Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Appendectomy Without Complex Principal Diagnosis

Facility

$20,453.53

Service Code	APR-DRG 2344
Hospital Charge Code	APRDRG2342
Min. Negotiated Rate	$20,453.53
Max. Negotiated Rate	$20,453.53
Rate for Payer: AHCCCS Medicaid	$20,453.53
Rate for Payer: Allwell Medicaid	$20,453.53
Rate for Payer: AZCH Complete Medicaid	$20,453.53
Rate for Payer: Banner UC Health Medicaid	$20,453.53
Rate for Payer: Mercy Care Medicaid	$20,453.53

Appendectomy Without Complex Principal Diagnosis

Facility

$5,804.79

Service Code	APR-DRG 2341
Hospital Charge Code	APRDRG2344
Min. Negotiated Rate	$5,804.79
Max. Negotiated Rate	$5,804.79
Rate for Payer: AHCCCS Medicaid	$5,804.79
Rate for Payer: Allwell Medicaid	$5,804.79
Rate for Payer: AZCH Complete Medicaid	$5,804.79
Rate for Payer: Banner UC Health Medicaid	$5,804.79
Rate for Payer: Mercy Care Medicaid	$5,804.79

Appendectomy Without Complex Principal Diagnosis

Facility

$7,213.20

Service Code	APR-DRG 2342
Hospital Charge Code	APRDRG2343
Min. Negotiated Rate	$7,213.20
Max. Negotiated Rate	$7,213.20
Rate for Payer: AHCCCS Medicaid	$7,213.20
Rate for Payer: Allwell Medicaid	$7,213.20
Rate for Payer: AZCH Complete Medicaid	$7,213.20
Rate for Payer: Banner UC Health Medicaid	$7,213.20
Rate for Payer: Mercy Care Medicaid	$7,213.20

Appendectomy Without Complex Principal Diagnosis

Facility

$7,213.20

Service Code	APR-DRG 2342
Hospital Charge Code	APRDRG2341
Min. Negotiated Rate	$7,213.20
Max. Negotiated Rate	$7,213.20
Rate for Payer: AHCCCS Medicaid	$7,213.20
Rate for Payer: Allwell Medicaid	$7,213.20
Rate for Payer: AZCH Complete Medicaid	$7,213.20
Rate for Payer: Banner UC Health Medicaid	$7,213.20
Rate for Payer: Mercy Care Medicaid	$7,213.20

APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS

Facility

$4,586.00

Service Code	CPT 15275
Hospital Charge Code	23922976
Hospital Revenue Code	761
Min. Negotiated Rate	$1,192.36
Max. Negotiated Rate	$4,127.40
Rate for Payer: Aetna of AZ Commercial	$4,127.40
Rate for Payer: Bisbee Police All Plans	$1,192.36
Rate for Payer: Cash Price	$3,668.80
Rate for Payer: Self Pay Self Pay	$3,668.80

APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS

Facility

$4,586.00

Service Code	CPT 15275
Hospital Charge Code	23922976
Hospital Revenue Code	761
Min. Negotiated Rate	$733.76
Max. Negotiated Rate	$4,127.40
Rate for Payer: Aetna of AZ Commercial	$4,127.40
Rate for Payer: Aetna of AZ Medicare	$1,284.08
Rate for Payer: AHCCCS Medicaid	$1,243.64
Rate for Payer: Allwell Medicaid	$1,243.64
Rate for Payer: Allwell Medicare	$733.76
Rate for Payer: Amerigroup Medicare	$733.76
Rate for Payer: APIPA Medicare/Medicaid	$1,712.87
Rate for Payer: AZCH Complete Medicaid	$1,243.64
Rate for Payer: AZCH Complete Medicare	$733.76
Rate for Payer: Banner UC Health Medicaid	$1,243.64
Rate for Payer: Banner UC Health Medicare	$733.76
Rate for Payer: Bisbee Police All Plans	$1,192.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,118.48
Rate for Payer: Cash Price	$3,668.80
Rate for Payer: Cash Price	$3,668.80
Rate for Payer: Cigna of AZ Commercial	$3,210.20
Rate for Payer: Copperpoint Commercial	$1,135.04
Rate for Payer: Health Net of AZ Commercial	$2,751.60
Rate for Payer: Health Net of AZ Medicare	$1,284.08
Rate for Payer: Humana of AZ Medicare	$733.76
Rate for Payer: Mercy Care Medicaid	$1,243.64
Rate for Payer: Self Pay Self Pay	$3,668.80
Rate for Payer: TriWest Medicare	$733.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$825.48

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, T

Facility

$586.00

Service Code	CPT 15273
Hospital Charge Code	24049290
Hospital Revenue Code	760
Min. Negotiated Rate	$93.76
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$527.40
Rate for Payer: Aetna of AZ Medicare	$164.08
Rate for Payer: AHCCCS Medicaid	$2,553.56
Rate for Payer: Allwell Medicaid	$2,553.56
Rate for Payer: Allwell Medicare	$93.76
Rate for Payer: Amerigroup Medicare	$93.76
Rate for Payer: APIPA Medicare/Medicaid	$218.87
Rate for Payer: AZCH Complete Medicaid	$2,553.56
Rate for Payer: AZCH Complete Medicare	$93.76
Rate for Payer: Banner UC Health Medicaid	$2,553.56
Rate for Payer: Banner UC Health Medicare	$93.76
Rate for Payer: Bisbee Police All Plans	$152.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$398.48
Rate for Payer: Cash Price	$468.80
Rate for Payer: Cash Price	$468.80
Rate for Payer: Cigna of AZ Commercial	$410.20
Rate for Payer: Copperpoint Commercial	$145.03
Rate for Payer: Health Net of AZ Commercial	$351.60
Rate for Payer: Health Net of AZ Medicare	$164.08
Rate for Payer: Humana of AZ Medicare	$93.76
Rate for Payer: Mercy Care Medicaid	$2,553.56
Rate for Payer: Self Pay Self Pay	$468.80
Rate for Payer: TriWest Medicare	$93.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$105.48

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, T

Facility

$4,586.00

Service Code	CPT 15271
Hospital Charge Code	23922975
Hospital Revenue Code	761
Min. Negotiated Rate	$733.76
Max. Negotiated Rate	$4,127.40
Rate for Payer: Aetna of AZ Commercial	$4,127.40
Rate for Payer: Aetna of AZ Medicare	$1,284.08
Rate for Payer: AHCCCS Medicaid	$1,243.64
Rate for Payer: Allwell Medicaid	$1,243.64
Rate for Payer: Allwell Medicare	$733.76
Rate for Payer: Amerigroup Medicare	$733.76
Rate for Payer: APIPA Medicare/Medicaid	$1,712.87
Rate for Payer: AZCH Complete Medicaid	$1,243.64
Rate for Payer: AZCH Complete Medicare	$733.76
Rate for Payer: Banner UC Health Medicaid	$1,243.64
Rate for Payer: Banner UC Health Medicare	$733.76
Rate for Payer: Bisbee Police All Plans	$1,192.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,118.48
Rate for Payer: Cash Price	$3,668.80
Rate for Payer: Cash Price	$3,668.80
Rate for Payer: Cigna of AZ Commercial	$3,210.20
Rate for Payer: Copperpoint Commercial	$1,135.04
Rate for Payer: Health Net of AZ Commercial	$2,751.60
Rate for Payer: Health Net of AZ Medicare	$1,284.08
Rate for Payer: Humana of AZ Medicare	$733.76
Rate for Payer: Mercy Care Medicaid	$1,243.64
Rate for Payer: Self Pay Self Pay	$3,668.80
Rate for Payer: TriWest Medicare	$733.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$825.48

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, T

Facility

$4,586.00

Service Code	CPT 15271
Hospital Charge Code	23922975
Hospital Revenue Code	761
Min. Negotiated Rate	$1,192.36
Max. Negotiated Rate	$4,127.40
Rate for Payer: Aetna of AZ Commercial	$4,127.40
Rate for Payer: Bisbee Police All Plans	$1,192.36
Rate for Payer: Cash Price	$3,668.80
Rate for Payer: Self Pay Self Pay	$3,668.80

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, T

Facility

$586.00

Service Code	CPT 15273
Hospital Charge Code	24049290
Hospital Revenue Code	760
Min. Negotiated Rate	$152.36
Max. Negotiated Rate	$527.40
Rate for Payer: Aetna of AZ Commercial	$527.40
Rate for Payer: Bisbee Police All Plans	$152.36
Rate for Payer: Cash Price	$468.80
Rate for Payer: Self Pay Self Pay	$468.80

AP with culdoplasty

Facility

$4,525.00

Service Code	CPT 57265
Hospital Charge Code	27291785
Hospital Revenue Code	360
Min. Negotiated Rate	$1,176.50
Max. Negotiated Rate	$4,072.50
Rate for Payer: Aetna of AZ Commercial	$4,072.50
Rate for Payer: Bisbee Police All Plans	$1,176.50
Rate for Payer: Cash Price	$3,620.00
Rate for Payer: Self Pay Self Pay	$3,620.00

AP with culdoplasty

Facility

$4,525.00

Service Code	CPT 57265
Hospital Charge Code	27291785
Hospital Revenue Code	360
Min. Negotiated Rate	$724.00
Max. Negotiated Rate	$4,072.50
Rate for Payer: Aetna of AZ Commercial	$4,072.50
Rate for Payer: Aetna of AZ Medicare	$1,267.00
Rate for Payer: AHCCCS Medicaid	$3,196.92
Rate for Payer: Allwell Medicaid	$3,196.92
Rate for Payer: Allwell Medicare	$724.00
Rate for Payer: Amerigroup Medicare	$724.00
Rate for Payer: APIPA Medicare/Medicaid	$1,690.09
Rate for Payer: AZCH Complete Medicaid	$3,196.92
Rate for Payer: AZCH Complete Medicare	$724.00
Rate for Payer: Banner UC Health Medicaid	$3,196.92
Rate for Payer: Banner UC Health Medicare	$724.00
Rate for Payer: Bisbee Police All Plans	$1,176.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,077.00
Rate for Payer: Cash Price	$3,620.00
Rate for Payer: Cash Price	$3,620.00
Rate for Payer: Cigna of AZ Commercial	$2,262.50
Rate for Payer: Copperpoint Commercial	$1,119.94
Rate for Payer: Health Net of AZ Commercial	$2,715.00
Rate for Payer: Health Net of AZ Medicare	$1,267.00
Rate for Payer: Humana of AZ Medicare	$724.00
Rate for Payer: Mercy Care Medicaid	$3,196.92
Rate for Payer: Self Pay Self Pay	$3,620.00
Rate for Payer: TriWest Medicare	$724.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,638.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$814.50

ARM4 ANORECTAL CATHETER

Facility

$695.00

Hospital Charge Code	27773233
Hospital Revenue Code	270
Min. Negotiated Rate	$111.20
Max. Negotiated Rate	$625.50
Rate for Payer: Aetna of AZ Commercial	$625.50
Rate for Payer: Aetna of AZ Medicare	$194.60
Rate for Payer: Allwell Medicare	$111.20
Rate for Payer: Amerigroup Medicare	$111.20
Rate for Payer: APIPA Medicare/Medicaid	$259.58
Rate for Payer: AZCH Complete Medicare	$111.20
Rate for Payer: Banner UC Health Medicare	$111.20
Rate for Payer: Bisbee Police All Plans	$180.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$472.60
Rate for Payer: Cash Price	$556.00
Rate for Payer: Cigna of AZ Commercial	$486.50
Rate for Payer: Copperpoint Commercial	$172.01
Rate for Payer: Health Net of AZ Commercial	$417.00
Rate for Payer: Health Net of AZ Medicare	$194.60
Rate for Payer: Humana of AZ Medicare	$111.20
Rate for Payer: Self Pay Self Pay	$556.00
Rate for Payer: TriWest Medicare	$111.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$405.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$125.10

ARM4 ANORECTAL CATHETER

Facility

$695.00

Hospital Charge Code	27773233
Hospital Revenue Code	270
Min. Negotiated Rate	$180.70
Max. Negotiated Rate	$625.50
Rate for Payer: Aetna of AZ Commercial	$625.50
Rate for Payer: Bisbee Police All Plans	$180.70
Rate for Payer: Cash Price	$556.00
Rate for Payer: Self Pay Self Pay	$556.00

ARMBOARD INFANT NEONATAL

Facility

$42.00

Hospital Charge Code	22543301
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

ARMBOARD INFANT NEONATAL

Facility

$42.00

Hospital Charge Code	22543301
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

ARSENIC BLOOD

Facility

$314.00

Service Code	CPT 82175
Hospital Charge Code	22481463
Hospital Revenue Code	301
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$282.60
Rate for Payer: Aetna of AZ Commercial	$282.60
Rate for Payer: Aetna of AZ Medicare	$87.92
Rate for Payer: Allwell Medicare	$50.24
Rate for Payer: Amerigroup Medicare	$50.24
Rate for Payer: APIPA Medicare/Medicaid	$117.28
Rate for Payer: AZCH Complete Medicare	$50.24
Rate for Payer: Banner UC Health Medicare	$50.24
Rate for Payer: Bisbee Police All Plans	$81.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$213.52
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cigna of AZ Commercial	$204.10
Rate for Payer: Copperpoint Commercial	$77.72
Rate for Payer: Health Net of AZ Commercial	$188.40
Rate for Payer: Health Net of AZ Medicare	$87.92
Rate for Payer: Humana of AZ Medicare	$50.24
Rate for Payer: Self Pay Self Pay	$251.20
Rate for Payer: TriWest Medicare	$50.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$183.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$56.52

ARSENIC BLOOD

Facility

$314.00

Service Code	CPT 82175
Hospital Charge Code	22481463
Hospital Revenue Code	301
Min. Negotiated Rate	$81.64
Max. Negotiated Rate	$282.60
Rate for Payer: Aetna of AZ Commercial	$282.60
Rate for Payer: Bisbee Police All Plans	$81.64
Rate for Payer: Cash Price	$251.20
Rate for Payer: Self Pay Self Pay	$251.20

Arsenic, Blood LC

Facility

$290.00

Service Code	CPT 82175
Hospital Charge Code	1285590
Hospital Revenue Code	301
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Aetna of AZ Medicare	$81.20
Rate for Payer: Allwell Medicare	$46.40
Rate for Payer: Amerigroup Medicare	$46.40
Rate for Payer: APIPA Medicare/Medicaid	$108.31
Rate for Payer: AZCH Complete Medicare	$46.40
Rate for Payer: Banner UC Health Medicare	$46.40
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$197.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$188.50
Rate for Payer: Copperpoint Commercial	$71.78
Rate for Payer: Health Net of AZ Commercial	$174.00
Rate for Payer: Health Net of AZ Medicare	$81.20
Rate for Payer: Humana of AZ Medicare	$46.40
Rate for Payer: Self Pay Self Pay	$232.00
Rate for Payer: TriWest Medicare	$46.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$169.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.20

Arsenic, Blood LC

Facility

$290.00

Service Code	CPT 82175
Hospital Charge Code	1285590
Hospital Revenue Code	301
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Self Pay Self Pay	$232.00

.Arsenic, Comment LC

Facility

$299.00

Service Code	CPT 82175
Hospital Charge Code	22311133
Hospital Revenue Code	301
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Aetna of AZ Medicare	$83.72
Rate for Payer: Allwell Medicare	$47.84
Rate for Payer: Amerigroup Medicare	$47.84
Rate for Payer: APIPA Medicare/Medicaid	$111.68
Rate for Payer: AZCH Complete Medicare	$47.84
Rate for Payer: Banner UC Health Medicare	$47.84
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$203.32
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cigna of AZ Commercial	$194.35
Rate for Payer: Copperpoint Commercial	$74.00
Rate for Payer: Health Net of AZ Commercial	$179.40
Rate for Payer: Health Net of AZ Medicare	$83.72
Rate for Payer: Humana of AZ Medicare	$47.84
Rate for Payer: Self Pay Self Pay	$239.20
Rate for Payer: TriWest Medicare	$47.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.82

.Arsenic, Comment LC

Facility

$299.00

Service Code	CPT 82175
Hospital Charge Code	22311133
Hospital Revenue Code	301
Min. Negotiated Rate	$77.74
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Cash Price	$239.20
Rate for Payer: Self Pay Self Pay	$239.20

Arterial Blood Gas

Facility

$322.00

Service Code	CPT 82803
Hospital Charge Code	22521717
Hospital Revenue Code	301
Min. Negotiated Rate	$51.52
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna of AZ Commercial	$289.80
Rate for Payer: Aetna of AZ Medicare	$90.16
Rate for Payer: Allwell Medicare	$51.52
Rate for Payer: Amerigroup Medicare	$51.52
Rate for Payer: APIPA Medicare/Medicaid	$120.27
Rate for Payer: AZCH Complete Medicare	$51.52
Rate for Payer: Banner UC Health Medicare	$51.52
Rate for Payer: Bisbee Police All Plans	$83.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$218.96
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cigna of AZ Commercial	$209.30
Rate for Payer: Copperpoint Commercial	$79.69
Rate for Payer: Health Net of AZ Commercial	$193.20
Rate for Payer: Health Net of AZ Medicare	$90.16
Rate for Payer: Humana of AZ Medicare	$51.52
Rate for Payer: Self Pay Self Pay	$257.60
Rate for Payer: TriWest Medicare	$51.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$187.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.96

Arterial Blood Gas

Facility

$322.00

Service Code	CPT 82803
Hospital Charge Code	22521717
Hospital Revenue Code	301
Min. Negotiated Rate	$83.72
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna of AZ Commercial	$289.80
Rate for Payer: Bisbee Police All Plans	$83.72
Rate for Payer: Cash Price	$257.60
Rate for Payer: Self Pay Self Pay	$257.60

Arterial Blood Gas Standard

Facility

$306.00

Service Code	CPT 82803
Hospital Charge Code	22146116
Hospital Revenue Code	301
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$275.40
Rate for Payer: Aetna of AZ Commercial	$275.40
Rate for Payer: Bisbee Police All Plans	$79.56
Rate for Payer: Cash Price	$244.80
Rate for Payer: Self Pay Self Pay	$244.80

Know your out-of-pocket cost for care.

All Charges