Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ORANGE INTRAOSSEOUS MODULE PEDS

Facility

$362.00

Hospital Charge Code	23175129
Hospital Revenue Code	272
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Aetna of AZ Medicare	$101.36
Rate for Payer: Allwell Medicare	$54.30
Rate for Payer: Amerigroup Medicare	$54.30
Rate for Payer: APIPA Medicare/Medicaid	$135.21
Rate for Payer: AZCH Complete Medicare	$54.30
Rate for Payer: Banner UC Health Medicare	$54.30
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.16
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cigna of AZ Commercial	$253.40
Rate for Payer: Copperpoint Commercial	$89.60
Rate for Payer: Health Net of AZ Commercial	$217.20
Rate for Payer: Health Net of AZ Medicare	$101.36
Rate for Payer: Humana of AZ Medicare	$54.30
Rate for Payer: Self Pay Self Pay	$289.60
Rate for Payer: TriWest Medicare	$54.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.16

ORANGE INTUBATION MODULE PEDS

Facility

$302.00

Hospital Charge Code	23175717
Hospital Revenue Code	272
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$45.30
Rate for Payer: Amerigroup Medicare	$45.30
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$45.30
Rate for Payer: Banner UC Health Medicare	$45.30
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$211.40
Rate for Payer: Copperpoint Commercial	$74.74
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$45.30
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$45.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

ORANGE INTUBATION MODULE PEDS

Facility

$302.00

Hospital Charge Code	23175717
Hospital Revenue Code	272
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

ORANGE IV DELIVERY MODULE PEDS

Facility

$290.00

Hospital Charge Code	23175710
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Aetna of AZ Medicare	$81.20
Rate for Payer: Allwell Medicare	$43.50
Rate for Payer: Amerigroup Medicare	$43.50
Rate for Payer: APIPA Medicare/Medicaid	$108.32
Rate for Payer: AZCH Complete Medicare	$43.50
Rate for Payer: Banner UC Health Medicare	$43.50
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$197.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$203.00
Rate for Payer: Copperpoint Commercial	$71.78
Rate for Payer: Health Net of AZ Commercial	$174.00
Rate for Payer: Health Net of AZ Medicare	$81.20
Rate for Payer: Humana of AZ Medicare	$43.50
Rate for Payer: Self Pay Self Pay	$232.00
Rate for Payer: TriWest Medicare	$43.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$169.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.20

ORANGE IV DELIVERY MODULE PEDS

Facility

$290.00

Hospital Charge Code	23175710
Hospital Revenue Code	272
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Self Pay Self Pay	$232.00

ORANGE OXYGEN DELIVERY SYSTEM PEDS

Facility

$121.00

Hospital Charge Code	23175703
Hospital Revenue Code	272
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of AZ Commercial	$108.90
Rate for Payer: Aetna of AZ Medicare	$33.88
Rate for Payer: Allwell Medicare	$18.15
Rate for Payer: Amerigroup Medicare	$18.15
Rate for Payer: APIPA Medicare/Medicaid	$45.19
Rate for Payer: AZCH Complete Medicare	$18.15
Rate for Payer: Banner UC Health Medicare	$18.15
Rate for Payer: Bisbee Police All Plans	$31.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$82.28
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cigna of AZ Commercial	$84.70
Rate for Payer: Copperpoint Commercial	$29.95
Rate for Payer: Health Net of AZ Commercial	$72.60
Rate for Payer: Health Net of AZ Medicare	$33.88
Rate for Payer: Humana of AZ Medicare	$18.15
Rate for Payer: Self Pay Self Pay	$96.80
Rate for Payer: TriWest Medicare	$18.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$70.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.78

ORANGE OXYGEN DELIVERY SYSTEM PEDS

Facility

$121.00

Hospital Charge Code	23175703
Hospital Revenue Code	272
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of AZ Commercial	$108.90
Rate for Payer: Bisbee Police All Plans	$31.46
Rate for Payer: Cash Price	$96.80
Rate for Payer: Self Pay Self Pay	$96.80

Orbit And Eye Procedures

Facility

$8,902.17

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$8,902.17
Max. Negotiated Rate	$8,902.17
Rate for Payer: AHCCCS Medicaid	$8,902.17
Rate for Payer: Allwell Medicaid	$8,902.17
Rate for Payer: AZCH Complete Medicaid	$8,902.17
Rate for Payer: Banner UC Health Medicaid	$8,902.17
Rate for Payer: Mercy Care Medicaid	$8,902.17

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Orbit And Eye Procedures

Facility

$8,902.17

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG0733
Min. Negotiated Rate	$8,902.17
Max. Negotiated Rate	$8,902.17
Rate for Payer: AHCCCS Medicaid	$8,902.17
Rate for Payer: Allwell Medicaid	$8,902.17
Rate for Payer: AZCH Complete Medicaid	$8,902.17
Rate for Payer: Banner UC Health Medicaid	$8,902.17
Rate for Payer: Mercy Care Medicaid	$8,902.17

Orbit And Eye Procedures

Facility

$15,146.73

Service Code	APR-DRG 0733
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$15,146.73
Max. Negotiated Rate	$15,146.73
Rate for Payer: AHCCCS Medicaid	$15,146.73
Rate for Payer: Allwell Medicaid	$15,146.73
Rate for Payer: AZCH Complete Medicaid	$15,146.73
Rate for Payer: Banner UC Health Medicaid	$15,146.73
Rate for Payer: Mercy Care Medicaid	$15,146.73

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0732
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Orbit And Eye Procedures

Facility

$28,755.30

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG0732
Min. Negotiated Rate	$28,755.30
Max. Negotiated Rate	$28,755.30
Rate for Payer: AHCCCS Medicaid	$28,755.30
Rate for Payer: Allwell Medicaid	$28,755.30
Rate for Payer: AZCH Complete Medicaid	$28,755.30
Rate for Payer: Banner UC Health Medicaid	$28,755.30
Rate for Payer: Mercy Care Medicaid	$28,755.30

Orbit And Eye Procedures

Facility

$15,146.73

Service Code	APR-DRG 0733
Hospital Charge Code	APRDRG0732
Min. Negotiated Rate	$15,146.73
Max. Negotiated Rate	$15,146.73
Rate for Payer: AHCCCS Medicaid	$15,146.73
Rate for Payer: Allwell Medicaid	$15,146.73
Rate for Payer: AZCH Complete Medicaid	$15,146.73
Rate for Payer: Banner UC Health Medicaid	$15,146.73
Rate for Payer: Mercy Care Medicaid	$15,146.73

Orbit And Eye Procedures

Facility

$8,902.17

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$8,902.17
Max. Negotiated Rate	$8,902.17
Rate for Payer: AHCCCS Medicaid	$8,902.17
Rate for Payer: Allwell Medicaid	$8,902.17
Rate for Payer: AZCH Complete Medicaid	$8,902.17
Rate for Payer: Banner UC Health Medicaid	$8,902.17
Rate for Payer: Mercy Care Medicaid	$8,902.17

Orbit And Eye Procedures

Facility

$28,755.30

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$28,755.30
Max. Negotiated Rate	$28,755.30
Rate for Payer: AHCCCS Medicaid	$28,755.30
Rate for Payer: Allwell Medicaid	$28,755.30
Rate for Payer: AZCH Complete Medicaid	$28,755.30
Rate for Payer: Banner UC Health Medicaid	$28,755.30
Rate for Payer: Mercy Care Medicaid	$28,755.30

Orbit And Eye Procedures

Facility

$15,146.73

Service Code	APR-DRG 0733
Hospital Charge Code	APRDRG0731
Min. Negotiated Rate	$15,146.73
Max. Negotiated Rate	$15,146.73
Rate for Payer: AHCCCS Medicaid	$15,146.73
Rate for Payer: Allwell Medicaid	$15,146.73
Rate for Payer: AZCH Complete Medicaid	$15,146.73
Rate for Payer: Banner UC Health Medicaid	$15,146.73
Rate for Payer: Mercy Care Medicaid	$15,146.73

Orbit And Eye Procedures

Facility

$28,755.30

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG0734
Min. Negotiated Rate	$28,755.30
Max. Negotiated Rate	$28,755.30
Rate for Payer: AHCCCS Medicaid	$28,755.30
Rate for Payer: Allwell Medicaid	$28,755.30
Rate for Payer: AZCH Complete Medicaid	$28,755.30
Rate for Payer: Banner UC Health Medicaid	$28,755.30
Rate for Payer: Mercy Care Medicaid	$28,755.30

Orbit And Eye Procedures

Facility

$8,902.17

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG0732
Min. Negotiated Rate	$8,902.17
Max. Negotiated Rate	$8,902.17
Rate for Payer: AHCCCS Medicaid	$8,902.17
Rate for Payer: Allwell Medicaid	$8,902.17
Rate for Payer: AZCH Complete Medicaid	$8,902.17
Rate for Payer: Banner UC Health Medicaid	$8,902.17
Rate for Payer: Mercy Care Medicaid	$8,902.17

Orbit And Eye Procedures

Facility

$15,146.73

Service Code	APR-DRG 0733
Hospital Charge Code	APRDRG0733
Min. Negotiated Rate	$15,146.73
Max. Negotiated Rate	$15,146.73
Rate for Payer: AHCCCS Medicaid	$15,146.73
Rate for Payer: Allwell Medicaid	$15,146.73
Rate for Payer: AZCH Complete Medicaid	$15,146.73
Rate for Payer: Banner UC Health Medicaid	$15,146.73
Rate for Payer: Mercy Care Medicaid	$15,146.73

Orbit And Eye Procedures

Facility

$28,755.30

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG0733
Min. Negotiated Rate	$28,755.30
Max. Negotiated Rate	$28,755.30
Rate for Payer: AHCCCS Medicaid	$28,755.30
Rate for Payer: Allwell Medicaid	$28,755.30
Rate for Payer: AZCH Complete Medicaid	$28,755.30
Rate for Payer: Banner UC Health Medicaid	$28,755.30
Rate for Payer: Mercy Care Medicaid	$28,755.30

Orbit And Eye Procedures

Facility

$6,265.61

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG0733
Min. Negotiated Rate	$6,265.61
Max. Negotiated Rate	$6,265.61
Rate for Payer: AHCCCS Medicaid	$6,265.61
Rate for Payer: Allwell Medicaid	$6,265.61
Rate for Payer: AZCH Complete Medicaid	$6,265.61
Rate for Payer: Banner UC Health Medicaid	$6,265.61
Rate for Payer: Mercy Care Medicaid	$6,265.61

Organic Mental Health Disturbances

Facility

$4,086.36

Service Code	APR-DRG 7572
Hospital Charge Code	APRDRG7573
Min. Negotiated Rate	$4,086.36
Max. Negotiated Rate	$4,086.36
Rate for Payer: AHCCCS Medicaid	$4,086.36
Rate for Payer: Allwell Medicaid	$4,086.36
Rate for Payer: AZCH Complete Medicaid	$4,086.36
Rate for Payer: Banner UC Health Medicaid	$4,086.36
Rate for Payer: Mercy Care Medicaid	$4,086.36

Organic Mental Health Disturbances

Facility

$7,742.75

Service Code	APR-DRG 7573
Hospital Charge Code	APRDRG7573
Min. Negotiated Rate	$7,742.75
Max. Negotiated Rate	$7,742.75
Rate for Payer: AHCCCS Medicaid	$7,742.75
Rate for Payer: Allwell Medicaid	$7,742.75
Rate for Payer: AZCH Complete Medicaid	$7,742.75
Rate for Payer: Banner UC Health Medicaid	$7,742.75
Rate for Payer: Mercy Care Medicaid	$7,742.75

Know your out-of-pocket cost for care.

All Charges