Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: AHCCCS Medicaid	$8,627.92
Rate for Payer: Allwell Medicaid	$8,627.92
Rate for Payer: AZCH Complete Medicaid	$8,627.92
Rate for Payer: Banner UC Health Medicaid	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: AHCCCS Medicaid	$8,627.92
Rate for Payer: Allwell Medicaid	$8,627.92
Rate for Payer: AZCH Complete Medicaid	$8,627.92
Rate for Payer: Banner UC Health Medicaid	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

CLIENT ABG STICK

Facility

$171.00

Service Code	CPT 36600
Hospital Charge Code	22331130
Hospital Revenue Code	460
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Aetna of AZ Medicare	$47.88
Rate for Payer: AHCCCS Medicaid	$162.32
Rate for Payer: Allwell Medicaid	$162.32
Rate for Payer: Allwell Medicare	$25.65
Rate for Payer: Amerigroup Medicare	$25.65
Rate for Payer: APIPA Medicare/Medicaid	$63.87
Rate for Payer: AZCH Complete Medicaid	$162.32
Rate for Payer: AZCH Complete Medicare	$25.65
Rate for Payer: Banner UC Health Medicaid	$162.32
Rate for Payer: Banner UC Health Medicare	$25.65
Rate for Payer: Bisbee Police All Plans	$44.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.28
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna of AZ Commercial	$119.70
Rate for Payer: Copperpoint Commercial	$42.32
Rate for Payer: Health Net of AZ Commercial	$102.60
Rate for Payer: Health Net of AZ Medicare	$47.88
Rate for Payer: Humana of AZ Medicare	$25.65
Rate for Payer: Mercy Care Medicaid	$162.32
Rate for Payer: Self Pay Self Pay	$136.80
Rate for Payer: TriWest Medicare	$25.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.78

CLIENT ABG STICK

Facility

$171.00

Service Code	CPT 36600
Hospital Charge Code	22331130
Hospital Revenue Code	460
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Bisbee Police All Plans	$44.46
Rate for Payer: Cash Price	$136.80
Rate for Payer: Self Pay Self Pay	$136.80

CLIENT ALCOHOL BREATH

Facility

$374.00

Service Code	CPT 82075
Hospital Charge Code	22331138
Hospital Revenue Code	301
Min. Negotiated Rate	$97.24
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Cash Price	$299.20
Rate for Payer: Self Pay Self Pay	$299.20

CLIENT ALCOHOL BREATH

Facility

$374.00

Service Code	CPT 82075
Hospital Charge Code	22331138
Hospital Revenue Code	301
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Aetna of AZ Medicare	$104.72
Rate for Payer: AHCCCS Medicaid	$30.00
Rate for Payer: Allwell Medicaid	$30.00
Rate for Payer: Allwell Medicare	$56.10
Rate for Payer: Amerigroup Medicare	$56.10
Rate for Payer: APIPA Medicare/Medicaid	$139.69
Rate for Payer: AZCH Complete Medicaid	$30.00
Rate for Payer: AZCH Complete Medicare	$56.10
Rate for Payer: Banner UC Health Medicaid	$30.00
Rate for Payer: Banner UC Health Medicare	$56.10
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$254.32
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cigna of AZ Commercial	$243.10
Rate for Payer: Copperpoint Commercial	$92.56
Rate for Payer: Health Net of AZ Commercial	$224.40
Rate for Payer: Health Net of AZ Medicare	$104.72
Rate for Payer: Humana of AZ Medicare	$56.10
Rate for Payer: Mercy Care Medicaid	$30.00
Rate for Payer: Self Pay Self Pay	$299.20
Rate for Payer: TriWest Medicare	$56.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$218.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$67.32

CLIENT AMYLASE

Facility

$20.00

Service Code	CPT 82150
Hospital Charge Code	22331142
Hospital Revenue Code	301
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

CLIENT AMYLASE

Facility

$20.00

Service Code	CPT 82150
Hospital Charge Code	22331142
Hospital Revenue Code	301
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: AHCCCS Medicaid	$6.48
Rate for Payer: Allwell Medicaid	$6.48
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 Medicaid	$6.48
Rate for Payer: AZCH Complete Medicare	$3.00
Rate for Payer: Banner UC Health Medicaid	$6.48
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: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$13.00
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: Mercy Care Medicaid	$6.48
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

CLIENT AUDIOMETRY

Facility

$30.00

Hospital Charge Code	22331153
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

CLIENT AUDIOMETRY

Facility

$30.00

Hospital Charge Code	22331153
Hospital Revenue Code	301
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

CLIENT BASIC PHYSICAL EXAM

Facility

$55.00

Hospital Charge Code	22331158
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicare	$8.25
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$35.75
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.25
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

CLIENT BASIC PHYSICAL EXAM

Facility

$55.00

Hospital Charge Code	22331158
Hospital Revenue Code	301
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

CLIENT BLOOD COLLECTION

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331170
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: AHCCCS Medicaid	$6.00
Rate for Payer: Allwell Medicaid	$6.00
Rate for Payer: Allwell Medicare	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicaid	$6.00
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicaid	$6.00
Rate for Payer: Banner UC Health Medicare	$1.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$7.80
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.80
Rate for Payer: Mercy Care Medicaid	$6.00
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CLIENT BLOOD COLLECTION

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331170
Hospital Revenue Code	300
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CLIENT BLOOD COLLECT LC

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331168
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: AHCCCS Medicaid	$6.00
Rate for Payer: Allwell Medicaid	$6.00
Rate for Payer: Allwell Medicare	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicaid	$6.00
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicaid	$6.00
Rate for Payer: Banner UC Health Medicare	$1.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$7.80
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.80
Rate for Payer: Mercy Care Medicaid	$6.00
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CLIENT BLOOD COLLECT LC

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331168
Hospital Revenue Code	300
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CLIENT BLOOD COLLECT SQ

Facility

$13.00

Service Code	CPT 36415
Hospital Charge Code	22331169
Hospital Revenue Code	300
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: AHCCCS Medicaid	$6.00
Rate for Payer: Allwell Medicaid	$6.00
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicaid	$6.00
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicaid	$6.00
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$8.45
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Mercy Care Medicaid	$6.00
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

Know your out-of-pocket cost for care.

All Charges