Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

00938 ANES INSERTION OF PENILE PROSTH ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406171
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00938 ANES INSERTION OF PENILE PROSTH ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406171
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00940 ANES VAGINAL PROCEDURES ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00940
Hospital Charge Code	22406174
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00940 ANES VAGINAL PROCEDURES ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00940
Hospital Charge Code	22406174
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00940 ANES VAGINAL PROCEDURES ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00940
Hospital Charge Code	22406175
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00940 ANES VAGINAL PROCEDURES ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00940
Hospital Charge Code	22406175
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00940 ANES VAGINAL PROCEDURES BASE CHARGE AND 1ST MINUTE

Facility

$746.00

Service Code	CPT 00940
Hospital Charge Code	22406173
Hospital Revenue Code	964
Min. Negotiated Rate	$193.96
Max. Negotiated Rate	$671.40
Rate for Payer: Aetna of AZ Commercial	$671.40
Rate for Payer: Bisbee Police All Plans	$193.96
Rate for Payer: Cash Price	$596.80
Rate for Payer: Self Pay Self Pay	$596.80

00940 ANES VAGINAL PROCEDURES BASE CHARGE AND 1ST MINUTE

Facility

$746.00

Service Code	CPT 00940
Hospital Charge Code	22406173
Hospital Revenue Code	964
Min. Negotiated Rate	$119.36
Max. Negotiated Rate	$671.40
Rate for Payer: Aetna of AZ Commercial	$671.40
Rate for Payer: Aetna of AZ Medicare	$208.88
Rate for Payer: Allwell Medicare	$119.36
Rate for Payer: Amerigroup Medicare	$119.36
Rate for Payer: APIPA Medicare/Medicaid	$278.63
Rate for Payer: AZCH Complete Medicare	$119.36
Rate for Payer: Banner UC Health Medicare	$119.36
Rate for Payer: Bisbee Police All Plans	$193.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$507.28
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cigna of AZ Commercial	$522.20
Rate for Payer: Copperpoint Commercial	$184.63
Rate for Payer: Health Net of AZ Commercial	$447.60
Rate for Payer: Health Net of AZ Medicare	$208.88
Rate for Payer: Humana of AZ Medicare	$119.36
Rate for Payer: Self Pay Self Pay	$596.80
Rate for Payer: TriWest Medicare	$119.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$434.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$134.28

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597458
Hospital Revenue Code	370
Min. Negotiated Rate	$153.66
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Cash Price	$472.80
Rate for Payer: Self Pay Self Pay	$472.80

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597459
Hospital Revenue Code	370
Min. Negotiated Rate	$153.66
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Cash Price	$472.80
Rate for Payer: Self Pay Self Pay	$472.80

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597458
Hospital Revenue Code	370
Min. Negotiated Rate	$94.56
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Aetna of AZ Medicare	$165.48
Rate for Payer: Allwell Medicare	$94.56
Rate for Payer: Amerigroup Medicare	$94.56
Rate for Payer: APIPA Medicare/Medicaid	$220.74
Rate for Payer: AZCH Complete Medicare	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$401.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Copperpoint Commercial	$146.27
Rate for Payer: Health Net of AZ Commercial	$354.60
Rate for Payer: Health Net of AZ Medicare	$165.48
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Self Pay Self Pay	$472.80
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$344.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$106.38

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597459
Hospital Revenue Code	370
Min. Negotiated Rate	$94.56
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Aetna of AZ Medicare	$165.48
Rate for Payer: Allwell Medicare	$94.56
Rate for Payer: Amerigroup Medicare	$94.56
Rate for Payer: APIPA Medicare/Medicaid	$220.74
Rate for Payer: AZCH Complete Medicare	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$401.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Copperpoint Commercial	$146.27
Rate for Payer: Health Net of AZ Commercial	$354.60
Rate for Payer: Health Net of AZ Medicare	$165.48
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Self Pay Self Pay	$472.80
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$344.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$106.38

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597457
Hospital Revenue Code	370
Min. Negotiated Rate	$94.56
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Aetna of AZ Medicare	$165.48
Rate for Payer: Allwell Medicare	$94.56
Rate for Payer: Amerigroup Medicare	$94.56
Rate for Payer: APIPA Medicare/Medicaid	$220.74
Rate for Payer: AZCH Complete Medicare	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$401.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Copperpoint Commercial	$146.27
Rate for Payer: Health Net of AZ Commercial	$354.60
Rate for Payer: Health Net of AZ Medicare	$165.48
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Self Pay Self Pay	$472.80
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$344.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$106.38

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597457
Hospital Revenue Code	370
Min. Negotiated Rate	$153.66
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Cash Price	$472.80
Rate for Payer: Self Pay Self Pay	$472.80

00952 ANES HYSTEROSCOPY ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00952
Hospital Charge Code	22406177
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00952 ANES HYSTEROSCOPY ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00952
Hospital Charge Code	22406177
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00952 ANES HYSTEROSCOPY ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00952
Hospital Charge Code	22406179
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00952 ANES HYSTEROSCOPY ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00952
Hospital Charge Code	22406179
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00955 INTRATHECAL INJECTION

Facility

$1,384.00

Service Code	CPT 00955
Hospital Charge Code	23361647
Hospital Revenue Code	370
Min. Negotiated Rate	$221.44
Max. Negotiated Rate	$1,245.60
Rate for Payer: Aetna of AZ Commercial	$1,245.60
Rate for Payer: Aetna of AZ Medicare	$387.52
Rate for Payer: Allwell Medicare	$221.44
Rate for Payer: Amerigroup Medicare	$221.44
Rate for Payer: APIPA Medicare/Medicaid	$516.92
Rate for Payer: AZCH Complete Medicare	$221.44
Rate for Payer: Banner UC Health Medicare	$221.44
Rate for Payer: Bisbee Police All Plans	$359.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$941.12
Rate for Payer: Cash Price	$1,107.20
Rate for Payer: Cigna of AZ Commercial	$899.60
Rate for Payer: Copperpoint Commercial	$342.54
Rate for Payer: Health Net of AZ Commercial	$830.40
Rate for Payer: Health Net of AZ Medicare	$387.52
Rate for Payer: Humana of AZ Medicare	$221.44
Rate for Payer: Self Pay Self Pay	$1,107.20
Rate for Payer: TriWest Medicare	$221.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$806.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$249.12

00955 INTRATHECAL INJECTION

Facility

$1,384.00

Service Code	CPT 00955
Hospital Charge Code	23361647
Hospital Revenue Code	370
Min. Negotiated Rate	$359.84
Max. Negotiated Rate	$1,245.60
Rate for Payer: Aetna of AZ Commercial	$1,245.60
Rate for Payer: Bisbee Police All Plans	$359.84
Rate for Payer: Cash Price	$1,107.20
Rate for Payer: Self Pay Self Pay	$1,107.20

01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 01360
Hospital Charge Code	22406182
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 01360
Hospital Charge Code	22406182
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDNL 30 CHARGE

Facility

$298.00

Service Code	CPT 01360
Hospital Charge Code	22406183
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

01360 ANES OPEN PROC LOWER 1/3 FEMUR ADDNL 30 CHARGE

Facility

$298.00

Service Code	CPT 01360
Hospital Charge Code	22406183
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

01360 ANES OPEN PROC LOWER 1/3 FEMUR BASE CHARGE AND 1ST MIN

Facility

$894.00

Service Code	CPT 01360
Hospital Charge Code	22406180
Hospital Revenue Code	964
Min. Negotiated Rate	$232.44
Max. Negotiated Rate	$804.60
Rate for Payer: Aetna of AZ Commercial	$804.60
Rate for Payer: Bisbee Police All Plans	$232.44
Rate for Payer: Cash Price	$715.20
Rate for Payer: Self Pay Self Pay	$715.20

Know your out-of-pocket cost for care.

All Charges