Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

$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

$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

$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

$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

$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	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	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

$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

$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

$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

$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

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

INTRAOP CYTO PATH CONSULT 1

Facility

$217.00

Service Code	CPT 88333
Hospital Charge Code	22545739
Hospital Revenue Code	310
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Aetna of AZ Medicare	$60.76
Rate for Payer: Allwell Medicare	$34.72
Rate for Payer: Amerigroup Medicare	$34.72
Rate for Payer: APIPA Medicare/Medicaid	$81.05
Rate for Payer: AZCH Complete Medicare	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
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: 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	$34.72
Rate for Payer: Self Pay Self Pay	$173.60
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.06

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 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

INTRAOP CYTO PATH CONSULT 2

Facility

$147.00

Service Code	CPT 88334
Hospital Charge Code	22545740
Hospital Revenue Code	310
Min. Negotiated Rate	$23.52
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: Allwell Medicare	$23.52
Rate for Payer: Amerigroup Medicare	$23.52
Rate for Payer: APIPA Medicare/Medicaid	$54.90
Rate for Payer: AZCH Complete Medicare	$23.52
Rate for Payer: Banner UC Health Medicare	$23.52
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: 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	$23.52
Rate for Payer: Self Pay Self Pay	$117.60
Rate for Payer: TriWest Medicare	$23.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$85.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.46

INTRAVENOUS ADMINISTRATI

Facility

$187.00

Service Code	CPT 96374
Hospital Charge Code	22247979
Hospital Revenue Code	260
Min. Negotiated Rate	$29.92
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Aetna of AZ Medicare	$52.36
Rate for Payer: AHCCCS Medicaid	$77.79
Rate for Payer: Allwell Medicaid	$77.79
Rate for Payer: Allwell Medicare	$29.92
Rate for Payer: Amerigroup Medicare	$29.92
Rate for Payer: APIPA Medicare/Medicaid	$69.84
Rate for Payer: AZCH Complete Medicaid	$77.79
Rate for Payer: AZCH Complete Medicare	$29.92
Rate for Payer: Banner UC Health Medicaid	$77.79
Rate for Payer: Banner UC Health Medicare	$29.92
Rate for Payer: Bisbee Police All Plans	$48.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$127.16
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cigna of AZ Commercial	$130.90
Rate for Payer: Copperpoint Commercial	$46.28
Rate for Payer: Health Net of AZ Commercial	$112.20
Rate for Payer: Health Net of AZ Medicare	$52.36
Rate for Payer: Humana of AZ Medicare	$29.92
Rate for Payer: Mercy Care Medicaid	$77.79
Rate for Payer: Self Pay Self Pay	$149.60
Rate for Payer: TriWest Medicare	$29.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$109.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.66

INTRAVENOUS ADMINISTRATI

Facility

$187.00

Service Code	CPT 96374
Hospital Charge Code	22247979
Hospital Revenue Code	260
Min. Negotiated Rate	$48.62
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Bisbee Police All Plans	$48.62
Rate for Payer: Cash Price	$149.60
Rate for Payer: Self Pay Self Pay	$149.60

Intrinsic Factor Abs LC

Facility

$179.00

Service Code	CPT 86340
Hospital Charge Code	2769559
Hospital Revenue Code	301
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Cash Price	$143.20
Rate for Payer: Self Pay Self Pay	$143.20

Intrinsic Factor Abs LC

Facility

$179.00

Service Code	CPT 86340
Hospital Charge Code	2769559
Hospital Revenue Code	301
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Aetna of AZ Medicare	$50.12
Rate for Payer: Allwell Medicare	$28.64
Rate for Payer: Amerigroup Medicare	$28.64
Rate for Payer: APIPA Medicare/Medicaid	$66.86
Rate for Payer: AZCH Complete Medicare	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$121.72
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$116.35
Rate for Payer: Copperpoint Commercial	$44.30
Rate for Payer: Health Net of AZ Commercial	$107.40
Rate for Payer: Health Net of AZ Medicare	$50.12
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Self Pay Self Pay	$143.20
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.22

INTRODUCER NEEDLE SET 12CM 18G

Facility

$180.00

Hospital Charge Code	22354314
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

INTRODUCER NEEDLE SET 12CM 18G

Facility

$180.00

Hospital Charge Code	22354314
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$28.80
Rate for Payer: Amerigroup Medicare	$28.80
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

INTRODUCER NEEDLE SET 20CM 18G

Facility

$180.00

Hospital Charge Code	22354315
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$28.80
Rate for Payer: Amerigroup Medicare	$28.80
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

INTRODUCER NEEDLE SET 20CM 18G

Facility

$180.00

Hospital Charge Code	22354315
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

Know your out-of-pocket cost for care.

All Charges