Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Aph RBC ACDA AS1 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011918
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC ACDA AS1 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011918
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC ACDA AS1 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	3566198
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC ACDA AS1 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	3566198
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC ACDA AS1 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	8545368
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC ACDA AS1 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	8545368
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC CP2D AS3 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011914
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC CP2D AS3 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011914
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC CP2D AS3 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	4004202
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC CP2D AS3 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	4004202
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC CP2D AS3 LR 2

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	4004201
Hospital Revenue Code	390
Min. Negotiated Rate	$197.86
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Cash Price	$608.80
Rate for Payer: Self Pay Self Pay	$608.80

Aph RBC CP2D AS3 LR 2

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	4004201
Hospital Revenue Code	390
Min. Negotiated Rate	$121.76
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Aetna of AZ Medicare	$213.08
Rate for Payer: Allwell Medicare	$121.76
Rate for Payer: Amerigroup Medicare	$121.76
Rate for Payer: APIPA Medicare/Medicaid	$284.23
Rate for Payer: AZCH Complete Medicare	$121.76
Rate for Payer: Banner UC Health Medicare	$121.76
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$517.48
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cigna of AZ Commercial	$494.65
Rate for Payer: Copperpoint Commercial	$188.35
Rate for Payer: Health Net of AZ Commercial	$456.60
Rate for Payer: Health Net of AZ Medicare	$213.08
Rate for Payer: Humana of AZ Medicare	$121.76
Rate for Payer: Self Pay Self Pay	$608.80
Rate for Payer: TriWest Medicare	$121.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$443.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$136.98

apixaban 5 mg Tab UD[CQCH]

Facility

$5.47

Service Code	NDC 3089431
Hospital Charge Code	130114009
Hospital Revenue Code	251
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$4.92
Rate for Payer: Aetna of AZ Commercial	$4.92
Rate for Payer: Aetna of AZ Medicare	$1.53
Rate for Payer: Allwell Medicare	$0.88
Rate for Payer: Amerigroup Medicare	$0.88
Rate for Payer: APIPA Medicare/Medicaid	$2.04
Rate for Payer: AZCH Complete Medicare	$0.88
Rate for Payer: Banner UC Health Medicare	$0.88
Rate for Payer: Bisbee Police All Plans	$1.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.72
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cigna of AZ Commercial	$3.56
Rate for Payer: Copperpoint Commercial	$1.35
Rate for Payer: Health Net of AZ Commercial	$3.28
Rate for Payer: Health Net of AZ Medicare	$1.53
Rate for Payer: Humana of AZ Medicare	$0.88
Rate for Payer: Self Pay Self Pay	$4.38
Rate for Payer: TriWest Medicare	$0.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.98

apixaban 5 mg Tab UD[CQCH]

Facility

$5.47

Service Code	NDC 3089431
Hospital Charge Code	130114009
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$4.92
Rate for Payer: Aetna of AZ Commercial	$4.92
Rate for Payer: Bisbee Police All Plans	$1.42
Rate for Payer: Cash Price	$4.38
Rate for Payer: Self Pay Self Pay	$4.38

APLIGRAF 44 SQ CM

Facility

$3,713.00

Hospital Charge Code	22354189
Hospital Revenue Code	270
Min. Negotiated Rate	$965.38
Max. Negotiated Rate	$3,341.70
Rate for Payer: Aetna of AZ Commercial	$3,341.70
Rate for Payer: Bisbee Police All Plans	$965.38
Rate for Payer: Cash Price	$2,970.40
Rate for Payer: Self Pay Self Pay	$2,970.40

APLIGRAF 44 SQ CM

Facility

$3,713.00

Hospital Charge Code	22354189
Hospital Revenue Code	270
Min. Negotiated Rate	$594.08
Max. Negotiated Rate	$3,341.70
Rate for Payer: Aetna of AZ Commercial	$3,341.70
Rate for Payer: Aetna of AZ Medicare	$1,039.64
Rate for Payer: Allwell Medicare	$594.08
Rate for Payer: Amerigroup Medicare	$594.08
Rate for Payer: APIPA Medicare/Medicaid	$1,386.81
Rate for Payer: AZCH Complete Medicare	$594.08
Rate for Payer: Banner UC Health Medicare	$594.08
Rate for Payer: Bisbee Police All Plans	$965.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,524.84
Rate for Payer: Cash Price	$2,970.40
Rate for Payer: Cigna of AZ Commercial	$2,599.10
Rate for Payer: Copperpoint Commercial	$918.97
Rate for Payer: Health Net of AZ Commercial	$2,227.80
Rate for Payer: Health Net of AZ Medicare	$1,039.64
Rate for Payer: Humana of AZ Medicare	$594.08
Rate for Payer: Self Pay Self Pay	$2,970.40
Rate for Payer: TriWest Medicare	$594.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,164.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$668.34

APLIGRAF, PER SQUARE CENTIMETER

Facility

$164.00

Service Code	CPT Q4101
Hospital Charge Code	24049285
Hospital Revenue Code	636
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Cash Price	$131.20
Rate for Payer: Self Pay Self Pay	$131.20

APLIGRAF, PER SQUARE CENTIMETER

Facility

$164.00

Service Code	CPT Q4101
Hospital Charge Code	24049285
Hospital Revenue Code	636
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Aetna of AZ Medicare	$45.92
Rate for Payer: Allwell Medicare	$26.24
Rate for Payer: Amerigroup Medicare	$26.24
Rate for Payer: APIPA Medicare/Medicaid	$61.25
Rate for Payer: AZCH Complete Medicare	$26.24
Rate for Payer: Banner UC Health Medicare	$26.24
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$111.52
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cigna of AZ Commercial	$114.80
Rate for Payer: Copperpoint Commercial	$40.59
Rate for Payer: Health Net of AZ Commercial	$98.40
Rate for Payer: Health Net of AZ Medicare	$45.92
Rate for Payer: Humana of AZ Medicare	$26.24
Rate for Payer: Self Pay Self Pay	$131.20
Rate for Payer: TriWest Medicare	$26.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.52

APLIGRAPH

Facility

$305.00

Service Code	CPT Q4101
Hospital Charge Code	24358081
Hospital Revenue Code	636
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Aetna of AZ Medicare	$85.40
Rate for Payer: Allwell Medicare	$48.80
Rate for Payer: Amerigroup Medicare	$48.80
Rate for Payer: APIPA Medicare/Medicaid	$113.92
Rate for Payer: AZCH Complete Medicare	$48.80
Rate for Payer: Banner UC Health Medicare	$48.80
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$207.40
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cigna of AZ Commercial	$213.50
Rate for Payer: Copperpoint Commercial	$75.49
Rate for Payer: Health Net of AZ Commercial	$183.00
Rate for Payer: Health Net of AZ Medicare	$85.40
Rate for Payer: Humana of AZ Medicare	$48.80
Rate for Payer: Self Pay Self Pay	$244.00
Rate for Payer: TriWest Medicare	$48.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$177.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.90

APLIGRAPH

Facility

$305.00

Service Code	CPT Q4101
Hospital Charge Code	24358081
Hospital Revenue Code	636
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Cash Price	$244.00
Rate for Payer: Self Pay Self Pay	$244.00

APOLIPOPROTEIN, EACH

Facility

$105.00

Service Code	CPT 82172
Hospital Charge Code	28010052
Hospital Revenue Code	302
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of AZ Commercial	$94.50
Rate for Payer: Bisbee Police All Plans	$27.30
Rate for Payer: Cash Price	$84.00
Rate for Payer: Self Pay Self Pay	$84.00

APOLIPOPROTEIN, EACH

Facility

$105.00

Service Code	CPT 82172
Hospital Charge Code	28010052
Hospital Revenue Code	302
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of AZ Commercial	$94.50
Rate for Payer: Aetna of AZ Medicare	$29.40
Rate for Payer: Allwell Medicare	$16.80
Rate for Payer: Amerigroup Medicare	$16.80
Rate for Payer: APIPA Medicare/Medicaid	$39.22
Rate for Payer: AZCH Complete Medicare	$16.80
Rate for Payer: Banner UC Health Medicare	$16.80
Rate for Payer: Bisbee Police All Plans	$27.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$71.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cigna of AZ Commercial	$68.25
Rate for Payer: Copperpoint Commercial	$25.99
Rate for Payer: Health Net of AZ Commercial	$63.00
Rate for Payer: Health Net of AZ Medicare	$29.40
Rate for Payer: Humana of AZ Medicare	$16.80
Rate for Payer: Self Pay Self Pay	$84.00
Rate for Payer: TriWest Medicare	$16.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.90

Appendectomy With Complex Principal Diagnosis

Facility

$12,458.97

Service Code	APR-DRG 2333
Hospital Charge Code	APRDRG2333
Min. Negotiated Rate	$12,458.97
Max. Negotiated Rate	$12,458.97
Rate for Payer: AHCCCS Medicaid	$12,458.97
Rate for Payer: Allwell Medicaid	$12,458.97
Rate for Payer: AZCH Complete Medicaid	$12,458.97
Rate for Payer: Banner UC Health Medicaid	$12,458.97
Rate for Payer: Mercy Care Medicaid	$12,458.97

Appendectomy With Complex Principal Diagnosis

Facility

$6,466.91

Service Code	APR-DRG 2331
Hospital Charge Code	APRDRG2333
Min. Negotiated Rate	$6,466.91
Max. Negotiated Rate	$6,466.91
Rate for Payer: AHCCCS Medicaid	$6,466.91
Rate for Payer: Allwell Medicaid	$6,466.91
Rate for Payer: AZCH Complete Medicaid	$6,466.91
Rate for Payer: Banner UC Health Medicaid	$6,466.91
Rate for Payer: Mercy Care Medicaid	$6,466.91

Appendectomy With Complex Principal Diagnosis

Facility

$6,466.91

Service Code	APR-DRG 2331
Hospital Charge Code	APRDRG2334
Min. Negotiated Rate	$6,466.91
Max. Negotiated Rate	$6,466.91
Rate for Payer: AHCCCS Medicaid	$6,466.91
Rate for Payer: Allwell Medicaid	$6,466.91
Rate for Payer: AZCH Complete Medicaid	$6,466.91
Rate for Payer: Banner UC Health Medicaid	$6,466.91
Rate for Payer: Mercy Care Medicaid	$6,466.91

Know your out-of-pocket cost for care.

All Charges