Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

STOCKING THIGH SMALL LONG

Facility

$58.00

Hospital Charge Code	22355116
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$8.70
Rate for Payer: Amerigroup Medicare	$8.70
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$8.70
Rate for Payer: Banner UC Health Medicare	$8.70
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$8.70
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$8.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

STOCKING THIGH SMALL REG

Facility

$41.00

Hospital Charge Code	22355121
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

STOCKING THIGH SMALL REG

Facility

$41.00

Hospital Charge Code	22355121
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

STOCKING THIGH SMALL SHORT

Facility

$58.00

Hospital Charge Code	22355115
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$8.70
Rate for Payer: Amerigroup Medicare	$8.70
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$8.70
Rate for Payer: Banner UC Health Medicare	$8.70
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$8.70
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$8.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

STOCKING THIGH SMALL SHORT

Facility

$58.00

Hospital Charge Code	22355115
Hospital Revenue Code	270
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Cash Price	$46.40
Rate for Payer: Self Pay Self Pay	$46.40

STOCKING THIGH X-LARGE LONG

Facility

$84.00

Hospital Charge Code	22354236
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Aetna of AZ Medicare	$23.52
Rate for Payer: Allwell Medicare	$12.60
Rate for Payer: Amerigroup Medicare	$12.60
Rate for Payer: APIPA Medicare/Medicaid	$31.37
Rate for Payer: AZCH Complete Medicare	$12.60
Rate for Payer: Banner UC Health Medicare	$12.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.12
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$58.80
Rate for Payer: Copperpoint Commercial	$20.79
Rate for Payer: Health Net of AZ Commercial	$50.40
Rate for Payer: Health Net of AZ Medicare	$23.52
Rate for Payer: Humana of AZ Medicare	$12.60
Rate for Payer: Self Pay Self Pay	$67.20
Rate for Payer: TriWest Medicare	$12.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.12

STOCKING THIGH X-LARGE LONG

Facility

$84.00

Hospital Charge Code	22354236
Hospital Revenue Code	270
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Cash Price	$67.20
Rate for Payer: Self Pay Self Pay	$67.20

STOCKING THIGH X-LARGE REG

Facility

$55.00

Hospital Charge Code	22354235
Hospital Revenue Code	270
Min. Negotiated Rate	$8.25
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: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.25
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: Cigna of AZ Commercial	$38.50
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: 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

STOCKING THIGH X-LARGE REG

Facility

$55.00

Hospital Charge Code	22354235
Hospital Revenue Code	270
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

STOII 19

Facility

$11,965.00

Hospital Charge Code	27519890
Hospital Revenue Code	270
Min. Negotiated Rate	$1,794.75
Max. Negotiated Rate	$10,768.50
Rate for Payer: Aetna of AZ Commercial	$10,768.50
Rate for Payer: Aetna of AZ Medicare	$3,350.20
Rate for Payer: Allwell Medicare	$1,794.75
Rate for Payer: Amerigroup Medicare	$1,794.75
Rate for Payer: APIPA Medicare/Medicaid	$4,468.93
Rate for Payer: AZCH Complete Medicare	$1,794.75
Rate for Payer: Banner UC Health Medicare	$1,794.75
Rate for Payer: Bisbee Police All Plans	$3,110.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8,136.20
Rate for Payer: Cash Price	$9,572.00
Rate for Payer: Cigna of AZ Commercial	$8,375.50
Rate for Payer: Copperpoint Commercial	$2,961.34
Rate for Payer: Health Net of AZ Commercial	$7,179.00
Rate for Payer: Health Net of AZ Medicare	$3,350.20
Rate for Payer: Humana of AZ Medicare	$1,794.75
Rate for Payer: Self Pay Self Pay	$9,572.00
Rate for Payer: TriWest Medicare	$1,794.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$6,975.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,153.70

STOII 19

Facility

$11,965.00

Hospital Charge Code	27519890
Hospital Revenue Code	270
Min. Negotiated Rate	$3,110.90
Max. Negotiated Rate	$10,768.50
Rate for Payer: Aetna of AZ Commercial	$10,768.50
Rate for Payer: Bisbee Police All Plans	$3,110.90
Rate for Payer: Cash Price	$9,572.00
Rate for Payer: Self Pay Self Pay	$9,572.00

STONEBREAKER CO2 CARTRIDGE

Facility

$79.00

Hospital Charge Code	22354455
Hospital Revenue Code	272
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Cash Price	$63.20
Rate for Payer: Self Pay Self Pay	$63.20

STONEBREAKER CO2 CARTRIDGE

Facility

$79.00

Hospital Charge Code	22354455
Hospital Revenue Code	272
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Aetna of AZ Medicare	$22.12
Rate for Payer: Allwell Medicare	$11.85
Rate for Payer: Amerigroup Medicare	$11.85
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicare	$11.85
Rate for Payer: Banner UC Health Medicare	$11.85
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.72
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$55.30
Rate for Payer: Copperpoint Commercial	$19.55
Rate for Payer: Health Net of AZ Commercial	$47.40
Rate for Payer: Health Net of AZ Medicare	$22.12
Rate for Payer: Humana of AZ Medicare	$11.85
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$11.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.22

STONE EXTR NITINOL

Facility

$544.00

Hospital Charge Code	22354218
Hospital Revenue Code	270
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Aetna of AZ Medicare	$152.32
Rate for Payer: Allwell Medicare	$81.60
Rate for Payer: Amerigroup Medicare	$81.60
Rate for Payer: APIPA Medicare/Medicaid	$203.18
Rate for Payer: AZCH Complete Medicare	$81.60
Rate for Payer: Banner UC Health Medicare	$81.60
Rate for Payer: Bisbee Police All Plans	$141.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$369.92
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cigna of AZ Commercial	$380.80
Rate for Payer: Copperpoint Commercial	$134.64
Rate for Payer: Health Net of AZ Commercial	$326.40
Rate for Payer: Health Net of AZ Medicare	$152.32
Rate for Payer: Humana of AZ Medicare	$81.60
Rate for Payer: Self Pay Self Pay	$435.20
Rate for Payer: TriWest Medicare	$81.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$317.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.92

STONE EXTR NITINOL

Facility

$544.00

Hospital Charge Code	22354218
Hospital Revenue Code	270
Min. Negotiated Rate	$141.44
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Bisbee Police All Plans	$141.44
Rate for Payer: Cash Price	$435.20
Rate for Payer: Self Pay Self Pay	$435.20

Stool Culture

Facility

$165.00

Service Code	CPT 87045
Hospital Charge Code	1151516
Hospital Revenue Code	306
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of AZ Commercial	$148.50
Rate for Payer: Bisbee Police All Plans	$42.90
Rate for Payer: Cash Price	$132.00
Rate for Payer: Self Pay Self Pay	$132.00

Stool Culture

Facility

$165.00

Service Code	CPT 87045
Hospital Charge Code	1151516
Hospital Revenue Code	306
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of AZ Commercial	$148.50
Rate for Payer: Aetna of AZ Medicare	$46.20
Rate for Payer: AHCCCS Medicaid	$9.44
Rate for Payer: Allwell Medicaid	$9.44
Rate for Payer: Allwell Medicare	$24.75
Rate for Payer: Amerigroup Medicare	$24.75
Rate for Payer: APIPA Medicare/Medicaid	$61.63
Rate for Payer: AZCH Complete Medicaid	$9.44
Rate for Payer: AZCH Complete Medicare	$24.75
Rate for Payer: Banner UC Health Medicaid	$9.44
Rate for Payer: Banner UC Health Medicare	$24.75
Rate for Payer: Bisbee Police All Plans	$42.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$112.20
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cigna of AZ Commercial	$107.25
Rate for Payer: Copperpoint Commercial	$40.84
Rate for Payer: Health Net of AZ Commercial	$99.00
Rate for Payer: Health Net of AZ Medicare	$46.20
Rate for Payer: Humana of AZ Medicare	$24.75
Rate for Payer: Mercy Care Medicaid	$9.44
Rate for Payer: Self Pay Self Pay	$132.00
Rate for Payer: TriWest Medicare	$24.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$96.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.70

STORZ D- BLADE

Facility

$90.00

Hospital Charge Code	22834566
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$13.50
Rate for Payer: Amerigroup Medicare	$13.50
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$13.50
Rate for Payer: Banner UC Health Medicare	$13.50
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$22.28
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$13.50
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$13.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

STORZ D- BLADE

Facility

$90.00

Hospital Charge Code	22834566
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

STORZ MAC #3

Facility

$90.00

Hospital Charge Code	22832863
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

STORZ MAC #3

Facility

$90.00

Hospital Charge Code	22832863
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$13.50
Rate for Payer: Amerigroup Medicare	$13.50
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$13.50
Rate for Payer: Banner UC Health Medicare	$13.50
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$22.28
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$13.50
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$13.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

STORZ MAC #4

Facility

$90.00

Hospital Charge Code	22834564
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

STORZ MAC #4

Facility

$90.00

Hospital Charge Code	22834564
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$13.50
Rate for Payer: Amerigroup Medicare	$13.50
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$13.50
Rate for Payer: Banner UC Health Medicare	$13.50
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$22.28
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$13.50
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$13.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

STORZ MILLER 0

Facility

$776.00

Hospital Charge Code	22834570
Hospital Revenue Code	272
Min. Negotiated Rate	$116.40
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Aetna of AZ Medicare	$217.28
Rate for Payer: Allwell Medicare	$116.40
Rate for Payer: Amerigroup Medicare	$116.40
Rate for Payer: APIPA Medicare/Medicaid	$289.84
Rate for Payer: AZCH Complete Medicare	$116.40
Rate for Payer: Banner UC Health Medicare	$116.40
Rate for Payer: Bisbee Police All Plans	$201.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$527.68
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cigna of AZ Commercial	$543.20
Rate for Payer: Copperpoint Commercial	$192.06
Rate for Payer: Health Net of AZ Commercial	$465.60
Rate for Payer: Health Net of AZ Medicare	$217.28
Rate for Payer: Humana of AZ Medicare	$116.40
Rate for Payer: Self Pay Self Pay	$620.80
Rate for Payer: TriWest Medicare	$116.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$452.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$139.68

STORZ MILLER 0

Facility

$776.00

Hospital Charge Code	22834570
Hospital Revenue Code	272
Min. Negotiated Rate	$201.76
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Bisbee Police All Plans	$201.76
Rate for Payer: Cash Price	$620.80
Rate for Payer: Self Pay Self Pay	$620.80

Know your out-of-pocket cost for care.

All Charges