Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Kidney Transplant

Facility

$30,772.52

Service Code	APR-DRG 4401
Hospital Charge Code	APRDRG4401
Min. Negotiated Rate	$30,772.52
Max. Negotiated Rate	$30,772.52
Rate for Payer: AHCCCS Medicaid	$30,772.52
Rate for Payer: Allwell Medicaid	$30,772.52
Rate for Payer: AZCH Complete Medicaid	$30,772.52
Rate for Payer: Banner UC Health Medicaid	$30,772.52
Rate for Payer: Mercy Care Medicaid	$30,772.52

Kidney Transplant

Facility

$37,932.41

Service Code	APR-DRG 4403
Hospital Charge Code	APRDRG4401
Min. Negotiated Rate	$37,932.41
Max. Negotiated Rate	$37,932.41
Rate for Payer: AHCCCS Medicaid	$37,932.41
Rate for Payer: Allwell Medicaid	$37,932.41
Rate for Payer: AZCH Complete Medicaid	$37,932.41
Rate for Payer: Banner UC Health Medicaid	$37,932.41
Rate for Payer: Mercy Care Medicaid	$37,932.41

Kidney Transplant

Facility

$37,932.41

Service Code	APR-DRG 4403
Hospital Charge Code	APRDRG4402
Min. Negotiated Rate	$37,932.41
Max. Negotiated Rate	$37,932.41
Rate for Payer: AHCCCS Medicaid	$37,932.41
Rate for Payer: Allwell Medicaid	$37,932.41
Rate for Payer: AZCH Complete Medicaid	$37,932.41
Rate for Payer: Banner UC Health Medicaid	$37,932.41
Rate for Payer: Mercy Care Medicaid	$37,932.41

Kidney Transplant

Facility

$32,709.79

Service Code	APR-DRG 4402
Hospital Charge Code	APRDRG4404
Min. Negotiated Rate	$32,709.79
Max. Negotiated Rate	$32,709.79
Rate for Payer: AHCCCS Medicaid	$32,709.79
Rate for Payer: Allwell Medicaid	$32,709.79
Rate for Payer: AZCH Complete Medicaid	$32,709.79
Rate for Payer: Banner UC Health Medicaid	$32,709.79
Rate for Payer: Mercy Care Medicaid	$32,709.79

Kidney Transplant

Facility

$30,772.52

Service Code	APR-DRG 4401
Hospital Charge Code	APRDRG4404
Min. Negotiated Rate	$30,772.52
Max. Negotiated Rate	$30,772.52
Rate for Payer: AHCCCS Medicaid	$30,772.52
Rate for Payer: Allwell Medicaid	$30,772.52
Rate for Payer: AZCH Complete Medicaid	$30,772.52
Rate for Payer: Banner UC Health Medicaid	$30,772.52
Rate for Payer: Mercy Care Medicaid	$30,772.52

Kidney Transplant

Facility

$37,932.41

Service Code	APR-DRG 4403
Hospital Charge Code	APRDRG4404
Min. Negotiated Rate	$37,932.41
Max. Negotiated Rate	$37,932.41
Rate for Payer: AHCCCS Medicaid	$37,932.41
Rate for Payer: Allwell Medicaid	$37,932.41
Rate for Payer: AZCH Complete Medicaid	$37,932.41
Rate for Payer: Banner UC Health Medicaid	$37,932.41
Rate for Payer: Mercy Care Medicaid	$37,932.41

Kidney Transplant

Facility

$32,709.79

Service Code	APR-DRG 4402
Hospital Charge Code	APRDRG4402
Min. Negotiated Rate	$32,709.79
Max. Negotiated Rate	$32,709.79
Rate for Payer: AHCCCS Medicaid	$32,709.79
Rate for Payer: Allwell Medicaid	$32,709.79
Rate for Payer: AZCH Complete Medicaid	$32,709.79
Rate for Payer: Banner UC Health Medicaid	$32,709.79
Rate for Payer: Mercy Care Medicaid	$32,709.79

Kidney Transplant

Facility

$37,932.41

Service Code	APR-DRG 4403
Hospital Charge Code	APRDRG4403
Min. Negotiated Rate	$37,932.41
Max. Negotiated Rate	$37,932.41
Rate for Payer: AHCCCS Medicaid	$37,932.41
Rate for Payer: Allwell Medicaid	$37,932.41
Rate for Payer: AZCH Complete Medicaid	$37,932.41
Rate for Payer: Banner UC Health Medicaid	$37,932.41
Rate for Payer: Mercy Care Medicaid	$37,932.41

Kidney Transplant

Facility

$32,709.79

Service Code	APR-DRG 4402
Hospital Charge Code	APRDRG4403
Min. Negotiated Rate	$32,709.79
Max. Negotiated Rate	$32,709.79
Rate for Payer: AHCCCS Medicaid	$32,709.79
Rate for Payer: Allwell Medicaid	$32,709.79
Rate for Payer: AZCH Complete Medicaid	$32,709.79
Rate for Payer: Banner UC Health Medicaid	$32,709.79
Rate for Payer: Mercy Care Medicaid	$32,709.79

Kidney Transplant

Facility

$58,385.24

Service Code	APR-DRG 4404
Hospital Charge Code	APRDRG4403
Min. Negotiated Rate	$58,385.24
Max. Negotiated Rate	$58,385.24
Rate for Payer: AHCCCS Medicaid	$58,385.24
Rate for Payer: Allwell Medicaid	$58,385.24
Rate for Payer: AZCH Complete Medicaid	$58,385.24
Rate for Payer: Banner UC Health Medicaid	$58,385.24
Rate for Payer: Mercy Care Medicaid	$58,385.24

KIT ABG

Facility

$8.00

Hospital Charge Code	22355779
Hospital Revenue Code	272
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Cash Price	$6.40
Rate for Payer: Self Pay Self Pay	$6.40

KIT ABG

Facility

$8.00

Hospital Charge Code	22355779
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Aetna of AZ Medicare	$2.24
Rate for Payer: Allwell Medicare	$1.20
Rate for Payer: Amerigroup Medicare	$1.20
Rate for Payer: APIPA Medicare/Medicaid	$2.99
Rate for Payer: AZCH Complete Medicare	$1.20
Rate for Payer: Banner UC Health Medicare	$1.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.44
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Copperpoint Commercial	$1.98
Rate for Payer: Health Net of AZ Commercial	$4.80
Rate for Payer: Health Net of AZ Medicare	$2.24
Rate for Payer: Humana of AZ Medicare	$1.20
Rate for Payer: Self Pay Self Pay	$6.40
Rate for Payer: TriWest Medicare	$1.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.44

KIT CATH 2 LUMEN 4FR

Facility

$323.00

Hospital Charge Code	22354825
Hospital Revenue Code	270
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$290.70
Rate for Payer: Aetna of AZ Commercial	$290.70
Rate for Payer: Bisbee Police All Plans	$83.98
Rate for Payer: Cash Price	$258.40
Rate for Payer: Self Pay Self Pay	$258.40

KIT CATH 2 LUMEN 4FR

Facility

$323.00

Hospital Charge Code	22354825
Hospital Revenue Code	270
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$290.70
Rate for Payer: Aetna of AZ Commercial	$290.70
Rate for Payer: Aetna of AZ Medicare	$90.44
Rate for Payer: Allwell Medicare	$48.45
Rate for Payer: Amerigroup Medicare	$48.45
Rate for Payer: APIPA Medicare/Medicaid	$120.64
Rate for Payer: AZCH Complete Medicare	$48.45
Rate for Payer: Banner UC Health Medicare	$48.45
Rate for Payer: Bisbee Police All Plans	$83.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$219.64
Rate for Payer: Cash Price	$258.40
Rate for Payer: Cigna of AZ Commercial	$226.10
Rate for Payer: Copperpoint Commercial	$79.94
Rate for Payer: Health Net of AZ Commercial	$193.80
Rate for Payer: Health Net of AZ Medicare	$90.44
Rate for Payer: Humana of AZ Medicare	$48.45
Rate for Payer: Self Pay Self Pay	$258.40
Rate for Payer: TriWest Medicare	$48.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$188.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.14

KIT CATH CAVITY DRAINAGE

Facility

$475.00

Hospital Charge Code	22354826
Hospital Revenue Code	270
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Aetna of AZ Medicare	$133.00
Rate for Payer: Allwell Medicare	$71.25
Rate for Payer: Amerigroup Medicare	$71.25
Rate for Payer: APIPA Medicare/Medicaid	$177.41
Rate for Payer: AZCH Complete Medicare	$71.25
Rate for Payer: Banner UC Health Medicare	$71.25
Rate for Payer: Bisbee Police All Plans	$123.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$323.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cigna of AZ Commercial	$332.50
Rate for Payer: Copperpoint Commercial	$117.56
Rate for Payer: Health Net of AZ Commercial	$285.00
Rate for Payer: Health Net of AZ Medicare	$133.00
Rate for Payer: Humana of AZ Medicare	$71.25
Rate for Payer: Self Pay Self Pay	$380.00
Rate for Payer: TriWest Medicare	$71.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$276.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$85.50

KIT CATH CAVITY DRAINAGE

Facility

$475.00

Hospital Charge Code	22354826
Hospital Revenue Code	270
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Bisbee Police All Plans	$123.50
Rate for Payer: Cash Price	$380.00
Rate for Payer: Self Pay Self Pay	$380.00

KIT CATH CRICOTHYROTOMY

Facility

$1,474.00

Hospital Charge Code	22354208
Hospital Revenue Code	270
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Aetna of AZ Medicare	$412.72
Rate for Payer: Allwell Medicare	$221.10
Rate for Payer: Amerigroup Medicare	$221.10
Rate for Payer: APIPA Medicare/Medicaid	$550.54
Rate for Payer: AZCH Complete Medicare	$221.10
Rate for Payer: Banner UC Health Medicare	$221.10
Rate for Payer: Bisbee Police All Plans	$383.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,002.32
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cigna of AZ Commercial	$1,031.80
Rate for Payer: Copperpoint Commercial	$364.82
Rate for Payer: Health Net of AZ Commercial	$884.40
Rate for Payer: Health Net of AZ Medicare	$412.72
Rate for Payer: Humana of AZ Medicare	$221.10
Rate for Payer: Self Pay Self Pay	$1,179.20
Rate for Payer: TriWest Medicare	$221.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$859.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$265.32

KIT CATH CRICOTHYROTOMY

Facility

$1,474.00

Hospital Charge Code	22354208
Hospital Revenue Code	270
Min. Negotiated Rate	$383.24
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Bisbee Police All Plans	$383.24
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Self Pay Self Pay	$1,179.20

KIT CATH MULTI-LUMEN CENTRAL VENOUS

Facility

$539.00

Hospital Charge Code	22354827
Hospital Revenue Code	270
Min. Negotiated Rate	$140.14
Max. Negotiated Rate	$485.10
Rate for Payer: Aetna of AZ Commercial	$485.10
Rate for Payer: Bisbee Police All Plans	$140.14
Rate for Payer: Cash Price	$431.20
Rate for Payer: Self Pay Self Pay	$431.20

KIT CATH MULTI-LUMEN CENTRAL VENOUS

Facility

$539.00

Hospital Charge Code	22354827
Hospital Revenue Code	270
Min. Negotiated Rate	$80.85
Max. Negotiated Rate	$485.10
Rate for Payer: Aetna of AZ Commercial	$485.10
Rate for Payer: Aetna of AZ Medicare	$150.92
Rate for Payer: Allwell Medicare	$80.85
Rate for Payer: Amerigroup Medicare	$80.85
Rate for Payer: APIPA Medicare/Medicaid	$201.32
Rate for Payer: AZCH Complete Medicare	$80.85
Rate for Payer: Banner UC Health Medicare	$80.85
Rate for Payer: Bisbee Police All Plans	$140.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$366.52
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cigna of AZ Commercial	$377.30
Rate for Payer: Copperpoint Commercial	$133.40
Rate for Payer: Health Net of AZ Commercial	$323.40
Rate for Payer: Health Net of AZ Medicare	$150.92
Rate for Payer: Humana of AZ Medicare	$80.85
Rate for Payer: Self Pay Self Pay	$431.20
Rate for Payer: TriWest Medicare	$80.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$314.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.02

KIT ENEMA DISPOSABLE EZ EM

Facility

$35.00

Hospital Charge Code	22355114
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Aetna of AZ Medicare	$9.80
Rate for Payer: Allwell Medicare	$5.25
Rate for Payer: Amerigroup Medicare	$5.25
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.25
Rate for Payer: Banner UC Health Medicare	$5.25
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$24.50
Rate for Payer: Copperpoint Commercial	$8.66
Rate for Payer: Health Net of AZ Commercial	$21.00
Rate for Payer: Health Net of AZ Medicare	$9.80
Rate for Payer: Humana of AZ Medicare	$5.25
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

KIT ENEMA DISPOSABLE EZ EM

Facility

$35.00

Hospital Charge Code	22355114
Hospital Revenue Code	270
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Cash Price	$28.00
Rate for Payer: Self Pay Self Pay	$28.00

KIT GASTRIC LAVAGE (TUM-E-VAC)

Facility

$205.00

Hospital Charge Code	22354485
Hospital Revenue Code	272
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

KIT GASTRIC LAVAGE (TUM-E-VAC)

Facility

$205.00

Hospital Charge Code	22354485
Hospital Revenue Code	272
Min. Negotiated Rate	$30.75
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	$30.75
Rate for Payer: Amerigroup Medicare	$30.75
Rate for Payer: APIPA Medicare/Medicaid	$76.57
Rate for Payer: AZCH Complete Medicare	$30.75
Rate for Payer: Banner UC Health Medicare	$30.75
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	$143.50
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	$30.75
Rate for Payer: Self Pay Self Pay	$164.00
Rate for Payer: TriWest Medicare	$30.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$119.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.90

KIT, IV START

Facility

$14.00

Hospital Charge Code	23254274
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Aetna of AZ Medicare	$3.92
Rate for Payer: Allwell Medicare	$2.10
Rate for Payer: Amerigroup Medicare	$2.10
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.10
Rate for Payer: Banner UC Health Medicare	$2.10
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$9.52
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Copperpoint Commercial	$3.46
Rate for Payer: Health Net of AZ Commercial	$8.40
Rate for Payer: Health Net of AZ Medicare	$3.92
Rate for Payer: Humana of AZ Medicare	$2.10
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

Know your out-of-pocket cost for care.

All Charges