Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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 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

$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	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

$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 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

Anal Sphincteroplasty

Facility

$3,900.00

Service Code	CPT 46750
Hospital Charge Code	27281896
Hospital Revenue Code	360
Min. Negotiated Rate	$624.00
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	$1,771.46
Rate for Payer: Allwell Medicaid	$1,771.46
Rate for Payer: Allwell Medicare	$624.00
Rate for Payer: Amerigroup Medicare	$624.00
Rate for Payer: APIPA Medicare/Medicaid	$1,456.65
Rate for Payer: AZCH Complete Medicaid	$1,771.46
Rate for Payer: AZCH Complete Medicare	$624.00
Rate for Payer: Banner UC Health Medicaid	$1,771.46
Rate for Payer: Banner UC Health Medicare	$624.00
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	$624.00
Rate for Payer: Mercy Care Medicaid	$1,771.46
Rate for Payer: Self Pay Self Pay	$3,120.00
Rate for Payer: TriWest Medicare	$624.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$702.00

ANA REFL, SM RNP AB

Facility

$108.00

Service Code	CPT 86235
Hospital Charge Code	22664813
Hospital Revenue Code	302
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Aetna of AZ Medicare	$30.24
Rate for Payer: Allwell Medicare	$17.28
Rate for Payer: Amerigroup Medicare	$17.28
Rate for Payer: APIPA Medicare/Medicaid	$40.34
Rate for Payer: AZCH Complete Medicare	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$73.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$70.20
Rate for Payer: Copperpoint Commercial	$26.73
Rate for Payer: Health Net of AZ Commercial	$64.80
Rate for Payer: Health Net of AZ Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Self Pay Self Pay	$86.40
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.44

ANA REFL, SM RNP AB

Facility

$108.00

Service Code	CPT 86235
Hospital Charge Code	22664813
Hospital Revenue Code	302
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Cash Price	$86.40
Rate for Payer: Self Pay Self Pay	$86.40

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	$25.60
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: Allwell Medicare	$25.60
Rate for Payer: Amerigroup Medicare	$25.60
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicare	$25.60
Rate for Payer: Banner UC Health Medicare	$25.60
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: 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	$25.60
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$25.60
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

$152.00

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

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	1285800
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

ANCA PANEL LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2269466
Hospital Revenue Code	301
Min. Negotiated Rate	$239.20
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: Allwell Medicare	$239.20
Rate for Payer: Amerigroup Medicare	$239.20
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicare	$239.20
Rate for Payer: Banner UC Health Medicare	$239.20
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: 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	$239.20
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$239.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

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 PROFILE (RDL) LC

Facility

$1,488.00

Service Code	CPT 83516
Hospital Charge Code	27469671
Hospital Revenue Code	301
Min. Negotiated Rate	$238.08
Max. Negotiated Rate	$1,339.20
Rate for Payer: Aetna of AZ Commercial	$1,339.20
Rate for Payer: Aetna of AZ Medicare	$416.64
Rate for Payer: Allwell Medicare	$238.08
Rate for Payer: Amerigroup Medicare	$238.08
Rate for Payer: APIPA Medicare/Medicaid	$555.77
Rate for Payer: AZCH Complete Medicare	$238.08
Rate for Payer: Banner UC Health Medicare	$238.08
Rate for Payer: Bisbee Police All Plans	$386.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,011.84
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cigna of AZ Commercial	$967.20
Rate for Payer: Copperpoint Commercial	$368.28
Rate for Payer: Health Net of AZ Commercial	$892.80
Rate for Payer: Health Net of AZ Medicare	$416.64
Rate for Payer: Humana of AZ Medicare	$238.08
Rate for Payer: Self Pay Self Pay	$1,190.40
Rate for Payer: TriWest Medicare	$238.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$867.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$267.84

ANCA PROFILE (RDL) LC

Facility

$1,488.00

Service Code	CPT 83516
Hospital Charge Code	27469671
Hospital Revenue Code	301
Min. Negotiated Rate	$386.88
Max. Negotiated Rate	$1,339.20
Rate for Payer: Aetna of AZ Commercial	$1,339.20
Rate for Payer: Bisbee Police All Plans	$386.88
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Self Pay Self Pay	$1,190.40

Androstenedione LC

Facility

$365.00

Service Code	CPT 82157
Hospital Charge Code	6738648
Hospital Revenue Code	301
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Cash Price	$292.00
Rate for Payer: Self Pay Self Pay	$292.00

Androstenedione LC

Facility

$365.00

Service Code	CPT 82157
Hospital Charge Code	6738648
Hospital Revenue Code	301
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Aetna of AZ Medicare	$102.20
Rate for Payer: Allwell Medicare	$58.40
Rate for Payer: Amerigroup Medicare	$58.40
Rate for Payer: APIPA Medicare/Medicaid	$136.33
Rate for Payer: AZCH Complete Medicare	$58.40
Rate for Payer: Banner UC Health Medicare	$58.40
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$248.20
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cigna of AZ Commercial	$237.25
Rate for Payer: Copperpoint Commercial	$90.34
Rate for Payer: Health Net of AZ Commercial	$219.00
Rate for Payer: Health Net of AZ Medicare	$102.20
Rate for Payer: Humana of AZ Medicare	$58.40
Rate for Payer: Self Pay Self Pay	$292.00
Rate for Payer: TriWest Medicare	$58.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$212.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.70

ANES ANESTHESIA PRONE POSITION 1ST 0:30

Facility

$591.00

Service Code	CPT 01922
Hospital Charge Code	22495017
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

ANES ANESTHESIA PRONE POSITION 1ST 0:30

Facility

$591.00

Service Code	CPT 01922
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 CHARGE BASE AND 1ST MINUTE

Facility

$591.00

Service Code	CPT 01922
Hospital Charge Code	22625272
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 CHARGE BASE AND 1ST MINUTE

Facility

$591.00

Service Code	CPT 01922
Hospital Charge Code	22625272
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

ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT 1S

Facility

$9.00

Service Code	CPT 01382
Hospital Charge Code	22625273
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

Know your out-of-pocket cost for care.

All Charges