Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: AHCCCS Medicaid	$11,545.04
Rate for Payer: Allwell Medicaid	$11,545.04
Rate for Payer: AZCH Complete Medicaid	$11,545.04
Rate for Payer: Banner UC Health Medicaid	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7592
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: AHCCCS Medicaid	$28,590.47
Rate for Payer: Allwell Medicaid	$28,590.47
Rate for Payer: AZCH Complete Medicaid	$28,590.47
Rate for Payer: Banner UC Health Medicaid	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: AHCCCS Medicaid	$8,143.96
Rate for Payer: Allwell Medicaid	$8,143.96
Rate for Payer: AZCH Complete Medicaid	$8,143.96
Rate for Payer: Banner UC Health Medicaid	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: AHCCCS Medicaid	$28,590.47
Rate for Payer: Allwell Medicaid	$28,590.47
Rate for Payer: AZCH Complete Medicaid	$28,590.47
Rate for Payer: Banner UC Health Medicaid	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: AHCCCS Medicaid	$28,590.47
Rate for Payer: Allwell Medicaid	$28,590.47
Rate for Payer: AZCH Complete Medicaid	$28,590.47
Rate for Payer: Banner UC Health Medicaid	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: AHCCCS Medicaid	$7,972.81
Rate for Payer: Allwell Medicaid	$7,972.81
Rate for Payer: AZCH Complete Medicaid	$7,972.81
Rate for Payer: Banner UC Health Medicaid	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: AHCCCS Medicaid	$8,143.96
Rate for Payer: Allwell Medicaid	$8,143.96
Rate for Payer: AZCH Complete Medicaid	$8,143.96
Rate for Payer: Banner UC Health Medicaid	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7592
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: AHCCCS Medicaid	$7,972.81
Rate for Payer: Allwell Medicaid	$7,972.81
Rate for Payer: AZCH Complete Medicaid	$7,972.81
Rate for Payer: Banner UC Health Medicaid	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: AHCCCS Medicaid	$7,972.81
Rate for Payer: Allwell Medicaid	$7,972.81
Rate for Payer: AZCH Complete Medicaid	$7,972.81
Rate for Payer: Banner UC Health Medicaid	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: AHCCCS Medicaid	$7,972.81
Rate for Payer: Allwell Medicaid	$7,972.81
Rate for Payer: AZCH Complete Medicaid	$7,972.81
Rate for Payer: Banner UC Health Medicaid	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: AHCCCS Medicaid	$8,143.96
Rate for Payer: Allwell Medicaid	$8,143.96
Rate for Payer: AZCH Complete Medicaid	$8,143.96
Rate for Payer: Banner UC Health Medicaid	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: AHCCCS Medicaid	$11,545.04
Rate for Payer: Allwell Medicaid	$11,545.04
Rate for Payer: AZCH Complete Medicaid	$11,545.04
Rate for Payer: Banner UC Health Medicaid	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: AHCCCS Medicaid	$11,545.04
Rate for Payer: Allwell Medicaid	$11,545.04
Rate for Payer: AZCH Complete Medicaid	$11,545.04
Rate for Payer: Banner UC Health Medicaid	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: AHCCCS Medicaid	$28,590.47
Rate for Payer: Allwell Medicaid	$28,590.47
Rate for Payer: AZCH Complete Medicaid	$28,590.47
Rate for Payer: Banner UC Health Medicaid	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47

EBv ab VCA, IGG

Facility

$148.00

Service Code	CPT 86665
Hospital Charge Code	23143918
Hospital Revenue Code	301
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Aetna of AZ Medicare	$41.44
Rate for Payer: Allwell Medicare	$23.68
Rate for Payer: Amerigroup Medicare	$23.68
Rate for Payer: APIPA Medicare/Medicaid	$55.28
Rate for Payer: AZCH Complete Medicare	$23.68
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.64
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$96.20
Rate for Payer: Copperpoint Commercial	$36.63
Rate for Payer: Health Net of AZ Commercial	$88.80
Rate for Payer: Health Net of AZ Medicare	$41.44
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Self Pay Self Pay	$118.40
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.64

EBv ab VCA, IGG

Facility

$148.00

Service Code	CPT 86665
Hospital Charge Code	23143918
Hospital Revenue Code	301
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

EBV Acute Infection Antibodies LC

Facility

$926.00

Service Code	CPT 87799
Hospital Charge Code	1285649
Hospital Revenue Code	301
Min. Negotiated Rate	$240.76
Max. Negotiated Rate	$833.40
Rate for Payer: Aetna of AZ Commercial	$833.40
Rate for Payer: Bisbee Police All Plans	$240.76
Rate for Payer: Cash Price	$740.80
Rate for Payer: Self Pay Self Pay	$740.80

EBV Acute Infection Antibodies LC

Facility

$926.00

Service Code	CPT 87799
Hospital Charge Code	1285649
Hospital Revenue Code	301
Min. Negotiated Rate	$148.16
Max. Negotiated Rate	$833.40
Rate for Payer: Aetna of AZ Commercial	$833.40
Rate for Payer: Aetna of AZ Medicare	$259.28
Rate for Payer: Allwell Medicare	$148.16
Rate for Payer: Amerigroup Medicare	$148.16
Rate for Payer: APIPA Medicare/Medicaid	$345.86
Rate for Payer: AZCH Complete Medicare	$148.16
Rate for Payer: Banner UC Health Medicare	$148.16
Rate for Payer: Bisbee Police All Plans	$240.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$629.68
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cigna of AZ Commercial	$601.90
Rate for Payer: Copperpoint Commercial	$229.19
Rate for Payer: Health Net of AZ Commercial	$555.60
Rate for Payer: Health Net of AZ Medicare	$259.28
Rate for Payer: Humana of AZ Medicare	$148.16
Rate for Payer: Self Pay Self Pay	$740.80
Rate for Payer: TriWest Medicare	$148.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$539.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$166.68

EBV Early AG aB igg

Facility

$163.00

Service Code	CPT 86663
Hospital Charge Code	23143917
Hospital Revenue Code	301
Min. Negotiated Rate	$26.08
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Aetna of AZ Medicare	$45.64
Rate for Payer: Allwell Medicare	$26.08
Rate for Payer: Amerigroup Medicare	$26.08
Rate for Payer: APIPA Medicare/Medicaid	$60.88
Rate for Payer: AZCH Complete Medicare	$26.08
Rate for Payer: Banner UC Health Medicare	$26.08
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$110.84
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cigna of AZ Commercial	$105.95
Rate for Payer: Copperpoint Commercial	$40.34
Rate for Payer: Health Net of AZ Commercial	$97.80
Rate for Payer: Health Net of AZ Medicare	$45.64
Rate for Payer: Humana of AZ Medicare	$26.08
Rate for Payer: Self Pay Self Pay	$130.40
Rate for Payer: TriWest Medicare	$26.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.34

EBV Early AG aB igg

Facility

$163.00

Service Code	CPT 86663
Hospital Charge Code	23143917
Hospital Revenue Code	301
Min. Negotiated Rate	$42.38
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Cash Price	$130.40
Rate for Payer: Self Pay Self Pay	$130.40

EBV Nuclear Ag AB Igg

Facility

$118.00

Service Code	CPT 86664
Hospital Charge Code	23143919
Hospital Revenue Code	301
Min. Negotiated Rate	$18.88
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Aetna of AZ Medicare	$33.04
Rate for Payer: Allwell Medicare	$18.88
Rate for Payer: Amerigroup Medicare	$18.88
Rate for Payer: APIPA Medicare/Medicaid	$44.07
Rate for Payer: AZCH Complete Medicare	$18.88
Rate for Payer: Banner UC Health Medicare	$18.88
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$80.24
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$76.70
Rate for Payer: Copperpoint Commercial	$29.20
Rate for Payer: Health Net of AZ Commercial	$70.80
Rate for Payer: Health Net of AZ Medicare	$33.04
Rate for Payer: Humana of AZ Medicare	$18.88
Rate for Payer: Self Pay Self Pay	$94.40
Rate for Payer: TriWest Medicare	$18.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.24

EBV Nuclear Ag AB Igg

Facility

$118.00

Service Code	CPT 86664
Hospital Charge Code	23143919
Hospital Revenue Code	301
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Cash Price	$94.40
Rate for Payer: Self Pay Self Pay	$94.40

eculizumab 10 mg/mL Sol[CQCH]

Facility

$217.43

Service Code	HCPCS J1300
Hospital Charge Code	189306752
Hospital Revenue Code	250
Min. Negotiated Rate	$34.79
Max. Negotiated Rate	$195.69
Rate for Payer: Aetna of AZ Commercial	$195.69
Rate for Payer: Aetna of AZ Medicare	$60.88
Rate for Payer: Allwell Medicare	$34.79
Rate for Payer: Amerigroup Medicare	$34.79
Rate for Payer: APIPA Medicare/Medicaid	$81.21
Rate for Payer: AZCH Complete Medicare	$34.79
Rate for Payer: Banner UC Health Medicare	$34.79
Rate for Payer: Bisbee Police All Plans	$56.53
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$147.85
Rate for Payer: Cash Price	$173.95
Rate for Payer: Cigna of AZ Commercial	$141.33
Rate for Payer: Copperpoint Commercial	$53.81
Rate for Payer: Health Net of AZ Commercial	$130.46
Rate for Payer: Health Net of AZ Medicare	$60.88
Rate for Payer: Humana of AZ Medicare	$34.79
Rate for Payer: Self Pay Self Pay	$173.94
Rate for Payer: TriWest Medicare	$34.79
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.14

eculizumab 10 mg/mL Sol[CQCH]

Facility

$217.43

Service Code	HCPCS J1300
Hospital Charge Code	189306752
Hospital Revenue Code	250
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$195.69
Rate for Payer: Aetna of AZ Commercial	$195.69
Rate for Payer: Bisbee Police All Plans	$56.53
Rate for Payer: Cash Price	$173.95
Rate for Payer: Self Pay Self Pay	$173.94

Edometrial Sampling (biopsy) w/ or w/o Endo

Facility

$186.00

Service Code	CPT 58100
Hospital Charge Code	22692053
Hospital Revenue Code	360
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: AHCCCS Medicaid	$123.48
Rate for Payer: Allwell Medicaid	$123.48
Rate for Payer: Allwell Medicare	$29.76
Rate for Payer: Amerigroup Medicare	$29.76
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicaid	$123.48
Rate for Payer: AZCH Complete Medicare	$29.76
Rate for Payer: Banner UC Health Medicaid	$123.48
Rate for Payer: Banner UC Health Medicare	$29.76
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$93.00
Rate for Payer: Copperpoint Commercial	$46.03
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$29.76
Rate for Payer: Mercy Care Medicaid	$123.48
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$29.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

Know your out-of-pocket cost for care.

All Charges