Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Intestinal Obstruction

Facility

$3,100.19

Service Code	APR-DRG 2471
Hospital Charge Code	APRDRG2474
Min. Negotiated Rate	$3,100.19
Max. Negotiated Rate	$3,100.19
Rate for Payer: AHCCCS Medicaid	$3,100.19
Rate for Payer: Allwell Medicaid	$3,100.19
Rate for Payer: AZCH Complete Medicaid	$3,100.19
Rate for Payer: Banner UC Health Medicaid	$3,100.19
Rate for Payer: Mercy Care Medicaid	$3,100.19

Intracranial Hemorrhage

Facility

$14,299.44

Service Code	APR-DRG 0444
Hospital Charge Code	APRDRG0441
Min. Negotiated Rate	$14,299.44
Max. Negotiated Rate	$14,299.44
Rate for Payer: AHCCCS Medicaid	$14,299.44
Rate for Payer: Allwell Medicaid	$14,299.44
Rate for Payer: AZCH Complete Medicaid	$14,299.44
Rate for Payer: Banner UC Health Medicaid	$14,299.44
Rate for Payer: Mercy Care Medicaid	$14,299.44

Intracranial Hemorrhage

Facility

$5,516.51

Service Code	APR-DRG 0441
Hospital Charge Code	APRDRG0441
Min. Negotiated Rate	$5,516.51
Max. Negotiated Rate	$5,516.51
Rate for Payer: AHCCCS Medicaid	$5,516.51
Rate for Payer: Allwell Medicaid	$5,516.51
Rate for Payer: AZCH Complete Medicaid	$5,516.51
Rate for Payer: Banner UC Health Medicaid	$5,516.51
Rate for Payer: Mercy Care Medicaid	$5,516.51

Intracranial Hemorrhage

Facility

$5,516.51

Service Code	APR-DRG 0441
Hospital Charge Code	APRDRG0442
Min. Negotiated Rate	$5,516.51
Max. Negotiated Rate	$5,516.51
Rate for Payer: AHCCCS Medicaid	$5,516.51
Rate for Payer: Allwell Medicaid	$5,516.51
Rate for Payer: AZCH Complete Medicaid	$5,516.51
Rate for Payer: Banner UC Health Medicaid	$5,516.51
Rate for Payer: Mercy Care Medicaid	$5,516.51

Intracranial Hemorrhage

Facility

$7,286.84

Service Code	APR-DRG 0442
Hospital Charge Code	APRDRG0444
Min. Negotiated Rate	$7,286.84
Max. Negotiated Rate	$7,286.84
Rate for Payer: AHCCCS Medicaid	$7,286.84
Rate for Payer: Allwell Medicaid	$7,286.84
Rate for Payer: AZCH Complete Medicaid	$7,286.84
Rate for Payer: Banner UC Health Medicaid	$7,286.84
Rate for Payer: Mercy Care Medicaid	$7,286.84

Intracranial Hemorrhage

Facility

$14,299.44

Service Code	APR-DRG 0444
Hospital Charge Code	APRDRG0443
Min. Negotiated Rate	$14,299.44
Max. Negotiated Rate	$14,299.44
Rate for Payer: AHCCCS Medicaid	$14,299.44
Rate for Payer: Allwell Medicaid	$14,299.44
Rate for Payer: AZCH Complete Medicaid	$14,299.44
Rate for Payer: Banner UC Health Medicaid	$14,299.44
Rate for Payer: Mercy Care Medicaid	$14,299.44

Intracranial Hemorrhage

Facility

$10,328.12

Service Code	APR-DRG 0443
Hospital Charge Code	APRDRG0441
Min. Negotiated Rate	$10,328.12
Max. Negotiated Rate	$10,328.12
Rate for Payer: AHCCCS Medicaid	$10,328.12
Rate for Payer: Allwell Medicaid	$10,328.12
Rate for Payer: AZCH Complete Medicaid	$10,328.12
Rate for Payer: Banner UC Health Medicaid	$10,328.12
Rate for Payer: Mercy Care Medicaid	$10,328.12

Intracranial Hemorrhage

Facility

$10,328.12

Service Code	APR-DRG 0443
Hospital Charge Code	APRDRG0444
Min. Negotiated Rate	$10,328.12
Max. Negotiated Rate	$10,328.12
Rate for Payer: AHCCCS Medicaid	$10,328.12
Rate for Payer: Allwell Medicaid	$10,328.12
Rate for Payer: AZCH Complete Medicaid	$10,328.12
Rate for Payer: Banner UC Health Medicaid	$10,328.12
Rate for Payer: Mercy Care Medicaid	$10,328.12

Intracranial Hemorrhage

Facility

$14,299.44

Service Code	APR-DRG 0444
Hospital Charge Code	APRDRG0444
Min. Negotiated Rate	$14,299.44
Max. Negotiated Rate	$14,299.44
Rate for Payer: AHCCCS Medicaid	$14,299.44
Rate for Payer: Allwell Medicaid	$14,299.44
Rate for Payer: AZCH Complete Medicaid	$14,299.44
Rate for Payer: Banner UC Health Medicaid	$14,299.44
Rate for Payer: Mercy Care Medicaid	$14,299.44

Intracranial Hemorrhage

Facility

$7,286.84

Service Code	APR-DRG 0442
Hospital Charge Code	APRDRG0442
Min. Negotiated Rate	$7,286.84
Max. Negotiated Rate	$7,286.84
Rate for Payer: AHCCCS Medicaid	$7,286.84
Rate for Payer: Allwell Medicaid	$7,286.84
Rate for Payer: AZCH Complete Medicaid	$7,286.84
Rate for Payer: Banner UC Health Medicaid	$7,286.84
Rate for Payer: Mercy Care Medicaid	$7,286.84

Intracranial Hemorrhage

Facility

$7,286.84

Service Code	APR-DRG 0442
Hospital Charge Code	APRDRG0443
Min. Negotiated Rate	$7,286.84
Max. Negotiated Rate	$7,286.84
Rate for Payer: AHCCCS Medicaid	$7,286.84
Rate for Payer: Allwell Medicaid	$7,286.84
Rate for Payer: AZCH Complete Medicaid	$7,286.84
Rate for Payer: Banner UC Health Medicaid	$7,286.84
Rate for Payer: Mercy Care Medicaid	$7,286.84

Intracranial Hemorrhage

Facility

$14,299.44

Service Code	APR-DRG 0444
Hospital Charge Code	APRDRG0442
Min. Negotiated Rate	$14,299.44
Max. Negotiated Rate	$14,299.44
Rate for Payer: AHCCCS Medicaid	$14,299.44
Rate for Payer: Allwell Medicaid	$14,299.44
Rate for Payer: AZCH Complete Medicaid	$14,299.44
Rate for Payer: Banner UC Health Medicaid	$14,299.44
Rate for Payer: Mercy Care Medicaid	$14,299.44

Intracranial Hemorrhage

Facility

$5,516.51

Service Code	APR-DRG 0441
Hospital Charge Code	APRDRG0443
Min. Negotiated Rate	$5,516.51
Max. Negotiated Rate	$5,516.51
Rate for Payer: AHCCCS Medicaid	$5,516.51
Rate for Payer: Allwell Medicaid	$5,516.51
Rate for Payer: AZCH Complete Medicaid	$5,516.51
Rate for Payer: Banner UC Health Medicaid	$5,516.51
Rate for Payer: Mercy Care Medicaid	$5,516.51

Intracranial Hemorrhage

Facility

$10,328.12

Service Code	APR-DRG 0443
Hospital Charge Code	APRDRG0443
Min. Negotiated Rate	$10,328.12
Max. Negotiated Rate	$10,328.12
Rate for Payer: AHCCCS Medicaid	$10,328.12
Rate for Payer: Allwell Medicaid	$10,328.12
Rate for Payer: AZCH Complete Medicaid	$10,328.12
Rate for Payer: Banner UC Health Medicaid	$10,328.12
Rate for Payer: Mercy Care Medicaid	$10,328.12

Intracranial Hemorrhage

Facility

$7,286.84

Service Code	APR-DRG 0442
Hospital Charge Code	APRDRG0441
Min. Negotiated Rate	$7,286.84
Max. Negotiated Rate	$7,286.84
Rate for Payer: AHCCCS Medicaid	$7,286.84
Rate for Payer: Allwell Medicaid	$7,286.84
Rate for Payer: AZCH Complete Medicaid	$7,286.84
Rate for Payer: Banner UC Health Medicaid	$7,286.84
Rate for Payer: Mercy Care Medicaid	$7,286.84

Intracranial Hemorrhage

Facility

$5,516.51

Service Code	APR-DRG 0441
Hospital Charge Code	APRDRG0444
Min. Negotiated Rate	$5,516.51
Max. Negotiated Rate	$5,516.51
Rate for Payer: AHCCCS Medicaid	$5,516.51
Rate for Payer: Allwell Medicaid	$5,516.51
Rate for Payer: AZCH Complete Medicaid	$5,516.51
Rate for Payer: Banner UC Health Medicaid	$5,516.51
Rate for Payer: Mercy Care Medicaid	$5,516.51

Intracranial Hemorrhage

Facility

$10,328.12

Service Code	APR-DRG 0443
Hospital Charge Code	APRDRG0442
Min. Negotiated Rate	$10,328.12
Max. Negotiated Rate	$10,328.12
Rate for Payer: AHCCCS Medicaid	$10,328.12
Rate for Payer: Allwell Medicaid	$10,328.12
Rate for Payer: AZCH Complete Medicaid	$10,328.12
Rate for Payer: Banner UC Health Medicaid	$10,328.12
Rate for Payer: Mercy Care Medicaid	$10,328.12

INTRAOP CYTO PATH CONSULT 1

Facility

$217.00

Service Code	CPT 88333
Hospital Charge Code	22545739
Hospital Revenue Code	310
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Cash Price	$173.60
Rate for Payer: Self Pay Self Pay	$173.60

INTRAOP CYTO PATH CONSULT 1

Facility

$217.00

Service Code	CPT 88333
Hospital Charge Code	22545739
Hospital Revenue Code	310
Min. Negotiated Rate	$32.55
Max. Negotiated Rate	$475.71
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Aetna of AZ Medicare	$60.76
Rate for Payer: AHCCCS Medicaid	$475.71
Rate for Payer: Allwell Medicaid	$475.71
Rate for Payer: Allwell Medicare	$32.55
Rate for Payer: Amerigroup Medicare	$32.55
Rate for Payer: APIPA Medicare/Medicaid	$81.05
Rate for Payer: AZCH Complete Medicaid	$475.71
Rate for Payer: AZCH Complete Medicare	$32.55
Rate for Payer: Banner UC Health Medicaid	$475.71
Rate for Payer: Banner UC Health Medicare	$32.55
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$147.56
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Copperpoint Commercial	$53.71
Rate for Payer: Health Net of AZ Commercial	$130.20
Rate for Payer: Health Net of AZ Medicare	$60.76
Rate for Payer: Humana of AZ Medicare	$32.55
Rate for Payer: Mercy Care Medicaid	$475.71
Rate for Payer: Self Pay Self Pay	$173.60
Rate for Payer: TriWest Medicare	$32.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.06

INTRAOP CYTO PATH CONSULT 2

Facility

$147.00

Service Code	CPT 88334
Hospital Charge Code	22545740
Hospital Revenue Code	310
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Aetna of AZ Medicare	$41.16
Rate for Payer: AHCCCS Medicaid	$12.26
Rate for Payer: Allwell Medicaid	$12.26
Rate for Payer: Allwell Medicare	$22.05
Rate for Payer: Amerigroup Medicare	$22.05
Rate for Payer: APIPA Medicare/Medicaid	$54.90
Rate for Payer: AZCH Complete Medicaid	$12.26
Rate for Payer: AZCH Complete Medicare	$22.05
Rate for Payer: Banner UC Health Medicaid	$12.26
Rate for Payer: Banner UC Health Medicare	$22.05
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$99.96
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cigna of AZ Commercial	$95.55
Rate for Payer: Copperpoint Commercial	$36.38
Rate for Payer: Health Net of AZ Commercial	$88.20
Rate for Payer: Health Net of AZ Medicare	$41.16
Rate for Payer: Humana of AZ Medicare	$22.05
Rate for Payer: Mercy Care Medicaid	$12.26
Rate for Payer: Self Pay Self Pay	$117.60
Rate for Payer: TriWest Medicare	$22.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$85.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.46

INTRAOP CYTO PATH CONSULT 2

Facility

$147.00

Service Code	CPT 88334
Hospital Charge Code	22545740
Hospital Revenue Code	310
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Cash Price	$117.60
Rate for Payer: Self Pay Self Pay	$117.60

INTRAVENOUS ADMINISTRATI

Facility

$139.00

Service Code	CPT 96374
Hospital Charge Code	22247979
Hospital Revenue Code	260
Min. Negotiated Rate	$36.14
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Cash Price	$111.20
Rate for Payer: Self Pay Self Pay	$111.20

INTRAVENOUS ADMINISTRATI

Facility

$139.00

Service Code	CPT 96374
Hospital Charge Code	22247979
Hospital Revenue Code	260
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$155.58
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Aetna of AZ Medicare	$38.92
Rate for Payer: AHCCCS Medicaid	$155.58
Rate for Payer: Allwell Medicaid	$155.58
Rate for Payer: Allwell Medicare	$20.85
Rate for Payer: Amerigroup Medicare	$20.85
Rate for Payer: APIPA Medicare/Medicaid	$51.92
Rate for Payer: AZCH Complete Medicaid	$155.58
Rate for Payer: AZCH Complete Medicare	$20.85
Rate for Payer: Banner UC Health Medicaid	$155.58
Rate for Payer: Banner UC Health Medicare	$20.85
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$94.52
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$97.30
Rate for Payer: Copperpoint Commercial	$34.40
Rate for Payer: Health Net of AZ Commercial	$83.40
Rate for Payer: Health Net of AZ Medicare	$38.92
Rate for Payer: Humana of AZ Medicare	$20.85
Rate for Payer: Mercy Care Medicaid	$155.58
Rate for Payer: Self Pay Self Pay	$111.20
Rate for Payer: TriWest Medicare	$20.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$81.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.02

Intrinsic Factor Abs LC

Facility

$188.00

Service Code	CPT 86340
Hospital Charge Code	2769559
Hospital Revenue Code	301
Min. Negotiated Rate	$48.88
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna of AZ Commercial	$169.20
Rate for Payer: Bisbee Police All Plans	$48.88
Rate for Payer: Cash Price	$150.40
Rate for Payer: Self Pay Self Pay	$150.40

Intrinsic Factor Abs LC

Facility

$188.00

Service Code	CPT 86340
Hospital Charge Code	2769559
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna of AZ Commercial	$169.20
Rate for Payer: Aetna of AZ Medicare	$52.64
Rate for Payer: AHCCCS Medicaid	$15.08
Rate for Payer: Allwell Medicaid	$15.08
Rate for Payer: Allwell Medicare	$28.20
Rate for Payer: Amerigroup Medicare	$28.20
Rate for Payer: APIPA Medicare/Medicaid	$70.22
Rate for Payer: AZCH Complete Medicaid	$15.08
Rate for Payer: AZCH Complete Medicare	$28.20
Rate for Payer: Banner UC Health Medicaid	$15.08
Rate for Payer: Banner UC Health Medicare	$28.20
Rate for Payer: Bisbee Police All Plans	$48.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$127.84
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cigna of AZ Commercial	$122.20
Rate for Payer: Copperpoint Commercial	$46.53
Rate for Payer: Health Net of AZ Commercial	$112.80
Rate for Payer: Health Net of AZ Medicare	$52.64
Rate for Payer: Humana of AZ Medicare	$28.20
Rate for Payer: Mercy Care Medicaid	$15.08
Rate for Payer: Self Pay Self Pay	$150.40
Rate for Payer: TriWest Medicare	$28.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$109.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.84

Know your out-of-pocket cost for care.

All Charges