Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4622
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	APRDRG4621
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	APRDRG4624
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

NERVE TEASING PREPARATIONS

Facility

$1,084.00

Service Code	CPT 88362
Hospital Charge Code	22545742
Hospital Revenue Code	310
Min. Negotiated Rate	$173.44
Max. Negotiated Rate	$975.60
Rate for Payer: Aetna of AZ Commercial	$975.60
Rate for Payer: Aetna of AZ Medicare	$303.52
Rate for Payer: Allwell Medicare	$173.44
Rate for Payer: Amerigroup Medicare	$173.44
Rate for Payer: APIPA Medicare/Medicaid	$404.87
Rate for Payer: AZCH Complete Medicare	$173.44
Rate for Payer: Banner UC Health Medicare	$173.44
Rate for Payer: Bisbee Police All Plans	$281.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$737.12
Rate for Payer: Cash Price	$867.20
Rate for Payer: Cigna of AZ Commercial	$704.60
Rate for Payer: Copperpoint Commercial	$268.29
Rate for Payer: Health Net of AZ Commercial	$650.40
Rate for Payer: Health Net of AZ Medicare	$303.52
Rate for Payer: Humana of AZ Medicare	$173.44
Rate for Payer: Self Pay Self Pay	$867.20
Rate for Payer: TriWest Medicare	$173.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$631.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$195.12

NERVE TEASING PREPARATIONS

Facility

$1,084.00

Service Code	CPT 88362
Hospital Charge Code	22545742
Hospital Revenue Code	310
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$975.60
Rate for Payer: Aetna of AZ Commercial	$975.60
Rate for Payer: Bisbee Police All Plans	$281.84
Rate for Payer: Cash Price	$867.20
Rate for Payer: Self Pay Self Pay	$867.20

Nervous System Malignancy

Facility

$5,862.30

Service Code	APR-DRG 0412
Hospital Charge Code	APRDRG0413
Min. Negotiated Rate	$5,862.30
Max. Negotiated Rate	$5,862.30
Rate for Payer: AHCCCS Medicaid	$5,862.30
Rate for Payer: Allwell Medicaid	$5,862.30
Rate for Payer: AZCH Complete Medicaid	$5,862.30
Rate for Payer: Banner UC Health Medicaid	$5,862.30
Rate for Payer: Mercy Care Medicaid	$5,862.30

Nervous System Malignancy

Facility

$12,266.78

Service Code	APR-DRG 0414
Hospital Charge Code	APRDRG0414
Min. Negotiated Rate	$12,266.78
Max. Negotiated Rate	$12,266.78
Rate for Payer: AHCCCS Medicaid	$12,266.78
Rate for Payer: Allwell Medicaid	$12,266.78
Rate for Payer: AZCH Complete Medicaid	$12,266.78
Rate for Payer: Banner UC Health Medicaid	$12,266.78
Rate for Payer: Mercy Care Medicaid	$12,266.78

Nervous System Malignancy

Facility

$5,242.97

Service Code	APR-DRG 0411
Hospital Charge Code	APRDRG0412
Min. Negotiated Rate	$5,242.97
Max. Negotiated Rate	$5,242.97
Rate for Payer: AHCCCS Medicaid	$5,242.97
Rate for Payer: Allwell Medicaid	$5,242.97
Rate for Payer: AZCH Complete Medicaid	$5,242.97
Rate for Payer: Banner UC Health Medicaid	$5,242.97
Rate for Payer: Mercy Care Medicaid	$5,242.97

Nervous System Malignancy

Facility

$12,266.78

Service Code	APR-DRG 0414
Hospital Charge Code	APRDRG0412
Min. Negotiated Rate	$12,266.78
Max. Negotiated Rate	$12,266.78
Rate for Payer: AHCCCS Medicaid	$12,266.78
Rate for Payer: Allwell Medicaid	$12,266.78
Rate for Payer: AZCH Complete Medicaid	$12,266.78
Rate for Payer: Banner UC Health Medicaid	$12,266.78
Rate for Payer: Mercy Care Medicaid	$12,266.78

Nervous System Malignancy

Facility

$5,862.30

Service Code	APR-DRG 0412
Hospital Charge Code	APRDRG0411
Min. Negotiated Rate	$5,862.30
Max. Negotiated Rate	$5,862.30
Rate for Payer: AHCCCS Medicaid	$5,862.30
Rate for Payer: Allwell Medicaid	$5,862.30
Rate for Payer: AZCH Complete Medicaid	$5,862.30
Rate for Payer: Banner UC Health Medicaid	$5,862.30
Rate for Payer: Mercy Care Medicaid	$5,862.30

Nervous System Malignancy

Facility

$12,266.78

Service Code	APR-DRG 0414
Hospital Charge Code	APRDRG0411
Min. Negotiated Rate	$12,266.78
Max. Negotiated Rate	$12,266.78
Rate for Payer: AHCCCS Medicaid	$12,266.78
Rate for Payer: Allwell Medicaid	$12,266.78
Rate for Payer: AZCH Complete Medicaid	$12,266.78
Rate for Payer: Banner UC Health Medicaid	$12,266.78
Rate for Payer: Mercy Care Medicaid	$12,266.78

Nervous System Malignancy

Facility

$5,862.30

Service Code	APR-DRG 0412
Hospital Charge Code	APRDRG0412
Min. Negotiated Rate	$5,862.30
Max. Negotiated Rate	$5,862.30
Rate for Payer: AHCCCS Medicaid	$5,862.30
Rate for Payer: Allwell Medicaid	$5,862.30
Rate for Payer: AZCH Complete Medicaid	$5,862.30
Rate for Payer: Banner UC Health Medicaid	$5,862.30
Rate for Payer: Mercy Care Medicaid	$5,862.30

Nervous System Malignancy

Facility

$5,862.30

Service Code	APR-DRG 0412
Hospital Charge Code	APRDRG0414
Min. Negotiated Rate	$5,862.30
Max. Negotiated Rate	$5,862.30
Rate for Payer: AHCCCS Medicaid	$5,862.30
Rate for Payer: Allwell Medicaid	$5,862.30
Rate for Payer: AZCH Complete Medicaid	$5,862.30
Rate for Payer: Banner UC Health Medicaid	$5,862.30
Rate for Payer: Mercy Care Medicaid	$5,862.30

Nervous System Malignancy

Facility

$7,829.03

Service Code	APR-DRG 0413
Hospital Charge Code	APRDRG0411
Min. Negotiated Rate	$7,829.03
Max. Negotiated Rate	$7,829.03
Rate for Payer: AHCCCS Medicaid	$7,829.03
Rate for Payer: Allwell Medicaid	$7,829.03
Rate for Payer: AZCH Complete Medicaid	$7,829.03
Rate for Payer: Banner UC Health Medicaid	$7,829.03
Rate for Payer: Mercy Care Medicaid	$7,829.03

Nervous System Malignancy

Facility

$7,829.03

Service Code	APR-DRG 0413
Hospital Charge Code	APRDRG0412
Min. Negotiated Rate	$7,829.03
Max. Negotiated Rate	$7,829.03
Rate for Payer: AHCCCS Medicaid	$7,829.03
Rate for Payer: Allwell Medicaid	$7,829.03
Rate for Payer: AZCH Complete Medicaid	$7,829.03
Rate for Payer: Banner UC Health Medicaid	$7,829.03
Rate for Payer: Mercy Care Medicaid	$7,829.03

Nervous System Malignancy

Facility

$7,829.03

Service Code	APR-DRG 0413
Hospital Charge Code	APRDRG0413
Min. Negotiated Rate	$7,829.03
Max. Negotiated Rate	$7,829.03
Rate for Payer: AHCCCS Medicaid	$7,829.03
Rate for Payer: Allwell Medicaid	$7,829.03
Rate for Payer: AZCH Complete Medicaid	$7,829.03
Rate for Payer: Banner UC Health Medicaid	$7,829.03
Rate for Payer: Mercy Care Medicaid	$7,829.03

Nervous System Malignancy

Facility

$5,242.97

Service Code	APR-DRG 0411
Hospital Charge Code	APRDRG0413
Min. Negotiated Rate	$5,242.97
Max. Negotiated Rate	$5,242.97
Rate for Payer: AHCCCS Medicaid	$5,242.97
Rate for Payer: Allwell Medicaid	$5,242.97
Rate for Payer: AZCH Complete Medicaid	$5,242.97
Rate for Payer: Banner UC Health Medicaid	$5,242.97
Rate for Payer: Mercy Care Medicaid	$5,242.97

Nervous System Malignancy

Facility

$12,266.78

Service Code	APR-DRG 0414
Hospital Charge Code	APRDRG0413
Min. Negotiated Rate	$12,266.78
Max. Negotiated Rate	$12,266.78
Rate for Payer: AHCCCS Medicaid	$12,266.78
Rate for Payer: Allwell Medicaid	$12,266.78
Rate for Payer: AZCH Complete Medicaid	$12,266.78
Rate for Payer: Banner UC Health Medicaid	$12,266.78
Rate for Payer: Mercy Care Medicaid	$12,266.78

Nervous System Malignancy

Facility

$7,829.03

Service Code	APR-DRG 0413
Hospital Charge Code	APRDRG0414
Min. Negotiated Rate	$7,829.03
Max. Negotiated Rate	$7,829.03
Rate for Payer: AHCCCS Medicaid	$7,829.03
Rate for Payer: Allwell Medicaid	$7,829.03
Rate for Payer: AZCH Complete Medicaid	$7,829.03
Rate for Payer: Banner UC Health Medicaid	$7,829.03
Rate for Payer: Mercy Care Medicaid	$7,829.03

Nervous System Malignancy

Facility

$5,242.97

Service Code	APR-DRG 0411
Hospital Charge Code	APRDRG0411
Min. Negotiated Rate	$5,242.97
Max. Negotiated Rate	$5,242.97
Rate for Payer: AHCCCS Medicaid	$5,242.97
Rate for Payer: Allwell Medicaid	$5,242.97
Rate for Payer: AZCH Complete Medicaid	$5,242.97
Rate for Payer: Banner UC Health Medicaid	$5,242.97
Rate for Payer: Mercy Care Medicaid	$5,242.97

Nervous System Malignancy

Facility

$5,242.97

Service Code	APR-DRG 0411
Hospital Charge Code	APRDRG0414
Min. Negotiated Rate	$5,242.97
Max. Negotiated Rate	$5,242.97
Rate for Payer: AHCCCS Medicaid	$5,242.97
Rate for Payer: Allwell Medicaid	$5,242.97
Rate for Payer: AZCH Complete Medicaid	$5,242.97
Rate for Payer: Banner UC Health Medicaid	$5,242.97
Rate for Payer: Mercy Care Medicaid	$5,242.97

NEURO STIMULATOR

Facility

$62,920.00

Service Code	CPT C1767
Hospital Charge Code	22354564
Hospital Revenue Code	270
Min. Negotiated Rate	$10,067.20
Max. Negotiated Rate	$56,628.00
Rate for Payer: Aetna of AZ Commercial	$56,628.00
Rate for Payer: Aetna of AZ Medicare	$17,617.60
Rate for Payer: Allwell Medicare	$10,067.20
Rate for Payer: Amerigroup Medicare	$10,067.20
Rate for Payer: APIPA Medicare/Medicaid	$23,500.62
Rate for Payer: AZCH Complete Medicare	$10,067.20
Rate for Payer: Banner UC Health Medicare	$10,067.20
Rate for Payer: Bisbee Police All Plans	$16,359.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42,785.60
Rate for Payer: Cash Price	$50,336.00
Rate for Payer: Cigna of AZ Commercial	$44,044.00
Rate for Payer: Copperpoint Commercial	$15,572.70
Rate for Payer: Health Net of AZ Commercial	$37,752.00
Rate for Payer: Health Net of AZ Medicare	$17,617.60
Rate for Payer: Humana of AZ Medicare	$10,067.20
Rate for Payer: Self Pay Self Pay	$50,336.00
Rate for Payer: TriWest Medicare	$10,067.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$36,682.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$11,325.60

NEURO STIMULATOR

Facility

$62,920.00

Service Code	CPT C1767
Hospital Charge Code	22354564
Hospital Revenue Code	270
Min. Negotiated Rate	$16,359.20
Max. Negotiated Rate	$56,628.00
Rate for Payer: Aetna of AZ Commercial	$56,628.00
Rate for Payer: Bisbee Police All Plans	$16,359.20
Rate for Payer: Cash Price	$50,336.00
Rate for Payer: Self Pay Self Pay	$50,336.00

NGAGE STONE EXTRACTOR 2.2 NITINOL

Facility

$1,322.30

Hospital Charge Code	22834568
Hospital Revenue Code	272
Min. Negotiated Rate	$343.80
Max. Negotiated Rate	$1,190.07
Rate for Payer: Aetna of AZ Commercial	$1,190.07
Rate for Payer: Bisbee Police All Plans	$343.80
Rate for Payer: Cash Price	$1,057.84
Rate for Payer: Self Pay Self Pay	$1,057.84

NGAGE STONE EXTRACTOR 2.2 NITINOL

Facility

$1,322.30

Hospital Charge Code	22834568
Hospital Revenue Code	272
Min. Negotiated Rate	$211.57
Max. Negotiated Rate	$1,190.07
Rate for Payer: Aetna of AZ Commercial	$1,190.07
Rate for Payer: Aetna of AZ Medicare	$370.24
Rate for Payer: Allwell Medicare	$211.57
Rate for Payer: Amerigroup Medicare	$211.57
Rate for Payer: APIPA Medicare/Medicaid	$493.88
Rate for Payer: AZCH Complete Medicare	$211.57
Rate for Payer: Banner UC Health Medicare	$211.57
Rate for Payer: Bisbee Police All Plans	$343.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$899.16
Rate for Payer: Cash Price	$1,057.84
Rate for Payer: Cigna of AZ Commercial	$925.61
Rate for Payer: Copperpoint Commercial	$327.27
Rate for Payer: Health Net of AZ Commercial	$793.38
Rate for Payer: Health Net of AZ Medicare	$370.24
Rate for Payer: Humana of AZ Medicare	$211.57
Rate for Payer: Self Pay Self Pay	$1,057.84
Rate for Payer: TriWest Medicare	$211.57
Rate for Payer: UnitedHealth Group of AZ Commercial	$770.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$238.01

Know your out-of-pocket cost for care.

All Charges