Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Neonate With Ecmo

Facility

$261,126.31

Service Code	APR-DRG 5834
Hospital Charge Code	APRDRG5832
Min. Negotiated Rate	$261,126.31
Max. Negotiated Rate	$261,126.31
Rate for Payer: AHCCCS Medicaid	$261,126.31
Rate for Payer: Allwell Medicaid	$261,126.31
Rate for Payer: AZCH Complete Medicaid	$261,126.31
Rate for Payer: Banner UC Health Medicaid	$261,126.31
Rate for Payer: Mercy Care Medicaid	$261,126.31

Neonate With Ecmo

Facility

$261,126.31

Service Code	APR-DRG 5834
Hospital Charge Code	APRDRG5833
Min. Negotiated Rate	$261,126.31
Max. Negotiated Rate	$261,126.31
Rate for Payer: AHCCCS Medicaid	$261,126.31
Rate for Payer: Allwell Medicaid	$261,126.31
Rate for Payer: AZCH Complete Medicaid	$261,126.31
Rate for Payer: Banner UC Health Medicaid	$261,126.31
Rate for Payer: Mercy Care Medicaid	$261,126.31

Neonate With Ecmo

Facility

$261,126.31

Service Code	APR-DRG 5834
Hospital Charge Code	APRDRG5834
Min. Negotiated Rate	$261,126.31
Max. Negotiated Rate	$261,126.31
Rate for Payer: AHCCCS Medicaid	$261,126.31
Rate for Payer: Allwell Medicaid	$261,126.31
Rate for Payer: AZCH Complete Medicaid	$261,126.31
Rate for Payer: Banner UC Health Medicaid	$261,126.31
Rate for Payer: Mercy Care Medicaid	$261,126.31

Neonate With Ecmo

Facility

$112,462.48

Service Code	APR-DRG 5831
Hospital Charge Code	APRDRG5833
Min. Negotiated Rate	$112,462.48
Max. Negotiated Rate	$112,462.48
Rate for Payer: AHCCCS Medicaid	$112,462.48
Rate for Payer: Allwell Medicaid	$112,462.48
Rate for Payer: AZCH Complete Medicaid	$112,462.48
Rate for Payer: Banner UC Health Medicaid	$112,462.48
Rate for Payer: Mercy Care Medicaid	$112,462.48

Neonate With Ecmo

Facility

$209,775.41

Service Code	APR-DRG 5833
Hospital Charge Code	APRDRG5834
Min. Negotiated Rate	$209,775.41
Max. Negotiated Rate	$209,775.41
Rate for Payer: AHCCCS Medicaid	$209,775.41
Rate for Payer: Allwell Medicaid	$209,775.41
Rate for Payer: AZCH Complete Medicaid	$209,775.41
Rate for Payer: Banner UC Health Medicaid	$209,775.41
Rate for Payer: Mercy Care Medicaid	$209,775.41

Neonate With Ecmo

Facility

$142,335.80

Service Code	APR-DRG 5832
Hospital Charge Code	APRDRG5831
Min. Negotiated Rate	$142,335.80
Max. Negotiated Rate	$142,335.80
Rate for Payer: AHCCCS Medicaid	$142,335.80
Rate for Payer: Allwell Medicaid	$142,335.80
Rate for Payer: AZCH Complete Medicaid	$142,335.80
Rate for Payer: Banner UC Health Medicaid	$142,335.80
Rate for Payer: Mercy Care Medicaid	$142,335.80

neostigmine 5 mg/ 10 mL Inj Sol [CQCH]

Facility

$1.83

Service Code	HCPCS J2710
Hospital Charge Code	105933754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.65
Rate for Payer: Aetna of AZ Commercial	$1.65
Rate for Payer: Aetna of AZ Medicare	$0.51
Rate for Payer: Allwell Medicare	$0.29
Rate for Payer: Amerigroup Medicare	$0.29
Rate for Payer: APIPA Medicare/Medicaid	$0.68
Rate for Payer: AZCH Complete Medicare	$0.29
Rate for Payer: Banner UC Health Medicare	$0.29
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.24
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna of AZ Commercial	$1.19
Rate for Payer: Copperpoint Commercial	$0.45
Rate for Payer: Health Net of AZ Commercial	$1.10
Rate for Payer: Health Net of AZ Medicare	$0.51
Rate for Payer: Humana of AZ Medicare	$0.29
Rate for Payer: Self Pay Self Pay	$1.46
Rate for Payer: TriWest Medicare	$0.29
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.33

neostigmine 5 mg/ 10 mL Inj Sol [CQCH]

Facility

$1.83

Service Code	HCPCS J2710
Hospital Charge Code	105933754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.65
Rate for Payer: Aetna of AZ Commercial	$1.65
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Cash Price	$1.47
Rate for Payer: Self Pay Self Pay	$1.46

NEO TEE RESUSCITATOR INFANT

Facility

$101.00

Hospital Charge Code	22562183
Hospital Revenue Code	272
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Bisbee Police All Plans	$26.26
Rate for Payer: Cash Price	$80.80
Rate for Payer: Self Pay Self Pay	$80.80

NEO TEE RESUSCITATOR INFANT

Facility

$101.00

Hospital Charge Code	22562183
Hospital Revenue Code	272
Min. Negotiated Rate	$16.16
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Aetna of AZ Medicare	$28.28
Rate for Payer: Allwell Medicare	$16.16
Rate for Payer: Amerigroup Medicare	$16.16
Rate for Payer: APIPA Medicare/Medicaid	$37.72
Rate for Payer: AZCH Complete Medicare	$16.16
Rate for Payer: Banner UC Health Medicare	$16.16
Rate for Payer: Bisbee Police All Plans	$26.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.68
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$70.70
Rate for Payer: Copperpoint Commercial	$25.00
Rate for Payer: Health Net of AZ Commercial	$60.60
Rate for Payer: Health Net of AZ Medicare	$28.28
Rate for Payer: Humana of AZ Medicare	$16.16
Rate for Payer: Self Pay Self Pay	$80.80
Rate for Payer: TriWest Medicare	$16.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.18

NEOTRACT UROLIFT SYSTEM

Facility

$2,663.00

Hospital Charge Code	23458651
Hospital Revenue Code	272
Min. Negotiated Rate	$426.08
Max. Negotiated Rate	$2,396.70
Rate for Payer: Aetna of AZ Commercial	$2,396.70
Rate for Payer: Aetna of AZ Medicare	$745.64
Rate for Payer: Allwell Medicare	$426.08
Rate for Payer: Amerigroup Medicare	$426.08
Rate for Payer: APIPA Medicare/Medicaid	$994.63
Rate for Payer: AZCH Complete Medicare	$426.08
Rate for Payer: Banner UC Health Medicare	$426.08
Rate for Payer: Bisbee Police All Plans	$692.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,810.84
Rate for Payer: Cash Price	$2,130.40
Rate for Payer: Cigna of AZ Commercial	$1,864.10
Rate for Payer: Copperpoint Commercial	$659.09
Rate for Payer: Health Net of AZ Commercial	$1,597.80
Rate for Payer: Health Net of AZ Medicare	$745.64
Rate for Payer: Humana of AZ Medicare	$426.08
Rate for Payer: Self Pay Self Pay	$2,130.40
Rate for Payer: TriWest Medicare	$426.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,552.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$479.34

NEOTRACT UROLIFT SYSTEM

Facility

$2,663.00

Hospital Charge Code	23458651
Hospital Revenue Code	272
Min. Negotiated Rate	$692.38
Max. Negotiated Rate	$2,396.70
Rate for Payer: Aetna of AZ Commercial	$2,396.70
Rate for Payer: Bisbee Police All Plans	$692.38
Rate for Payer: Cash Price	$2,130.40
Rate for Payer: Self Pay Self Pay	$2,130.40

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: AHCCCS Medicaid	$9,501.87
Rate for Payer: Allwell Medicaid	$9,501.87
Rate for Payer: AZCH Complete Medicaid	$9,501.87
Rate for Payer: Banner UC Health Medicaid	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$4,672.03
Max. Negotiated Rate	$4,672.03
Rate for Payer: AHCCCS Medicaid	$4,672.03
Rate for Payer: Allwell Medicaid	$4,672.03
Rate for Payer: AZCH Complete Medicaid	$4,672.03
Rate for Payer: Banner UC Health Medicaid	$4,672.03
Rate for Payer: Mercy Care Medicaid	$4,672.03

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: AHCCCS Medicaid	$3,229.95
Rate for Payer: Allwell Medicaid	$3,229.95
Rate for Payer: AZCH Complete Medicaid	$3,229.95
Rate for Payer: Banner UC Health Medicaid	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: AHCCCS Medicaid	$22,136.18
Rate for Payer: Allwell Medicaid	$22,136.18
Rate for Payer: AZCH Complete Medicaid	$22,136.18
Rate for Payer: Banner UC Health Medicaid	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: AHCCCS Medicaid	$9,501.87
Rate for Payer: Allwell Medicaid	$9,501.87
Rate for Payer: AZCH Complete Medicaid	$9,501.87
Rate for Payer: Banner UC Health Medicaid	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: AHCCCS Medicaid	$22,136.18
Rate for Payer: Allwell Medicaid	$22,136.18
Rate for Payer: AZCH Complete Medicaid	$22,136.18
Rate for Payer: Banner UC Health Medicaid	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: AHCCCS Medicaid	$3,229.95
Rate for Payer: Allwell Medicaid	$3,229.95
Rate for Payer: AZCH Complete Medicaid	$3,229.95
Rate for Payer: Banner UC Health Medicaid	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$4,672.03
Max. Negotiated Rate	$4,672.03
Rate for Payer: AHCCCS Medicaid	$4,672.03
Rate for Payer: Allwell Medicaid	$4,672.03
Rate for Payer: AZCH Complete Medicaid	$4,672.03
Rate for Payer: Banner UC Health Medicaid	$4,672.03
Rate for Payer: Mercy Care Medicaid	$4,672.03

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: AHCCCS Medicaid	$3,229.95
Rate for Payer: Allwell Medicaid	$3,229.95
Rate for Payer: AZCH Complete Medicaid	$3,229.95
Rate for Payer: Banner UC Health Medicaid	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: AHCCCS Medicaid	$9,501.87
Rate for Payer: Allwell Medicaid	$9,501.87
Rate for Payer: AZCH Complete Medicaid	$9,501.87
Rate for Payer: Banner UC Health Medicaid	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: AHCCCS Medicaid	$9,501.87
Rate for Payer: Allwell Medicaid	$9,501.87
Rate for Payer: AZCH Complete Medicaid	$9,501.87
Rate for Payer: Banner UC Health Medicaid	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: AHCCCS Medicaid	$22,136.18
Rate for Payer: Allwell Medicaid	$22,136.18
Rate for Payer: AZCH Complete Medicaid	$22,136.18
Rate for Payer: Banner UC Health Medicaid	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: AHCCCS Medicaid	$22,136.18
Rate for Payer: Allwell Medicaid	$22,136.18
Rate for Payer: AZCH Complete Medicaid	$22,136.18
Rate for Payer: Banner UC Health Medicaid	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18

Know your out-of-pocket cost for care.

All Charges