Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2031
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: AHCCCS Medicaid	$3,615.02
Rate for Payer: Allwell Medicaid	$3,615.02
Rate for Payer: AZCH Complete Medicaid	$3,615.02
Rate for Payer: Banner UC Health Medicaid	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2032
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: AHCCCS Medicaid	$5,097.07
Rate for Payer: Allwell Medicaid	$5,097.07
Rate for Payer: AZCH Complete Medicaid	$5,097.07
Rate for Payer: Banner UC Health Medicaid	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: AHCCCS Medicaid	$3,615.02
Rate for Payer: Allwell Medicaid	$3,615.02
Rate for Payer: AZCH Complete Medicaid	$3,615.02
Rate for Payer: Banner UC Health Medicaid	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: AHCCCS Medicaid	$5,097.07
Rate for Payer: Allwell Medicaid	$5,097.07
Rate for Payer: AZCH Complete Medicaid	$5,097.07
Rate for Payer: Banner UC Health Medicaid	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07

Chest Pain

Facility

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$7,157.09
Max. Negotiated Rate	$7,157.09
Rate for Payer: AHCCCS Medicaid	$7,157.09
Rate for Payer: Allwell Medicaid	$7,157.09
Rate for Payer: AZCH Complete Medicaid	$7,157.09
Rate for Payer: Banner UC Health Medicaid	$7,157.09
Rate for Payer: Mercy Care Medicaid	$7,157.09

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2032
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: AHCCCS Medicaid	$3,615.02
Rate for Payer: Allwell Medicaid	$3,615.02
Rate for Payer: AZCH Complete Medicaid	$3,615.02
Rate for Payer: Banner UC Health Medicaid	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2031
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: AHCCCS Medicaid	$4,107.40
Rate for Payer: Allwell Medicaid	$4,107.40
Rate for Payer: AZCH Complete Medicaid	$4,107.40
Rate for Payer: Banner UC Health Medicaid	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40

Chest Pain

Facility

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$7,157.09
Max. Negotiated Rate	$7,157.09
Rate for Payer: AHCCCS Medicaid	$7,157.09
Rate for Payer: Allwell Medicaid	$7,157.09
Rate for Payer: AZCH Complete Medicaid	$7,157.09
Rate for Payer: Banner UC Health Medicaid	$7,157.09
Rate for Payer: Mercy Care Medicaid	$7,157.09

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: AHCCCS Medicaid	$5,097.07
Rate for Payer: Allwell Medicaid	$5,097.07
Rate for Payer: AZCH Complete Medicaid	$5,097.07
Rate for Payer: Banner UC Health Medicaid	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: AHCCCS Medicaid	$4,107.40
Rate for Payer: Allwell Medicaid	$4,107.40
Rate for Payer: AZCH Complete Medicaid	$4,107.40
Rate for Payer: Banner UC Health Medicaid	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: AHCCCS Medicaid	$4,107.40
Rate for Payer: Allwell Medicaid	$4,107.40
Rate for Payer: AZCH Complete Medicaid	$4,107.40
Rate for Payer: Banner UC Health Medicaid	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40

CHEST TUBE TRAY INSERTION

Facility

$362.00

Hospital Charge Code	23914674
Hospital Revenue Code	270
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Cash Price	$289.60
Rate for Payer: Self Pay Self Pay	$289.60

CHEST TUBE TRAY INSERTION

Facility

$362.00

Hospital Charge Code	23914674
Hospital Revenue Code	270
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Aetna of AZ Medicare	$101.36
Rate for Payer: Allwell Medicare	$54.30
Rate for Payer: Amerigroup Medicare	$54.30
Rate for Payer: APIPA Medicare/Medicaid	$135.21
Rate for Payer: AZCH Complete Medicare	$54.30
Rate for Payer: Banner UC Health Medicare	$54.30
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.16
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cigna of AZ Commercial	$253.40
Rate for Payer: Copperpoint Commercial	$89.60
Rate for Payer: Health Net of AZ Commercial	$217.20
Rate for Payer: Health Net of AZ Medicare	$101.36
Rate for Payer: Humana of AZ Medicare	$54.30
Rate for Payer: Self Pay Self Pay	$289.60
Rate for Payer: TriWest Medicare	$54.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.16

Chlamydia/GC Amplification LC

Facility

$434.00

Service Code	CPT 87491
Hospital Charge Code	1285827
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Aetna of AZ Medicare	$121.52
Rate for Payer: AHCCCS Medicaid	$35.09
Rate for Payer: Allwell Medicaid	$35.09
Rate for Payer: Allwell Medicare	$65.10
Rate for Payer: Amerigroup Medicare	$65.10
Rate for Payer: APIPA Medicare/Medicaid	$162.10
Rate for Payer: AZCH Complete Medicaid	$35.09
Rate for Payer: AZCH Complete Medicare	$65.10
Rate for Payer: Banner UC Health Medicaid	$35.09
Rate for Payer: Banner UC Health Medicare	$65.10
Rate for Payer: Bisbee Police All Plans	$112.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$295.12
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cigna of AZ Commercial	$282.10
Rate for Payer: Copperpoint Commercial	$107.42
Rate for Payer: Health Net of AZ Commercial	$260.40
Rate for Payer: Health Net of AZ Medicare	$121.52
Rate for Payer: Humana of AZ Medicare	$65.10
Rate for Payer: Mercy Care Medicaid	$35.09
Rate for Payer: Self Pay Self Pay	$347.20
Rate for Payer: TriWest Medicare	$65.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$253.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$78.12

Chlamydia/GC Amplification LC

Facility

$434.00

Service Code	CPT 87491
Hospital Charge Code	1285827
Hospital Revenue Code	300
Min. Negotiated Rate	$112.84
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Bisbee Police All Plans	$112.84
Rate for Payer: Cash Price	$347.20
Rate for Payer: Self Pay Self Pay	$347.20

Chlamydia trachomatis, NAA LC

Facility

$434.00

Service Code	CPT 87491
Hospital Charge Code	7314701
Hospital Revenue Code	300
Min. Negotiated Rate	$112.84
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Bisbee Police All Plans	$112.84
Rate for Payer: Cash Price	$347.20
Rate for Payer: Self Pay Self Pay	$347.20

Chlamydia trachomatis, NAA LC

Facility

$434.00

Service Code	CPT 87491
Hospital Charge Code	7314701
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Aetna of AZ Medicare	$121.52
Rate for Payer: AHCCCS Medicaid	$35.09
Rate for Payer: Allwell Medicaid	$35.09
Rate for Payer: Allwell Medicare	$65.10
Rate for Payer: Amerigroup Medicare	$65.10
Rate for Payer: APIPA Medicare/Medicaid	$162.10
Rate for Payer: AZCH Complete Medicaid	$35.09
Rate for Payer: AZCH Complete Medicare	$65.10
Rate for Payer: Banner UC Health Medicaid	$35.09
Rate for Payer: Banner UC Health Medicare	$65.10
Rate for Payer: Bisbee Police All Plans	$112.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$295.12
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cigna of AZ Commercial	$282.10
Rate for Payer: Copperpoint Commercial	$107.42
Rate for Payer: Health Net of AZ Commercial	$260.40
Rate for Payer: Health Net of AZ Medicare	$121.52
Rate for Payer: Humana of AZ Medicare	$65.10
Rate for Payer: Mercy Care Medicaid	$35.09
Rate for Payer: Self Pay Self Pay	$347.20
Rate for Payer: TriWest Medicare	$65.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$253.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$78.12

CHLORAPREP APPLICATOR 10.5ML ORANGE

Facility

$20.00

Hospital Charge Code	23891147
Hospital Revenue Code	270
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.00
Rate for Payer: Amerigroup Medicare	$3.00
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.00
Rate for Payer: Banner UC Health Medicare	$3.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.00
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

CHLORAPREP APPLICATOR 10.5ML ORANGE

Facility

$20.00

Hospital Charge Code	23891147
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

CHLORAPREP SKIN PREP 26ML

Facility

$44.00

Hospital Charge Code	22355403
Hospital Revenue Code	270
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

CHLORAPREP SKIN PREP 26ML

Facility

$44.00

Hospital Charge Code	22355403
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$6.60
Rate for Payer: Amerigroup Medicare	$6.60
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$6.60
Rate for Payer: Banner UC Health Medicare	$6.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$6.60
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$6.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

chlordiazePOXIDE 25 mg Cap [CQCH]

Facility

$0.52

Service Code	NDC 555015902
Hospital Charge Code	105916113
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of AZ Commercial	$0.47
Rate for Payer: Bisbee Police All Plans	$0.14
Rate for Payer: Cash Price	$0.42
Rate for Payer: Self Pay Self Pay	$0.42

chlordiazePOXIDE 25 mg Cap [CQCH]

Facility

$0.52

Service Code	NDC 555015902
Hospital Charge Code	105916113
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of AZ Commercial	$0.47
Rate for Payer: Aetna of AZ Medicare	$0.15
Rate for Payer: Allwell Medicare	$0.08
Rate for Payer: Amerigroup Medicare	$0.08
Rate for Payer: APIPA Medicare/Medicaid	$0.19
Rate for Payer: AZCH Complete Medicare	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Bisbee Police All Plans	$0.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.35
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of AZ Commercial	$0.34
Rate for Payer: Copperpoint Commercial	$0.13
Rate for Payer: Health Net of AZ Commercial	$0.31
Rate for Payer: Health Net of AZ Medicare	$0.15
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Self Pay Self Pay	$0.42
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.09

Chloride Level

Facility

$75.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Cash Price	$60.00
Rate for Payer: Self Pay Self Pay	$60.00

Chloride Level

Facility

$75.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Aetna of AZ Medicare	$21.00
Rate for Payer: AHCCCS Medicaid	$4.60
Rate for Payer: Allwell Medicaid	$4.60
Rate for Payer: Allwell Medicare	$11.25
Rate for Payer: Amerigroup Medicare	$11.25
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicaid	$4.60
Rate for Payer: AZCH Complete Medicare	$11.25
Rate for Payer: Banner UC Health Medicaid	$4.60
Rate for Payer: Banner UC Health Medicare	$11.25
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$48.75
Rate for Payer: Copperpoint Commercial	$18.56
Rate for Payer: Health Net of AZ Commercial	$45.00
Rate for Payer: Health Net of AZ Medicare	$21.00
Rate for Payer: Humana of AZ Medicare	$11.25
Rate for Payer: Mercy Care Medicaid	$4.60
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$11.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

Know your out-of-pocket cost for care.

All Charges