Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

UNIHEART LO FLOW NEB

Facility

$41.00

Hospital Charge Code	22355556
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

UNIVERSAL NASAL TUBING 70MM

Facility

$72.00

Hospital Charge Code	27664818
Hospital Revenue Code	270
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Cash Price	$57.60
Rate for Payer: Self Pay Self Pay	$57.60

UNIVERSAL NASAL TUBING 70MM

Facility

$72.00

Hospital Charge Code	27664818
Hospital Revenue Code	270
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Aetna of AZ Medicare	$20.16
Rate for Payer: Allwell Medicare	$11.52
Rate for Payer: Amerigroup Medicare	$11.52
Rate for Payer: APIPA Medicare/Medicaid	$26.89
Rate for Payer: AZCH Complete Medicare	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Copperpoint Commercial	$17.82
Rate for Payer: Health Net of AZ Commercial	$43.20
Rate for Payer: Health Net of AZ Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Self Pay Self Pay	$57.60
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.96

UNIVERSAL SOFT URETERAL STENT SET 6FRX22CM

Facility

$525.00

Hospital Charge Code	27753960
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FRX22CM

Facility

$525.00

Hospital Charge Code	27753960
Hospital Revenue Code	270
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

UNIVERSAL SOFT URETERAL STENT SET 6FR X 24CM

Facility

$525.00

Hospital Charge Code	27751228
Hospital Revenue Code	270
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

UNIVERSAL SOFT URETERAL STENT SET 6FR X 24CM

Facility

$525.00

Hospital Charge Code	27751228
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FRX26CM

Facility

$525.00

Hospital Charge Code	27753961
Hospital Revenue Code	270
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

UNIVERSAL SOFT URETERAL STENT SET 6FRX26CM

Facility

$525.00

Hospital Charge Code	27753961
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FRX28CM

Facility

$525.00

Hospital Charge Code	27753962
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Cash Price	$420.00
Rate for Payer: Self Pay Self Pay	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FRX28CM

Facility

$525.00

Hospital Charge Code	27753962
Hospital Revenue Code	270
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Aetna of AZ Medicare	$147.00
Rate for Payer: Allwell Medicare	$84.00
Rate for Payer: Amerigroup Medicare	$84.00
Rate for Payer: APIPA Medicare/Medicaid	$196.09
Rate for Payer: AZCH Complete Medicare	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Bisbee Police All Plans	$136.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$357.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Copperpoint Commercial	$129.94
Rate for Payer: Health Net of AZ Commercial	$315.00
Rate for Payer: Health Net of AZ Medicare	$147.00
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Self Pay Self Pay	$420.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$306.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.50

UNIVERSAL TROCAR 5MM

Facility

$524.00

Hospital Charge Code	22546418
Hospital Revenue Code	272
Min. Negotiated Rate	$136.24
Max. Negotiated Rate	$471.60
Rate for Payer: Aetna of AZ Commercial	$471.60
Rate for Payer: Bisbee Police All Plans	$136.24
Rate for Payer: Cash Price	$419.20
Rate for Payer: Self Pay Self Pay	$419.20

UNIVERSAL TROCAR 5MM

Facility

$524.00

Hospital Charge Code	22546418
Hospital Revenue Code	272
Min. Negotiated Rate	$83.84
Max. Negotiated Rate	$471.60
Rate for Payer: Aetna of AZ Commercial	$471.60
Rate for Payer: Aetna of AZ Medicare	$146.72
Rate for Payer: Allwell Medicare	$83.84
Rate for Payer: Amerigroup Medicare	$83.84
Rate for Payer: APIPA Medicare/Medicaid	$195.71
Rate for Payer: AZCH Complete Medicare	$83.84
Rate for Payer: Banner UC Health Medicare	$83.84
Rate for Payer: Bisbee Police All Plans	$136.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$356.32
Rate for Payer: Cash Price	$419.20
Rate for Payer: Cigna of AZ Commercial	$366.80
Rate for Payer: Copperpoint Commercial	$129.69
Rate for Payer: Health Net of AZ Commercial	$314.40
Rate for Payer: Health Net of AZ Medicare	$146.72
Rate for Payer: Humana of AZ Medicare	$83.84
Rate for Payer: Self Pay Self Pay	$419.20
Rate for Payer: TriWest Medicare	$83.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$305.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$94.32

UNNA BOOT 3X10

Facility

$38.00

Hospital Charge Code	22355140
Hospital Revenue Code	270
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Aetna of AZ Medicare	$10.64
Rate for Payer: Allwell Medicare	$6.08
Rate for Payer: Amerigroup Medicare	$6.08
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.84
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Copperpoint Commercial	$9.40
Rate for Payer: Health Net of AZ Commercial	$22.80
Rate for Payer: Health Net of AZ Medicare	$10.64
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

UNNA BOOT 3X10

Facility

$38.00

Hospital Charge Code	22355140
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, CLEARANCE

Facility

$35.95

Service Code	CPT 84545
Hospital Charge Code	28011457
Hospital Revenue Code	302
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$32.35
Rate for Payer: Aetna of AZ Commercial	$32.35
Rate for Payer: Aetna of AZ Medicare	$10.07
Rate for Payer: Allwell Medicare	$5.75
Rate for Payer: Amerigroup Medicare	$5.75
Rate for Payer: APIPA Medicare/Medicaid	$13.43
Rate for Payer: AZCH Complete Medicare	$5.75
Rate for Payer: Banner UC Health Medicare	$5.75
Rate for Payer: Bisbee Police All Plans	$9.35
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$24.45
Rate for Payer: Cash Price	$28.76
Rate for Payer: Cigna of AZ Commercial	$23.37
Rate for Payer: Copperpoint Commercial	$8.90
Rate for Payer: Health Net of AZ Commercial	$21.57
Rate for Payer: Health Net of AZ Medicare	$10.07
Rate for Payer: Humana of AZ Medicare	$5.75
Rate for Payer: Self Pay Self Pay	$28.76
Rate for Payer: TriWest Medicare	$5.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.47

UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, CLEARANCE

Facility

$35.95

Service Code	CPT 84545
Hospital Charge Code	28011457
Hospital Revenue Code	302
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$32.35
Rate for Payer: Aetna of AZ Commercial	$32.35
Rate for Payer: Bisbee Police All Plans	$9.35
Rate for Payer: Cash Price	$28.76
Rate for Payer: Self Pay Self Pay	$28.76

URETERAL OPTIMA STENT 6FR 24CM

Facility

$1,431.00

Hospital Charge Code	27744361
Hospital Revenue Code	270
Min. Negotiated Rate	$228.96
Max. Negotiated Rate	$1,287.90
Rate for Payer: Aetna of AZ Commercial	$1,287.90
Rate for Payer: Aetna of AZ Medicare	$400.68
Rate for Payer: Allwell Medicare	$228.96
Rate for Payer: Amerigroup Medicare	$228.96
Rate for Payer: APIPA Medicare/Medicaid	$534.48
Rate for Payer: AZCH Complete Medicare	$228.96
Rate for Payer: Banner UC Health Medicare	$228.96
Rate for Payer: Bisbee Police All Plans	$372.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$973.08
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Cigna of AZ Commercial	$1,001.70
Rate for Payer: Copperpoint Commercial	$354.17
Rate for Payer: Health Net of AZ Commercial	$858.60
Rate for Payer: Health Net of AZ Medicare	$400.68
Rate for Payer: Humana of AZ Medicare	$228.96
Rate for Payer: Self Pay Self Pay	$1,144.80
Rate for Payer: TriWest Medicare	$228.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$834.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$257.58

URETERAL OPTIMA STENT 6FR 24CM

Facility

$1,431.00

Hospital Charge Code	27744361
Hospital Revenue Code	270
Min. Negotiated Rate	$372.06
Max. Negotiated Rate	$1,287.90
Rate for Payer: Aetna of AZ Commercial	$1,287.90
Rate for Payer: Bisbee Police All Plans	$372.06
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Self Pay Self Pay	$1,144.80

URETERAL OPTIMA STENT 6FR 26CM

Facility

$1,431.00

Hospital Charge Code	27744363
Hospital Revenue Code	270
Min. Negotiated Rate	$228.96
Max. Negotiated Rate	$1,287.90
Rate for Payer: Aetna of AZ Commercial	$1,287.90
Rate for Payer: Aetna of AZ Medicare	$400.68
Rate for Payer: Allwell Medicare	$228.96
Rate for Payer: Amerigroup Medicare	$228.96
Rate for Payer: APIPA Medicare/Medicaid	$534.48
Rate for Payer: AZCH Complete Medicare	$228.96
Rate for Payer: Banner UC Health Medicare	$228.96
Rate for Payer: Bisbee Police All Plans	$372.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$973.08
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Cigna of AZ Commercial	$1,001.70
Rate for Payer: Copperpoint Commercial	$354.17
Rate for Payer: Health Net of AZ Commercial	$858.60
Rate for Payer: Health Net of AZ Medicare	$400.68
Rate for Payer: Humana of AZ Medicare	$228.96
Rate for Payer: Self Pay Self Pay	$1,144.80
Rate for Payer: TriWest Medicare	$228.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$834.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$257.58

URETERAL OPTIMA STENT 6FR 26CM

Facility

$1,431.00

Hospital Charge Code	27744363
Hospital Revenue Code	270
Min. Negotiated Rate	$372.06
Max. Negotiated Rate	$1,287.90
Rate for Payer: Aetna of AZ Commercial	$1,287.90
Rate for Payer: Bisbee Police All Plans	$372.06
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Self Pay Self Pay	$1,144.80

URETERAL OPTIMA STENT 6FR 28CM

Facility

$1,362.95

Hospital Charge Code	27744362
Hospital Revenue Code	270
Min. Negotiated Rate	$354.37
Max. Negotiated Rate	$1,226.65
Rate for Payer: Aetna of AZ Commercial	$1,226.65
Rate for Payer: Bisbee Police All Plans	$354.37
Rate for Payer: Cash Price	$1,090.36
Rate for Payer: Self Pay Self Pay	$1,090.36

URETERAL OPTIMA STENT 6FR 28CM

Facility

$1,362.95

Hospital Charge Code	27744362
Hospital Revenue Code	270
Min. Negotiated Rate	$218.07
Max. Negotiated Rate	$1,226.65
Rate for Payer: Aetna of AZ Commercial	$1,226.65
Rate for Payer: Aetna of AZ Medicare	$381.63
Rate for Payer: Allwell Medicare	$218.07
Rate for Payer: Amerigroup Medicare	$218.07
Rate for Payer: APIPA Medicare/Medicaid	$509.06
Rate for Payer: AZCH Complete Medicare	$218.07
Rate for Payer: Banner UC Health Medicare	$218.07
Rate for Payer: Bisbee Police All Plans	$354.37
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$926.81
Rate for Payer: Cash Price	$1,090.36
Rate for Payer: Cigna of AZ Commercial	$954.07
Rate for Payer: Copperpoint Commercial	$337.33
Rate for Payer: Health Net of AZ Commercial	$817.77
Rate for Payer: Health Net of AZ Medicare	$381.63
Rate for Payer: Humana of AZ Medicare	$218.07
Rate for Payer: Self Pay Self Pay	$1,090.36
Rate for Payer: TriWest Medicare	$218.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$794.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$245.33

Urethral And Transurethral Procedures

Facility

$20,260.64

Service Code	APR-DRG 4464
Hospital Charge Code	APRDRG4463
Min. Negotiated Rate	$20,260.64
Max. Negotiated Rate	$20,260.64
Rate for Payer: AHCCCS Medicaid	$20,260.64
Rate for Payer: Allwell Medicaid	$20,260.64
Rate for Payer: AZCH Complete Medicaid	$20,260.64
Rate for Payer: Banner UC Health Medicaid	$20,260.64
Rate for Payer: Mercy Care Medicaid	$20,260.64

Urethral And Transurethral Procedures

Facility

$11,218.19

Service Code	APR-DRG 4463
Hospital Charge Code	APRDRG4462
Min. Negotiated Rate	$11,218.19
Max. Negotiated Rate	$11,218.19
Rate for Payer: AHCCCS Medicaid	$11,218.19
Rate for Payer: Allwell Medicaid	$11,218.19
Rate for Payer: AZCH Complete Medicaid	$11,218.19
Rate for Payer: Banner UC Health Medicaid	$11,218.19
Rate for Payer: Mercy Care Medicaid	$11,218.19

Know your out-of-pocket cost for care.

All Charges