Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

$17,275.48

Service Code	APR-DRG 0424
Hospital Charge Code	APRDRG0421
Min. Negotiated Rate	$17,275.48
Max. Negotiated Rate	$17,275.48
Rate for Payer: AHCCCS Medicaid	$17,275.48
Rate for Payer: Allwell Medicaid	$17,275.48
Rate for Payer: AZCH Complete Medicaid	$17,275.48
Rate for Payer: Banner UC Health Medicaid	$17,275.48
Rate for Payer: Mercy Care Medicaid	$17,275.48

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

$8,202.87

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG0422
Min. Negotiated Rate	$8,202.87
Max. Negotiated Rate	$8,202.87
Rate for Payer: AHCCCS Medicaid	$8,202.87
Rate for Payer: Allwell Medicaid	$8,202.87
Rate for Payer: AZCH Complete Medicaid	$8,202.87
Rate for Payer: Banner UC Health Medicaid	$8,202.87
Rate for Payer: Mercy Care Medicaid	$8,202.87

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

$8,202.87

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG0423
Min. Negotiated Rate	$8,202.87
Max. Negotiated Rate	$8,202.87
Rate for Payer: AHCCCS Medicaid	$8,202.87
Rate for Payer: Allwell Medicaid	$8,202.87
Rate for Payer: AZCH Complete Medicaid	$8,202.87
Rate for Payer: Banner UC Health Medicaid	$8,202.87
Rate for Payer: Mercy Care Medicaid	$8,202.87

Dehydroepiandrosterone (DHEA) LC

Facility

$796.00

Service Code	CPT 82626
Hospital Charge Code	1906831
Hospital Revenue Code	301
Min. Negotiated Rate	$127.36
Max. Negotiated Rate	$716.40
Rate for Payer: Aetna of AZ Commercial	$716.40
Rate for Payer: Aetna of AZ Medicare	$222.88
Rate for Payer: Allwell Medicare	$127.36
Rate for Payer: Amerigroup Medicare	$127.36
Rate for Payer: APIPA Medicare/Medicaid	$297.31
Rate for Payer: AZCH Complete Medicare	$127.36
Rate for Payer: Banner UC Health Medicare	$127.36
Rate for Payer: Bisbee Police All Plans	$206.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$541.28
Rate for Payer: Cash Price	$636.80
Rate for Payer: Cigna of AZ Commercial	$517.40
Rate for Payer: Copperpoint Commercial	$197.01
Rate for Payer: Health Net of AZ Commercial	$477.60
Rate for Payer: Health Net of AZ Medicare	$222.88
Rate for Payer: Humana of AZ Medicare	$127.36
Rate for Payer: Self Pay Self Pay	$636.80
Rate for Payer: TriWest Medicare	$127.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$464.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.28

Dehydroepiandrosterone (DHEA) LC

Facility

$796.00

Service Code	CPT 82626
Hospital Charge Code	1906831
Hospital Revenue Code	301
Min. Negotiated Rate	$206.96
Max. Negotiated Rate	$716.40
Rate for Payer: Aetna of AZ Commercial	$716.40
Rate for Payer: Bisbee Police All Plans	$206.96
Rate for Payer: Cash Price	$636.80
Rate for Payer: Self Pay Self Pay	$636.80

Dehydroepiandrosterone Sulfate LC

Facility

$459.00

Service Code	CPT 82627
Hospital Charge Code	1906835
Hospital Revenue Code	301
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna of AZ Commercial	$413.10
Rate for Payer: Aetna of AZ Medicare	$128.52
Rate for Payer: Allwell Medicare	$73.44
Rate for Payer: Amerigroup Medicare	$73.44
Rate for Payer: APIPA Medicare/Medicaid	$171.44
Rate for Payer: AZCH Complete Medicare	$73.44
Rate for Payer: Banner UC Health Medicare	$73.44
Rate for Payer: Bisbee Police All Plans	$119.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$312.12
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cigna of AZ Commercial	$298.35
Rate for Payer: Copperpoint Commercial	$113.60
Rate for Payer: Health Net of AZ Commercial	$275.40
Rate for Payer: Health Net of AZ Medicare	$128.52
Rate for Payer: Humana of AZ Medicare	$73.44
Rate for Payer: Self Pay Self Pay	$367.20
Rate for Payer: TriWest Medicare	$73.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$267.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$82.62

Dehydroepiandrosterone Sulfate LC

Facility

$459.00

Service Code	CPT 82627
Hospital Charge Code	1906835
Hospital Revenue Code	301
Min. Negotiated Rate	$119.34
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna of AZ Commercial	$413.10
Rate for Payer: Bisbee Police All Plans	$119.34
Rate for Payer: Cash Price	$367.20
Rate for Payer: Self Pay Self Pay	$367.20

denosumab 60 mg/mL Sol[CQCH]

Facility

$1,391.12

Service Code	HCPCS J0897
Hospital Charge Code	187942023
Hospital Revenue Code	250
Min. Negotiated Rate	$361.69
Max. Negotiated Rate	$1,252.01
Rate for Payer: Aetna of AZ Commercial	$1,252.01
Rate for Payer: Bisbee Police All Plans	$361.69
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Self Pay Self Pay	$1,112.90

denosumab 60 mg/mL Sol[CQCH]

Facility

$1,391.12

Service Code	HCPCS J0897
Hospital Charge Code	187942023
Hospital Revenue Code	250
Min. Negotiated Rate	$222.58
Max. Negotiated Rate	$1,252.01
Rate for Payer: Aetna of AZ Commercial	$1,252.01
Rate for Payer: Aetna of AZ Medicare	$389.51
Rate for Payer: Allwell Medicare	$222.58
Rate for Payer: Amerigroup Medicare	$222.58
Rate for Payer: APIPA Medicare/Medicaid	$519.58
Rate for Payer: AZCH Complete Medicare	$222.58
Rate for Payer: Banner UC Health Medicare	$222.58
Rate for Payer: Bisbee Police All Plans	$361.69
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$945.96
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Cigna of AZ Commercial	$904.23
Rate for Payer: Copperpoint Commercial	$344.30
Rate for Payer: Health Net of AZ Commercial	$834.67
Rate for Payer: Health Net of AZ Medicare	$389.51
Rate for Payer: Humana of AZ Medicare	$222.58
Rate for Payer: Self Pay Self Pay	$1,112.90
Rate for Payer: TriWest Medicare	$222.58
Rate for Payer: UnitedHealth Group of AZ Commercial	$811.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$250.40

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: AHCCCS Medicaid	$15,899.34
Rate for Payer: Allwell Medicaid	$15,899.34
Rate for Payer: AZCH Complete Medicaid	$15,899.34
Rate for Payer: Banner UC Health Medicaid	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: AHCCCS Medicaid	$15,899.34
Rate for Payer: Allwell Medicaid	$15,899.34
Rate for Payer: AZCH Complete Medicaid	$15,899.34
Rate for Payer: Banner UC Health Medicaid	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: AHCCCS Medicaid	$2,844.88
Rate for Payer: Allwell Medicaid	$2,844.88
Rate for Payer: AZCH Complete Medicaid	$2,844.88
Rate for Payer: Banner UC Health Medicaid	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: AHCCCS Medicaid	$2,844.88
Rate for Payer: Allwell Medicaid	$2,844.88
Rate for Payer: AZCH Complete Medicaid	$2,844.88
Rate for Payer: Banner UC Health Medicaid	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: AHCCCS Medicaid	$15,899.34
Rate for Payer: Allwell Medicaid	$15,899.34
Rate for Payer: AZCH Complete Medicaid	$15,899.34
Rate for Payer: Banner UC Health Medicaid	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: AHCCCS Medicaid	$3,871.73
Rate for Payer: Allwell Medicaid	$3,871.73
Rate for Payer: AZCH Complete Medicaid	$3,871.73
Rate for Payer: Banner UC Health Medicaid	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: AHCCCS Medicaid	$6,513.20
Rate for Payer: Allwell Medicaid	$6,513.20
Rate for Payer: AZCH Complete Medicaid	$6,513.20
Rate for Payer: Banner UC Health Medicaid	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: AHCCCS Medicaid	$6,513.20
Rate for Payer: Allwell Medicaid	$6,513.20
Rate for Payer: AZCH Complete Medicaid	$6,513.20
Rate for Payer: Banner UC Health Medicaid	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: AHCCCS Medicaid	$6,513.20
Rate for Payer: Allwell Medicaid	$6,513.20
Rate for Payer: AZCH Complete Medicaid	$6,513.20
Rate for Payer: Banner UC Health Medicaid	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: AHCCCS Medicaid	$3,871.73
Rate for Payer: Allwell Medicaid	$3,871.73
Rate for Payer: AZCH Complete Medicaid	$3,871.73
Rate for Payer: Banner UC Health Medicaid	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: AHCCCS Medicaid	$3,871.73
Rate for Payer: Allwell Medicaid	$3,871.73
Rate for Payer: AZCH Complete Medicaid	$3,871.73
Rate for Payer: Banner UC Health Medicaid	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: AHCCCS Medicaid	$15,899.34
Rate for Payer: Allwell Medicaid	$15,899.34
Rate for Payer: AZCH Complete Medicaid	$15,899.34
Rate for Payer: Banner UC Health Medicaid	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: AHCCCS Medicaid	$6,513.20
Rate for Payer: Allwell Medicaid	$6,513.20
Rate for Payer: AZCH Complete Medicaid	$6,513.20
Rate for Payer: Banner UC Health Medicaid	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: AHCCCS Medicaid	$3,871.73
Rate for Payer: Allwell Medicaid	$3,871.73
Rate for Payer: AZCH Complete Medicaid	$3,871.73
Rate for Payer: Banner UC Health Medicaid	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: AHCCCS Medicaid	$2,844.88
Rate for Payer: Allwell Medicaid	$2,844.88
Rate for Payer: AZCH Complete Medicaid	$2,844.88
Rate for Payer: Banner UC Health Medicaid	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: AHCCCS Medicaid	$2,844.88
Rate for Payer: Allwell Medicaid	$2,844.88
Rate for Payer: AZCH Complete Medicaid	$2,844.88
Rate for Payer: Banner UC Health Medicaid	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88

Know your out-of-pocket cost for care.

All Charges