Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PR

Facility

$307.00

Service Code	CPT 11755
Hospital Charge Code	24049514
Hospital Revenue Code	360
Min. Negotiated Rate	$46.05
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$276.30
Rate for Payer: Aetna of AZ Medicare	$85.96
Rate for Payer: AHCCCS Medicaid	$901.86
Rate for Payer: Allwell Medicaid	$901.86
Rate for Payer: Allwell Medicare	$46.05
Rate for Payer: Amerigroup Medicare	$46.05
Rate for Payer: APIPA Medicare/Medicaid	$114.66
Rate for Payer: AZCH Complete Medicaid	$901.86
Rate for Payer: AZCH Complete Medicare	$46.05
Rate for Payer: Banner UC Health Medicaid	$901.86
Rate for Payer: Banner UC Health Medicare	$46.05
Rate for Payer: Bisbee Police All Plans	$79.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$208.76
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cigna of AZ Commercial	$153.50
Rate for Payer: Copperpoint Commercial	$75.98
Rate for Payer: Health Net of AZ Commercial	$184.20
Rate for Payer: Health Net of AZ Medicare	$85.96
Rate for Payer: Humana of AZ Medicare	$46.05
Rate for Payer: Mercy Care Medicaid	$901.86
Rate for Payer: Self Pay Self Pay	$245.60
Rate for Payer: TriWest Medicare	$46.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.26

BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL U

Facility

$3,325.00

Service Code	CPT 43239
Hospital Charge Code	23598978
Hospital Revenue Code	750
Min. Negotiated Rate	$498.75
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna of AZ Commercial	$2,992.50
Rate for Payer: Aetna of AZ Medicare	$931.00
Rate for Payer: AHCCCS Medicaid	$1,173.92
Rate for Payer: Allwell Medicaid	$1,173.92
Rate for Payer: Allwell Medicare	$498.75
Rate for Payer: Amerigroup Medicare	$498.75
Rate for Payer: APIPA Medicare/Medicaid	$1,241.89
Rate for Payer: AZCH Complete Medicaid	$1,173.92
Rate for Payer: AZCH Complete Medicare	$498.75
Rate for Payer: Banner UC Health Medicaid	$1,173.92
Rate for Payer: Banner UC Health Medicare	$498.75
Rate for Payer: Bisbee Police All Plans	$864.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,261.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cigna of AZ Commercial	$2,327.50
Rate for Payer: Copperpoint Commercial	$822.94
Rate for Payer: Health Net of AZ Commercial	$1,995.00
Rate for Payer: Health Net of AZ Medicare	$931.00
Rate for Payer: Humana of AZ Medicare	$498.75
Rate for Payer: Mercy Care Medicaid	$1,173.92
Rate for Payer: Self Pay Self Pay	$2,660.00
Rate for Payer: TriWest Medicare	$498.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$598.50

BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL U

Facility

$3,325.00

Service Code	CPT 43239
Hospital Charge Code	23598978
Hospital Revenue Code	750
Min. Negotiated Rate	$864.50
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna of AZ Commercial	$2,992.50
Rate for Payer: Bisbee Police All Plans	$864.50
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Self Pay Self Pay	$2,660.00

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION

Facility

$1,236.00

Service Code	CPT 56605
Hospital Charge Code	22729650
Hospital Revenue Code	360
Min. Negotiated Rate	$185.40
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$1,112.40
Rate for Payer: Aetna of AZ Medicare	$346.08
Rate for Payer: AHCCCS Medicaid	$918.44
Rate for Payer: Allwell Medicaid	$918.44
Rate for Payer: Allwell Medicare	$185.40
Rate for Payer: Amerigroup Medicare	$185.40
Rate for Payer: APIPA Medicare/Medicaid	$461.65
Rate for Payer: AZCH Complete Medicaid	$918.44
Rate for Payer: AZCH Complete Medicare	$185.40
Rate for Payer: Banner UC Health Medicaid	$918.44
Rate for Payer: Banner UC Health Medicare	$185.40
Rate for Payer: Bisbee Police All Plans	$321.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$840.48
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cigna of AZ Commercial	$618.00
Rate for Payer: Copperpoint Commercial	$305.91
Rate for Payer: Health Net of AZ Commercial	$741.60
Rate for Payer: Health Net of AZ Medicare	$346.08
Rate for Payer: Humana of AZ Medicare	$185.40
Rate for Payer: Mercy Care Medicaid	$918.44
Rate for Payer: Self Pay Self Pay	$988.80
Rate for Payer: TriWest Medicare	$185.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$222.48

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION

Facility

$1,236.00

Service Code	CPT 56605
Hospital Charge Code	22729650
Hospital Revenue Code	360
Min. Negotiated Rate	$321.36
Max. Negotiated Rate	$1,112.40
Rate for Payer: Aetna of AZ Commercial	$1,112.40
Rate for Payer: Bisbee Police All Plans	$321.36
Rate for Payer: Cash Price	$988.80
Rate for Payer: Self Pay Self Pay	$988.80

BIPAP SET-UP

Facility

$4,256.00

Service Code	CPT 94002
Hospital Charge Code	1886931
Hospital Revenue Code	410
Min. Negotiated Rate	$638.40
Max. Negotiated Rate	$3,830.40
Rate for Payer: Aetna of AZ Commercial	$3,830.40
Rate for Payer: Aetna of AZ Medicare	$1,191.68
Rate for Payer: AHCCCS Medicaid	$703.62
Rate for Payer: Allwell Medicaid	$703.62
Rate for Payer: Allwell Medicare	$638.40
Rate for Payer: Amerigroup Medicare	$638.40
Rate for Payer: APIPA Medicare/Medicaid	$1,589.62
Rate for Payer: AZCH Complete Medicaid	$703.62
Rate for Payer: AZCH Complete Medicare	$638.40
Rate for Payer: Banner UC Health Medicaid	$703.62
Rate for Payer: Banner UC Health Medicare	$638.40
Rate for Payer: Bisbee Police All Plans	$1,106.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,894.08
Rate for Payer: Cash Price	$3,404.80
Rate for Payer: Cash Price	$3,404.80
Rate for Payer: Cigna of AZ Commercial	$2,979.20
Rate for Payer: Copperpoint Commercial	$1,053.36
Rate for Payer: Health Net of AZ Commercial	$2,553.60
Rate for Payer: Health Net of AZ Medicare	$1,191.68
Rate for Payer: Humana of AZ Medicare	$638.40
Rate for Payer: Mercy Care Medicaid	$703.62
Rate for Payer: Self Pay Self Pay	$3,404.80
Rate for Payer: TriWest Medicare	$638.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,481.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$766.08

BIPAP SET-UP

Facility

$4,256.00

Service Code	CPT 94002
Hospital Charge Code	1886931
Hospital Revenue Code	410
Min. Negotiated Rate	$1,106.56
Max. Negotiated Rate	$3,830.40
Rate for Payer: Aetna of AZ Commercial	$3,830.40
Rate for Payer: Bisbee Police All Plans	$1,106.56
Rate for Payer: Cash Price	$3,404.80
Rate for Payer: Self Pay Self Pay	$3,404.80

BIPAP SUBSEQUENT DAY

Facility

$3,001.00

Service Code	CPT 94003
Hospital Charge Code	1886932
Hospital Revenue Code	410
Min. Negotiated Rate	$780.26
Max. Negotiated Rate	$2,700.90
Rate for Payer: Aetna of AZ Commercial	$2,700.90
Rate for Payer: Bisbee Police All Plans	$780.26
Rate for Payer: Cash Price	$2,400.80
Rate for Payer: Self Pay Self Pay	$2,400.80

BIPAP SUBSEQUENT DAY

Facility

$3,001.00

Service Code	CPT 94003
Hospital Charge Code	1886932
Hospital Revenue Code	410
Min. Negotiated Rate	$450.15
Max. Negotiated Rate	$2,700.90
Rate for Payer: Aetna of AZ Commercial	$2,700.90
Rate for Payer: Aetna of AZ Medicare	$840.28
Rate for Payer: AHCCCS Medicaid	$703.62
Rate for Payer: Allwell Medicaid	$703.62
Rate for Payer: Allwell Medicare	$450.15
Rate for Payer: Amerigroup Medicare	$450.15
Rate for Payer: APIPA Medicare/Medicaid	$1,120.87
Rate for Payer: AZCH Complete Medicaid	$703.62
Rate for Payer: AZCH Complete Medicare	$450.15
Rate for Payer: Banner UC Health Medicaid	$703.62
Rate for Payer: Banner UC Health Medicare	$450.15
Rate for Payer: Bisbee Police All Plans	$780.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,040.68
Rate for Payer: Cash Price	$2,400.80
Rate for Payer: Cash Price	$2,400.80
Rate for Payer: Cigna of AZ Commercial	$2,100.70
Rate for Payer: Copperpoint Commercial	$742.75
Rate for Payer: Health Net of AZ Commercial	$1,800.60
Rate for Payer: Health Net of AZ Medicare	$840.28
Rate for Payer: Humana of AZ Medicare	$450.15
Rate for Payer: Mercy Care Medicaid	$703.62
Rate for Payer: Self Pay Self Pay	$2,400.80
Rate for Payer: TriWest Medicare	$450.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,749.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$540.18

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: AHCCCS Medicaid	$2,662.51
Rate for Payer: Allwell Medicaid	$2,662.51
Rate for Payer: AZCH Complete Medicaid	$2,662.51
Rate for Payer: Banner UC Health Medicaid	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: AHCCCS Medicaid	$3,659.91
Rate for Payer: Allwell Medicaid	$3,659.91
Rate for Payer: AZCH Complete Medicaid	$3,659.91
Rate for Payer: Banner UC Health Medicaid	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: AHCCCS Medicaid	$6,434.64
Rate for Payer: Allwell Medicaid	$6,434.64
Rate for Payer: AZCH Complete Medicaid	$6,434.64
Rate for Payer: Banner UC Health Medicaid	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: AHCCCS Medicaid	$12,588.03
Rate for Payer: Allwell Medicaid	$12,588.03
Rate for Payer: AZCH Complete Medicaid	$12,588.03
Rate for Payer: Banner UC Health Medicaid	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03

Know your out-of-pocket cost for care.

All Charges