Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Adrenal Procedures

Facility

$22,228.77

Service Code	APR-DRG 4013
Hospital Charge Code	APRDRG4013
Min. Negotiated Rate	$22,228.77
Max. Negotiated Rate	$22,228.77
Rate for Payer: AHCCCS Medicaid	$22,228.77
Rate for Payer: Allwell Medicaid	$22,228.77
Rate for Payer: AZCH Complete Medicaid	$22,228.77
Rate for Payer: Banner UC Health Medicaid	$22,228.77
Rate for Payer: Mercy Care Medicaid	$22,228.77

Adrenal Procedures

Facility

$8,435.74

Service Code	APR-DRG 4011
Hospital Charge Code	APRDRG4013
Min. Negotiated Rate	$8,435.74
Max. Negotiated Rate	$8,435.74
Rate for Payer: AHCCCS Medicaid	$8,435.74
Rate for Payer: Allwell Medicaid	$8,435.74
Rate for Payer: AZCH Complete Medicaid	$8,435.74
Rate for Payer: Banner UC Health Medicaid	$8,435.74
Rate for Payer: Mercy Care Medicaid	$8,435.74

Adrenal Procedures

Facility

$22,228.77

Service Code	APR-DRG 4013
Hospital Charge Code	APRDRG4011
Min. Negotiated Rate	$22,228.77
Max. Negotiated Rate	$22,228.77
Rate for Payer: AHCCCS Medicaid	$22,228.77
Rate for Payer: Allwell Medicaid	$22,228.77
Rate for Payer: AZCH Complete Medicaid	$22,228.77
Rate for Payer: Banner UC Health Medicaid	$22,228.77
Rate for Payer: Mercy Care Medicaid	$22,228.77

Adrenal Procedures

Facility

$16,455.55

Service Code	APR-DRG 4012
Hospital Charge Code	APRDRG4014
Min. Negotiated Rate	$16,455.55
Max. Negotiated Rate	$16,455.55
Rate for Payer: AHCCCS Medicaid	$16,455.55
Rate for Payer: Allwell Medicaid	$16,455.55
Rate for Payer: AZCH Complete Medicaid	$16,455.55
Rate for Payer: Banner UC Health Medicaid	$16,455.55
Rate for Payer: Mercy Care Medicaid	$16,455.55

ADULT AMBU BAG

Facility

$135.00

Hospital Charge Code	22354982
Hospital Revenue Code	270
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Aetna of AZ Medicare	$37.80
Rate for Payer: Allwell Medicare	$21.60
Rate for Payer: Amerigroup Medicare	$21.60
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicare	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$94.50
Rate for Payer: Copperpoint Commercial	$33.41
Rate for Payer: Health Net of AZ Commercial	$81.00
Rate for Payer: Health Net of AZ Medicare	$37.80
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.30

ADULT AMBU BAG

Facility

$135.00

Hospital Charge Code	22354982
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Cash Price	$108.00
Rate for Payer: Self Pay Self Pay	$108.00

AEROSTAT CHOLANGIOGRAPHY CATH 6FR

Facility

$238.00

Hospital Charge Code	27465745
Hospital Revenue Code	270
Min. Negotiated Rate	$38.08
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Aetna of AZ Medicare	$66.64
Rate for Payer: Allwell Medicare	$38.08
Rate for Payer: Amerigroup Medicare	$38.08
Rate for Payer: APIPA Medicare/Medicaid	$88.89
Rate for Payer: AZCH Complete Medicare	$38.08
Rate for Payer: Banner UC Health Medicare	$38.08
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.84
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$166.60
Rate for Payer: Copperpoint Commercial	$58.91
Rate for Payer: Health Net of AZ Commercial	$142.80
Rate for Payer: Health Net of AZ Medicare	$66.64
Rate for Payer: Humana of AZ Medicare	$38.08
Rate for Payer: Self Pay Self Pay	$190.40
Rate for Payer: TriWest Medicare	$38.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.84

AEROSTAT CHOLANGIOGRAPHY CATH 6FR

Facility

$238.00

Hospital Charge Code	27465745
Hospital Revenue Code	270
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Cash Price	$190.40
Rate for Payer: Self Pay Self Pay	$190.40

AFC GENERIC ADD-ON

Facility

$361.00

Service Code	CPT 82677
Hospital Charge Code	22543272
Hospital Revenue Code	301
Min. Negotiated Rate	$57.76
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna of AZ Commercial	$324.90
Rate for Payer: Aetna of AZ Medicare	$101.08
Rate for Payer: Allwell Medicare	$57.76
Rate for Payer: Amerigroup Medicare	$57.76
Rate for Payer: APIPA Medicare/Medicaid	$134.83
Rate for Payer: AZCH Complete Medicare	$57.76
Rate for Payer: Banner UC Health Medicare	$57.76
Rate for Payer: Bisbee Police All Plans	$93.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$245.48
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cigna of AZ Commercial	$234.65
Rate for Payer: Copperpoint Commercial	$89.35
Rate for Payer: Health Net of AZ Commercial	$216.60
Rate for Payer: Health Net of AZ Medicare	$101.08
Rate for Payer: Humana of AZ Medicare	$57.76
Rate for Payer: Self Pay Self Pay	$288.80
Rate for Payer: TriWest Medicare	$57.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$210.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.98

AFC GENERIC ADD-ON

Facility

$246.00

Service Code	CPT 86336
Hospital Charge Code	22543274
Hospital Revenue Code	302
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Aetna of AZ Medicare	$68.88
Rate for Payer: Allwell Medicare	$39.36
Rate for Payer: Amerigroup Medicare	$39.36
Rate for Payer: APIPA Medicare/Medicaid	$91.88
Rate for Payer: AZCH Complete Medicare	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$167.28
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$159.90
Rate for Payer: Copperpoint Commercial	$60.88
Rate for Payer: Health Net of AZ Commercial	$147.60
Rate for Payer: Health Net of AZ Medicare	$68.88
Rate for Payer: Humana of AZ Medicare	$39.36
Rate for Payer: Self Pay Self Pay	$196.80
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$143.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.28

AFC GENERIC ADD-ON

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	22543270
Hospital Revenue Code	302
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Cash Price	$68.00
Rate for Payer: Self Pay Self Pay	$68.00

AFC GENERIC ADD-ON

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22543271
Hospital Revenue Code	302
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Cash Price	$79.20
Rate for Payer: Self Pay Self Pay	$79.20

AFC GENERIC ADD-ON

Facility

$246.00

Service Code	CPT 86336
Hospital Charge Code	22543274
Hospital Revenue Code	302
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Cash Price	$196.80
Rate for Payer: Self Pay Self Pay	$196.80

AFC GENERIC ADD-ON

Facility

$215.00

Service Code	CPT 84702
Hospital Charge Code	22543273
Hospital Revenue Code	301
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Bisbee Police All Plans	$55.90
Rate for Payer: Cash Price	$172.00
Rate for Payer: Self Pay Self Pay	$172.00

AFC GENERIC ADD-ON

Facility

$361.00

Service Code	CPT 82677
Hospital Charge Code	22543272
Hospital Revenue Code	301
Min. Negotiated Rate	$93.86
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna of AZ Commercial	$324.90
Rate for Payer: Bisbee Police All Plans	$93.86
Rate for Payer: Cash Price	$288.80
Rate for Payer: Self Pay Self Pay	$288.80

AFC GENERIC ADD-ON

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22543271
Hospital Revenue Code	302
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Aetna of AZ Medicare	$27.72
Rate for Payer: Allwell Medicare	$15.84
Rate for Payer: Amerigroup Medicare	$15.84
Rate for Payer: APIPA Medicare/Medicaid	$36.98
Rate for Payer: AZCH Complete Medicare	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$67.32
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Copperpoint Commercial	$24.50
Rate for Payer: Health Net of AZ Commercial	$59.40
Rate for Payer: Health Net of AZ Medicare	$27.72
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Self Pay Self Pay	$79.20
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.82

AFC GENERIC ADD-ON

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	22543270
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Aetna of AZ Medicare	$23.80
Rate for Payer: Allwell Medicare	$13.60
Rate for Payer: Amerigroup Medicare	$13.60
Rate for Payer: APIPA Medicare/Medicaid	$31.75
Rate for Payer: AZCH Complete Medicare	$13.60
Rate for Payer: Banner UC Health Medicare	$13.60
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.80
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cigna of AZ Commercial	$55.25
Rate for Payer: Copperpoint Commercial	$21.04
Rate for Payer: Health Net of AZ Commercial	$51.00
Rate for Payer: Health Net of AZ Medicare	$23.80
Rate for Payer: Humana of AZ Medicare	$13.60
Rate for Payer: Self Pay Self Pay	$68.00
Rate for Payer: TriWest Medicare	$13.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$49.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.30

AFC GENERIC ADD-ON

Facility

$286.00

Service Code	CPT 86256
Hospital Charge Code	22543634
Hospital Revenue Code	302
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Aetna of AZ Medicare	$80.08
Rate for Payer: Allwell Medicare	$45.76
Rate for Payer: Amerigroup Medicare	$45.76
Rate for Payer: APIPA Medicare/Medicaid	$106.82
Rate for Payer: AZCH Complete Medicare	$45.76
Rate for Payer: Banner UC Health Medicare	$45.76
Rate for Payer: Bisbee Police All Plans	$74.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$194.48
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cigna of AZ Commercial	$185.90
Rate for Payer: Copperpoint Commercial	$70.78
Rate for Payer: Health Net of AZ Commercial	$171.60
Rate for Payer: Health Net of AZ Medicare	$80.08
Rate for Payer: Humana of AZ Medicare	$45.76
Rate for Payer: Self Pay Self Pay	$228.80
Rate for Payer: TriWest Medicare	$45.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$166.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.48

AFC GENERIC ADD-ON

Facility

$215.00

Service Code	CPT 84702
Hospital Charge Code	22543273
Hospital Revenue Code	301
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Aetna of AZ Medicare	$60.20
Rate for Payer: Allwell Medicare	$34.40
Rate for Payer: Amerigroup Medicare	$34.40
Rate for Payer: APIPA Medicare/Medicaid	$80.30
Rate for Payer: AZCH Complete Medicare	$34.40
Rate for Payer: Banner UC Health Medicare	$34.40
Rate for Payer: Bisbee Police All Plans	$55.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$146.20
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cigna of AZ Commercial	$139.75
Rate for Payer: Copperpoint Commercial	$53.21
Rate for Payer: Health Net of AZ Commercial	$129.00
Rate for Payer: Health Net of AZ Medicare	$60.20
Rate for Payer: Humana of AZ Medicare	$34.40
Rate for Payer: Self Pay Self Pay	$172.00
Rate for Payer: TriWest Medicare	$34.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$125.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.70

AFC GENERIC ADD-ON

Facility

$286.00

Service Code	CPT 86256
Hospital Charge Code	22543634
Hospital Revenue Code	302
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Bisbee Police All Plans	$74.36
Rate for Payer: Cash Price	$228.80
Rate for Payer: Self Pay Self Pay	$228.80

Affinity

Facility

$11,218.00

Service Code	CPT Q4159
Hospital Charge Code	24383280
Hospital Revenue Code	636
Min. Negotiated Rate	$2,916.68
Max. Negotiated Rate	$10,096.20
Rate for Payer: Aetna of AZ Commercial	$10,096.20
Rate for Payer: Bisbee Police All Plans	$2,916.68
Rate for Payer: Cash Price	$8,974.40
Rate for Payer: Self Pay Self Pay	$8,974.40

Affinity

Facility

$11,218.00

Service Code	CPT Q4159
Hospital Charge Code	24383280
Hospital Revenue Code	636
Min. Negotiated Rate	$1,794.88
Max. Negotiated Rate	$10,096.20
Rate for Payer: Aetna of AZ Commercial	$10,096.20
Rate for Payer: Aetna of AZ Medicare	$3,141.04
Rate for Payer: Allwell Medicare	$1,794.88
Rate for Payer: Amerigroup Medicare	$1,794.88
Rate for Payer: APIPA Medicare/Medicaid	$4,189.92
Rate for Payer: AZCH Complete Medicare	$1,794.88
Rate for Payer: Banner UC Health Medicare	$1,794.88
Rate for Payer: Bisbee Police All Plans	$2,916.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7,628.24
Rate for Payer: Cash Price	$8,974.40
Rate for Payer: Cigna of AZ Commercial	$7,852.60
Rate for Payer: Copperpoint Commercial	$2,776.45
Rate for Payer: Health Net of AZ Commercial	$6,730.80
Rate for Payer: Health Net of AZ Medicare	$3,141.04
Rate for Payer: Humana of AZ Medicare	$1,794.88
Rate for Payer: Self Pay Self Pay	$8,974.40
Rate for Payer: TriWest Medicare	$1,794.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$6,540.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,019.24

AFP, Serum, Tumor Marker LC

Facility

$365.00

Service Code	CPT 82105
Hospital Charge Code	1905891
Hospital Revenue Code	301
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Aetna of AZ Medicare	$102.20
Rate for Payer: Allwell Medicare	$58.40
Rate for Payer: Amerigroup Medicare	$58.40
Rate for Payer: APIPA Medicare/Medicaid	$136.33
Rate for Payer: AZCH Complete Medicare	$58.40
Rate for Payer: Banner UC Health Medicare	$58.40
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$248.20
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cigna of AZ Commercial	$237.25
Rate for Payer: Copperpoint Commercial	$90.34
Rate for Payer: Health Net of AZ Commercial	$219.00
Rate for Payer: Health Net of AZ Medicare	$102.20
Rate for Payer: Humana of AZ Medicare	$58.40
Rate for Payer: Self Pay Self Pay	$292.00
Rate for Payer: TriWest Medicare	$58.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$212.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.70

AFP, Serum, Tumor Marker LC

Facility

$365.00

Service Code	CPT 82105
Hospital Charge Code	1905891
Hospital Revenue Code	301
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Cash Price	$292.00
Rate for Payer: Self Pay Self Pay	$292.00

AFP, Serum, Tumor Marker LC

Facility

$331.00

Service Code	CPT 82105
Hospital Charge Code	1905887
Hospital Revenue Code	301
Min. Negotiated Rate	$52.96
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Medicare	$92.68
Rate for Payer: Allwell Medicare	$52.96
Rate for Payer: Amerigroup Medicare	$52.96
Rate for Payer: APIPA Medicare/Medicaid	$123.63
Rate for Payer: AZCH Complete Medicare	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.08
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Copperpoint Commercial	$81.92
Rate for Payer: Health Net of AZ Commercial	$198.60
Rate for Payer: Health Net of AZ Medicare	$92.68
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Self Pay Self Pay	$264.80
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.58

Know your out-of-pocket cost for care.

All Charges