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	$980.80
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	$980.80
Rate for Payer: Amerigroup Medicare	$980.80
Rate for Payer: APIPA Medicare/Medicaid	$2,289.55
Rate for Payer: AZCH Complete Medicare	$980.80
Rate for Payer: Banner UC Health Medicare	$980.80
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	$1,517.17
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	$980.80
Rate for Payer: Self Pay Self Pay	$4,904.00
Rate for Payer: TriWest Medicare	$980.80
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	$317.60
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	$317.60
Rate for Payer: Amerigroup Medicare	$317.60
Rate for Payer: APIPA Medicare/Medicaid	$741.40
Rate for Payer: AZCH Complete Medicare	$317.60
Rate for Payer: Banner UC Health Medicare	$317.60
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	$317.60
Rate for Payer: Self Pay Self Pay	$1,588.00
Rate for Payer: TriWest Medicare	$317.60
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	$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 700 CX MS PUMP 18CM CYLINDERS

Facility

$24,031.00

Hospital Charge Code	22354150
Hospital Revenue Code	270
Min. Negotiated Rate	$3,844.96
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	$3,844.96
Rate for Payer: Amerigroup Medicare	$3,844.96
Rate for Payer: APIPA Medicare/Medicaid	$8,975.58
Rate for Payer: AZCH Complete Medicare	$3,844.96
Rate for Payer: Banner UC Health Medicare	$3,844.96
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	$3,844.96
Rate for Payer: Self Pay Self Pay	$19,224.80
Rate for Payer: TriWest Medicare	$3,844.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$14,010.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$4,325.58

AMS SKW RETRACTION KIT

Facility

$1,111.00

Hospital Charge Code	22354148
Hospital Revenue Code	270
Min. Negotiated Rate	$177.76
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	$177.76
Rate for Payer: Amerigroup Medicare	$177.76
Rate for Payer: APIPA Medicare/Medicaid	$414.96
Rate for Payer: AZCH Complete Medicare	$177.76
Rate for Payer: Banner UC Health Medicare	$177.76
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	$177.76
Rate for Payer: Self Pay Self Pay	$888.80
Rate for Payer: TriWest Medicare	$177.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$647.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$199.98

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

Amylase Level

Facility

$189.00

Service Code	CPT 82150
Hospital Charge Code	631567
Hospital Revenue Code	301
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Aetna of AZ Medicare	$52.92
Rate for Payer: Allwell Medicare	$30.24
Rate for Payer: Amerigroup Medicare	$30.24
Rate for Payer: APIPA Medicare/Medicaid	$70.59
Rate for Payer: AZCH Complete Medicare	$30.24
Rate for Payer: Banner UC Health Medicare	$30.24
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$128.52
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna of AZ Commercial	$122.85
Rate for Payer: Copperpoint Commercial	$46.78
Rate for Payer: Health Net of AZ Commercial	$113.40
Rate for Payer: Health Net of AZ Medicare	$52.92
Rate for Payer: Humana of AZ Medicare	$30.24
Rate for Payer: Self Pay Self Pay	$151.20
Rate for Payer: TriWest Medicare	$30.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$110.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.02

Amylase Level

Facility

$189.00

Service Code	CPT 82150
Hospital Charge Code	631567
Hospital Revenue Code	301
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Cash Price	$151.20
Rate for Payer: Self Pay Self Pay	$151.20

ANA Ab Reflex Cascade LC

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	2269416
Hospital Revenue Code	300
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Aetna of AZ Medicare	$42.56
Rate for Payer: Allwell Medicare	$24.32
Rate for Payer: Amerigroup Medicare	$24.32
Rate for Payer: APIPA Medicare/Medicaid	$56.77
Rate for Payer: AZCH Complete Medicare	$24.32
Rate for Payer: Banner UC Health Medicare	$24.32
Rate for Payer: Bisbee Police All Plans	$39.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$103.36
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cigna of AZ Commercial	$98.80
Rate for Payer: Copperpoint Commercial	$37.62
Rate for Payer: Health Net of AZ Commercial	$91.20
Rate for Payer: Health Net of AZ Medicare	$42.56
Rate for Payer: Humana of AZ Medicare	$24.32
Rate for Payer: Self Pay Self Pay	$121.60
Rate for Payer: TriWest Medicare	$24.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.36

ANA Ab Reflex Cascade LC

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	2269416
Hospital Revenue Code	300
Min. Negotiated Rate	$39.52
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Bisbee Police All Plans	$39.52
Rate for Payer: Cash Price	$121.60
Rate for Payer: Self Pay Self Pay	$121.60

ANA Comprehensive Panel LC

Facility

$1,422.00

Service Code	CPT 86225
Hospital Charge Code	1285648
Hospital Revenue Code	302
Min. Negotiated Rate	$369.72
Max. Negotiated Rate	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Bisbee Police All Plans	$369.72
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Self Pay Self Pay	$1,137.60

ANA Comprehensive Panel LC

Facility

$1,422.00

Service Code	CPT 86225
Hospital Charge Code	1285648
Hospital Revenue Code	302
Min. Negotiated Rate	$227.52
Max. Negotiated Rate	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Aetna of AZ Medicare	$398.16
Rate for Payer: Allwell Medicare	$227.52
Rate for Payer: Amerigroup Medicare	$227.52
Rate for Payer: APIPA Medicare/Medicaid	$531.12
Rate for Payer: AZCH Complete Medicare	$227.52
Rate for Payer: Banner UC Health Medicare	$227.52
Rate for Payer: Bisbee Police All Plans	$369.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$966.96
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cigna of AZ Commercial	$924.30
Rate for Payer: Copperpoint Commercial	$351.94
Rate for Payer: Health Net of AZ Commercial	$853.20
Rate for Payer: Health Net of AZ Medicare	$398.16
Rate for Payer: Humana of AZ Medicare	$227.52
Rate for Payer: Self Pay Self Pay	$1,137.60
Rate for Payer: TriWest Medicare	$227.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$829.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$255.96

Anaerobic Culture

Facility

$419.00

Service Code	CPT 87075
Hospital Charge Code	1053537
Hospital Revenue Code	306
Min. Negotiated Rate	$108.94
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Bisbee Police All Plans	$108.94
Rate for Payer: Cash Price	$335.20
Rate for Payer: Self Pay Self Pay	$335.20

Anaerobic Culture

Facility

$419.00

Service Code	CPT 87075
Hospital Charge Code	1053537
Hospital Revenue Code	306
Min. Negotiated Rate	$67.04
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Aetna of AZ Medicare	$117.32
Rate for Payer: Allwell Medicare	$67.04
Rate for Payer: Amerigroup Medicare	$67.04
Rate for Payer: APIPA Medicare/Medicaid	$156.50
Rate for Payer: AZCH Complete Medicare	$67.04
Rate for Payer: Banner UC Health Medicare	$67.04
Rate for Payer: Bisbee Police All Plans	$108.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$284.92
Rate for Payer: Cash Price	$335.20
Rate for Payer: Cigna of AZ Commercial	$272.35
Rate for Payer: Copperpoint Commercial	$103.70
Rate for Payer: Health Net of AZ Commercial	$251.40
Rate for Payer: Health Net of AZ Medicare	$117.32
Rate for Payer: Humana of AZ Medicare	$67.04
Rate for Payer: Self Pay Self Pay	$335.20
Rate for Payer: TriWest Medicare	$67.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$244.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.42

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

$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

$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

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

$26,716.33

Service Code	APR-DRG 2264
Hospital Charge Code	APRDRG2264
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

$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

$7,831.83

Service Code	APR-DRG 2262
Hospital Charge Code	APRDRG2263
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

$26,716.33

Service Code	APR-DRG 2264
Hospital Charge Code	APRDRG2262
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

$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

Know your out-of-pocket cost for care.

All Charges