Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SPLINT WRIST SMALL RIGHT

Facility

$47.00

Hospital Charge Code	22354251
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 SMALL RIGHT

Facility

$47.00

Hospital Charge Code	22354251
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 XS PED LEFT

Facility

$98.00

Hospital Charge Code	22354187
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Aetna of AZ Medicare	$27.44
Rate for Payer: Allwell Medicare	$14.70
Rate for Payer: Amerigroup Medicare	$14.70
Rate for Payer: APIPA Medicare/Medicaid	$36.60
Rate for Payer: AZCH Complete Medicare	$14.70
Rate for Payer: Banner UC Health Medicare	$14.70
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$66.64
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Copperpoint Commercial	$24.26
Rate for Payer: Health Net of AZ Commercial	$58.80
Rate for Payer: Health Net of AZ Medicare	$27.44
Rate for Payer: Humana of AZ Medicare	$14.70
Rate for Payer: Self Pay Self Pay	$78.40
Rate for Payer: TriWest Medicare	$14.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.64

SPLINT WRIST XS PED LEFT

Facility

$98.00

Hospital Charge Code	22354187
Hospital Revenue Code	270
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Cash Price	$78.40
Rate for Payer: Self Pay Self Pay	$78.40

SPONGE PEANUT

Facility

$9.00

Hospital Charge Code	22355591
Hospital Revenue Code	272
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

SPONGE PEANUT

Facility

$9.00

Hospital Charge Code	22355591
Hospital Revenue Code	272
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

Sputum Culture

Facility

$182.00

Service Code	CPT 87070
Hospital Charge Code	858006
Hospital Revenue Code	306
Min. Negotiated Rate	$47.32
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna of AZ Commercial	$163.80
Rate for Payer: Bisbee Police All Plans	$47.32
Rate for Payer: Cash Price	$145.60
Rate for Payer: Self Pay Self Pay	$145.60

Sputum Culture

Facility

$182.00

Service Code	CPT 87070
Hospital Charge Code	858006
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna of AZ Commercial	$163.80
Rate for Payer: Aetna of AZ Medicare	$50.96
Rate for Payer: AHCCCS Medicaid	$8.62
Rate for Payer: Allwell Medicaid	$8.62
Rate for Payer: Allwell Medicare	$27.30
Rate for Payer: Amerigroup Medicare	$27.30
Rate for Payer: APIPA Medicare/Medicaid	$67.98
Rate for Payer: AZCH Complete Medicaid	$8.62
Rate for Payer: AZCH Complete Medicare	$27.30
Rate for Payer: Banner UC Health Medicaid	$8.62
Rate for Payer: Banner UC Health Medicare	$27.30
Rate for Payer: Bisbee Police All Plans	$47.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.76
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cigna of AZ Commercial	$118.30
Rate for Payer: Copperpoint Commercial	$45.04
Rate for Payer: Health Net of AZ Commercial	$109.20
Rate for Payer: Health Net of AZ Medicare	$50.96
Rate for Payer: Humana of AZ Medicare	$27.30
Rate for Payer: Mercy Care Medicaid	$8.62
Rate for Payer: Self Pay Self Pay	$145.60
Rate for Payer: TriWest Medicare	$27.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$106.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.76

SPUTUM INDUCT

Facility

$92.00

Service Code	CPT 94664
Hospital Charge Code	1886886
Hospital Revenue Code	412
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$272.42
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Aetna of AZ Medicare	$25.76
Rate for Payer: AHCCCS Medicaid	$272.42
Rate for Payer: Allwell Medicaid	$272.42
Rate for Payer: Allwell Medicare	$13.80
Rate for Payer: Amerigroup Medicare	$13.80
Rate for Payer: APIPA Medicare/Medicaid	$34.36
Rate for Payer: AZCH Complete Medicaid	$272.42
Rate for Payer: AZCH Complete Medicare	$13.80
Rate for Payer: Banner UC Health Medicaid	$272.42
Rate for Payer: Banner UC Health Medicare	$13.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.56
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$64.40
Rate for Payer: Copperpoint Commercial	$22.77
Rate for Payer: Health Net of AZ Commercial	$55.20
Rate for Payer: Health Net of AZ Medicare	$25.76
Rate for Payer: Humana of AZ Medicare	$13.80
Rate for Payer: Mercy Care Medicaid	$272.42
Rate for Payer: Self Pay Self Pay	$73.60
Rate for Payer: TriWest Medicare	$13.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.56

SPUTUM INDUCT

Facility

$92.00

Service Code	CPT 94664
Hospital Charge Code	1886886
Hospital Revenue Code	412
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Cash Price	$73.60
Rate for Payer: Self Pay Self Pay	$73.60

SSA Urine

Facility

$55.00

Service Code	CPT 81099
Hospital Charge Code	1657596
Hospital Revenue Code	300
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$8.25
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$35.75
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.25
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

SSA Urine

Facility

$55.00

Service Code	CPT 81099
Hospital Charge Code	1657596
Hospital Revenue Code	300
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

STAPLER 35W

Facility

$109.00

Hospital Charge Code	22355362
Hospital Revenue Code	270
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$16.35
Rate for Payer: Amerigroup Medicare	$16.35
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$16.35
Rate for Payer: Banner UC Health Medicare	$16.35
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$16.35
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$16.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

STAPLER 35W

Facility

$109.00

Hospital Charge Code	22355362
Hospital Revenue Code	270
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

STAPLER ENDOSHEARS 5MM STRL

Facility

$1,478.00

Hospital Charge Code	22354872
Hospital Revenue Code	270
Min. Negotiated Rate	$384.28
Max. Negotiated Rate	$1,330.20
Rate for Payer: Aetna of AZ Commercial	$1,330.20
Rate for Payer: Bisbee Police All Plans	$384.28
Rate for Payer: Cash Price	$1,182.40
Rate for Payer: Self Pay Self Pay	$1,182.40

STAPLER ENDOSHEARS 5MM STRL

Facility

$1,478.00

Hospital Charge Code	22354872
Hospital Revenue Code	270
Min. Negotiated Rate	$221.70
Max. Negotiated Rate	$1,330.20
Rate for Payer: Aetna of AZ Commercial	$1,330.20
Rate for Payer: Aetna of AZ Medicare	$413.84
Rate for Payer: Allwell Medicare	$221.70
Rate for Payer: Amerigroup Medicare	$221.70
Rate for Payer: APIPA Medicare/Medicaid	$552.03
Rate for Payer: AZCH Complete Medicare	$221.70
Rate for Payer: Banner UC Health Medicare	$221.70
Rate for Payer: Bisbee Police All Plans	$384.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,005.04
Rate for Payer: Cash Price	$1,182.40
Rate for Payer: Cigna of AZ Commercial	$1,034.60
Rate for Payer: Copperpoint Commercial	$365.80
Rate for Payer: Health Net of AZ Commercial	$886.80
Rate for Payer: Health Net of AZ Medicare	$413.84
Rate for Payer: Humana of AZ Medicare	$221.70
Rate for Payer: Self Pay Self Pay	$1,182.40
Rate for Payer: TriWest Medicare	$221.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$861.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$266.04

STAPLER PREM 35 MF

Facility

$719.00

Hospital Charge Code	22354871
Hospital Revenue Code	270
Min. Negotiated Rate	$186.94
Max. Negotiated Rate	$647.10
Rate for Payer: Aetna of AZ Commercial	$647.10
Rate for Payer: Bisbee Police All Plans	$186.94
Rate for Payer: Cash Price	$575.20
Rate for Payer: Self Pay Self Pay	$575.20

STAPLER PREM 35 MF

Facility

$719.00

Hospital Charge Code	22354871
Hospital Revenue Code	270
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$647.10
Rate for Payer: Aetna of AZ Commercial	$647.10
Rate for Payer: Aetna of AZ Medicare	$201.32
Rate for Payer: Allwell Medicare	$107.85
Rate for Payer: Amerigroup Medicare	$107.85
Rate for Payer: APIPA Medicare/Medicaid	$268.55
Rate for Payer: AZCH Complete Medicare	$107.85
Rate for Payer: Banner UC Health Medicare	$107.85
Rate for Payer: Bisbee Police All Plans	$186.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$488.92
Rate for Payer: Cash Price	$575.20
Rate for Payer: Cigna of AZ Commercial	$503.30
Rate for Payer: Copperpoint Commercial	$177.95
Rate for Payer: Health Net of AZ Commercial	$431.40
Rate for Payer: Health Net of AZ Medicare	$201.32
Rate for Payer: Humana of AZ Medicare	$107.85
Rate for Payer: Self Pay Self Pay	$575.20
Rate for Payer: TriWest Medicare	$107.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$419.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.42

STAPLER SKIN 3M PRECISE

Facility

$33.00

Hospital Charge Code	22355545
Hospital Revenue Code	272
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

STAPLER SKIN 3M PRECISE

Facility

$33.00

Hospital Charge Code	22355545
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
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	$4.95
Rate for Payer: Amerigroup Medicare	$4.95
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$4.95
Rate for Payer: Banner UC Health Medicare	$4.95
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	$4.95
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$4.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

STAPLER SKIN PXW35

Facility

$44.00

Hospital Charge Code	22354873
Hospital Revenue Code	270
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

STAPLER SKIN PXW35

Facility

$44.00

Hospital Charge Code	22354873
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$6.60
Rate for Payer: Amerigroup Medicare	$6.60
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$6.60
Rate for Payer: Banner UC Health Medicare	$6.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$6.60
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$6.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

STATLOCK PICC PLUS STABILIZATION DEVICE

Facility

$21.00

Hospital Charge Code	24093278
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of AZ Commercial	$18.90
Rate for Payer: Bisbee Police All Plans	$5.46
Rate for Payer: Cash Price	$16.80
Rate for Payer: Self Pay Self Pay	$16.80

STATLOCK PICC PLUS STABILIZATION DEVICE

Facility

$21.00

Hospital Charge Code	24093278
Hospital Revenue Code	270
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of AZ Commercial	$18.90
Rate for Payer: Aetna of AZ Medicare	$5.88
Rate for Payer: Allwell Medicare	$3.15
Rate for Payer: Amerigroup Medicare	$3.15
Rate for Payer: APIPA Medicare/Medicaid	$7.84
Rate for Payer: AZCH Complete Medicare	$3.15
Rate for Payer: Banner UC Health Medicare	$3.15
Rate for Payer: Bisbee Police All Plans	$5.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.28
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cigna of AZ Commercial	$14.70
Rate for Payer: Copperpoint Commercial	$5.20
Rate for Payer: Health Net of AZ Commercial	$12.60
Rate for Payer: Health Net of AZ Medicare	$5.88
Rate for Payer: Humana of AZ Medicare	$3.15
Rate for Payer: Self Pay Self Pay	$16.80
Rate for Payer: TriWest Medicare	$3.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.78

STENT FILIFORM DOUBLE PIGTAIL 6.0FR/24CM

Facility

$543.00

Hospital Charge Code	22354214
Hospital Revenue Code	270
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$488.70
Rate for Payer: Aetna of AZ Commercial	$488.70
Rate for Payer: Aetna of AZ Medicare	$152.04
Rate for Payer: Allwell Medicare	$81.45
Rate for Payer: Amerigroup Medicare	$81.45
Rate for Payer: APIPA Medicare/Medicaid	$202.81
Rate for Payer: AZCH Complete Medicare	$81.45
Rate for Payer: Banner UC Health Medicare	$81.45
Rate for Payer: Bisbee Police All Plans	$141.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$369.24
Rate for Payer: Cash Price	$434.40
Rate for Payer: Cigna of AZ Commercial	$380.10
Rate for Payer: Copperpoint Commercial	$134.39
Rate for Payer: Health Net of AZ Commercial	$325.80
Rate for Payer: Health Net of AZ Medicare	$152.04
Rate for Payer: Humana of AZ Medicare	$81.45
Rate for Payer: Self Pay Self Pay	$434.40
Rate for Payer: TriWest Medicare	$81.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$316.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.74

Know your out-of-pocket cost for care.

All Charges