Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Supplies

Facility

$1,029.00

Hospital Charge Code	22528829
Hospital Revenue Code	270
Min. Negotiated Rate	$267.54
Max. Negotiated Rate	$926.10
Rate for Payer: Aetna of AZ Commercial	$926.10
Rate for Payer: Bisbee Police All Plans	$267.54
Rate for Payer: Cash Price	$823.20
Rate for Payer: Self Pay Self Pay	$823.20

Supplies

Facility

$4,891.00

Hospital Charge Code	22528817
Hospital Revenue Code	270
Min. Negotiated Rate	$1,271.66
Max. Negotiated Rate	$4,401.90
Rate for Payer: Aetna of AZ Commercial	$4,401.90
Rate for Payer: Bisbee Police All Plans	$1,271.66
Rate for Payer: Cash Price	$3,912.80
Rate for Payer: Self Pay Self Pay	$3,912.80

Supplies

Facility

$2,141.00

Hospital Charge Code	22528803
Hospital Revenue Code	270
Min. Negotiated Rate	$556.66
Max. Negotiated Rate	$1,926.90
Rate for Payer: Aetna of AZ Commercial	$1,926.90
Rate for Payer: Bisbee Police All Plans	$556.66
Rate for Payer: Cash Price	$1,712.80
Rate for Payer: Self Pay Self Pay	$1,712.80

Supplies

Facility

$1,904.00

Hospital Charge Code	22528813
Hospital Revenue Code	270
Min. Negotiated Rate	$304.64
Max. Negotiated Rate	$1,713.60
Rate for Payer: Aetna of AZ Commercial	$1,713.60
Rate for Payer: Aetna of AZ Medicare	$533.12
Rate for Payer: Allwell Medicare	$304.64
Rate for Payer: Amerigroup Medicare	$304.64
Rate for Payer: APIPA Medicare/Medicaid	$711.14
Rate for Payer: AZCH Complete Medicare	$304.64
Rate for Payer: Banner UC Health Medicare	$304.64
Rate for Payer: Bisbee Police All Plans	$495.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,294.72
Rate for Payer: Cash Price	$1,523.20
Rate for Payer: Cigna of AZ Commercial	$1,332.80
Rate for Payer: Copperpoint Commercial	$471.24
Rate for Payer: Health Net of AZ Commercial	$1,142.40
Rate for Payer: Health Net of AZ Medicare	$533.12
Rate for Payer: Humana of AZ Medicare	$304.64
Rate for Payer: Self Pay Self Pay	$1,523.20
Rate for Payer: TriWest Medicare	$304.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,110.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$342.72

Supplies

Facility

$810.00

Hospital Charge Code	22528825
Hospital Revenue Code	270
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$729.00
Rate for Payer: Aetna of AZ Commercial	$729.00
Rate for Payer: Aetna of AZ Medicare	$226.80
Rate for Payer: Allwell Medicare	$129.60
Rate for Payer: Amerigroup Medicare	$129.60
Rate for Payer: APIPA Medicare/Medicaid	$302.54
Rate for Payer: AZCH Complete Medicare	$129.60
Rate for Payer: Banner UC Health Medicare	$129.60
Rate for Payer: Bisbee Police All Plans	$210.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$550.80
Rate for Payer: Cash Price	$648.00
Rate for Payer: Cigna of AZ Commercial	$567.00
Rate for Payer: Copperpoint Commercial	$200.47
Rate for Payer: Health Net of AZ Commercial	$486.00
Rate for Payer: Health Net of AZ Medicare	$226.80
Rate for Payer: Humana of AZ Medicare	$129.60
Rate for Payer: Self Pay Self Pay	$648.00
Rate for Payer: TriWest Medicare	$129.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$472.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$145.80

Supplies

Facility

$805.00

Hospital Charge Code	22528823
Hospital Revenue Code	270
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$724.50
Rate for Payer: Aetna of AZ Commercial	$724.50
Rate for Payer: Aetna of AZ Medicare	$225.40
Rate for Payer: Allwell Medicare	$128.80
Rate for Payer: Amerigroup Medicare	$128.80
Rate for Payer: APIPA Medicare/Medicaid	$300.67
Rate for Payer: AZCH Complete Medicare	$128.80
Rate for Payer: Banner UC Health Medicare	$128.80
Rate for Payer: Bisbee Police All Plans	$209.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$547.40
Rate for Payer: Cash Price	$644.00
Rate for Payer: Cigna of AZ Commercial	$563.50
Rate for Payer: Copperpoint Commercial	$199.24
Rate for Payer: Health Net of AZ Commercial	$483.00
Rate for Payer: Health Net of AZ Medicare	$225.40
Rate for Payer: Humana of AZ Medicare	$128.80
Rate for Payer: Self Pay Self Pay	$644.00
Rate for Payer: TriWest Medicare	$128.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$469.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.90

Supplies

Facility

$2,099.00

Hospital Charge Code	22528809
Hospital Revenue Code	270
Min. Negotiated Rate	$335.84
Max. Negotiated Rate	$1,889.10
Rate for Payer: Aetna of AZ Commercial	$1,889.10
Rate for Payer: Aetna of AZ Medicare	$587.72
Rate for Payer: Allwell Medicare	$335.84
Rate for Payer: Amerigroup Medicare	$335.84
Rate for Payer: APIPA Medicare/Medicaid	$783.98
Rate for Payer: AZCH Complete Medicare	$335.84
Rate for Payer: Banner UC Health Medicare	$335.84
Rate for Payer: Bisbee Police All Plans	$545.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,427.32
Rate for Payer: Cash Price	$1,679.20
Rate for Payer: Cigna of AZ Commercial	$1,469.30
Rate for Payer: Copperpoint Commercial	$519.50
Rate for Payer: Health Net of AZ Commercial	$1,259.40
Rate for Payer: Health Net of AZ Medicare	$587.72
Rate for Payer: Humana of AZ Medicare	$335.84
Rate for Payer: Self Pay Self Pay	$1,679.20
Rate for Payer: TriWest Medicare	$335.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,223.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$377.82

Supplies

Facility

$810.00

Hospital Charge Code	22528821
Hospital Revenue Code	270
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$729.00
Rate for Payer: Aetna of AZ Commercial	$729.00
Rate for Payer: Aetna of AZ Medicare	$226.80
Rate for Payer: Allwell Medicare	$129.60
Rate for Payer: Amerigroup Medicare	$129.60
Rate for Payer: APIPA Medicare/Medicaid	$302.54
Rate for Payer: AZCH Complete Medicare	$129.60
Rate for Payer: Banner UC Health Medicare	$129.60
Rate for Payer: Bisbee Police All Plans	$210.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$550.80
Rate for Payer: Cash Price	$648.00
Rate for Payer: Cigna of AZ Commercial	$567.00
Rate for Payer: Copperpoint Commercial	$200.47
Rate for Payer: Health Net of AZ Commercial	$486.00
Rate for Payer: Health Net of AZ Medicare	$226.80
Rate for Payer: Humana of AZ Medicare	$129.60
Rate for Payer: Self Pay Self Pay	$648.00
Rate for Payer: TriWest Medicare	$129.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$472.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$145.80

Supplies

Facility

$2,141.00

Hospital Charge Code	22528803
Hospital Revenue Code	270
Min. Negotiated Rate	$342.56
Max. Negotiated Rate	$1,926.90
Rate for Payer: Aetna of AZ Commercial	$1,926.90
Rate for Payer: Aetna of AZ Medicare	$599.48
Rate for Payer: Allwell Medicare	$342.56
Rate for Payer: Amerigroup Medicare	$342.56
Rate for Payer: APIPA Medicare/Medicaid	$799.66
Rate for Payer: AZCH Complete Medicare	$342.56
Rate for Payer: Banner UC Health Medicare	$342.56
Rate for Payer: Bisbee Police All Plans	$556.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,455.88
Rate for Payer: Cash Price	$1,712.80
Rate for Payer: Cigna of AZ Commercial	$1,498.70
Rate for Payer: Copperpoint Commercial	$529.90
Rate for Payer: Health Net of AZ Commercial	$1,284.60
Rate for Payer: Health Net of AZ Medicare	$599.48
Rate for Payer: Humana of AZ Medicare	$342.56
Rate for Payer: Self Pay Self Pay	$1,712.80
Rate for Payer: TriWest Medicare	$342.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,248.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$385.38

Supplies

Facility

$4,891.00

Hospital Charge Code	22528817
Hospital Revenue Code	270
Min. Negotiated Rate	$782.56
Max. Negotiated Rate	$4,401.90
Rate for Payer: Aetna of AZ Commercial	$4,401.90
Rate for Payer: Aetna of AZ Medicare	$1,369.48
Rate for Payer: Allwell Medicare	$782.56
Rate for Payer: Amerigroup Medicare	$782.56
Rate for Payer: APIPA Medicare/Medicaid	$1,826.79
Rate for Payer: AZCH Complete Medicare	$782.56
Rate for Payer: Banner UC Health Medicare	$782.56
Rate for Payer: Bisbee Police All Plans	$1,271.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,325.88
Rate for Payer: Cash Price	$3,912.80
Rate for Payer: Cigna of AZ Commercial	$3,423.70
Rate for Payer: Copperpoint Commercial	$1,210.52
Rate for Payer: Health Net of AZ Commercial	$2,934.60
Rate for Payer: Health Net of AZ Medicare	$1,369.48
Rate for Payer: Humana of AZ Medicare	$782.56
Rate for Payer: Self Pay Self Pay	$3,912.80
Rate for Payer: TriWest Medicare	$782.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,851.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$880.38

Supplies

Facility

$805.00

Hospital Charge Code	22528827
Hospital Revenue Code	270
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$724.50
Rate for Payer: Aetna of AZ Commercial	$724.50
Rate for Payer: Bisbee Police All Plans	$209.30
Rate for Payer: Cash Price	$644.00
Rate for Payer: Self Pay Self Pay	$644.00

Supplies SLING DESARA

Facility

$3,297.00

Hospital Charge Code	22528819
Hospital Revenue Code	270
Min. Negotiated Rate	$857.22
Max. Negotiated Rate	$2,967.30
Rate for Payer: Aetna of AZ Commercial	$2,967.30
Rate for Payer: Bisbee Police All Plans	$857.22
Rate for Payer: Cash Price	$2,637.60
Rate for Payer: Self Pay Self Pay	$2,637.60

Supplies SLING DESARA

Facility

$3,297.00

Hospital Charge Code	22528819
Hospital Revenue Code	270
Min. Negotiated Rate	$527.52
Max. Negotiated Rate	$2,967.30
Rate for Payer: Aetna of AZ Commercial	$2,967.30
Rate for Payer: Aetna of AZ Medicare	$923.16
Rate for Payer: Allwell Medicare	$527.52
Rate for Payer: Amerigroup Medicare	$527.52
Rate for Payer: APIPA Medicare/Medicaid	$1,231.43
Rate for Payer: AZCH Complete Medicare	$527.52
Rate for Payer: Banner UC Health Medicare	$527.52
Rate for Payer: Bisbee Police All Plans	$857.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,241.96
Rate for Payer: Cash Price	$2,637.60
Rate for Payer: Cigna of AZ Commercial	$2,307.90
Rate for Payer: Copperpoint Commercial	$816.01
Rate for Payer: Health Net of AZ Commercial	$1,978.20
Rate for Payer: Health Net of AZ Medicare	$923.16
Rate for Payer: Humana of AZ Medicare	$527.52
Rate for Payer: Self Pay Self Pay	$2,637.60
Rate for Payer: TriWest Medicare	$527.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,922.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$593.46

SUPPORTER ADULT LG

Facility

$88.00

Hospital Charge Code	22354192
Hospital Revenue Code	270
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Aetna of AZ Medicare	$24.64
Rate for Payer: Allwell Medicare	$14.08
Rate for Payer: Amerigroup Medicare	$14.08
Rate for Payer: APIPA Medicare/Medicaid	$32.87
Rate for Payer: AZCH Complete Medicare	$14.08
Rate for Payer: Banner UC Health Medicare	$14.08
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$61.60
Rate for Payer: Copperpoint Commercial	$21.78
Rate for Payer: Health Net of AZ Commercial	$52.80
Rate for Payer: Health Net of AZ Medicare	$24.64
Rate for Payer: Humana of AZ Medicare	$14.08
Rate for Payer: Self Pay Self Pay	$70.40
Rate for Payer: TriWest Medicare	$14.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.84

SUPPORTER ADULT LG

Facility

$88.00

Hospital Charge Code	22354192
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Cash Price	$70.40
Rate for Payer: Self Pay Self Pay	$70.40

SUPPORTER ADULT MED

Facility

$26.00

Hospital Charge Code	22354191
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.43
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SUPPORTER ADULT MED

Facility

$26.00

Hospital Charge Code	22354191
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

SUPPORTER ADULT SMALL

Facility

$88.00

Hospital Charge Code	22354190
Hospital Revenue Code	270
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Aetna of AZ Medicare	$24.64
Rate for Payer: Allwell Medicare	$14.08
Rate for Payer: Amerigroup Medicare	$14.08
Rate for Payer: APIPA Medicare/Medicaid	$32.87
Rate for Payer: AZCH Complete Medicare	$14.08
Rate for Payer: Banner UC Health Medicare	$14.08
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$61.60
Rate for Payer: Copperpoint Commercial	$21.78
Rate for Payer: Health Net of AZ Commercial	$52.80
Rate for Payer: Health Net of AZ Medicare	$24.64
Rate for Payer: Humana of AZ Medicare	$14.08
Rate for Payer: Self Pay Self Pay	$70.40
Rate for Payer: TriWest Medicare	$14.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.84

SUPPORTER ADULT SMALL

Facility

$88.00

Hospital Charge Code	22354190
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Cash Price	$70.40
Rate for Payer: Self Pay Self Pay	$70.40

SUPPORTER ADULT XL

Facility

$42.00

Hospital Charge Code	22354193
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

SUPPORTER ADULT XL

Facility

$42.00

Hospital Charge Code	22354193
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

SURECLIP 11MM REPOSITIONABLE

Facility

$718.00

Hospital Charge Code	23152396
Hospital Revenue Code	272
Min. Negotiated Rate	$186.68
Max. Negotiated Rate	$646.20
Rate for Payer: Aetna of AZ Commercial	$646.20
Rate for Payer: Bisbee Police All Plans	$186.68
Rate for Payer: Cash Price	$574.40
Rate for Payer: Self Pay Self Pay	$574.40

SURECLIP 11MM REPOSITIONABLE

Facility

$718.00

Hospital Charge Code	23152396
Hospital Revenue Code	272
Min. Negotiated Rate	$114.88
Max. Negotiated Rate	$646.20
Rate for Payer: Aetna of AZ Commercial	$646.20
Rate for Payer: Aetna of AZ Medicare	$201.04
Rate for Payer: Allwell Medicare	$114.88
Rate for Payer: Amerigroup Medicare	$114.88
Rate for Payer: APIPA Medicare/Medicaid	$268.17
Rate for Payer: AZCH Complete Medicare	$114.88
Rate for Payer: Banner UC Health Medicare	$114.88
Rate for Payer: Bisbee Police All Plans	$186.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$488.24
Rate for Payer: Cash Price	$574.40
Rate for Payer: Cigna of AZ Commercial	$502.60
Rate for Payer: Copperpoint Commercial	$177.71
Rate for Payer: Health Net of AZ Commercial	$430.80
Rate for Payer: Health Net of AZ Medicare	$201.04
Rate for Payer: Humana of AZ Medicare	$114.88
Rate for Payer: Self Pay Self Pay	$574.40
Rate for Payer: TriWest Medicare	$114.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$418.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.24

SUREFIX TI SCREW CAP 18MM

Facility

$2,085.25

Hospital Charge Code	27595624
Hospital Revenue Code	270
Min. Negotiated Rate	$333.64
Max. Negotiated Rate	$1,876.72
Rate for Payer: Aetna of AZ Commercial	$1,876.72
Rate for Payer: Aetna of AZ Medicare	$583.87
Rate for Payer: Allwell Medicare	$333.64
Rate for Payer: Amerigroup Medicare	$333.64
Rate for Payer: APIPA Medicare/Medicaid	$778.84
Rate for Payer: AZCH Complete Medicare	$333.64
Rate for Payer: Banner UC Health Medicare	$333.64
Rate for Payer: Bisbee Police All Plans	$542.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,417.97
Rate for Payer: Cash Price	$1,668.20
Rate for Payer: Cigna of AZ Commercial	$1,459.67
Rate for Payer: Copperpoint Commercial	$516.10
Rate for Payer: Health Net of AZ Commercial	$1,251.15
Rate for Payer: Health Net of AZ Medicare	$583.87
Rate for Payer: Humana of AZ Medicare	$333.64
Rate for Payer: Self Pay Self Pay	$1,668.20
Rate for Payer: TriWest Medicare	$333.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,215.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$375.35

SUREFIX TI SCREW CAP 18MM

Facility

$2,085.25

Hospital Charge Code	27595624
Hospital Revenue Code	270
Min. Negotiated Rate	$542.16
Max. Negotiated Rate	$1,876.72
Rate for Payer: Aetna of AZ Commercial	$1,876.72
Rate for Payer: Bisbee Police All Plans	$542.16
Rate for Payer: Cash Price	$1,668.20
Rate for Payer: Self Pay Self Pay	$1,668.20

Know your out-of-pocket cost for care.

All Charges