Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SPLINT LEG MEDIUM

Facility

$102.00

Hospital Charge Code	22354300
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Cash Price	$81.60
Rate for Payer: Self Pay Self Pay	$81.60

SPLINT LEG SMALL

Facility

$102.00

Hospital Charge Code	22354299
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Cash Price	$81.60
Rate for Payer: Self Pay Self Pay	$81.60

SPLINT LEG SMALL

Facility

$102.00

Hospital Charge Code	22354299
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Aetna of AZ Medicare	$28.56
Rate for Payer: Allwell Medicare	$15.30
Rate for Payer: Amerigroup Medicare	$15.30
Rate for Payer: APIPA Medicare/Medicaid	$38.10
Rate for Payer: AZCH Complete Medicare	$15.30
Rate for Payer: Banner UC Health Medicare	$15.30
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$69.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cigna of AZ Commercial	$71.40
Rate for Payer: Copperpoint Commercial	$25.24
Rate for Payer: Health Net of AZ Commercial	$61.20
Rate for Payer: Health Net of AZ Medicare	$28.56
Rate for Payer: Humana of AZ Medicare	$15.30
Rate for Payer: Self Pay Self Pay	$81.60
Rate for Payer: TriWest Medicare	$15.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$59.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.36

SPLINT WRIST/FA LG LEFT HAND

Facility

$93.00

Hospital Charge Code	22354270
Hospital Revenue Code	270
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Cash Price	$74.40
Rate for Payer: Self Pay Self Pay	$74.40

SPLINT WRIST/FA LG LEFT HAND

Facility

$93.00

Hospital Charge Code	22354270
Hospital Revenue Code	270
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Aetna of AZ Medicare	$26.04
Rate for Payer: Allwell Medicare	$13.95
Rate for Payer: Amerigroup Medicare	$13.95
Rate for Payer: APIPA Medicare/Medicaid	$34.74
Rate for Payer: AZCH Complete Medicare	$13.95
Rate for Payer: Banner UC Health Medicare	$13.95
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.24
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cigna of AZ Commercial	$65.10
Rate for Payer: Copperpoint Commercial	$23.02
Rate for Payer: Health Net of AZ Commercial	$55.80
Rate for Payer: Health Net of AZ Medicare	$26.04
Rate for Payer: Humana of AZ Medicare	$13.95
Rate for Payer: Self Pay Self Pay	$74.40
Rate for Payer: TriWest Medicare	$13.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.74

SPLINT WRIST/FA LG RIGHT HAND

Facility

$93.00

Hospital Charge Code	22354269
Hospital Revenue Code	270
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Cash Price	$74.40
Rate for Payer: Self Pay Self Pay	$74.40

SPLINT WRIST/FA LG RIGHT HAND

Facility

$93.00

Hospital Charge Code	22354269
Hospital Revenue Code	270
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Aetna of AZ Medicare	$26.04
Rate for Payer: Allwell Medicare	$13.95
Rate for Payer: Amerigroup Medicare	$13.95
Rate for Payer: APIPA Medicare/Medicaid	$34.74
Rate for Payer: AZCH Complete Medicare	$13.95
Rate for Payer: Banner UC Health Medicare	$13.95
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.24
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cigna of AZ Commercial	$65.10
Rate for Payer: Copperpoint Commercial	$23.02
Rate for Payer: Health Net of AZ Commercial	$55.80
Rate for Payer: Health Net of AZ Medicare	$26.04
Rate for Payer: Humana of AZ Medicare	$13.95
Rate for Payer: Self Pay Self Pay	$74.40
Rate for Payer: TriWest Medicare	$13.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.74

SPLINT WRIST/FA MED LEFT HAND

Facility

$116.00

Hospital Charge Code	22354248
Hospital Revenue Code	270
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Aetna of AZ Medicare	$32.48
Rate for Payer: Allwell Medicare	$17.40
Rate for Payer: Amerigroup Medicare	$17.40
Rate for Payer: APIPA Medicare/Medicaid	$43.33
Rate for Payer: AZCH Complete Medicare	$17.40
Rate for Payer: Banner UC Health Medicare	$17.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.88
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$81.20
Rate for Payer: Copperpoint Commercial	$28.71
Rate for Payer: Health Net of AZ Commercial	$69.60
Rate for Payer: Health Net of AZ Medicare	$32.48
Rate for Payer: Humana of AZ Medicare	$17.40
Rate for Payer: Self Pay Self Pay	$92.80
Rate for Payer: TriWest Medicare	$17.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.88

SPLINT WRIST/FA MED LEFT HAND

Facility

$116.00

Hospital Charge Code	22354248
Hospital Revenue Code	270
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Cash Price	$92.80
Rate for Payer: Self Pay Self Pay	$92.80

SPLINT WRIST/FA MED RIGHT HAND

Facility

$116.00

Hospital Charge Code	22354249
Hospital Revenue Code	270
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Cash Price	$92.80
Rate for Payer: Self Pay Self Pay	$92.80

SPLINT WRIST/FA MED RIGHT HAND

Facility

$116.00

Hospital Charge Code	22354249
Hospital Revenue Code	270
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Aetna of AZ Medicare	$32.48
Rate for Payer: Allwell Medicare	$17.40
Rate for Payer: Amerigroup Medicare	$17.40
Rate for Payer: APIPA Medicare/Medicaid	$43.33
Rate for Payer: AZCH Complete Medicare	$17.40
Rate for Payer: Banner UC Health Medicare	$17.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.88
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$81.20
Rate for Payer: Copperpoint Commercial	$28.71
Rate for Payer: Health Net of AZ Commercial	$69.60
Rate for Payer: Health Net of AZ Medicare	$32.48
Rate for Payer: Humana of AZ Medicare	$17.40
Rate for Payer: Self Pay Self Pay	$92.80
Rate for Payer: TriWest Medicare	$17.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.88

SPLINT WRIST/FA SM LEFT HAND

Facility

$116.00

Hospital Charge Code	22354266
Hospital Revenue Code	270
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Cash Price	$92.80
Rate for Payer: Self Pay Self Pay	$92.80

SPLINT WRIST/FA SM LEFT HAND

Facility

$116.00

Hospital Charge Code	22354266
Hospital Revenue Code	270
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Aetna of AZ Medicare	$32.48
Rate for Payer: Allwell Medicare	$17.40
Rate for Payer: Amerigroup Medicare	$17.40
Rate for Payer: APIPA Medicare/Medicaid	$43.33
Rate for Payer: AZCH Complete Medicare	$17.40
Rate for Payer: Banner UC Health Medicare	$17.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.88
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$81.20
Rate for Payer: Copperpoint Commercial	$28.71
Rate for Payer: Health Net of AZ Commercial	$69.60
Rate for Payer: Health Net of AZ Medicare	$32.48
Rate for Payer: Humana of AZ Medicare	$17.40
Rate for Payer: Self Pay Self Pay	$92.80
Rate for Payer: TriWest Medicare	$17.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.88

SPLINT WRIST/FA SM RIGHT HAND

Facility

$93.00

Hospital Charge Code	22354268
Hospital Revenue Code	270
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Aetna of AZ Medicare	$26.04
Rate for Payer: Allwell Medicare	$13.95
Rate for Payer: Amerigroup Medicare	$13.95
Rate for Payer: APIPA Medicare/Medicaid	$34.74
Rate for Payer: AZCH Complete Medicare	$13.95
Rate for Payer: Banner UC Health Medicare	$13.95
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.24
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cigna of AZ Commercial	$65.10
Rate for Payer: Copperpoint Commercial	$23.02
Rate for Payer: Health Net of AZ Commercial	$55.80
Rate for Payer: Health Net of AZ Medicare	$26.04
Rate for Payer: Humana of AZ Medicare	$13.95
Rate for Payer: Self Pay Self Pay	$74.40
Rate for Payer: TriWest Medicare	$13.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.74

SPLINT WRIST/FA SM RIGHT HAND

Facility

$93.00

Hospital Charge Code	22354268
Hospital Revenue Code	270
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Cash Price	$74.40
Rate for Payer: Self Pay Self Pay	$74.40

SPLINT WRIST LARGE LEFT

Facility

$46.00

Hospital Charge Code	22354254
Hospital Revenue Code	270
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$6.90
Rate for Payer: Amerigroup Medicare	$6.90
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$6.90
Rate for Payer: Banner UC Health Medicare	$6.90
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$6.90
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$6.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

SPLINT WRIST LARGE LEFT

Facility

$46.00

Hospital Charge Code	22354254
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

SPLINT WRIST LARGE RIGHT

Facility

$38.00

Hospital Charge Code	22354255
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Aetna of AZ Medicare	$10.64
Rate for Payer: Allwell Medicare	$5.70
Rate for Payer: Amerigroup Medicare	$5.70
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$5.70
Rate for Payer: Banner UC Health Medicare	$5.70
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.84
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Copperpoint Commercial	$9.40
Rate for Payer: Health Net of AZ Commercial	$22.80
Rate for Payer: Health Net of AZ Medicare	$10.64
Rate for Payer: Humana of AZ Medicare	$5.70
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$5.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

SPLINT WRIST LARGE RIGHT

Facility

$38.00

Hospital Charge Code	22354255
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

SPLINT WRIST MEDIUM LEFT

Facility

$47.00

Hospital Charge Code	22354252
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

SPLINT WRIST MEDIUM LEFT

Facility

$47.00

Hospital Charge Code	22354252
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

SPLINT WRIST MEDIUM RIGHT

Facility

$47.00

Hospital Charge Code	22354253
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

SPLINT WRIST MEDIUM RIGHT

Facility

$47.00

Hospital Charge Code	22354253
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

SPLINT WRIST SMALL LEFT

Facility

$47.00

Hospital Charge Code	22354250
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

SPLINT WRIST SMALL LEFT

Facility

$47.00

Hospital Charge Code	22354250
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Know your out-of-pocket cost for care.

All Charges