Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

$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

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2032
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	APRDRG2031
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

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2032
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	APRDRG2033
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

$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

$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

Chlamydia/GC Amplification LC

Facility

$412.00

Service Code	CPT 87491
Hospital Charge Code	1285827
Hospital Revenue Code	300
Min. Negotiated Rate	$65.92
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Aetna of AZ Medicare	$115.36
Rate for Payer: Allwell Medicare	$65.92
Rate for Payer: Amerigroup Medicare	$65.92
Rate for Payer: APIPA Medicare/Medicaid	$153.88
Rate for Payer: AZCH Complete Medicare	$65.92
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Bisbee Police All Plans	$107.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$280.16
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cigna of AZ Commercial	$267.80
Rate for Payer: Copperpoint Commercial	$101.97
Rate for Payer: Health Net of AZ Commercial	$247.20
Rate for Payer: Health Net of AZ Medicare	$115.36
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Self Pay Self Pay	$329.60
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$240.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$74.16

Chlamydia/GC Amplification LC

Facility

$412.00

Service Code	CPT 87491
Hospital Charge Code	1285827
Hospital Revenue Code	300
Min. Negotiated Rate	$107.12
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Bisbee Police All Plans	$107.12
Rate for Payer: Cash Price	$329.60
Rate for Payer: Self Pay Self Pay	$329.60

Chlamydia trachomatis, NAA LC

Facility

$412.00

Service Code	CPT 87491
Hospital Charge Code	7314701
Hospital Revenue Code	300
Min. Negotiated Rate	$107.12
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Bisbee Police All Plans	$107.12
Rate for Payer: Cash Price	$329.60
Rate for Payer: Self Pay Self Pay	$329.60

Chlamydia trachomatis, NAA LC

Facility

$412.00

Service Code	CPT 87491
Hospital Charge Code	7314701
Hospital Revenue Code	300
Min. Negotiated Rate	$65.92
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Aetna of AZ Medicare	$115.36
Rate for Payer: Allwell Medicare	$65.92
Rate for Payer: Amerigroup Medicare	$65.92
Rate for Payer: APIPA Medicare/Medicaid	$153.88
Rate for Payer: AZCH Complete Medicare	$65.92
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Bisbee Police All Plans	$107.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$280.16
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cigna of AZ Commercial	$267.80
Rate for Payer: Copperpoint Commercial	$101.97
Rate for Payer: Health Net of AZ Commercial	$247.20
Rate for Payer: Health Net of AZ Medicare	$115.36
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Self Pay Self Pay	$329.60
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$240.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$74.16

CHLORAPREP SKIN PREP 26ML

Facility

$44.00

Hospital Charge Code	22355403
Hospital Revenue Code	270
Min. Negotiated Rate	$7.04
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	$7.04
Rate for Payer: Amerigroup Medicare	$7.04
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$7.04
Rate for Payer: Banner UC Health Medicare	$7.04
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	$7.04
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$7.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

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

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

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

Chloride Level

Facility

$75.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$12.00
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: Allwell Medicare	$12.00
Rate for Payer: Amerigroup Medicare	$12.00
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicare	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
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: 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	$12.00
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

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 URIN

Facility

$71.00

Service Code	CPT 82436
Hospital Charge Code	22481466
Hospital Revenue Code	301
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$46.15
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

CHLORIDE URIN

Facility

$71.00

Service Code	CPT 82436
Hospital Charge Code	22481466
Hospital Revenue Code	301
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

chlorproMAZINE 25 mg/mL Sol[CQCH]

Facility

$24.18

Service Code	HCPCS J3230
Hospital Charge Code	136256467
Hospital Revenue Code	250
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$21.76
Rate for Payer: Aetna of AZ Commercial	$21.76
Rate for Payer: Bisbee Police All Plans	$6.29
Rate for Payer: Cash Price	$19.35
Rate for Payer: Self Pay Self Pay	$19.34

chlorproMAZINE 25 mg/mL Sol[CQCH]

Facility

$24.18

Service Code	HCPCS J3230
Hospital Charge Code	136256467
Hospital Revenue Code	250
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$21.76
Rate for Payer: Aetna of AZ Commercial	$21.76
Rate for Payer: Aetna of AZ Medicare	$6.77
Rate for Payer: Allwell Medicare	$3.87
Rate for Payer: Amerigroup Medicare	$3.87
Rate for Payer: APIPA Medicare/Medicaid	$9.03
Rate for Payer: AZCH Complete Medicare	$3.87
Rate for Payer: Banner UC Health Medicare	$3.87
Rate for Payer: Bisbee Police All Plans	$6.29
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.44
Rate for Payer: Cash Price	$19.35
Rate for Payer: Cigna of AZ Commercial	$15.72
Rate for Payer: Copperpoint Commercial	$5.98
Rate for Payer: Health Net of AZ Commercial	$14.51
Rate for Payer: Health Net of AZ Medicare	$6.77
Rate for Payer: Humana of AZ Medicare	$3.87
Rate for Payer: Self Pay Self Pay	$19.34
Rate for Payer: TriWest Medicare	$3.87
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.35

chlorproMAZINE 50 mg inj Sol [CQCH]

Facility

$11.65

Service Code	HCPCS J3230
Hospital Charge Code	108650203
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna of AZ Commercial	$10.48
Rate for Payer: Bisbee Police All Plans	$3.03
Rate for Payer: Cash Price	$9.32
Rate for Payer: Self Pay Self Pay	$9.32

chlorproMAZINE 50 mg inj Sol [CQCH]

Facility

$11.65

Service Code	HCPCS J3230
Hospital Charge Code	108650203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna of AZ Commercial	$10.48
Rate for Payer: Aetna of AZ Medicare	$3.26
Rate for Payer: Allwell Medicare	$1.86
Rate for Payer: Amerigroup Medicare	$1.86
Rate for Payer: APIPA Medicare/Medicaid	$4.35
Rate for Payer: AZCH Complete Medicare	$1.86
Rate for Payer: Banner UC Health Medicare	$1.86
Rate for Payer: Bisbee Police All Plans	$3.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.92
Rate for Payer: Cash Price	$9.32
Rate for Payer: Cigna of AZ Commercial	$7.57
Rate for Payer: Copperpoint Commercial	$2.88
Rate for Payer: Health Net of AZ Commercial	$6.99
Rate for Payer: Health Net of AZ Medicare	$3.26
Rate for Payer: Humana of AZ Medicare	$1.86
Rate for Payer: Self Pay Self Pay	$9.32
Rate for Payer: TriWest Medicare	$1.86
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.10

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$23,209.33
Max. Negotiated Rate	$23,209.33
Rate for Payer: AHCCCS Medicaid	$23,209.33
Rate for Payer: Allwell Medicaid	$23,209.33
Rate for Payer: AZCH Complete Medicaid	$23,209.33
Rate for Payer: Banner UC Health Medicaid	$23,209.33
Rate for Payer: Mercy Care Medicaid	$23,209.33

Know your out-of-pocket cost for care.

All Charges