Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ondansetron 4 mg Dis Tab [CQCH]

Facility

$0.23

Service Code	HCPCS Q0162
Hospital Charge Code	105934883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of AZ Commercial	$0.21
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: AHCCCS Medicaid	$0.02
Rate for Payer: Allwell Medicaid	$0.02
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.09
Rate for Payer: AZCH Complete Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicaid	$0.02
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.16
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.15
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.14
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Mercy Care Medicaid	$0.02
Rate for Payer: Self Pay Self Pay	$0.18
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: AHCCCS Medicaid	$13,508.96
Rate for Payer: Allwell Medicaid	$13,508.96
Rate for Payer: AZCH Complete Medicaid	$13,508.96
Rate for Payer: Banner UC Health Medicaid	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: AHCCCS Medicaid	$13,508.96
Rate for Payer: Allwell Medicaid	$13,508.96
Rate for Payer: AZCH Complete Medicaid	$13,508.96
Rate for Payer: Banner UC Health Medicaid	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: AHCCCS Medicaid	$44,853.13
Rate for Payer: Allwell Medicaid	$44,853.13
Rate for Payer: AZCH Complete Medicaid	$44,853.13
Rate for Payer: Banner UC Health Medicaid	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: AHCCCS Medicaid	$27,410.01
Rate for Payer: Allwell Medicaid	$27,410.01
Rate for Payer: AZCH Complete Medicaid	$27,410.01
Rate for Payer: Banner UC Health Medicaid	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: AHCCCS Medicaid	$27,410.01
Rate for Payer: Allwell Medicaid	$27,410.01
Rate for Payer: AZCH Complete Medicaid	$27,410.01
Rate for Payer: Banner UC Health Medicaid	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: AHCCCS Medicaid	$17,671.77
Rate for Payer: Allwell Medicaid	$17,671.77
Rate for Payer: AZCH Complete Medicaid	$17,671.77
Rate for Payer: Banner UC Health Medicaid	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: AHCCCS Medicaid	$44,853.13
Rate for Payer: Allwell Medicaid	$44,853.13
Rate for Payer: AZCH Complete Medicaid	$44,853.13
Rate for Payer: Banner UC Health Medicaid	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: AHCCCS Medicaid	$17,671.77
Rate for Payer: Allwell Medicaid	$17,671.77
Rate for Payer: AZCH Complete Medicaid	$17,671.77
Rate for Payer: Banner UC Health Medicaid	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: AHCCCS Medicaid	$44,853.13
Rate for Payer: Allwell Medicaid	$44,853.13
Rate for Payer: AZCH Complete Medicaid	$44,853.13
Rate for Payer: Banner UC Health Medicaid	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: AHCCCS Medicaid	$13,508.96
Rate for Payer: Allwell Medicaid	$13,508.96
Rate for Payer: AZCH Complete Medicaid	$13,508.96
Rate for Payer: Banner UC Health Medicaid	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: AHCCCS Medicaid	$13,508.96
Rate for Payer: Allwell Medicaid	$13,508.96
Rate for Payer: AZCH Complete Medicaid	$13,508.96
Rate for Payer: Banner UC Health Medicaid	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: AHCCCS Medicaid	$17,671.77
Rate for Payer: Allwell Medicaid	$17,671.77
Rate for Payer: AZCH Complete Medicaid	$17,671.77
Rate for Payer: Banner UC Health Medicaid	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: AHCCCS Medicaid	$44,853.13
Rate for Payer: Allwell Medicaid	$44,853.13
Rate for Payer: AZCH Complete Medicaid	$44,853.13
Rate for Payer: Banner UC Health Medicaid	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: AHCCCS Medicaid	$17,671.77
Rate for Payer: Allwell Medicaid	$17,671.77
Rate for Payer: AZCH Complete Medicaid	$17,671.77
Rate for Payer: Banner UC Health Medicaid	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: AHCCCS Medicaid	$27,410.01
Rate for Payer: Allwell Medicaid	$27,410.01
Rate for Payer: AZCH Complete Medicaid	$27,410.01
Rate for Payer: Banner UC Health Medicaid	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: AHCCCS Medicaid	$27,410.01
Rate for Payer: Allwell Medicaid	$27,410.01
Rate for Payer: AZCH Complete Medicaid	$27,410.01
Rate for Payer: Banner UC Health Medicaid	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01

Open Craniotomy For Trauma

Facility

$14,951.74

Service Code	APR-DRG 0201
Hospital Charge Code	APRDRG0202
Min. Negotiated Rate	$14,951.74
Max. Negotiated Rate	$14,951.74
Rate for Payer: AHCCCS Medicaid	$14,951.74
Rate for Payer: Allwell Medicaid	$14,951.74
Rate for Payer: AZCH Complete Medicaid	$14,951.74
Rate for Payer: Banner UC Health Medicaid	$14,951.74
Rate for Payer: Mercy Care Medicaid	$14,951.74

Open Craniotomy For Trauma

Facility

$18,754.73

Service Code	APR-DRG 0202
Hospital Charge Code	APRDRG0201
Min. Negotiated Rate	$18,754.73
Max. Negotiated Rate	$18,754.73
Rate for Payer: AHCCCS Medicaid	$18,754.73
Rate for Payer: Allwell Medicaid	$18,754.73
Rate for Payer: AZCH Complete Medicaid	$18,754.73
Rate for Payer: Banner UC Health Medicaid	$18,754.73
Rate for Payer: Mercy Care Medicaid	$18,754.73

Open Craniotomy For Trauma

Facility

$14,951.74

Service Code	APR-DRG 0201
Hospital Charge Code	APRDRG0203
Min. Negotiated Rate	$14,951.74
Max. Negotiated Rate	$14,951.74
Rate for Payer: AHCCCS Medicaid	$14,951.74
Rate for Payer: Allwell Medicaid	$14,951.74
Rate for Payer: AZCH Complete Medicaid	$14,951.74
Rate for Payer: Banner UC Health Medicaid	$14,951.74
Rate for Payer: Mercy Care Medicaid	$14,951.74

Open Craniotomy For Trauma

Facility

$24,253.71

Service Code	APR-DRG 0203
Hospital Charge Code	APRDRG0201
Min. Negotiated Rate	$24,253.71
Max. Negotiated Rate	$24,253.71
Rate for Payer: AHCCCS Medicaid	$24,253.71
Rate for Payer: Allwell Medicaid	$24,253.71
Rate for Payer: AZCH Complete Medicaid	$24,253.71
Rate for Payer: Banner UC Health Medicaid	$24,253.71
Rate for Payer: Mercy Care Medicaid	$24,253.71

Open Craniotomy For Trauma

Facility

$24,253.71

Service Code	APR-DRG 0203
Hospital Charge Code	APRDRG0202
Min. Negotiated Rate	$24,253.71
Max. Negotiated Rate	$24,253.71
Rate for Payer: AHCCCS Medicaid	$24,253.71
Rate for Payer: Allwell Medicaid	$24,253.71
Rate for Payer: AZCH Complete Medicaid	$24,253.71
Rate for Payer: Banner UC Health Medicaid	$24,253.71
Rate for Payer: Mercy Care Medicaid	$24,253.71

Open Craniotomy For Trauma

Facility

$40,117.98

Service Code	APR-DRG 0204
Hospital Charge Code	APRDRG0203
Min. Negotiated Rate	$40,117.98
Max. Negotiated Rate	$40,117.98
Rate for Payer: AHCCCS Medicaid	$40,117.98
Rate for Payer: Allwell Medicaid	$40,117.98
Rate for Payer: AZCH Complete Medicaid	$40,117.98
Rate for Payer: Banner UC Health Medicaid	$40,117.98
Rate for Payer: Mercy Care Medicaid	$40,117.98

Open Craniotomy For Trauma

Facility

$24,253.71

Service Code	APR-DRG 0203
Hospital Charge Code	APRDRG0204
Min. Negotiated Rate	$24,253.71
Max. Negotiated Rate	$24,253.71
Rate for Payer: AHCCCS Medicaid	$24,253.71
Rate for Payer: Allwell Medicaid	$24,253.71
Rate for Payer: AZCH Complete Medicaid	$24,253.71
Rate for Payer: Banner UC Health Medicaid	$24,253.71
Rate for Payer: Mercy Care Medicaid	$24,253.71

Open Craniotomy For Trauma

Facility

$14,951.74

Service Code	APR-DRG 0201
Hospital Charge Code	APRDRG0204
Min. Negotiated Rate	$14,951.74
Max. Negotiated Rate	$14,951.74
Rate for Payer: AHCCCS Medicaid	$14,951.74
Rate for Payer: Allwell Medicaid	$14,951.74
Rate for Payer: AZCH Complete Medicaid	$14,951.74
Rate for Payer: Banner UC Health Medicaid	$14,951.74
Rate for Payer: Mercy Care Medicaid	$14,951.74

Know your out-of-pocket cost for care.

All Charges