38
Rate for Payer: Cash Price	$50.40
Rate for Payer: Self Pay Self Pay	$50.40

SHOE POST-OP FEMALE SMALL

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354282
Hospital Revenue Code	270
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Aetna of AZ Medicare	$24.36
Rate for Payer: Allwell Medicare	$13.92
Rate for Payer: Amerigroup Medicare	$13.92
Rate for Payer: APIPA Medicare/Medicaid	$32.49
Rate for Payer: AZCH Complete Medicare	$13.92
Rate for Payer: Banner UC Health Medicare	$13.92
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.16
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cigna of AZ Commercial	$60.90
Rate for Payer: Copperpoint Commercial	$21.53
Rate for Payer: Health Net of AZ Commercial	$52.20
Rate for Payer: Health Net of AZ Medicare	$24.36
Rate for Payer: Humana of AZ Medicare	$13.92
Rate for Payer: Self Pay Self Pay	$69.60
Rate for Payer: TriWest Medicare	$13.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.66

SHOE POST-OP FEMALE SMALL

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354282
Hospital Revenue Code	270
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Cash Price	$69.60
Rate for Payer: Self Pay Self Pay	$69.60

SHOE POST-OP MALE LARGE

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354287
Hospital Revenue Code	270
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Aetna of AZ Medicare	$24.36
Rate for Payer: Allwell Medicare	$13.92
Rate for Payer: Amerigroup Medicare	$13.92
Rate for Payer: APIPA Medicare/Medicaid	$32.49
Rate for Payer: AZCH Complete Medicare	$13.92
Rate for Payer: Banner UC Health Medicare	$13.92
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.16
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cigna of AZ Commercial	$60.90
Rate for Payer: Copperpoint Commercial	$21.53
Rate for Payer: Health Net of AZ Commercial	$52.20
Rate for Payer: Health Net of AZ Medicare	$24.36
Rate for Payer: Humana of AZ Medicare	$13.92
Rate for Payer: Self Pay Self Pay	$69.60
Rate for Payer: TriWest Medicare	$13.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.66

SHOE POST-OP MALE LARGE

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354287
Hospital Revenue Code	270
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Cash Price	$69.60
Rate for Payer: Self Pay Self Pay	$69.60

SHOE POST-OP MALE MEDIUM

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354286
Hospital Revenue Code	270
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Cash Price	$69.60
Rate for Payer: Self Pay Self Pay	$69.60

SHOE POST-OP MALE MEDIUM

Facility

$87.00

Service Code	CPT L3260
Hospital Charge Code	22354286
Hospital Revenue Code	270
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$78.30
Rate for Payer: Aetna of AZ Commercial	$78.30
Rate for Payer: Aetna of AZ Medicare	$24.36
Rate for Payer: Allwell Medicare	$13.92
Rate for Payer: Amerigroup Medicare	$13.92
Rate for Payer: APIPA Medicare/Medicaid	$32.49
Rate for Payer: AZCH Complete Medicare	$13.92
Rate for Payer: Banner UC Health Medicare	$13.92
Rate for Payer: Bisbee Police All Plans	$22.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.16
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cigna of AZ Commercial	$60.90
Rate for Payer: Copperpoint Commercial	$21.53
Rate for Payer: Health Net of AZ Commercial	$52.20
Rate for Payer: Health Net of AZ Medicare	$24.36
Rate for Payer: Humana of AZ Medicare	$13.92
Rate for Payer: Self Pay Self Pay	$69.60
Rate for Payer: TriWest Medicare	$13.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.66

SHOE POST-OP MALE SMALL

Facility

$33.00

Service Code	CPT L3260
Hospital Charge Code	22354285
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

SHOE POST-OP MALE SMALL

Facility

$33.00

Service Code	CPT L3260
Hospital Charge Code	22354285
Hospital Revenue Code	270
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

SHOE POST-OP MALE X-SMALL

Facility

$33.00

Service Code	CPT L3260
Hospital Charge Code	22354306
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

SHOE POST-OP MALE X-SMALL

Facility

$33.00

Service Code	CPT L3260
Hospital Charge Code	22354306
Hospital Revenue Code	270
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

SHOE POST OP XL

Facility

$33.00

Hospital Charge Code	24045512
Hospital Revenue Code	270
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

SHOE POST OP XL

Facility

$33.00

Hospital Charge Code	24045512
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

Shoulder And Elbow Joint Replacement

Facility

$10,051.76

Service Code	APR-DRG 3221
Hospital Charge Code	APRDRG3223
Min. Negotiated Rate	$10,051.76
Max. Negotiated Rate	$10,051.76
Rate for Payer: AHCCCS Medicaid	$10,051.76
Rate for Payer: Allwell Medicaid	$10,051.76
Rate for Payer: AZCH Complete Medicaid	$10,051.76
Rate for Payer: Banner UC Health Medicaid	$10,051.76
Rate for Payer: Mercy Care Medicaid	$10,051.76

Shoulder And Elbow Joint Replacement

Facility

$11,399.15

Service Code	APR-DRG 3222
Hospital Charge Code	APRDRG3221
Min. Negotiated Rate	$11,399.15
Max. Negotiated Rate	$11,399.15
Rate for Payer: AHCCCS Medicaid	$11,399.15
Rate for Payer: Allwell Medicaid	$11,399.15
Rate for Payer: AZCH Complete Medicaid	$11,399.15
Rate for Payer: Banner UC Health Medicaid	$11,399.15
Rate for Payer: Mercy Care Medicaid	$11,399.15

Shoulder And Elbow Joint Replacement

Facility

$15,847.43

Service Code	APR-DRG 3223
Hospital Charge Code	APRDRG3223
Min. Negotiated Rate	$15,847.43
Max. Negotiated Rate	$15,847.43
Rate for Payer: AHCCCS Medicaid	$15,847.43
Rate for Payer: Allwell Medicaid	$15,847.43
Rate for Payer: AZCH Complete Medicaid	$15,847.43
Rate for Payer: Banner UC Health Medicaid	$15,847.43
Rate for Payer: Mercy Care Medicaid	$15,847.43

Shoulder And Elbow Joint Replacement

Facility

$15,847.43

Service Code	APR-DRG 3223
Hospital Charge Code	APRDRG3221
Min. Negotiated Rate	$15,847.43
Max. Negotiated Rate	$15,847.43
Rate for Payer: AHCCCS Medicaid	$15,847.43
Rate for Payer: Allwell Medicaid	$15,847.43
Rate for Payer: AZCH Complete Medicaid	$15,847.43
Rate for Payer: Banner UC Health Medicaid	$15,847.43
Rate for Payer: Mercy Care Medicaid	$15,847.43

Know your out-of-pocket cost for care.

All Charges