Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

STOCKING THIGH X-LARGE REG

Facility

$55.00

Hospital Charge Code	22354235
Hospital Revenue Code	270
Min. Negotiated Rate	$8.80
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	$8.80
Rate for Payer: Amerigroup Medicare	$8.80
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
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	$8.80
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.80
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	$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

STOII 19

Facility

$11,965.00

Hospital Charge Code	27519890
Hospital Revenue Code	270
Min. Negotiated Rate	$1,914.40
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	$1,914.40
Rate for Payer: Amerigroup Medicare	$1,914.40
Rate for Payer: APIPA Medicare/Medicaid	$4,468.93
Rate for Payer: AZCH Complete Medicare	$1,914.40
Rate for Payer: Banner UC Health Medicare	$1,914.40
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	$1,914.40
Rate for Payer: Self Pay Self Pay	$9,572.00
Rate for Payer: TriWest Medicare	$1,914.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$6,975.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,153.70

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

STONE EXTR NITINOL

Facility

$544.00

Hospital Charge Code	22354218
Hospital Revenue Code	270
Min. Negotiated Rate	$87.04
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	$87.04
Rate for Payer: Amerigroup Medicare	$87.04
Rate for Payer: APIPA Medicare/Medicaid	$203.18
Rate for Payer: AZCH Complete Medicare	$87.04
Rate for Payer: Banner UC Health Medicare	$87.04
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	$87.04
Rate for Payer: Self Pay Self Pay	$435.20
Rate for Payer: TriWest Medicare	$87.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$317.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.92

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 D- BLADE

Facility

$90.00

Hospital Charge Code	22834566
Hospital Revenue Code	272
Min. Negotiated Rate	$14.40
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	$14.40
Rate for Payer: Amerigroup Medicare	$14.40
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
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	$22.27
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	$14.40
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

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	$14.40
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	$14.40
Rate for Payer: Amerigroup Medicare	$14.40
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
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	$22.27
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	$14.40
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$14.40
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	$14.40
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	$14.40
Rate for Payer: Amerigroup Medicare	$14.40
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
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	$22.27
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	$14.40
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$14.40
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	$124.16
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	$124.16
Rate for Payer: Amerigroup Medicare	$124.16
Rate for Payer: APIPA Medicare/Medicaid	$289.84
Rate for Payer: AZCH Complete Medicare	$124.16
Rate for Payer: Banner UC Health Medicare	$124.16
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	$124.16
Rate for Payer: Self Pay Self Pay	$620.80
Rate for Payer: TriWest Medicare	$124.16
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

STORZ MILLER 1

Facility

$104.00

Hospital Charge Code	22834572
Hospital Revenue Code	272
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$16.64
Rate for Payer: Amerigroup Medicare	$16.64
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

STORZ MILLER 1

Facility

$104.00

Hospital Charge Code	22834572
Hospital Revenue Code	272
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

STRAP CLAVICLE ADULT

Facility

$66.00

Hospital Charge Code	22354243
Hospital Revenue Code	270
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Cash Price	$52.80
Rate for Payer: Self Pay Self Pay	$52.80

STRAP CLAVICLE ADULT

Facility

$66.00

Hospital Charge Code	22354243
Hospital Revenue Code	270
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Aetna of AZ Medicare	$18.48
Rate for Payer: Allwell Medicare	$10.56
Rate for Payer: Amerigroup Medicare	$10.56
Rate for Payer: APIPA Medicare/Medicaid	$24.65
Rate for Payer: AZCH Complete Medicare	$10.56
Rate for Payer: Banner UC Health Medicare	$10.56
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$46.20
Rate for Payer: Copperpoint Commercial	$16.34
Rate for Payer: Health Net of AZ Commercial	$39.60
Rate for Payer: Health Net of AZ Medicare	$18.48
Rate for Payer: Humana of AZ Medicare	$10.56
Rate for Payer: Self Pay Self Pay	$52.80
Rate for Payer: TriWest Medicare	$10.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$38.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.88

STRAP CLAVICLE CHILD

Facility

$104.00

Hospital Charge Code	22354245
Hospital Revenue Code	270
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

STRAP CLAVICLE CHILD

Facility

$104.00

Hospital Charge Code	22354245
Hospital Revenue Code	270
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$16.64
Rate for Payer: Amerigroup Medicare	$16.64
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

STRAP CLAVICLE YOUTH

Facility

$45.00

Hospital Charge Code	22354260
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Aetna of AZ Medicare	$12.60
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$16.81
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Copperpoint Commercial	$11.14
Rate for Payer: Health Net of AZ Commercial	$27.00
Rate for Payer: Health Net of AZ Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$36.00
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.10

STRAP CLAVICLE YOUTH

Facility

$45.00

Hospital Charge Code	22354260
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Cash Price	$36.00
Rate for Payer: Self Pay Self Pay	$36.00

Strep A Rapid Screen

Facility

$195.00

Service Code	CPT 87880
Hospital Charge Code	5850971
Hospital Revenue Code	306
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Aetna of AZ Medicare	$54.60
Rate for Payer: Allwell Medicare	$31.20
Rate for Payer: Amerigroup Medicare	$31.20
Rate for Payer: APIPA Medicare/Medicaid	$72.83
Rate for Payer: AZCH Complete Medicare	$31.20
Rate for Payer: Banner UC Health Medicare	$31.20
Rate for Payer: Bisbee Police All Plans	$50.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$132.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cigna of AZ Commercial	$126.75
Rate for Payer: Copperpoint Commercial	$48.26
Rate for Payer: Health Net of AZ Commercial	$117.00
Rate for Payer: Health Net of AZ Medicare	$54.60
Rate for Payer: Humana of AZ Medicare	$31.20
Rate for Payer: Self Pay Self Pay	$156.00
Rate for Payer: TriWest Medicare	$31.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$113.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.10

Strep A Rapid Screen

Facility

$195.00

Service Code	CPT 87880
Hospital Charge Code	5850971
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Bisbee Police All Plans	$50.70
Rate for Payer: Cash Price	$156.00
Rate for Payer: Self Pay Self Pay	$156.00

Strep Confirmation

Facility

$173.00

Service Code	CPT 87081
Hospital Charge Code	853207
Hospital Revenue Code	306
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Aetna of AZ Medicare	$48.44
Rate for Payer: Allwell Medicare	$27.68
Rate for Payer: Amerigroup Medicare	$27.68
Rate for Payer: APIPA Medicare/Medicaid	$64.62
Rate for Payer: AZCH Complete Medicare	$27.68
Rate for Payer: Banner UC Health Medicare	$27.68
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$117.64
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$112.45
Rate for Payer: Copperpoint Commercial	$42.82
Rate for Payer: Health Net of AZ Commercial	$103.80
Rate for Payer: Health Net of AZ Medicare	$48.44
Rate for Payer: Humana of AZ Medicare	$27.68
Rate for Payer: Self Pay Self Pay	$138.40
Rate for Payer: TriWest Medicare	$27.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.14

Know your out-of-pocket cost for care.

All Charges