Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: AHCCCS Medicaid	$5,705.19
Rate for Payer: Allwell Medicaid	$5,705.19
Rate for Payer: AZCH Complete Medicaid	$5,705.19
Rate for Payer: Banner UC Health Medicaid	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19

Inborn Errors Of Metabolism

Facility

$8,634.23

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$8,634.23
Max. Negotiated Rate	$8,634.23
Rate for Payer: AHCCCS Medicaid	$8,634.23
Rate for Payer: Allwell Medicaid	$8,634.23
Rate for Payer: AZCH Complete Medicaid	$8,634.23
Rate for Payer: Banner UC Health Medicaid	$8,634.23
Rate for Payer: Mercy Care Medicaid	$8,634.23

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: AHCCCS Medicaid	$3,920.83
Rate for Payer: Allwell Medicaid	$3,920.83
Rate for Payer: AZCH Complete Medicaid	$3,920.83
Rate for Payer: Banner UC Health Medicaid	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4234
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: AHCCCS Medicaid	$3,920.83
Rate for Payer: Allwell Medicaid	$3,920.83
Rate for Payer: AZCH Complete Medicaid	$3,920.83
Rate for Payer: Banner UC Health Medicaid	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83

Inborn Errors Of Metabolism

Facility

$8,634.23

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG4234
Min. Negotiated Rate	$8,634.23
Max. Negotiated Rate	$8,634.23
Rate for Payer: AHCCCS Medicaid	$8,634.23
Rate for Payer: Allwell Medicaid	$8,634.23
Rate for Payer: AZCH Complete Medicaid	$8,634.23
Rate for Payer: Banner UC Health Medicaid	$8,634.23
Rate for Payer: Mercy Care Medicaid	$8,634.23

Inborn Errors Of Metabolism

Facility

$20,239.60

Service Code	APR-DRG 4234
Hospital Charge Code	APRDRG4234
Min. Negotiated Rate	$20,239.60
Max. Negotiated Rate	$20,239.60
Rate for Payer: AHCCCS Medicaid	$20,239.60
Rate for Payer: Allwell Medicaid	$20,239.60
Rate for Payer: AZCH Complete Medicaid	$20,239.60
Rate for Payer: Banner UC Health Medicaid	$20,239.60
Rate for Payer: Mercy Care Medicaid	$20,239.60

Inborn Errors Of Metabolism

Facility

$20,239.60

Service Code	APR-DRG 4234
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$20,239.60
Max. Negotiated Rate	$20,239.60
Rate for Payer: AHCCCS Medicaid	$20,239.60
Rate for Payer: Allwell Medicaid	$20,239.60
Rate for Payer: AZCH Complete Medicaid	$20,239.60
Rate for Payer: Banner UC Health Medicaid	$20,239.60
Rate for Payer: Mercy Care Medicaid	$20,239.60

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4234
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: AHCCCS Medicaid	$5,705.19
Rate for Payer: Allwell Medicaid	$5,705.19
Rate for Payer: AZCH Complete Medicaid	$5,705.19
Rate for Payer: Banner UC Health Medicaid	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19

Inborn Errors Of Metabolism

Facility

$8,634.23

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG4233
Min. Negotiated Rate	$8,634.23
Max. Negotiated Rate	$8,634.23
Rate for Payer: AHCCCS Medicaid	$8,634.23
Rate for Payer: Allwell Medicaid	$8,634.23
Rate for Payer: AZCH Complete Medicaid	$8,634.23
Rate for Payer: Banner UC Health Medicaid	$8,634.23
Rate for Payer: Mercy Care Medicaid	$8,634.23

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: AHCCCS Medicaid	$5,705.19
Rate for Payer: Allwell Medicaid	$5,705.19
Rate for Payer: AZCH Complete Medicaid	$5,705.19
Rate for Payer: Banner UC Health Medicaid	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: AHCCCS Medicaid	$3,920.83
Rate for Payer: Allwell Medicaid	$3,920.83
Rate for Payer: AZCH Complete Medicaid	$3,920.83
Rate for Payer: Banner UC Health Medicaid	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4233
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: AHCCCS Medicaid	$5,705.19
Rate for Payer: Allwell Medicaid	$5,705.19
Rate for Payer: AZCH Complete Medicaid	$5,705.19
Rate for Payer: Banner UC Health Medicaid	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19

INCENTIVE SPIROMTRY

Facility

$112.00

Service Code	CPT 94010
Hospital Charge Code	1886937
Hospital Revenue Code	412
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Aetna of AZ Medicare	$31.36
Rate for Payer: Allwell Medicare	$17.92
Rate for Payer: Amerigroup Medicare	$17.92
Rate for Payer: APIPA Medicare/Medicaid	$41.83
Rate for Payer: AZCH Complete Medicare	$17.92
Rate for Payer: Banner UC Health Medicare	$17.92
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$76.16
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cigna of AZ Commercial	$78.40
Rate for Payer: Copperpoint Commercial	$27.72
Rate for Payer: Health Net of AZ Commercial	$67.20
Rate for Payer: Health Net of AZ Medicare	$31.36
Rate for Payer: Humana of AZ Medicare	$17.92
Rate for Payer: Self Pay Self Pay	$89.60
Rate for Payer: TriWest Medicare	$17.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$65.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.16

INCENTIVE SPIROMTRY

Facility

$112.00

Service Code	CPT 94010
Hospital Charge Code	1886937
Hospital Revenue Code	412
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Cash Price	$89.60
Rate for Payer: Self Pay Self Pay	$89.60

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE

Facility

$874.00

Service Code	CPT 10061
Hospital Charge Code	24049283
Hospital Revenue Code	360
Min. Negotiated Rate	$227.24
Max. Negotiated Rate	$786.60
Rate for Payer: Aetna of AZ Commercial	$786.60
Rate for Payer: Bisbee Police All Plans	$227.24
Rate for Payer: Cash Price	$699.20
Rate for Payer: Self Pay Self Pay	$699.20

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE

Facility

$874.00

Service Code	CPT 10061
Hospital Charge Code	24049283
Hospital Revenue Code	360
Min. Negotiated Rate	$139.84
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$786.60
Rate for Payer: Aetna of AZ Medicare	$244.72
Rate for Payer: AHCCCS Medicaid	$250.73
Rate for Payer: Allwell Medicaid	$250.73
Rate for Payer: Allwell Medicare	$139.84
Rate for Payer: Amerigroup Medicare	$139.84
Rate for Payer: APIPA Medicare/Medicaid	$326.44
Rate for Payer: AZCH Complete Medicaid	$250.73
Rate for Payer: AZCH Complete Medicare	$139.84
Rate for Payer: Banner UC Health Medicaid	$250.73
Rate for Payer: Banner UC Health Medicare	$139.84
Rate for Payer: Bisbee Police All Plans	$227.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$594.32
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cigna of AZ Commercial	$437.00
Rate for Payer: Copperpoint Commercial	$216.31
Rate for Payer: Health Net of AZ Commercial	$524.40
Rate for Payer: Health Net of AZ Medicare	$244.72
Rate for Payer: Humana of AZ Medicare	$139.84
Rate for Payer: Mercy Care Medicaid	$250.73
Rate for Payer: Self Pay Self Pay	$699.20
Rate for Payer: TriWest Medicare	$139.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$157.32

INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS

Facility

$694.00

Service Code	CPT 56420
Hospital Charge Code	23008149
Hospital Revenue Code	360
Min. Negotiated Rate	$111.04
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$624.60
Rate for Payer: Aetna of AZ Medicare	$194.32
Rate for Payer: AHCCCS Medicaid	$123.48
Rate for Payer: Allwell Medicaid	$123.48
Rate for Payer: Allwell Medicare	$111.04
Rate for Payer: Amerigroup Medicare	$111.04
Rate for Payer: APIPA Medicare/Medicaid	$259.21
Rate for Payer: AZCH Complete Medicaid	$123.48
Rate for Payer: AZCH Complete Medicare	$111.04
Rate for Payer: Banner UC Health Medicaid	$123.48
Rate for Payer: Banner UC Health Medicare	$111.04
Rate for Payer: Bisbee Police All Plans	$180.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$471.92
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cigna of AZ Commercial	$347.00
Rate for Payer: Copperpoint Commercial	$171.76
Rate for Payer: Health Net of AZ Commercial	$416.40
Rate for Payer: Health Net of AZ Medicare	$194.32
Rate for Payer: Humana of AZ Medicare	$111.04
Rate for Payer: Mercy Care Medicaid	$123.48
Rate for Payer: Self Pay Self Pay	$555.20
Rate for Payer: TriWest Medicare	$111.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$124.92

INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS

Facility

$694.00

Service Code	CPT 56420
Hospital Charge Code	23008149
Hospital Revenue Code	360
Min. Negotiated Rate	$180.44
Max. Negotiated Rate	$624.60
Rate for Payer: Aetna of AZ Commercial	$624.60
Rate for Payer: Bisbee Police All Plans	$180.44
Rate for Payer: Cash Price	$555.20
Rate for Payer: Self Pay Self Pay	$555.20

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;

Facility

$901.00

Service Code	CPT 10121
Hospital Charge Code	24049284
Hospital Revenue Code	360
Min. Negotiated Rate	$144.16
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Aetna of AZ Medicare	$252.28
Rate for Payer: AHCCCS Medicaid	$1,020.08
Rate for Payer: Allwell Medicaid	$1,020.08
Rate for Payer: Allwell Medicare	$144.16
Rate for Payer: Amerigroup Medicare	$144.16
Rate for Payer: APIPA Medicare/Medicaid	$336.52
Rate for Payer: AZCH Complete Medicaid	$1,020.08
Rate for Payer: AZCH Complete Medicare	$144.16
Rate for Payer: Banner UC Health Medicaid	$1,020.08
Rate for Payer: Banner UC Health Medicare	$144.16
Rate for Payer: Bisbee Police All Plans	$234.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$612.68
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cigna of AZ Commercial	$450.50
Rate for Payer: Copperpoint Commercial	$223.00
Rate for Payer: Health Net of AZ Commercial	$540.60
Rate for Payer: Health Net of AZ Medicare	$252.28
Rate for Payer: Humana of AZ Medicare	$144.16
Rate for Payer: Mercy Care Medicaid	$1,020.08
Rate for Payer: Self Pay Self Pay	$720.80
Rate for Payer: TriWest Medicare	$144.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$162.18

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;

Facility

$901.00

Service Code	CPT 10121
Hospital Charge Code	24049284
Hospital Revenue Code	360
Min. Negotiated Rate	$234.26
Max. Negotiated Rate	$810.90
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Bisbee Police All Plans	$234.26
Rate for Payer: Cash Price	$720.80
Rate for Payer: Self Pay Self Pay	$720.80

inclisiran 284 mg/1.5 mL Sol[CQCH]

Facility

$2,254.28

Service Code	HCPCS J1306
Hospital Charge Code	242946825
Hospital Revenue Code	250
Min. Negotiated Rate	$586.11
Max. Negotiated Rate	$2,028.85
Rate for Payer: Aetna of AZ Commercial	$2,028.85
Rate for Payer: Bisbee Police All Plans	$586.11
Rate for Payer: Cash Price	$1,803.42
Rate for Payer: Self Pay Self Pay	$1,803.42

inclisiran 284 mg/1.5 mL Sol[CQCH]

Facility

$2,254.28

Service Code	HCPCS J1306
Hospital Charge Code	242946825
Hospital Revenue Code	250
Min. Negotiated Rate	$360.68
Max. Negotiated Rate	$2,028.85
Rate for Payer: Aetna of AZ Commercial	$2,028.85
Rate for Payer: Aetna of AZ Medicare	$631.20
Rate for Payer: Allwell Medicare	$360.68
Rate for Payer: Amerigroup Medicare	$360.68
Rate for Payer: APIPA Medicare/Medicaid	$841.97
Rate for Payer: AZCH Complete Medicare	$360.68
Rate for Payer: Banner UC Health Medicare	$360.68
Rate for Payer: Bisbee Police All Plans	$586.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,532.91
Rate for Payer: Cash Price	$1,803.42
Rate for Payer: Cigna of AZ Commercial	$1,465.28
Rate for Payer: Copperpoint Commercial	$557.93
Rate for Payer: Health Net of AZ Commercial	$1,352.57
Rate for Payer: Health Net of AZ Medicare	$631.20
Rate for Payer: Humana of AZ Medicare	$360.68
Rate for Payer: Self Pay Self Pay	$1,803.42
Rate for Payer: TriWest Medicare	$360.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,314.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$405.77

indomethacin 25 mg Cap [CQCH]

Facility

$0.19

Service Code	NDC 31722054201
Hospital Charge Code	105926578
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.15
Rate for Payer: Self Pay Self Pay	$0.15

indomethacin 25 mg Cap [CQCH]

Facility

$0.19

Service Code	NDC 31722054201
Hospital Charge Code	105926578
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Aetna of AZ Medicare	$0.05
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.13
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.11
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.15
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

INFANT NASAL PRNG 3MM TO 4MM

Facility

$42.00

Hospital Charge Code	27704483
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.39
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

Know your out-of-pocket cost for care.

All Charges