Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cobalt, Urine LC

Facility

$238.00

Service Code	CPT 83018
Hospital Charge Code	22311184
Hospital Revenue Code	301
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Cash Price	$190.40
Rate for Payer: Self Pay Self Pay	$190.40

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: AHCCCS Medicaid	$12,860.17
Rate for Payer: Allwell Medicaid	$12,860.17
Rate for Payer: AZCH Complete Medicaid	$12,860.17
Rate for Payer: Banner UC Health Medicaid	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: AHCCCS Medicaid	$12,860.17
Rate for Payer: Allwell Medicaid	$12,860.17
Rate for Payer: AZCH Complete Medicaid	$12,860.17
Rate for Payer: Banner UC Health Medicaid	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17

Cocaine Abuse And Dependence

Facility

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: AHCCCS Medicaid	$2,327.25
Rate for Payer: Allwell Medicaid	$2,327.25
Rate for Payer: AZCH Complete Medicaid	$2,327.25
Rate for Payer: Banner UC Health Medicaid	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25

Cocaine Abuse And Dependence

Facility

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: AHCCCS Medicaid	$2,327.25
Rate for Payer: Allwell Medicaid	$2,327.25
Rate for Payer: AZCH Complete Medicaid	$2,327.25
Rate for Payer: Banner UC Health Medicaid	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: AHCCCS Medicaid	$4,609.60
Rate for Payer: Allwell Medicaid	$4,609.60
Rate for Payer: AZCH Complete Medicaid	$4,609.60
Rate for Payer: Banner UC Health Medicaid	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: AHCCCS Medicaid	$4,609.60
Rate for Payer: Allwell Medicaid	$4,609.60
Rate for Payer: AZCH Complete Medicaid	$4,609.60
Rate for Payer: Banner UC Health Medicaid	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60

Cocaine Abuse And Dependence

Facility

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: AHCCCS Medicaid	$2,327.25
Rate for Payer: Allwell Medicaid	$2,327.25
Rate for Payer: AZCH Complete Medicaid	$2,327.25
Rate for Payer: Banner UC Health Medicaid	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25

Cocaine Abuse And Dependence

Facility

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: AHCCCS Medicaid	$2,586.06
Rate for Payer: Allwell Medicaid	$2,586.06
Rate for Payer: AZCH Complete Medicaid	$2,586.06
Rate for Payer: Banner UC Health Medicaid	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: AHCCCS Medicaid	$4,609.60
Rate for Payer: Allwell Medicaid	$4,609.60
Rate for Payer: AZCH Complete Medicaid	$4,609.60
Rate for Payer: Banner UC Health Medicaid	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60

Cocaine Abuse And Dependence

Facility

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: AHCCCS Medicaid	$2,586.06
Rate for Payer: Allwell Medicaid	$2,586.06
Rate for Payer: AZCH Complete Medicaid	$2,586.06
Rate for Payer: Banner UC Health Medicaid	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06

Cocaine Abuse And Dependence

Facility

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: AHCCCS Medicaid	$2,586.06
Rate for Payer: Allwell Medicaid	$2,586.06
Rate for Payer: AZCH Complete Medicaid	$2,586.06
Rate for Payer: Banner UC Health Medicaid	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06

Cocaine Abuse And Dependence

Facility

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: AHCCCS Medicaid	$2,327.25
Rate for Payer: Allwell Medicaid	$2,327.25
Rate for Payer: AZCH Complete Medicaid	$2,327.25
Rate for Payer: Banner UC Health Medicaid	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: AHCCCS Medicaid	$12,860.17
Rate for Payer: Allwell Medicaid	$12,860.17
Rate for Payer: AZCH Complete Medicaid	$12,860.17
Rate for Payer: Banner UC Health Medicaid	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: AHCCCS Medicaid	$12,860.17
Rate for Payer: Allwell Medicaid	$12,860.17
Rate for Payer: AZCH Complete Medicaid	$12,860.17
Rate for Payer: Banner UC Health Medicaid	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: AHCCCS Medicaid	$4,609.60
Rate for Payer: Allwell Medicaid	$4,609.60
Rate for Payer: AZCH Complete Medicaid	$4,609.60
Rate for Payer: Banner UC Health Medicaid	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60

Cocaine Abuse And Dependence

Facility

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: AHCCCS Medicaid	$2,586.06
Rate for Payer: Allwell Medicaid	$2,586.06
Rate for Payer: AZCH Complete Medicaid	$2,586.06
Rate for Payer: Banner UC Health Medicaid	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06

COCAINE METABOLITE

Facility

$237.00

Hospital Charge Code	23294367
Hospital Revenue Code	301
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Aetna of AZ Medicare	$66.36
Rate for Payer: Allwell Medicare	$35.55
Rate for Payer: Amerigroup Medicare	$35.55
Rate for Payer: APIPA Medicare/Medicaid	$88.52
Rate for Payer: AZCH Complete Medicare	$35.55
Rate for Payer: Banner UC Health Medicare	$35.55
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Copperpoint Commercial	$58.66
Rate for Payer: Health Net of AZ Commercial	$142.20
Rate for Payer: Health Net of AZ Medicare	$66.36
Rate for Payer: Humana of AZ Medicare	$35.55
Rate for Payer: Self Pay Self Pay	$189.60
Rate for Payer: TriWest Medicare	$35.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.66

COCAINE METABOLITE

Facility

$237.00

Hospital Charge Code	23294367
Hospital Revenue Code	301
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Cash Price	$189.60
Rate for Payer: Self Pay Self Pay	$189.60

Coccidioides Abs, IgG/IgM, EIA LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22311185
Hospital Revenue Code	309
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: AHCCCS Medicaid	$11.47
Rate for Payer: Allwell Medicaid	$11.47
Rate for Payer: Allwell Medicare	$21.30
Rate for Payer: Amerigroup Medicare	$21.30
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicaid	$11.47
Rate for Payer: AZCH Complete Medicare	$21.30
Rate for Payer: Banner UC Health Medicaid	$11.47
Rate for Payer: Banner UC Health Medicare	$21.30
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Copperpoint Commercial	$35.14
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$21.30
Rate for Payer: Mercy Care Medicaid	$11.47
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$21.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

Coccidioides Abs, IgG/IgM, EIA LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22311185
Hospital Revenue Code	309
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

.Coccidioides Abs, Qn, DID LC

Facility

$115.00

Service Code	CPT 86635
Hospital Charge Code	22311141
Hospital Revenue Code	302
Min. Negotiated Rate	$29.90
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Cash Price	$92.00
Rate for Payer: Self Pay Self Pay	$92.00

.Coccidioides Abs, Qn, DID LC

Facility

$115.00

Service Code	CPT 86635
Hospital Charge Code	22311141
Hospital Revenue Code	302
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Aetna of AZ Medicare	$32.20
Rate for Payer: AHCCCS Medicaid	$11.47
Rate for Payer: Allwell Medicaid	$11.47
Rate for Payer: Allwell Medicare	$17.25
Rate for Payer: Amerigroup Medicare	$17.25
Rate for Payer: APIPA Medicare/Medicaid	$42.95
Rate for Payer: AZCH Complete Medicaid	$11.47
Rate for Payer: AZCH Complete Medicare	$17.25
Rate for Payer: Banner UC Health Medicaid	$11.47
Rate for Payer: Banner UC Health Medicare	$17.25
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.20
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cigna of AZ Commercial	$74.75
Rate for Payer: Copperpoint Commercial	$28.46
Rate for Payer: Health Net of AZ Commercial	$69.00
Rate for Payer: Health Net of AZ Medicare	$32.20
Rate for Payer: Humana of AZ Medicare	$17.25
Rate for Payer: Mercy Care Medicaid	$11.47
Rate for Payer: Self Pay Self Pay	$92.00
Rate for Payer: TriWest Medicare	$17.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.70

Coccidioides Abs, Qn, DID LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22242102
Hospital Revenue Code	309
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: AHCCCS Medicaid	$11.47
Rate for Payer: Allwell Medicaid	$11.47
Rate for Payer: Allwell Medicare	$21.30
Rate for Payer: Amerigroup Medicare	$21.30
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicaid	$11.47
Rate for Payer: AZCH Complete Medicare	$21.30
Rate for Payer: Banner UC Health Medicaid	$11.47
Rate for Payer: Banner UC Health Medicare	$21.30
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Copperpoint Commercial	$35.14
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$21.30
Rate for Payer: Mercy Care Medicaid	$11.47
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$21.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

Coccidioides Abs, Qn, DID LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22242102
Hospital Revenue Code	309
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

Know your out-of-pocket cost for care.

All Charges