Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE TROCARE 5CM STR REFLEX

Facility

$106.00

Hospital Charge Code	22706520
Hospital Revenue Code	272
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$16.96
Rate for Payer: Amerigroup Medicare	$16.96
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$74.20
Rate for Payer: Copperpoint Commercial	$26.23
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

SLEEVE TROCARE 5CM STR REFLEX

Facility

$106.00

Hospital Charge Code	22706520
Hospital Revenue Code	272
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

Slide Coagulase

Facility

$35.00

Service Code	CPT 87147
Hospital Charge Code	634041
Hospital Revenue Code	301
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Cash Price	$28.00
Rate for Payer: Self Pay Self Pay	$28.00

Slide Coagulase

Facility

$35.00

Service Code	CPT 87147
Hospital Charge Code	634041
Hospital Revenue Code	301
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Aetna of AZ Medicare	$9.80
Rate for Payer: Allwell Medicare	$5.60
Rate for Payer: Amerigroup Medicare	$5.60
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.60
Rate for Payer: Banner UC Health Medicare	$5.60
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$22.75
Rate for Payer: Copperpoint Commercial	$8.66
Rate for Payer: Health Net of AZ Commercial	$21.00
Rate for Payer: Health Net of AZ Medicare	$9.80
Rate for Payer: Humana of AZ Medicare	$5.60
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

SLING ARM LARGE

Facility

$30.00

Service Code	CPT A4565
Hospital Charge Code	22354278
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.21
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

SLING ARM LARGE

Facility

$30.00

Service Code	CPT A4565
Hospital Charge Code	22354278
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

SLING ARM LG

Facility

$25.00

Hospital Charge Code	22354133
Hospital Revenue Code	270
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Cash Price	$20.00
Rate for Payer: Self Pay Self Pay	$20.00

SLING ARM LG

Facility

$25.00

Hospital Charge Code	22354133
Hospital Revenue Code	270
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Aetna of AZ Medicare	$7.00
Rate for Payer: Allwell Medicare	$4.00
Rate for Payer: Amerigroup Medicare	$4.00
Rate for Payer: APIPA Medicare/Medicaid	$9.34
Rate for Payer: AZCH Complete Medicare	$4.00
Rate for Payer: Banner UC Health Medicare	$4.00
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cigna of AZ Commercial	$17.50
Rate for Payer: Copperpoint Commercial	$6.19
Rate for Payer: Health Net of AZ Commercial	$15.00
Rate for Payer: Health Net of AZ Medicare	$7.00
Rate for Payer: Humana of AZ Medicare	$4.00
Rate for Payer: Self Pay Self Pay	$20.00
Rate for Payer: TriWest Medicare	$4.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.50

SLING ARM LG ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354164
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

SLING ARM LG ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354164
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

SLING ARM MD ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354163
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

SLING ARM MD ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354163
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

SLING ARM MEDIUM

Facility

$23.00

Service Code	CPT A4565
Hospital Charge Code	22354277
Hospital Revenue Code	270
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Cash Price	$18.40
Rate for Payer: Self Pay Self Pay	$18.40

SLING ARM MEDIUM

Facility

$23.00

Service Code	CPT A4565
Hospital Charge Code	22354277
Hospital Revenue Code	270
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Aetna of AZ Medicare	$6.44
Rate for Payer: Allwell Medicare	$3.68
Rate for Payer: Amerigroup Medicare	$3.68
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.64
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Copperpoint Commercial	$5.69
Rate for Payer: Health Net of AZ Commercial	$13.80
Rate for Payer: Health Net of AZ Medicare	$6.44
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.14

SLING ARM SM ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354162
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

SLING ARM SM ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354162
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

SLING ARM XL ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354165
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

SLING ARM XL ZIMMER

Facility

$42.00

Service Code	CPT A4565
Hospital Charge Code	22354165
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

SLING ARM XS-CHILD ZIMMER

Facility

$80.00

Service Code	CPT A4565
Hospital Charge Code	22354166
Hospital Revenue Code	270
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: Allwell Medicare	$12.80
Rate for Payer: Amerigroup Medicare	$12.80
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicare	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$56.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

SLING ARM XS-CHILD ZIMMER

Facility

$80.00

Service Code	CPT A4565
Hospital Charge Code	22354166
Hospital Revenue Code	270
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Self Pay Self Pay	$64.00

SLING BLADDER SPARC

Facility

$3,470.00

Service Code	CPT C1771
Hospital Charge Code	22354146
Hospital Revenue Code	270
Min. Negotiated Rate	$555.20
Max. Negotiated Rate	$3,123.00
Rate for Payer: Aetna of AZ Commercial	$3,123.00
Rate for Payer: Aetna of AZ Medicare	$971.60
Rate for Payer: Allwell Medicare	$555.20
Rate for Payer: Amerigroup Medicare	$555.20
Rate for Payer: APIPA Medicare/Medicaid	$1,296.05
Rate for Payer: AZCH Complete Medicare	$555.20
Rate for Payer: Banner UC Health Medicare	$555.20
Rate for Payer: Bisbee Police All Plans	$902.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,359.60
Rate for Payer: Cash Price	$2,776.00
Rate for Payer: Cigna of AZ Commercial	$2,429.00
Rate for Payer: Copperpoint Commercial	$858.83
Rate for Payer: Health Net of AZ Commercial	$2,082.00
Rate for Payer: Health Net of AZ Medicare	$971.60
Rate for Payer: Humana of AZ Medicare	$555.20
Rate for Payer: Self Pay Self Pay	$2,776.00
Rate for Payer: TriWest Medicare	$555.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,023.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$624.60

SLING BLADDER SPARC

Facility

$3,470.00

Service Code	CPT C1771
Hospital Charge Code	22354146
Hospital Revenue Code	270
Min. Negotiated Rate	$902.20
Max. Negotiated Rate	$3,123.00
Rate for Payer: Aetna of AZ Commercial	$3,123.00
Rate for Payer: Bisbee Police All Plans	$902.20
Rate for Payer: Cash Price	$2,776.00
Rate for Payer: Self Pay Self Pay	$2,776.00

SLING MINIARC PRECISE SINGLE INCISION

Facility

$4,415.00

Service Code	CPT C1771
Hospital Charge Code	22354153
Hospital Revenue Code	270
Min. Negotiated Rate	$1,147.90
Max. Negotiated Rate	$3,973.50
Rate for Payer: Aetna of AZ Commercial	$3,973.50
Rate for Payer: Bisbee Police All Plans	$1,147.90
Rate for Payer: Cash Price	$3,532.00
Rate for Payer: Self Pay Self Pay	$3,532.00

SLING MINIARC PRECISE SINGLE INCISION

Facility

$4,415.00

Service Code	CPT C1771
Hospital Charge Code	22354153
Hospital Revenue Code	270
Min. Negotiated Rate	$706.40
Max. Negotiated Rate	$3,973.50
Rate for Payer: Aetna of AZ Commercial	$3,973.50
Rate for Payer: Aetna of AZ Medicare	$1,236.20
Rate for Payer: Allwell Medicare	$706.40
Rate for Payer: Amerigroup Medicare	$706.40
Rate for Payer: APIPA Medicare/Medicaid	$1,649.00
Rate for Payer: AZCH Complete Medicare	$706.40
Rate for Payer: Banner UC Health Medicare	$706.40
Rate for Payer: Bisbee Police All Plans	$1,147.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,002.20
Rate for Payer: Cash Price	$3,532.00
Rate for Payer: Cigna of AZ Commercial	$3,090.50
Rate for Payer: Copperpoint Commercial	$1,092.71
Rate for Payer: Health Net of AZ Commercial	$2,649.00
Rate for Payer: Health Net of AZ Medicare	$1,236.20
Rate for Payer: Humana of AZ Medicare	$706.40
Rate for Payer: Self Pay Self Pay	$3,532.00
Rate for Payer: TriWest Medicare	$706.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,573.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$794.70

SLING MINIARC SINGLE INCISION

Facility

$3,999.00

Service Code	CPT C1771
Hospital Charge Code	22354151
Hospital Revenue Code	270
Min. Negotiated Rate	$1,039.74
Max. Negotiated Rate	$3,599.10
Rate for Payer: Aetna of AZ Commercial	$3,599.10
Rate for Payer: Bisbee Police All Plans	$1,039.74
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Self Pay Self Pay	$3,199.20

Know your out-of-pocket cost for care.

All Charges