Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	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

$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	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

$26,716.33

Service Code	APR-DRG 2264
Hospital Charge Code	APRDRG2263
Min. Negotiated Rate	$26,716.33
Max. Negotiated Rate	$26,716.33
Rate for Payer: AHCCCS Medicaid	$26,716.33
Rate for Payer: Allwell Medicaid	$26,716.33
Rate for Payer: AZCH Complete Medicaid	$26,716.33
Rate for Payer: Banner UC Health Medicaid	$26,716.33
Rate for Payer: Mercy Care Medicaid	$26,716.33

Anal Procedures

Facility

$5,699.58

Service Code	APR-DRG 2261
Hospital Charge Code	APRDRG2264
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

$5,699.58

Service Code	APR-DRG 2261
Hospital Charge Code	APRDRG2262
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 Sphincteroplasty

Facility

$3,900.00

Service Code	CPT 46750
Hospital Charge Code	27281896
Hospital Revenue Code	360
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$3,510.00
Rate for Payer: Aetna of AZ Medicare	$1,092.00
Rate for Payer: AHCCCS Medicaid	$3,542.92
Rate for Payer: Allwell Medicaid	$3,542.92
Rate for Payer: Allwell Medicare	$585.00
Rate for Payer: Amerigroup Medicare	$585.00
Rate for Payer: APIPA Medicare/Medicaid	$1,456.65
Rate for Payer: AZCH Complete Medicaid	$3,542.92
Rate for Payer: AZCH Complete Medicare	$585.00
Rate for Payer: Banner UC Health Medicaid	$3,542.92
Rate for Payer: Banner UC Health Medicare	$585.00
Rate for Payer: Bisbee Police All Plans	$1,014.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,652.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Cigna of AZ Commercial	$1,950.00
Rate for Payer: Copperpoint Commercial	$965.25
Rate for Payer: Health Net of AZ Commercial	$2,340.00
Rate for Payer: Health Net of AZ Medicare	$1,092.00
Rate for Payer: Humana of AZ Medicare	$585.00
Rate for Payer: Mercy Care Medicaid	$3,542.92
Rate for Payer: Self Pay Self Pay	$3,120.00
Rate for Payer: TriWest Medicare	$585.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$702.00

Anal Sphincteroplasty

Facility

$3,900.00

Service Code	CPT 46750
Hospital Charge Code	27281896
Hospital Revenue Code	360
Min. Negotiated Rate	$1,014.00
Max. Negotiated Rate	$3,510.00
Rate for Payer: Aetna of AZ Commercial	$3,510.00
Rate for Payer: Bisbee Police All Plans	$1,014.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Self Pay Self Pay	$3,120.00

ANA REFL, SM RNP AB

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	22664813
Hospital Revenue Code	302
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Cash Price	$91.20
Rate for Payer: Self Pay Self Pay	$91.20

ANA REFL, SM RNP AB

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	22664813
Hospital Revenue Code	302
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Medicare	$31.92
Rate for Payer: AHCCCS Medicaid	$17.93
Rate for Payer: Allwell Medicaid	$17.93
Rate for Payer: Allwell Medicare	$17.10
Rate for Payer: Amerigroup Medicare	$17.10
Rate for Payer: APIPA Medicare/Medicaid	$42.58
Rate for Payer: AZCH Complete Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$17.10
Rate for Payer: Banner UC Health Medicaid	$17.93
Rate for Payer: Banner UC Health Medicare	$17.10
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$77.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Copperpoint Commercial	$28.22
Rate for Payer: Health Net of AZ Commercial	$68.40
Rate for Payer: Health Net of AZ Medicare	$31.92
Rate for Payer: Humana of AZ Medicare	$17.10
Rate for Payer: Mercy Care Medicaid	$17.93
Rate for Payer: Self Pay Self Pay	$91.20
Rate for Payer: TriWest Medicare	$17.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$66.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.52

ANA w/Reflex if Positive LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	7328631
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 w/Reflex if Positive LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	7328631
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 w/Reflex LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	1285800
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 w/Reflex LC

Facility

$160.00

Service Code	CPT 86038
Hospital Charge Code	1285800
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

ANCA PANEL LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2269466
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

ANCA PANEL LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2269466
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

ANCA PROFILE (RDL) LC

Facility

$1,570.00

Service Code	CPT 83516
Hospital Charge Code	27469671
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,413.00
Rate for Payer: Aetna of AZ Commercial	$1,413.00
Rate for Payer: Aetna of AZ Medicare	$439.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$235.50
Rate for Payer: Amerigroup Medicare	$235.50
Rate for Payer: APIPA Medicare/Medicaid	$586.40
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$235.50
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$235.50
Rate for Payer: Bisbee Police All Plans	$408.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,067.60
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Cigna of AZ Commercial	$1,020.50
Rate for Payer: Copperpoint Commercial	$388.58
Rate for Payer: Health Net of AZ Commercial	$942.00
Rate for Payer: Health Net of AZ Medicare	$439.60
Rate for Payer: Humana of AZ Medicare	$235.50
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,256.00
Rate for Payer: TriWest Medicare	$235.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$915.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$282.60

ANCA PROFILE (RDL) LC

Facility

$1,570.00

Service Code	CPT 83516
Hospital Charge Code	27469671
Hospital Revenue Code	301
Min. Negotiated Rate	$408.20
Max. Negotiated Rate	$1,413.00
Rate for Payer: Aetna of AZ Commercial	$1,413.00
Rate for Payer: Bisbee Police All Plans	$408.20
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Self Pay Self Pay	$1,256.00

Androstenedione LC

Facility

$384.00

Service Code	CPT 82157
Hospital Charge Code	6738648
Hospital Revenue Code	301
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Aetna of AZ Medicare	$107.52
Rate for Payer: AHCCCS Medicaid	$29.28
Rate for Payer: Allwell Medicaid	$29.28
Rate for Payer: Allwell Medicare	$57.60
Rate for Payer: Amerigroup Medicare	$57.60
Rate for Payer: APIPA Medicare/Medicaid	$143.42
Rate for Payer: AZCH Complete Medicaid	$29.28
Rate for Payer: AZCH Complete Medicare	$57.60
Rate for Payer: Banner UC Health Medicaid	$29.28
Rate for Payer: Banner UC Health Medicare	$57.60
Rate for Payer: Bisbee Police All Plans	$99.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$261.12
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cigna of AZ Commercial	$249.60
Rate for Payer: Copperpoint Commercial	$95.04
Rate for Payer: Health Net of AZ Commercial	$230.40
Rate for Payer: Health Net of AZ Medicare	$107.52
Rate for Payer: Humana of AZ Medicare	$57.60
Rate for Payer: Mercy Care Medicaid	$29.28
Rate for Payer: Self Pay Self Pay	$307.20
Rate for Payer: TriWest Medicare	$57.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$223.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$69.12

Androstenedione LC

Facility

$384.00

Service Code	CPT 82157
Hospital Charge Code	6738648
Hospital Revenue Code	301
Min. Negotiated Rate	$99.84
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Bisbee Police All Plans	$99.84
Rate for Payer: Cash Price	$307.20
Rate for Payer: Self Pay Self Pay	$307.20

ANES ANESTHESIA PRONE POSITION 1ST 0:30

Facility

$591.00

Service Code	CPT 01992
Hospital Charge Code	22495017
Hospital Revenue Code	370
Min. Negotiated Rate	$0.13
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: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$88.65
Rate for Payer: Amerigroup Medicare	$88.65
Rate for Payer: APIPA Medicare/Medicaid	$220.74
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$88.65
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$88.65
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: 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	$88.65
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$472.80
Rate for Payer: TriWest Medicare	$88.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$344.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$106.38

ANES ANESTHESIA PRONE POSITION 1ST 0:30

Facility

$591.00

Service Code	CPT 01992
Hospital Charge Code	22495017
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

ANES ANESTHESIA PRONE POSITION ADDTNL 0:30

Facility

$9.00

Service Code	CPT 01992
Hospital Charge Code	22427752
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

ANES ANESTHESIA PRONE POSITION ADDTNL 0:30

Facility

$9.00

Service Code	CPT 01992
Hospital Charge Code	22427752
Hospital Revenue Code	370
Min. Negotiated Rate	$0.13
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: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$1.35
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: 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	$1.35
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

Know your out-of-pocket cost for care.

All Charges