Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

AMS 65ML RESERVOIR

Facility

$6,130.00

Hospital Charge Code	22354149
Hospital Revenue Code	270
Min. Negotiated Rate	$1,593.80
Max. Negotiated Rate	$5,517.00
Rate for Payer: Aetna of AZ Commercial	$5,517.00
Rate for Payer: Bisbee Police All Plans	$1,593.80
Rate for Payer: Cash Price	$4,904.00
Rate for Payer: Self Pay Self Pay	$4,904.00

AMS 65ML RESERVOIR

Facility

$6,130.00

Hospital Charge Code	22354149
Hospital Revenue Code	270
Min. Negotiated Rate	$919.50
Max. Negotiated Rate	$5,517.00
Rate for Payer: Aetna of AZ Commercial	$5,517.00
Rate for Payer: Aetna of AZ Medicare	$1,716.40
Rate for Payer: Allwell Medicare	$919.50
Rate for Payer: Amerigroup Medicare	$919.50
Rate for Payer: APIPA Medicare/Medicaid	$2,289.56
Rate for Payer: AZCH Complete Medicare	$919.50
Rate for Payer: Banner UC Health Medicare	$919.50
Rate for Payer: Bisbee Police All Plans	$1,593.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,168.40
Rate for Payer: Cash Price	$4,904.00
Rate for Payer: Cigna of AZ Commercial	$4,291.00
Rate for Payer: Copperpoint Commercial	$1,517.18
Rate for Payer: Health Net of AZ Commercial	$3,678.00
Rate for Payer: Health Net of AZ Medicare	$1,716.40
Rate for Payer: Humana of AZ Medicare	$919.50
Rate for Payer: Self Pay Self Pay	$4,904.00
Rate for Payer: TriWest Medicare	$919.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,573.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,103.40

AMS 700 ACCESSORY KIT

Facility

$1,985.00

Hospital Charge Code	22354145
Hospital Revenue Code	270
Min. Negotiated Rate	$297.75
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Aetna of AZ Medicare	$555.80
Rate for Payer: Allwell Medicare	$297.75
Rate for Payer: Amerigroup Medicare	$297.75
Rate for Payer: APIPA Medicare/Medicaid	$741.40
Rate for Payer: AZCH Complete Medicare	$297.75
Rate for Payer: Banner UC Health Medicare	$297.75
Rate for Payer: Bisbee Police All Plans	$516.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,349.80
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cigna of AZ Commercial	$1,389.50
Rate for Payer: Copperpoint Commercial	$491.29
Rate for Payer: Health Net of AZ Commercial	$1,191.00
Rate for Payer: Health Net of AZ Medicare	$555.80
Rate for Payer: Humana of AZ Medicare	$297.75
Rate for Payer: Self Pay Self Pay	$1,588.00
Rate for Payer: TriWest Medicare	$297.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,157.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$357.30

AMS 700 ACCESSORY KIT

Facility

$1,985.00

Hospital Charge Code	22354145
Hospital Revenue Code	270
Min. Negotiated Rate	$516.10
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Bisbee Police All Plans	$516.10
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Self Pay Self Pay	$1,588.00

AMS 700 CX MS PUMP 18CM CYLINDERS

Facility

$24,031.00

Hospital Charge Code	22354150
Hospital Revenue Code	270
Min. Negotiated Rate	$3,604.65
Max. Negotiated Rate	$21,627.90
Rate for Payer: Aetna of AZ Commercial	$21,627.90
Rate for Payer: Aetna of AZ Medicare	$6,728.68
Rate for Payer: Allwell Medicare	$3,604.65
Rate for Payer: Amerigroup Medicare	$3,604.65
Rate for Payer: APIPA Medicare/Medicaid	$8,975.58
Rate for Payer: AZCH Complete Medicare	$3,604.65
Rate for Payer: Banner UC Health Medicare	$3,604.65
Rate for Payer: Bisbee Police All Plans	$6,248.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16,341.08
Rate for Payer: Cash Price	$19,224.80
Rate for Payer: Cigna of AZ Commercial	$16,821.70
Rate for Payer: Copperpoint Commercial	$5,947.67
Rate for Payer: Health Net of AZ Commercial	$14,418.60
Rate for Payer: Health Net of AZ Medicare	$6,728.68
Rate for Payer: Humana of AZ Medicare	$3,604.65
Rate for Payer: Self Pay Self Pay	$19,224.80
Rate for Payer: TriWest Medicare	$3,604.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$14,010.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$4,325.58

AMS 700 CX MS PUMP 18CM CYLINDERS

Facility

$24,031.00

Hospital Charge Code	22354150
Hospital Revenue Code	270
Min. Negotiated Rate	$6,248.06
Max. Negotiated Rate	$21,627.90
Rate for Payer: Aetna of AZ Commercial	$21,627.90
Rate for Payer: Bisbee Police All Plans	$6,248.06
Rate for Payer: Cash Price	$19,224.80
Rate for Payer: Self Pay Self Pay	$19,224.80

AMS SKW RETRACTION KIT

Facility

$1,111.00

Hospital Charge Code	22354148
Hospital Revenue Code	270
Min. Negotiated Rate	$288.86
Max. Negotiated Rate	$999.90
Rate for Payer: Aetna of AZ Commercial	$999.90
Rate for Payer: Bisbee Police All Plans	$288.86
Rate for Payer: Cash Price	$888.80
Rate for Payer: Self Pay Self Pay	$888.80

AMS SKW RETRACTION KIT

Facility

$1,111.00

Hospital Charge Code	22354148
Hospital Revenue Code	270
Min. Negotiated Rate	$166.65
Max. Negotiated Rate	$999.90
Rate for Payer: Aetna of AZ Commercial	$999.90
Rate for Payer: Aetna of AZ Medicare	$311.08
Rate for Payer: Allwell Medicare	$166.65
Rate for Payer: Amerigroup Medicare	$166.65
Rate for Payer: APIPA Medicare/Medicaid	$414.96
Rate for Payer: AZCH Complete Medicare	$166.65
Rate for Payer: Banner UC Health Medicare	$166.65
Rate for Payer: Bisbee Police All Plans	$288.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$755.48
Rate for Payer: Cash Price	$888.80
Rate for Payer: Cigna of AZ Commercial	$777.70
Rate for Payer: Copperpoint Commercial	$274.97
Rate for Payer: Health Net of AZ Commercial	$666.60
Rate for Payer: Health Net of AZ Medicare	$311.08
Rate for Payer: Humana of AZ Medicare	$166.65
Rate for Payer: Self Pay Self Pay	$888.80
Rate for Payer: TriWest Medicare	$166.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$647.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$199.98

Amylase Level

Facility

$199.00

Service Code	CPT 82150
Hospital Charge Code	631567
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$179.10
Rate for Payer: Aetna of AZ Commercial	$179.10
Rate for Payer: Aetna of AZ Medicare	$55.72
Rate for Payer: AHCCCS Medicaid	$6.48
Rate for Payer: Allwell Medicaid	$6.48
Rate for Payer: Allwell Medicare	$29.85
Rate for Payer: Amerigroup Medicare	$29.85
Rate for Payer: APIPA Medicare/Medicaid	$74.33
Rate for Payer: AZCH Complete Medicaid	$6.48
Rate for Payer: AZCH Complete Medicare	$29.85
Rate for Payer: Banner UC Health Medicaid	$6.48
Rate for Payer: Banner UC Health Medicare	$29.85
Rate for Payer: Bisbee Police All Plans	$51.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$135.32
Rate for Payer: Cash Price	$159.20
Rate for Payer: Cash Price	$159.20
Rate for Payer: Cigna of AZ Commercial	$129.35
Rate for Payer: Copperpoint Commercial	$49.25
Rate for Payer: Health Net of AZ Commercial	$119.40
Rate for Payer: Health Net of AZ Medicare	$55.72
Rate for Payer: Humana of AZ Medicare	$29.85
Rate for Payer: Mercy Care Medicaid	$6.48
Rate for Payer: Self Pay Self Pay	$159.20
Rate for Payer: TriWest Medicare	$29.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$116.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.82

Amylase Level

Facility

$199.00

Service Code	CPT 82150
Hospital Charge Code	631567
Hospital Revenue Code	301
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$179.10
Rate for Payer: Aetna of AZ Commercial	$179.10
Rate for Payer: Bisbee Police All Plans	$51.74
Rate for Payer: Cash Price	$159.20
Rate for Payer: Self Pay Self Pay	$159.20

ANA Ab Reflex Cascade LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	2269416
Hospital Revenue Code	300
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Aetna of AZ Medicare	$44.80
Rate for Payer: AHCCCS Medicaid	$12.09
Rate for Payer: Allwell Medicaid	$12.09
Rate for Payer: Allwell Medicare	$24.00
Rate for Payer: Amerigroup Medicare	$24.00
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicaid	$12.09
Rate for Payer: AZCH Complete Medicare	$24.00
Rate for Payer: Banner UC Health Medicaid	$12.09
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.80
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cigna of AZ Commercial	$104.00
Rate for Payer: Copperpoint Commercial	$39.60
Rate for Payer: Health Net of AZ Commercial	$96.00
Rate for Payer: Health Net of AZ Medicare	$44.80
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Mercy Care Medicaid	$12.09
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.80

ANA Ab Reflex Cascade LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	2269416
Hospital Revenue Code	300
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Self Pay Self Pay	$128.00

ANA Comprehensive Panel LC

Facility

$1,497.00

Service Code	CPT 86225
Hospital Charge Code	1285648
Hospital Revenue Code	302
Min. Negotiated Rate	$389.22
Max. Negotiated Rate	$1,347.30
Rate for Payer: Aetna of AZ Commercial	$1,347.30
Rate for Payer: Bisbee Police All Plans	$389.22
Rate for Payer: Cash Price	$1,197.60
Rate for Payer: Self Pay Self Pay	$1,197.60

ANA Comprehensive Panel LC

Facility

$1,497.00

Service Code	CPT 86225
Hospital Charge Code	1285648
Hospital Revenue Code	302
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$1,347.30
Rate for Payer: Aetna of AZ Commercial	$1,347.30
Rate for Payer: Aetna of AZ Medicare	$419.16
Rate for Payer: AHCCCS Medicaid	$13.74
Rate for Payer: Allwell Medicaid	$13.74
Rate for Payer: Allwell Medicare	$224.55
Rate for Payer: Amerigroup Medicare	$224.55
Rate for Payer: APIPA Medicare/Medicaid	$559.13
Rate for Payer: AZCH Complete Medicaid	$13.74
Rate for Payer: AZCH Complete Medicare	$224.55
Rate for Payer: Banner UC Health Medicaid	$13.74
Rate for Payer: Banner UC Health Medicare	$224.55
Rate for Payer: Bisbee Police All Plans	$389.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,017.96
Rate for Payer: Cash Price	$1,197.60
Rate for Payer: Cash Price	$1,197.60
Rate for Payer: Cigna of AZ Commercial	$973.05
Rate for Payer: Copperpoint Commercial	$370.51
Rate for Payer: Health Net of AZ Commercial	$898.20
Rate for Payer: Health Net of AZ Medicare	$419.16
Rate for Payer: Humana of AZ Medicare	$224.55
Rate for Payer: Mercy Care Medicaid	$13.74
Rate for Payer: Self Pay Self Pay	$1,197.60
Rate for Payer: TriWest Medicare	$224.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$872.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.46

Anaerobic Culture

Facility

$270.00

Service Code	CPT 87075
Hospital Charge Code	1053537
Hospital Revenue Code	306
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Self Pay Self Pay	$216.00

Anaerobic Culture

Facility

$270.00

Service Code	CPT 87075
Hospital Charge Code	1053537
Hospital Revenue Code	306
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Aetna of AZ Medicare	$75.60
Rate for Payer: AHCCCS Medicaid	$9.47
Rate for Payer: Allwell Medicaid	$9.47
Rate for Payer: Allwell Medicare	$40.50
Rate for Payer: Amerigroup Medicare	$40.50
Rate for Payer: APIPA Medicare/Medicaid	$100.84
Rate for Payer: AZCH Complete Medicaid	$9.47
Rate for Payer: AZCH Complete Medicare	$40.50
Rate for Payer: Banner UC Health Medicaid	$9.47
Rate for Payer: Banner UC Health Medicare	$40.50
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$183.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna of AZ Commercial	$175.50
Rate for Payer: Copperpoint Commercial	$66.82
Rate for Payer: Health Net of AZ Commercial	$162.00
Rate for Payer: Health Net of AZ Medicare	$75.60
Rate for Payer: Humana of AZ Medicare	$40.50
Rate for Payer: Mercy Care Medicaid	$9.47
Rate for Payer: Self Pay Self Pay	$216.00
Rate for Payer: TriWest Medicare	$40.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$157.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.60

Anal Procedures

Facility

$7,831.83

Service Code	APR-DRG 2262
Hospital Charge Code	APRDRG2261
Min. Negotiated Rate	$7,831.83
Max. Negotiated Rate	$7,831.83
Rate for Payer: AHCCCS Medicaid	$7,831.83
Rate for Payer: Allwell Medicaid	$7,831.83
Rate for Payer: AZCH Complete Medicaid	$7,831.83
Rate for Payer: Banner UC Health Medicaid	$7,831.83
Rate for Payer: Mercy Care Medicaid	$7,831.83

Anal Procedures

Facility

$11,389.33

Service Code	APR-DRG 2263
Hospital Charge Code	APRDRG2263
Min. Negotiated Rate	$11,389.33
Max. Negotiated Rate	$11,389.33
Rate for Payer: AHCCCS Medicaid	$11,389.33
Rate for Payer: Allwell Medicaid	$11,389.33
Rate for Payer: AZCH Complete Medicaid	$11,389.33
Rate for Payer: Banner UC Health Medicaid	$11,389.33
Rate for Payer: Mercy Care Medicaid	$11,389.33

Anal Procedures

Facility

$11,389.33

Service Code	APR-DRG 2263
Hospital Charge Code	APRDRG2261
Min. Negotiated Rate	$11,389.33
Max. Negotiated Rate	$11,389.33
Rate for Payer: AHCCCS Medicaid	$11,389.33
Rate for Payer: Allwell Medicaid	$11,389.33
Rate for Payer: AZCH Complete Medicaid	$11,389.33
Rate for Payer: Banner UC Health Medicaid	$11,389.33
Rate for Payer: Mercy Care Medicaid	$11,389.33

Anal Procedures

Facility

$7,831.83

Service Code	APR-DRG 2262
Hospital Charge Code	APRDRG2264
Min. Negotiated Rate	$7,831.83
Max. Negotiated Rate	$7,831.83
Rate for Payer: AHCCCS Medicaid	$7,831.83
Rate for Payer: Allwell Medicaid	$7,831.83
Rate for Payer: AZCH Complete Medicaid	$7,831.83
Rate for Payer: Banner UC Health Medicaid	$7,831.83
Rate for Payer: Mercy Care Medicaid	$7,831.83

Anal Procedures

Facility

$11,389.33

Service Code	APR-DRG 2263
Hospital Charge Code	APRDRG2262
Min. Negotiated Rate	$11,389.33
Max. Negotiated Rate	$11,389.33
Rate for Payer: AHCCCS Medicaid	$11,389.33
Rate for Payer: Allwell Medicaid	$11,389.33
Rate for Payer: AZCH Complete Medicaid	$11,389.33
Rate for Payer: Banner UC Health Medicaid	$11,389.33
Rate for Payer: Mercy Care Medicaid	$11,389.33

Anal Procedures

Facility

$11,389.33

Service Code	APR-DRG 2263
Hospital Charge Code	APRDRG2264
Min. Negotiated Rate	$11,389.33
Max. Negotiated Rate	$11,389.33
Rate for Payer: AHCCCS Medicaid	$11,389.33
Rate for Payer: Allwell Medicaid	$11,389.33
Rate for Payer: AZCH Complete Medicaid	$11,389.33
Rate for Payer: Banner UC Health Medicaid	$11,389.33
Rate for Payer: Mercy Care Medicaid	$11,389.33

Anal Procedures

Facility

$5,699.58

Service Code	APR-DRG 2261
Hospital Charge Code	APRDRG2263
Min. Negotiated Rate	$5,699.58
Max. Negotiated Rate	$5,699.58
Rate for Payer: AHCCCS Medicaid	$5,699.58
Rate for Payer: Allwell Medicaid	$5,699.58
Rate for Payer: AZCH Complete Medicaid	$5,699.58
Rate for Payer: Banner UC Health Medicaid	$5,699.58
Rate for Payer: Mercy Care Medicaid	$5,699.58

Anal Procedures

Facility

$7,831.83

Service Code	APR-DRG 2262
Hospital Charge Code	APRDRG2262
Min. Negotiated Rate	$7,831.83
Max. Negotiated Rate	$7,831.83
Rate for Payer: AHCCCS Medicaid	$7,831.83
Rate for Payer: Allwell Medicaid	$7,831.83
Rate for Payer: AZCH Complete Medicaid	$7,831.83
Rate for Payer: Banner UC Health Medicaid	$7,831.83
Rate for Payer: Mercy Care Medicaid	$7,831.83

Anal Procedures

Facility

$5,699.58

Service Code	APR-DRG 2261
Hospital Charge Code	APRDRG2261
Min. Negotiated Rate	$5,699.58
Max. Negotiated Rate	$5,699.58
Rate for Payer: AHCCCS Medicaid	$5,699.58
Rate for Payer: Allwell Medicaid	$5,699.58
Rate for Payer: AZCH Complete Medicaid	$5,699.58
Rate for Payer: Banner UC Health Medicaid	$5,699.58
Rate for Payer: Mercy Care Medicaid	$5,699.58

Know your out-of-pocket cost for care.

All Charges