Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PADDED GAIT BELT SM

Facility

$216.00

Hospital Charge Code	27446677
Hospital Revenue Code	270
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Aetna of AZ Medicare	$60.48
Rate for Payer: Allwell Medicare	$32.40
Rate for Payer: Amerigroup Medicare	$32.40
Rate for Payer: APIPA Medicare/Medicaid	$80.68
Rate for Payer: AZCH Complete Medicare	$32.40
Rate for Payer: Banner UC Health Medicare	$32.40
Rate for Payer: Bisbee Police All Plans	$56.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$146.88
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna of AZ Commercial	$151.20
Rate for Payer: Copperpoint Commercial	$53.46
Rate for Payer: Health Net of AZ Commercial	$129.60
Rate for Payer: Health Net of AZ Medicare	$60.48
Rate for Payer: Humana of AZ Medicare	$32.40
Rate for Payer: Self Pay Self Pay	$172.80
Rate for Payer: TriWest Medicare	$32.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$125.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.88

PAD GROUNDING (BOVIE) CONMED

Facility

$18.00

Hospital Charge Code	22355702
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

PAD GROUNDING (BOVIE) CONMED

Facility

$18.00

Hospital Charge Code	22355702
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.70
Rate for Payer: Amerigroup Medicare	$2.70
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.70
Rate for Payer: Banner UC Health Medicare	$2.70
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.70
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

PAD GROUNDING PAD ELECTRO

Facility

$18.00

Hospital Charge Code	22355606
Hospital Revenue Code	272
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.70
Rate for Payer: Amerigroup Medicare	$2.70
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.70
Rate for Payer: Banner UC Health Medicare	$2.70
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.70
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

PAD GROUNDING PAD ELECTRO

Facility

$18.00

Hospital Charge Code	22355606
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

Pain Management drug screen

Facility

$69.00

Service Code	CPT 80305 QW
Hospital Charge Code	1491676
Hospital Revenue Code	301
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$10.35
Rate for Payer: Amerigroup Medicare	$10.35
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$10.35
Rate for Payer: Banner UC Health Medicare	$10.35
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$44.85
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$10.35
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$10.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

Pain Management drug screen

Facility

$69.00

Service Code	CPT 80305 QW
Hospital Charge Code	1491676
Hospital Revenue Code	301
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: AHCCCS Medicaid	$58,558.48
Rate for Payer: Allwell Medicaid	$58,558.48
Rate for Payer: AZCH Complete Medicaid	$58,558.48
Rate for Payer: Banner UC Health Medicaid	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: AHCCCS Medicaid	$97,322.06
Rate for Payer: Allwell Medicaid	$97,322.06
Rate for Payer: AZCH Complete Medicaid	$97,322.06
Rate for Payer: Banner UC Health Medicaid	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: AHCCCS Medicaid	$97,322.06
Rate for Payer: Allwell Medicaid	$97,322.06
Rate for Payer: AZCH Complete Medicaid	$97,322.06
Rate for Payer: Banner UC Health Medicaid	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: AHCCCS Medicaid	$97,322.06
Rate for Payer: Allwell Medicaid	$97,322.06
Rate for Payer: AZCH Complete Medicaid	$97,322.06
Rate for Payer: Banner UC Health Medicaid	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: AHCCCS Medicaid	$58,558.48
Rate for Payer: Allwell Medicaid	$58,558.48
Rate for Payer: AZCH Complete Medicaid	$58,558.48
Rate for Payer: Banner UC Health Medicaid	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: AHCCCS Medicaid	$58,558.48
Rate for Payer: Allwell Medicaid	$58,558.48
Rate for Payer: AZCH Complete Medicaid	$58,558.48
Rate for Payer: Banner UC Health Medicaid	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: AHCCCS Medicaid	$97,322.06
Rate for Payer: Allwell Medicaid	$97,322.06
Rate for Payer: AZCH Complete Medicaid	$97,322.06
Rate for Payer: Banner UC Health Medicaid	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: AHCCCS Medicaid	$58,558.48
Rate for Payer: Allwell Medicaid	$58,558.48
Rate for Payer: AZCH Complete Medicaid	$58,558.48
Rate for Payer: Banner UC Health Medicaid	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: AHCCCS Medicaid	$52,492.07
Rate for Payer: Allwell Medicaid	$52,492.07
Rate for Payer: AZCH Complete Medicaid	$52,492.07
Rate for Payer: Banner UC Health Medicaid	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07

pantoprazole 40 mg IV Inj [CQCH]

Facility

$3.42

Service Code	NDC 8092351
Hospital Charge Code	105969840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna of AZ Commercial	$3.08
Rate for Payer: Bisbee Police All Plans	$0.89
Rate for Payer: Cash Price	$2.74
Rate for Payer: Self Pay Self Pay	$2.74

pantoprazole 40 mg IV Inj [CQCH]

Facility

$3.42

Service Code	NDC 8092351
Hospital Charge Code	105969840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna of AZ Commercial	$3.08
Rate for Payer: Aetna of AZ Medicare	$0.96
Rate for Payer: Allwell Medicare	$0.51
Rate for Payer: Amerigroup Medicare	$0.51
Rate for Payer: APIPA Medicare/Medicaid	$1.28
Rate for Payer: AZCH Complete Medicare	$0.51
Rate for Payer: Banner UC Health Medicare	$0.51
Rate for Payer: Bisbee Police All Plans	$0.89
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.33
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cigna of AZ Commercial	$2.22
Rate for Payer: Copperpoint Commercial	$0.85
Rate for Payer: Health Net of AZ Commercial	$2.05
Rate for Payer: Health Net of AZ Medicare	$0.96
Rate for Payer: Humana of AZ Medicare	$0.51
Rate for Payer: Self Pay Self Pay	$2.74
Rate for Payer: TriWest Medicare	$0.51
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.62

Know your out-of-pocket cost for care.

All Charges