Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

01382 ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JO

Facility

$591.00

Service Code	CPT 01382
Hospital Charge Code	22889347
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

01382 ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JO

Facility

$591.00

Service Code	CPT 01382
Hospital Charge Code	22889347
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

01462 Anesthesia for all closed procedures on lower leg, ank

Facility

$8.00

Service Code	CPT 01462
Hospital Charge Code	24062579
Hospital Revenue Code	370
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Cash Price	$6.40
Rate for Payer: Self Pay Self Pay	$6.40

01462 Anesthesia for all closed procedures on lower leg, ank

Facility

$8.00

Service Code	CPT 01462
Hospital Charge Code	24062579
Hospital Revenue Code	370
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Aetna of AZ Medicare	$2.24
Rate for Payer: Allwell Medicare	$1.28
Rate for Payer: Amerigroup Medicare	$1.28
Rate for Payer: APIPA Medicare/Medicaid	$2.99
Rate for Payer: AZCH Complete Medicare	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.44
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.20
Rate for Payer: Copperpoint Commercial	$1.98
Rate for Payer: Health Net of AZ Commercial	$4.80
Rate for Payer: Health Net of AZ Medicare	$2.24
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Self Pay Self Pay	$6.40
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.44

01462 ANESTHESIA LOWER LEG ANKLE FOOT FMC CHARGE

Facility

$573.00

Service Code	CPT 01462
Hospital Charge Code	22385160
Hospital Revenue Code	964
Min. Negotiated Rate	$148.98
Max. Negotiated Rate	$515.70
Rate for Payer: Aetna of AZ Commercial	$515.70
Rate for Payer: Bisbee Police All Plans	$148.98
Rate for Payer: Cash Price	$458.40
Rate for Payer: Self Pay Self Pay	$458.40

01462 ANESTHESIA LOWER LEG ANKLE FOOT FMC CHARGE

Facility

$573.00

Service Code	CPT 01462
Hospital Charge Code	22385160
Hospital Revenue Code	964
Min. Negotiated Rate	$91.68
Max. Negotiated Rate	$515.70
Rate for Payer: Aetna of AZ Commercial	$515.70
Rate for Payer: Aetna of AZ Medicare	$160.44
Rate for Payer: Allwell Medicare	$91.68
Rate for Payer: Amerigroup Medicare	$91.68
Rate for Payer: APIPA Medicare/Medicaid	$214.02
Rate for Payer: AZCH Complete Medicare	$91.68
Rate for Payer: Banner UC Health Medicare	$91.68
Rate for Payer: Bisbee Police All Plans	$148.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$389.64
Rate for Payer: Cash Price	$458.40
Rate for Payer: Cigna of AZ Commercial	$401.10
Rate for Payer: Copperpoint Commercial	$141.82
Rate for Payer: Health Net of AZ Commercial	$343.80
Rate for Payer: Health Net of AZ Medicare	$160.44
Rate for Payer: Humana of AZ Medicare	$91.68
Rate for Payer: Self Pay Self Pay	$458.40
Rate for Payer: TriWest Medicare	$91.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$334.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$103.14

01470 ANES OPEN FOOT ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 01470
Hospital Charge Code	22406202
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

01470 ANES OPEN FOOT ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 01470
Hospital Charge Code	22406202
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

01470 ANES OPEN FOOT ADDTNL 0:30 CHARGE

Facility

$9.00

Service Code	CPT 01470
Hospital Charge Code	22406205
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

01470 ANES OPEN FOOT ADDTNL 0:30 CHARGE

Facility

$9.00

Service Code	CPT 01470
Hospital Charge Code	22406205
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

01470 ANES OPEN FOOT PROCEDURE BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Service Code	CPT 01470
Hospital Charge Code	22406199
Hospital Revenue Code	964
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Cash Price	$392.00
Rate for Payer: Self Pay Self Pay	$392.00

01470 ANES OPEN FOOT PROCEDURE BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Service Code	CPT 01470
Hospital Charge Code	22406199
Hospital Revenue Code	964
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Aetna of AZ Medicare	$137.20
Rate for Payer: Allwell Medicare	$78.40
Rate for Payer: Amerigroup Medicare	$78.40
Rate for Payer: APIPA Medicare/Medicaid	$183.01
Rate for Payer: AZCH Complete Medicare	$78.40
Rate for Payer: Banner UC Health Medicare	$78.40
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$333.20
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cigna of AZ Commercial	$343.00
Rate for Payer: Copperpoint Commercial	$121.28
Rate for Payer: Health Net of AZ Commercial	$294.00
Rate for Payer: Health Net of AZ Medicare	$137.20
Rate for Payer: Humana of AZ Medicare	$78.40
Rate for Payer: Self Pay Self Pay	$392.00
Rate for Payer: TriWest Medicare	$78.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$285.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.20

01810 ANES PROCEDURES LOWER ARM ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 01810
Hospital Charge Code	22406188
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

01810 ANES PROCEDURES LOWER ARM ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 01810
Hospital Charge Code	22406188
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

01810 ANES PROCEDURES LOWER ARM ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 01810
Hospital Charge Code	22406189
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

01810 ANES PROCEDURES LOWER ARM ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 01810
Hospital Charge Code	22406189
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

01922 ANES NON INVASIVE IMAG OR RAD THER ADDITONAL MINUTES

Facility

$9.00

Service Code	CPT 01922
Hospital Charge Code	22406191
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

01922 ANES NON INVASIVE IMAG OR RAD THER ADDITONAL MINUTES

Facility

$9.00

Service Code	CPT 01922
Hospital Charge Code	22406191
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

01922 ANES NON INVASIVE IMAG OR RAD THER ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 01922
Hospital Charge Code	22406192
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

01922 ANES NON INVASIVE IMAG OR RAD THER ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 01922
Hospital Charge Code	22406192
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

01999 ANES UNLISTED ANESTHESIA PRO ADDTNL 0:30 CHARGE

Facility

$595.00

Service Code	CPT 01999
Hospital Charge Code	22406197
Hospital Revenue Code	370
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna of AZ Commercial	$535.50
Rate for Payer: Bisbee Police All Plans	$154.70
Rate for Payer: Cash Price	$476.00
Rate for Payer: Self Pay Self Pay	$476.00

01999 ANES UNLISTED ANESTHESIA PRO ADDTNL 0:30 CHARGE

Facility

$595.00

Service Code	CPT 01999
Hospital Charge Code	22406197
Hospital Revenue Code	370
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna of AZ Commercial	$535.50
Rate for Payer: Aetna of AZ Medicare	$166.60
Rate for Payer: Allwell Medicare	$95.20
Rate for Payer: Amerigroup Medicare	$95.20
Rate for Payer: APIPA Medicare/Medicaid	$222.23
Rate for Payer: AZCH Complete Medicare	$95.20
Rate for Payer: Banner UC Health Medicare	$95.20
Rate for Payer: Bisbee Police All Plans	$154.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$404.60
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cigna of AZ Commercial	$386.75
Rate for Payer: Copperpoint Commercial	$147.26
Rate for Payer: Health Net of AZ Commercial	$357.00
Rate for Payer: Health Net of AZ Medicare	$166.60
Rate for Payer: Humana of AZ Medicare	$95.20
Rate for Payer: Self Pay Self Pay	$476.00
Rate for Payer: TriWest Medicare	$95.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$346.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$107.10

01999 ANES UNLISTED ANESTHESIA PROCED ADDITONAL MINUTES

Facility

$9.00

Service Code	CPT 01999
Hospital Charge Code	22406194
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

01999 ANES UNLISTED ANESTHESIA PROCED ADDITONAL MINUTES

Facility

$9.00

Service Code	CPT 01999
Hospital Charge Code	22406194
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

Know your out-of-pocket cost for care.

All Charges