Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Inflammatory Bowel Disease

Facility

$13,758.66

Service Code	APR-DRG 2454
Hospital Charge Code	APRDRG2454
Min. Negotiated Rate	$13,758.66
Max. Negotiated Rate	$13,758.66
Rate for Payer: AHCCCS Medicaid	$13,758.66
Rate for Payer: Allwell Medicaid	$13,758.66
Rate for Payer: AZCH Complete Medicaid	$13,758.66
Rate for Payer: Banner UC Health Medicaid	$13,758.66
Rate for Payer: Mercy Care Medicaid	$13,758.66

Inflammatory Bowel Disease

Facility

$3,807.20

Service Code	APR-DRG 2451
Hospital Charge Code	APRDRG2451
Min. Negotiated Rate	$3,807.20
Max. Negotiated Rate	$3,807.20
Rate for Payer: AHCCCS Medicaid	$3,807.20
Rate for Payer: Allwell Medicaid	$3,807.20
Rate for Payer: AZCH Complete Medicaid	$3,807.20
Rate for Payer: Banner UC Health Medicaid	$3,807.20
Rate for Payer: Mercy Care Medicaid	$3,807.20

Inflammatory Bowel Disease

Facility

$13,758.66

Service Code	APR-DRG 2454
Hospital Charge Code	APRDRG2452
Min. Negotiated Rate	$13,758.66
Max. Negotiated Rate	$13,758.66
Rate for Payer: AHCCCS Medicaid	$13,758.66
Rate for Payer: Allwell Medicaid	$13,758.66
Rate for Payer: AZCH Complete Medicaid	$13,758.66
Rate for Payer: Banner UC Health Medicaid	$13,758.66
Rate for Payer: Mercy Care Medicaid	$13,758.66

Inflammatory Bowel Disease

Facility

$4,831.94

Service Code	APR-DRG 2452
Hospital Charge Code	APRDRG2451
Min. Negotiated Rate	$4,831.94
Max. Negotiated Rate	$4,831.94
Rate for Payer: AHCCCS Medicaid	$4,831.94
Rate for Payer: Allwell Medicaid	$4,831.94
Rate for Payer: AZCH Complete Medicaid	$4,831.94
Rate for Payer: Banner UC Health Medicaid	$4,831.94
Rate for Payer: Mercy Care Medicaid	$4,831.94

Inflammatory Bowel Disease

Facility

$7,278.43

Service Code	APR-DRG 2453
Hospital Charge Code	APRDRG2453
Min. Negotiated Rate	$7,278.43
Max. Negotiated Rate	$7,278.43
Rate for Payer: AHCCCS Medicaid	$7,278.43
Rate for Payer: Allwell Medicaid	$7,278.43
Rate for Payer: AZCH Complete Medicaid	$7,278.43
Rate for Payer: Banner UC Health Medicaid	$7,278.43
Rate for Payer: Mercy Care Medicaid	$7,278.43

Inflammatory Bowel Disease

Facility

$3,807.20

Service Code	APR-DRG 2451
Hospital Charge Code	APRDRG2452
Min. Negotiated Rate	$3,807.20
Max. Negotiated Rate	$3,807.20
Rate for Payer: AHCCCS Medicaid	$3,807.20
Rate for Payer: Allwell Medicaid	$3,807.20
Rate for Payer: AZCH Complete Medicaid	$3,807.20
Rate for Payer: Banner UC Health Medicaid	$3,807.20
Rate for Payer: Mercy Care Medicaid	$3,807.20

Inflammatory Bowel Disease

Facility

$7,278.43

Service Code	APR-DRG 2453
Hospital Charge Code	APRDRG2451
Min. Negotiated Rate	$7,278.43
Max. Negotiated Rate	$7,278.43
Rate for Payer: AHCCCS Medicaid	$7,278.43
Rate for Payer: Allwell Medicaid	$7,278.43
Rate for Payer: AZCH Complete Medicaid	$7,278.43
Rate for Payer: Banner UC Health Medicaid	$7,278.43
Rate for Payer: Mercy Care Medicaid	$7,278.43

Inflammatory Bowel Disease

Facility

$4,831.94

Service Code	APR-DRG 2452
Hospital Charge Code	APRDRG2452
Min. Negotiated Rate	$4,831.94
Max. Negotiated Rate	$4,831.94
Rate for Payer: AHCCCS Medicaid	$4,831.94
Rate for Payer: Allwell Medicaid	$4,831.94
Rate for Payer: AZCH Complete Medicaid	$4,831.94
Rate for Payer: Banner UC Health Medicaid	$4,831.94
Rate for Payer: Mercy Care Medicaid	$4,831.94

Inflammatory Bowel Disease

Facility

$7,278.43

Service Code	APR-DRG 2453
Hospital Charge Code	APRDRG2452
Min. Negotiated Rate	$7,278.43
Max. Negotiated Rate	$7,278.43
Rate for Payer: AHCCCS Medicaid	$7,278.43
Rate for Payer: Allwell Medicaid	$7,278.43
Rate for Payer: AZCH Complete Medicaid	$7,278.43
Rate for Payer: Banner UC Health Medicaid	$7,278.43
Rate for Payer: Mercy Care Medicaid	$7,278.43

Inflammatory Bowel Disease

Facility

$7,278.43

Service Code	APR-DRG 2453
Hospital Charge Code	APRDRG2454
Min. Negotiated Rate	$7,278.43
Max. Negotiated Rate	$7,278.43
Rate for Payer: AHCCCS Medicaid	$7,278.43
Rate for Payer: Allwell Medicaid	$7,278.43
Rate for Payer: AZCH Complete Medicaid	$7,278.43
Rate for Payer: Banner UC Health Medicaid	$7,278.43
Rate for Payer: Mercy Care Medicaid	$7,278.43

Inflammatory Bowel Disease

Facility

$3,807.20

Service Code	APR-DRG 2451
Hospital Charge Code	APRDRG2453
Min. Negotiated Rate	$3,807.20
Max. Negotiated Rate	$3,807.20
Rate for Payer: AHCCCS Medicaid	$3,807.20
Rate for Payer: Allwell Medicaid	$3,807.20
Rate for Payer: AZCH Complete Medicaid	$3,807.20
Rate for Payer: Banner UC Health Medicaid	$3,807.20
Rate for Payer: Mercy Care Medicaid	$3,807.20

inFLIXimab 100 mg REC[CQCH]

Facility

$460.52

Service Code	HCPCS J1745
Hospital Charge Code	199586827
Hospital Revenue Code	250
Min. Negotiated Rate	$119.74
Max. Negotiated Rate	$414.47
Rate for Payer: Aetna of AZ Commercial	$414.47
Rate for Payer: Bisbee Police All Plans	$119.74
Rate for Payer: Cash Price	$368.42
Rate for Payer: Self Pay Self Pay	$368.42

inFLIXimab 100 mg REC[CQCH]

Facility

$460.52

Service Code	HCPCS J1745
Hospital Charge Code	199586827
Hospital Revenue Code	250
Min. Negotiated Rate	$73.68
Max. Negotiated Rate	$414.47
Rate for Payer: Aetna of AZ Commercial	$414.47
Rate for Payer: Aetna of AZ Medicare	$128.95
Rate for Payer: Allwell Medicare	$73.68
Rate for Payer: Amerigroup Medicare	$73.68
Rate for Payer: APIPA Medicare/Medicaid	$172.00
Rate for Payer: AZCH Complete Medicare	$73.68
Rate for Payer: Banner UC Health Medicare	$73.68
Rate for Payer: Bisbee Police All Plans	$119.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$313.15
Rate for Payer: Cash Price	$368.42
Rate for Payer: Cigna of AZ Commercial	$299.34
Rate for Payer: Copperpoint Commercial	$113.98
Rate for Payer: Health Net of AZ Commercial	$276.31
Rate for Payer: Health Net of AZ Medicare	$128.95
Rate for Payer: Humana of AZ Medicare	$73.68
Rate for Payer: Self Pay Self Pay	$368.42
Rate for Payer: TriWest Medicare	$73.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$268.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$82.89

inFLIXimab abda 100 mg REC[CQCH]

Facility

$347.81

Service Code	HCPCS Q5104
Hospital Charge Code	218718750
Hospital Revenue Code	250
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$313.03
Rate for Payer: Aetna of AZ Commercial	$313.03
Rate for Payer: Aetna of AZ Medicare	$97.39
Rate for Payer: Allwell Medicare	$55.65
Rate for Payer: Amerigroup Medicare	$55.65
Rate for Payer: APIPA Medicare/Medicaid	$129.91
Rate for Payer: AZCH Complete Medicare	$55.65
Rate for Payer: Banner UC Health Medicare	$55.65
Rate for Payer: Bisbee Police All Plans	$90.43
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$236.51
Rate for Payer: Cash Price	$278.25
Rate for Payer: Cigna of AZ Commercial	$226.08
Rate for Payer: Copperpoint Commercial	$86.08
Rate for Payer: Health Net of AZ Commercial	$208.69
Rate for Payer: Health Net of AZ Medicare	$97.39
Rate for Payer: Humana of AZ Medicare	$55.65
Rate for Payer: Self Pay Self Pay	$278.25
Rate for Payer: TriWest Medicare	$55.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$202.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$62.61

inFLIXimab abda 100 mg REC[CQCH]

Facility

$347.81

Service Code	HCPCS Q5104
Hospital Charge Code	218718750
Hospital Revenue Code	250
Min. Negotiated Rate	$90.43
Max. Negotiated Rate	$313.03
Rate for Payer: Aetna of AZ Commercial	$313.03
Rate for Payer: Bisbee Police All Plans	$90.43
Rate for Payer: Cash Price	$278.25
Rate for Payer: Self Pay Self Pay	$278.25

inFLIXimab axxq 100 mg REC[CQCH]

Facility

$454.48

Service Code	HCPCS Q5104
Hospital Charge Code	193373980
Hospital Revenue Code	250
Min. Negotiated Rate	$118.16
Max. Negotiated Rate	$409.03
Rate for Payer: Aetna of AZ Commercial	$409.03
Rate for Payer: Bisbee Police All Plans	$118.16
Rate for Payer: Cash Price	$363.58
Rate for Payer: Self Pay Self Pay	$363.58

inFLIXimab axxq 100 mg REC[CQCH]

Facility

$454.48

Service Code	HCPCS Q5104
Hospital Charge Code	193373980
Hospital Revenue Code	250
Min. Negotiated Rate	$72.72
Max. Negotiated Rate	$409.03
Rate for Payer: Aetna of AZ Commercial	$409.03
Rate for Payer: Aetna of AZ Medicare	$127.25
Rate for Payer: Allwell Medicare	$72.72
Rate for Payer: Amerigroup Medicare	$72.72
Rate for Payer: APIPA Medicare/Medicaid	$169.75
Rate for Payer: AZCH Complete Medicare	$72.72
Rate for Payer: Banner UC Health Medicare	$72.72
Rate for Payer: Bisbee Police All Plans	$118.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$309.05
Rate for Payer: Cash Price	$363.58
Rate for Payer: Cigna of AZ Commercial	$295.41
Rate for Payer: Copperpoint Commercial	$112.48
Rate for Payer: Health Net of AZ Commercial	$272.69
Rate for Payer: Health Net of AZ Medicare	$127.25
Rate for Payer: Humana of AZ Medicare	$72.72
Rate for Payer: Self Pay Self Pay	$363.58
Rate for Payer: TriWest Medicare	$72.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$264.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$81.81

inFLIXimab dyyb 100 mg REC[CQCH]

Facility

$491.58

Service Code	HCPCS Q5103
Hospital Charge Code	218723016
Hospital Revenue Code	250
Min. Negotiated Rate	$78.65
Max. Negotiated Rate	$442.42
Rate for Payer: Aetna of AZ Commercial	$442.42
Rate for Payer: Aetna of AZ Medicare	$137.64
Rate for Payer: Allwell Medicare	$78.65
Rate for Payer: Amerigroup Medicare	$78.65
Rate for Payer: APIPA Medicare/Medicaid	$183.61
Rate for Payer: AZCH Complete Medicare	$78.65
Rate for Payer: Banner UC Health Medicare	$78.65
Rate for Payer: Bisbee Police All Plans	$127.81
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$334.27
Rate for Payer: Cash Price	$393.26
Rate for Payer: Cigna of AZ Commercial	$319.53
Rate for Payer: Copperpoint Commercial	$121.67
Rate for Payer: Health Net of AZ Commercial	$294.95
Rate for Payer: Health Net of AZ Medicare	$137.64
Rate for Payer: Humana of AZ Medicare	$78.65
Rate for Payer: Self Pay Self Pay	$393.26
Rate for Payer: TriWest Medicare	$78.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$286.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.48

inFLIXimab dyyb 100 mg REC[CQCH]

Facility

$491.58

Service Code	HCPCS Q5103
Hospital Charge Code	218723016
Hospital Revenue Code	250
Min. Negotiated Rate	$127.81
Max. Negotiated Rate	$442.42
Rate for Payer: Aetna of AZ Commercial	$442.42
Rate for Payer: Bisbee Police All Plans	$127.81
Rate for Payer: Cash Price	$393.26
Rate for Payer: Self Pay Self Pay	$393.26

INFLOW PUMP TUBING

Facility

$242.50

Hospital Charge Code	25519689
Hospital Revenue Code	270
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$218.25
Rate for Payer: Aetna of AZ Commercial	$218.25
Rate for Payer: Aetna of AZ Medicare	$67.90
Rate for Payer: Allwell Medicare	$38.80
Rate for Payer: Amerigroup Medicare	$38.80
Rate for Payer: APIPA Medicare/Medicaid	$90.57
Rate for Payer: AZCH Complete Medicare	$38.80
Rate for Payer: Banner UC Health Medicare	$38.80
Rate for Payer: Bisbee Police All Plans	$63.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$164.90
Rate for Payer: Cash Price	$194.00
Rate for Payer: Cigna of AZ Commercial	$169.75
Rate for Payer: Copperpoint Commercial	$60.02
Rate for Payer: Health Net of AZ Commercial	$145.50
Rate for Payer: Health Net of AZ Medicare	$67.90
Rate for Payer: Humana of AZ Medicare	$38.80
Rate for Payer: Self Pay Self Pay	$194.00
Rate for Payer: TriWest Medicare	$38.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.65

INFLOW PUMP TUBING

Facility

$242.50

Hospital Charge Code	25519689
Hospital Revenue Code	270
Min. Negotiated Rate	$63.05
Max. Negotiated Rate	$218.25
Rate for Payer: Aetna of AZ Commercial	$218.25
Rate for Payer: Bisbee Police All Plans	$63.05
Rate for Payer: Cash Price	$194.00
Rate for Payer: Self Pay Self Pay	$194.00

INFLU B SCN

Facility

$205.00

Service Code	CPT 87804
Hospital Charge Code	22481485
Hospital Revenue Code	306
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Cash Price	$164.00
Rate for Payer: Self Pay Self Pay	$164.00

INFLU B SCN

Facility

$205.00

Service Code	CPT 87804
Hospital Charge Code	22481485
Hospital Revenue Code	306
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Aetna of AZ Medicare	$57.40
Rate for Payer: Allwell Medicare	$32.80
Rate for Payer: Amerigroup Medicare	$32.80
Rate for Payer: APIPA Medicare/Medicaid	$76.57
Rate for Payer: AZCH Complete Medicare	$32.80
Rate for Payer: Banner UC Health Medicare	$32.80
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$139.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cigna of AZ Commercial	$133.25
Rate for Payer: Copperpoint Commercial	$50.74
Rate for Payer: Health Net of AZ Commercial	$123.00
Rate for Payer: Health Net of AZ Medicare	$57.40
Rate for Payer: Humana of AZ Medicare	$32.80
Rate for Payer: Self Pay Self Pay	$164.00
Rate for Payer: TriWest Medicare	$32.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$119.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.90

Influenza A/B POC

Facility

$130.00

Service Code	CPT 87804 QW
Hospital Charge Code	13407374
Hospital Revenue Code	306
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Self Pay Self Pay	$104.00

Influenza A/B POC

Facility

$130.00

Service Code	CPT 87804 QW
Hospital Charge Code	13407374
Hospital Revenue Code	306
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Aetna of AZ Medicare	$36.40
Rate for Payer: Allwell Medicare	$20.80
Rate for Payer: Amerigroup Medicare	$20.80
Rate for Payer: APIPA Medicare/Medicaid	$48.55
Rate for Payer: AZCH Complete Medicare	$20.80
Rate for Payer: Banner UC Health Medicare	$20.80
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$88.40
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.17
Rate for Payer: Health Net of AZ Commercial	$78.00
Rate for Payer: Health Net of AZ Medicare	$36.40
Rate for Payer: Humana of AZ Medicare	$20.80
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$20.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

Know your out-of-pocket cost for care.

All Charges