Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Acute Hepatitis LC

Facility

$1,209.00

Service Code	CPT 80074
Hospital Charge Code	26187661
Hospital Revenue Code	301
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$1,088.10
Rate for Payer: Aetna of AZ Commercial	$1,088.10
Rate for Payer: Aetna of AZ Medicare	$338.52
Rate for Payer: AHCCCS Medicaid	$47.63
Rate for Payer: Allwell Medicaid	$47.63
Rate for Payer: Allwell Medicare	$181.35
Rate for Payer: Amerigroup Medicare	$181.35
Rate for Payer: APIPA Medicare/Medicaid	$451.56
Rate for Payer: AZCH Complete Medicaid	$47.63
Rate for Payer: AZCH Complete Medicare	$181.35
Rate for Payer: Banner UC Health Medicaid	$47.63
Rate for Payer: Banner UC Health Medicare	$181.35
Rate for Payer: Bisbee Police All Plans	$314.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$822.12
Rate for Payer: Cash Price	$967.20
Rate for Payer: Cash Price	$967.20
Rate for Payer: Cigna of AZ Commercial	$785.85
Rate for Payer: Copperpoint Commercial	$299.23
Rate for Payer: Health Net of AZ Commercial	$725.40
Rate for Payer: Health Net of AZ Medicare	$338.52
Rate for Payer: Humana of AZ Medicare	$181.35
Rate for Payer: Mercy Care Medicaid	$47.63
Rate for Payer: Self Pay Self Pay	$967.20
Rate for Payer: TriWest Medicare	$181.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$704.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$217.62

Acute Hepatitis LC

Facility

$1,209.00

Service Code	CPT 80074
Hospital Charge Code	26187661
Hospital Revenue Code	301
Min. Negotiated Rate	$314.34
Max. Negotiated Rate	$1,088.10
Rate for Payer: Aetna of AZ Commercial	$1,088.10
Rate for Payer: Bisbee Police All Plans	$314.34
Rate for Payer: Cash Price	$967.20
Rate for Payer: Self Pay Self Pay	$967.20

Acute Kidney Injury

Facility

$12,796.34

Service Code	APR-DRG 4694
Hospital Charge Code	APRDRG4693
Min. Negotiated Rate	$12,796.34
Max. Negotiated Rate	$12,796.34
Rate for Payer: AHCCCS Medicaid	$12,796.34
Rate for Payer: Allwell Medicaid	$12,796.34
Rate for Payer: AZCH Complete Medicaid	$12,796.34
Rate for Payer: Banner UC Health Medicaid	$12,796.34
Rate for Payer: Mercy Care Medicaid	$12,796.34

Acute Kidney Injury

Facility

$12,796.34

Service Code	APR-DRG 4694
Hospital Charge Code	APRDRG4691
Min. Negotiated Rate	$12,796.34
Max. Negotiated Rate	$12,796.34
Rate for Payer: AHCCCS Medicaid	$12,796.34
Rate for Payer: Allwell Medicaid	$12,796.34
Rate for Payer: AZCH Complete Medicaid	$12,796.34
Rate for Payer: Banner UC Health Medicaid	$12,796.34
Rate for Payer: Mercy Care Medicaid	$12,796.34

Acute Kidney Injury

Facility

$4,072.33

Service Code	APR-DRG 4692
Hospital Charge Code	APRDRG4691
Min. Negotiated Rate	$4,072.33
Max. Negotiated Rate	$4,072.33
Rate for Payer: AHCCCS Medicaid	$4,072.33
Rate for Payer: Allwell Medicaid	$4,072.33
Rate for Payer: AZCH Complete Medicaid	$4,072.33
Rate for Payer: Banner UC Health Medicaid	$4,072.33
Rate for Payer: Mercy Care Medicaid	$4,072.33

Acute Kidney Injury

Facility

$4,072.33

Service Code	APR-DRG 4692
Hospital Charge Code	APRDRG4692
Min. Negotiated Rate	$4,072.33
Max. Negotiated Rate	$4,072.33
Rate for Payer: AHCCCS Medicaid	$4,072.33
Rate for Payer: Allwell Medicaid	$4,072.33
Rate for Payer: AZCH Complete Medicaid	$4,072.33
Rate for Payer: Banner UC Health Medicaid	$4,072.33
Rate for Payer: Mercy Care Medicaid	$4,072.33

Acute Kidney Injury

Facility

$12,796.34

Service Code	APR-DRG 4694
Hospital Charge Code	APRDRG4692
Min. Negotiated Rate	$12,796.34
Max. Negotiated Rate	$12,796.34
Rate for Payer: AHCCCS Medicaid	$12,796.34
Rate for Payer: Allwell Medicaid	$12,796.34
Rate for Payer: AZCH Complete Medicaid	$12,796.34
Rate for Payer: Banner UC Health Medicaid	$12,796.34
Rate for Payer: Mercy Care Medicaid	$12,796.34

Acute Kidney Injury

Facility

$3,009.01

Service Code	APR-DRG 4691
Hospital Charge Code	APRDRG4694
Min. Negotiated Rate	$3,009.01
Max. Negotiated Rate	$3,009.01
Rate for Payer: AHCCCS Medicaid	$3,009.01
Rate for Payer: Allwell Medicaid	$3,009.01
Rate for Payer: AZCH Complete Medicaid	$3,009.01
Rate for Payer: Banner UC Health Medicaid	$3,009.01
Rate for Payer: Mercy Care Medicaid	$3,009.01

Acute Kidney Injury

Facility

$4,072.33

Service Code	APR-DRG 4692
Hospital Charge Code	APRDRG4694
Min. Negotiated Rate	$4,072.33
Max. Negotiated Rate	$4,072.33
Rate for Payer: AHCCCS Medicaid	$4,072.33
Rate for Payer: Allwell Medicaid	$4,072.33
Rate for Payer: AZCH Complete Medicaid	$4,072.33
Rate for Payer: Banner UC Health Medicaid	$4,072.33
Rate for Payer: Mercy Care Medicaid	$4,072.33

Acute Kidney Injury

Facility

$3,009.01

Service Code	APR-DRG 4691
Hospital Charge Code	APRDRG4691
Min. Negotiated Rate	$3,009.01
Max. Negotiated Rate	$3,009.01
Rate for Payer: AHCCCS Medicaid	$3,009.01
Rate for Payer: Allwell Medicaid	$3,009.01
Rate for Payer: AZCH Complete Medicaid	$3,009.01
Rate for Payer: Banner UC Health Medicaid	$3,009.01
Rate for Payer: Mercy Care Medicaid	$3,009.01

Acute Kidney Injury

Facility

$3,009.01

Service Code	APR-DRG 4691
Hospital Charge Code	APRDRG4693
Min. Negotiated Rate	$3,009.01
Max. Negotiated Rate	$3,009.01
Rate for Payer: AHCCCS Medicaid	$3,009.01
Rate for Payer: Allwell Medicaid	$3,009.01
Rate for Payer: AZCH Complete Medicaid	$3,009.01
Rate for Payer: Banner UC Health Medicaid	$3,009.01
Rate for Payer: Mercy Care Medicaid	$3,009.01

Acute Kidney Injury

Facility

$12,796.34

Service Code	APR-DRG 4694
Hospital Charge Code	APRDRG4694
Min. Negotiated Rate	$12,796.34
Max. Negotiated Rate	$12,796.34
Rate for Payer: AHCCCS Medicaid	$12,796.34
Rate for Payer: Allwell Medicaid	$12,796.34
Rate for Payer: AZCH Complete Medicaid	$12,796.34
Rate for Payer: Banner UC Health Medicaid	$12,796.34
Rate for Payer: Mercy Care Medicaid	$12,796.34

Acute Kidney Injury

Facility

$6,575.63

Service Code	APR-DRG 4693
Hospital Charge Code	APRDRG4691
Min. Negotiated Rate	$6,575.63
Max. Negotiated Rate	$6,575.63
Rate for Payer: AHCCCS Medicaid	$6,575.63
Rate for Payer: Allwell Medicaid	$6,575.63
Rate for Payer: AZCH Complete Medicaid	$6,575.63
Rate for Payer: Banner UC Health Medicaid	$6,575.63
Rate for Payer: Mercy Care Medicaid	$6,575.63

Acute Kidney Injury

Facility

$4,072.33

Service Code	APR-DRG 4692
Hospital Charge Code	APRDRG4693
Min. Negotiated Rate	$4,072.33
Max. Negotiated Rate	$4,072.33
Rate for Payer: AHCCCS Medicaid	$4,072.33
Rate for Payer: Allwell Medicaid	$4,072.33
Rate for Payer: AZCH Complete Medicaid	$4,072.33
Rate for Payer: Banner UC Health Medicaid	$4,072.33
Rate for Payer: Mercy Care Medicaid	$4,072.33

Acute Kidney Injury

Facility

$6,575.63

Service Code	APR-DRG 4693
Hospital Charge Code	APRDRG4692
Min. Negotiated Rate	$6,575.63
Max. Negotiated Rate	$6,575.63
Rate for Payer: AHCCCS Medicaid	$6,575.63
Rate for Payer: Allwell Medicaid	$6,575.63
Rate for Payer: AZCH Complete Medicaid	$6,575.63
Rate for Payer: Banner UC Health Medicaid	$6,575.63
Rate for Payer: Mercy Care Medicaid	$6,575.63

Acute Kidney Injury

Facility

$6,575.63

Service Code	APR-DRG 4693
Hospital Charge Code	APRDRG4693
Min. Negotiated Rate	$6,575.63
Max. Negotiated Rate	$6,575.63
Rate for Payer: AHCCCS Medicaid	$6,575.63
Rate for Payer: Allwell Medicaid	$6,575.63
Rate for Payer: AZCH Complete Medicaid	$6,575.63
Rate for Payer: Banner UC Health Medicaid	$6,575.63
Rate for Payer: Mercy Care Medicaid	$6,575.63

Acute Kidney Injury

Facility

$6,575.63

Service Code	APR-DRG 4693
Hospital Charge Code	APRDRG4694
Min. Negotiated Rate	$6,575.63
Max. Negotiated Rate	$6,575.63
Rate for Payer: AHCCCS Medicaid	$6,575.63
Rate for Payer: Allwell Medicaid	$6,575.63
Rate for Payer: AZCH Complete Medicaid	$6,575.63
Rate for Payer: Banner UC Health Medicaid	$6,575.63
Rate for Payer: Mercy Care Medicaid	$6,575.63

Acute Kidney Injury

Facility

$3,009.01

Service Code	APR-DRG 4691
Hospital Charge Code	APRDRG4692
Min. Negotiated Rate	$3,009.01
Max. Negotiated Rate	$3,009.01
Rate for Payer: AHCCCS Medicaid	$3,009.01
Rate for Payer: Allwell Medicaid	$3,009.01
Rate for Payer: AZCH Complete Medicaid	$3,009.01
Rate for Payer: Banner UC Health Medicaid	$3,009.01
Rate for Payer: Mercy Care Medicaid	$3,009.01

Acute Leukemia

Facility

$8,829.92

Service Code	APR-DRG 6901
Hospital Charge Code	APRDRG6902
Min. Negotiated Rate	$8,829.92
Max. Negotiated Rate	$8,829.92
Rate for Payer: AHCCCS Medicaid	$8,829.92
Rate for Payer: Allwell Medicaid	$8,829.92
Rate for Payer: AZCH Complete Medicaid	$8,829.92
Rate for Payer: Banner UC Health Medicaid	$8,829.92
Rate for Payer: Mercy Care Medicaid	$8,829.92

Acute Leukemia

Facility

$14,831.80

Service Code	APR-DRG 6902
Hospital Charge Code	APRDRG6904
Min. Negotiated Rate	$14,831.80
Max. Negotiated Rate	$14,831.80
Rate for Payer: AHCCCS Medicaid	$14,831.80
Rate for Payer: Allwell Medicaid	$14,831.80
Rate for Payer: AZCH Complete Medicaid	$14,831.80
Rate for Payer: Banner UC Health Medicaid	$14,831.80
Rate for Payer: Mercy Care Medicaid	$14,831.80

Acute Leukemia

Facility

$30,254.19

Service Code	APR-DRG 6903
Hospital Charge Code	APRDRG6901
Min. Negotiated Rate	$30,254.19
Max. Negotiated Rate	$30,254.19
Rate for Payer: AHCCCS Medicaid	$30,254.19
Rate for Payer: Allwell Medicaid	$30,254.19
Rate for Payer: AZCH Complete Medicaid	$30,254.19
Rate for Payer: Banner UC Health Medicaid	$30,254.19
Rate for Payer: Mercy Care Medicaid	$30,254.19

Acute Leukemia

Facility

$48,504.62

Service Code	APR-DRG 6904
Hospital Charge Code	APRDRG6901
Min. Negotiated Rate	$48,504.62
Max. Negotiated Rate	$48,504.62
Rate for Payer: AHCCCS Medicaid	$48,504.62
Rate for Payer: Allwell Medicaid	$48,504.62
Rate for Payer: AZCH Complete Medicaid	$48,504.62
Rate for Payer: Banner UC Health Medicaid	$48,504.62
Rate for Payer: Mercy Care Medicaid	$48,504.62

Acute Leukemia

Facility

$48,504.62

Service Code	APR-DRG 6904
Hospital Charge Code	APRDRG6903
Min. Negotiated Rate	$48,504.62
Max. Negotiated Rate	$48,504.62
Rate for Payer: AHCCCS Medicaid	$48,504.62
Rate for Payer: Allwell Medicaid	$48,504.62
Rate for Payer: AZCH Complete Medicaid	$48,504.62
Rate for Payer: Banner UC Health Medicaid	$48,504.62
Rate for Payer: Mercy Care Medicaid	$48,504.62

Acute Leukemia

Facility

$48,504.62

Service Code	APR-DRG 6904
Hospital Charge Code	APRDRG6904
Min. Negotiated Rate	$48,504.62
Max. Negotiated Rate	$48,504.62
Rate for Payer: AHCCCS Medicaid	$48,504.62
Rate for Payer: Allwell Medicaid	$48,504.62
Rate for Payer: AZCH Complete Medicaid	$48,504.62
Rate for Payer: Banner UC Health Medicaid	$48,504.62
Rate for Payer: Mercy Care Medicaid	$48,504.62

Acute Leukemia

Facility

$14,831.80

Service Code	APR-DRG 6902
Hospital Charge Code	APRDRG6902
Min. Negotiated Rate	$14,831.80
Max. Negotiated Rate	$14,831.80
Rate for Payer: AHCCCS Medicaid	$14,831.80
Rate for Payer: Allwell Medicaid	$14,831.80
Rate for Payer: AZCH Complete Medicaid	$14,831.80
Rate for Payer: Banner UC Health Medicaid	$14,831.80
Rate for Payer: Mercy Care Medicaid	$14,831.80

Know your out-of-pocket cost for care.

All Charges