Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CHLORIDE URIN

Facility

$75.00

Service Code	CPT 82436
Hospital Charge Code	22481466
Hospital Revenue Code	301
Min. Negotiated Rate	$5.75
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	$5.75
Rate for Payer: Allwell Medicaid	$5.75
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	$5.75
Rate for Payer: AZCH Complete Medicare	$11.25
Rate for Payer: Banner UC Health Medicaid	$5.75
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	$5.75
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

CHLORIDE URIN

Facility

$75.00

Service Code	CPT 82436
Hospital Charge Code	22481466
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

chlorproMAZINE 25 mg/mL Sol[CQCH]

Facility

$24.18

Service Code	HCPCS J3230
Hospital Charge Code	136256467
Hospital Revenue Code	250
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$69.10
Rate for Payer: Aetna of AZ Commercial	$21.76
Rate for Payer: Aetna of AZ Medicare	$6.77
Rate for Payer: AHCCCS Medicaid	$69.10
Rate for Payer: Allwell Medicaid	$69.10
Rate for Payer: Allwell Medicare	$3.63
Rate for Payer: Amerigroup Medicare	$3.63
Rate for Payer: APIPA Medicare/Medicaid	$9.03
Rate for Payer: AZCH Complete Medicaid	$69.10
Rate for Payer: AZCH Complete Medicare	$3.63
Rate for Payer: Banner UC Health Medicaid	$69.10
Rate for Payer: Banner UC Health Medicare	$3.63
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: 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	$3.63
Rate for Payer: Mercy Care Medicaid	$69.10
Rate for Payer: Self Pay Self Pay	$19.34
Rate for Payer: TriWest Medicare	$3.63
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.35

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 50 mg inj Sol [CQCH]

Facility

$11.65

Service Code	HCPCS J3230
Hospital Charge Code	108650203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$69.10
Rate for Payer: Aetna of AZ Commercial	$10.48
Rate for Payer: Aetna of AZ Medicare	$3.26
Rate for Payer: AHCCCS Medicaid	$69.10
Rate for Payer: Allwell Medicaid	$69.10
Rate for Payer: Allwell Medicare	$1.75
Rate for Payer: Amerigroup Medicare	$1.75
Rate for Payer: APIPA Medicare/Medicaid	$4.35
Rate for Payer: AZCH Complete Medicaid	$69.10
Rate for Payer: AZCH Complete Medicare	$1.75
Rate for Payer: Banner UC Health Medicaid	$69.10
Rate for Payer: Banner UC Health Medicare	$1.75
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: 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	$1.75
Rate for Payer: Mercy Care Medicaid	$69.10
Rate for Payer: Self Pay Self Pay	$9.32
Rate for Payer: TriWest Medicare	$1.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.10

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

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: AHCCCS Medicaid	$6,917.21
Rate for Payer: Allwell Medicaid	$6,917.21
Rate for Payer: AZCH Complete Medicaid	$6,917.21
Rate for Payer: Banner UC Health Medicaid	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: AHCCCS Medicaid	$8,723.31
Rate for Payer: Allwell Medicaid	$8,723.31
Rate for Payer: AZCH Complete Medicaid	$8,723.31
Rate for Payer: Banner UC Health Medicaid	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: AHCCCS Medicaid	$11,408.27
Rate for Payer: Allwell Medicaid	$11,408.27
Rate for Payer: AZCH Complete Medicaid	$11,408.27
Rate for Payer: Banner UC Health Medicaid	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: AHCCCS Medicaid	$6,917.21
Rate for Payer: Allwell Medicaid	$6,917.21
Rate for Payer: AZCH Complete Medicaid	$6,917.21
Rate for Payer: Banner UC Health Medicaid	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: AHCCCS Medicaid	$6,917.21
Rate for Payer: Allwell Medicaid	$6,917.21
Rate for Payer: AZCH Complete Medicaid	$6,917.21
Rate for Payer: Banner UC Health Medicaid	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: AHCCCS Medicaid	$8,723.31
Rate for Payer: Allwell Medicaid	$8,723.31
Rate for Payer: AZCH Complete Medicaid	$8,723.31
Rate for Payer: Banner UC Health Medicaid	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2634
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

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: AHCCCS Medicaid	$11,408.27
Rate for Payer: Allwell Medicaid	$11,408.27
Rate for Payer: AZCH Complete Medicaid	$11,408.27
Rate for Payer: Banner UC Health Medicaid	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2632
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

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: AHCCCS Medicaid	$8,723.31
Rate for Payer: Allwell Medicaid	$8,723.31
Rate for Payer: AZCH Complete Medicaid	$8,723.31
Rate for Payer: Banner UC Health Medicaid	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2633
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

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: AHCCCS Medicaid	$8,723.31
Rate for Payer: Allwell Medicaid	$8,723.31
Rate for Payer: AZCH Complete Medicaid	$8,723.31
Rate for Payer: Banner UC Health Medicaid	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31

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

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: AHCCCS Medicaid	$6,917.21
Rate for Payer: Allwell Medicaid	$6,917.21
Rate for Payer: AZCH Complete Medicaid	$6,917.21
Rate for Payer: Banner UC Health Medicaid	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: AHCCCS Medicaid	$11,408.27
Rate for Payer: Allwell Medicaid	$11,408.27
Rate for Payer: AZCH Complete Medicaid	$11,408.27
Rate for Payer: Banner UC Health Medicaid	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: AHCCCS Medicaid	$11,408.27
Rate for Payer: Allwell Medicaid	$11,408.27
Rate for Payer: AZCH Complete Medicaid	$11,408.27
Rate for Payer: Banner UC Health Medicaid	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27

Cholesterol High Density Lipid

Facility

$104.00

Service Code	CPT 83718
Hospital Charge Code	633703
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: AHCCCS Medicaid	$8.19
Rate for Payer: Allwell Medicaid	$8.19
Rate for Payer: Allwell Medicare	$15.60
Rate for Payer: Amerigroup Medicare	$15.60
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicaid	$8.19
Rate for Payer: AZCH Complete Medicare	$15.60
Rate for Payer: Banner UC Health Medicaid	$8.19
Rate for Payer: Banner UC Health Medicare	$15.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$67.60
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$15.60
Rate for Payer: Mercy Care Medicaid	$8.19
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$15.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

Cholesterol High Density Lipid

Facility

$104.00

Service Code	CPT 83718
Hospital Charge Code	633703
Hospital Revenue Code	301
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

Cholesterol Total

Facility

$80.00

Service Code	CPT 82465
Hospital Charge Code	633705
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: AHCCCS Medicaid	$4.35
Rate for Payer: Allwell Medicaid	$4.35
Rate for Payer: Allwell Medicare	$12.00
Rate for Payer: Amerigroup Medicare	$12.00
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicaid	$4.35
Rate for Payer: AZCH Complete Medicare	$12.00
Rate for Payer: Banner UC Health Medicaid	$4.35
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Mercy Care Medicaid	$4.35
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

Know your out-of-pocket cost for care.

All Charges