Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

$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

$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

$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	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 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	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

Pancreatic Elastase, Fecal LC

Facility

$115.00

Service Code	CPT 82653
Hospital Charge Code	22201909
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Aetna of AZ Medicare	$32.20
Rate for Payer: Allwell Medicare	$18.40
Rate for Payer: Amerigroup Medicare	$18.40
Rate for Payer: APIPA Medicare/Medicaid	$42.95
Rate for Payer: AZCH Complete Medicare	$18.40
Rate for Payer: Banner UC Health Medicare	$18.40
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.20
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cigna of AZ Commercial	$74.75
Rate for Payer: Copperpoint Commercial	$28.46
Rate for Payer: Health Net of AZ Commercial	$69.00
Rate for Payer: Health Net of AZ Medicare	$32.20
Rate for Payer: Humana of AZ Medicare	$18.40
Rate for Payer: Self Pay Self Pay	$92.00
Rate for Payer: TriWest Medicare	$18.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.70

Pancreatic Elastase, Fecal LC

Facility

$115.00

Service Code	CPT 82653
Hospital Charge Code	22201909
Hospital Revenue Code	301
Min. Negotiated Rate	$29.90
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Cash Price	$92.00
Rate for Payer: Self Pay Self Pay	$92.00

pantoprazole 40 mg IV Inj [CQCH]

Facility

$3.42

Service Code	NDC 8092351
Hospital Charge Code	105969840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.55
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	$0.55
Rate for Payer: Amerigroup Medicare	$0.55
Rate for Payer: APIPA Medicare/Medicaid	$1.28
Rate for Payer: AZCH Complete Medicare	$0.55
Rate for Payer: Banner UC Health Medicare	$0.55
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	$0.55
Rate for Payer: Self Pay Self Pay	$2.74
Rate for Payer: TriWest Medicare	$0.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.62

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 Tab [CQCH]

Facility

$0.15

Service Code	NDC 51079005120
Hospital Charge Code	105935743
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.09
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.12
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

pantoprazole 40 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 51079005120
Hospital Charge Code	105935743
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.12
Rate for Payer: Self Pay Self Pay	$0.12

Parasite ID, Worm LC

Facility

$84.00

Service Code	CPT 87169
Hospital Charge Code	22311201
Hospital Revenue Code	306
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Aetna of AZ Medicare	$23.52
Rate for Payer: Allwell Medicare	$13.44
Rate for Payer: Amerigroup Medicare	$13.44
Rate for Payer: APIPA Medicare/Medicaid	$31.37
Rate for Payer: AZCH Complete Medicare	$13.44
Rate for Payer: Banner UC Health Medicare	$13.44
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.12
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$20.79
Rate for Payer: Health Net of AZ Commercial	$50.40
Rate for Payer: Health Net of AZ Medicare	$23.52
Rate for Payer: Humana of AZ Medicare	$13.44
Rate for Payer: Self Pay Self Pay	$67.20
Rate for Payer: TriWest Medicare	$13.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.12

Parasite ID, Worm LC

Facility

$84.00

Service Code	CPT 87169
Hospital Charge Code	22311201
Hospital Revenue Code	306
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Cash Price	$67.20
Rate for Payer: Self Pay Self Pay	$67.20

.Parasite ID, Worm Result LC

Facility

$80.00

Service Code	CPT 87169
Hospital Charge Code	22311160
Hospital Revenue Code	306
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: Allwell Medicare	$12.80
Rate for Payer: Amerigroup Medicare	$12.80
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicare	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

.Parasite ID, Worm Result LC

Facility

$80.00

Service Code	CPT 87169
Hospital Charge Code	22311160
Hospital Revenue Code	306
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Self Pay Self Pay	$64.00

Paravaginal repair abdominal or vaginal

Facility

$4,320.00

Service Code	CPT 57284
Hospital Charge Code	27267806
Hospital Revenue Code	360
Min. Negotiated Rate	$691.20
Max. Negotiated Rate	$3,888.00
Rate for Payer: Aetna of AZ Commercial	$3,888.00
Rate for Payer: Aetna of AZ Medicare	$1,209.60
Rate for Payer: AHCCCS Medicaid	$3,196.92
Rate for Payer: Allwell Medicaid	$3,196.92
Rate for Payer: Allwell Medicare	$691.20
Rate for Payer: Amerigroup Medicare	$691.20
Rate for Payer: APIPA Medicare/Medicaid	$1,613.52
Rate for Payer: AZCH Complete Medicaid	$3,196.92
Rate for Payer: AZCH Complete Medicare	$691.20
Rate for Payer: Banner UC Health Medicaid	$3,196.92
Rate for Payer: Banner UC Health Medicare	$691.20
Rate for Payer: Bisbee Police All Plans	$1,123.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,937.60
Rate for Payer: Cash Price	$3,456.00
Rate for Payer: Cash Price	$3,456.00
Rate for Payer: Cigna of AZ Commercial	$2,160.00
Rate for Payer: Copperpoint Commercial	$1,069.20
Rate for Payer: Health Net of AZ Commercial	$2,592.00
Rate for Payer: Health Net of AZ Medicare	$1,209.60
Rate for Payer: Humana of AZ Medicare	$691.20
Rate for Payer: Mercy Care Medicaid	$3,196.92
Rate for Payer: Self Pay Self Pay	$3,456.00
Rate for Payer: TriWest Medicare	$691.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,518.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$777.60

Paravaginal repair abdominal or vaginal

Facility

$4,320.00

Service Code	CPT 57284
Hospital Charge Code	27267806
Hospital Revenue Code	360
Min. Negotiated Rate	$1,123.20
Max. Negotiated Rate	$3,888.00
Rate for Payer: Aetna of AZ Commercial	$3,888.00
Rate for Payer: Bisbee Police All Plans	$1,123.20
Rate for Payer: Cash Price	$3,456.00
Rate for Payer: Self Pay Self Pay	$3,456.00

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN

Facility

$148.00

Service Code	CPT 11057
Hospital Charge Code	24049518
Hospital Revenue Code	360
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Aetna of AZ Medicare	$41.44
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$23.68
Rate for Payer: Amerigroup Medicare	$23.68
Rate for Payer: APIPA Medicare/Medicaid	$55.28
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$23.68
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.64
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$74.00
Rate for Payer: Copperpoint Commercial	$36.63
Rate for Payer: Health Net of AZ Commercial	$88.80
Rate for Payer: Health Net of AZ Medicare	$41.44
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$118.40
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.64

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN

Facility

$77.00

Service Code	CPT 11055
Hospital Charge Code	24049516
Hospital Revenue Code	360
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Cash Price	$61.60
Rate for Payer: Self Pay Self Pay	$61.60

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN

Facility

$77.00

Service Code	CPT 11055
Hospital Charge Code	24049516
Hospital Revenue Code	360
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Aetna of AZ Medicare	$21.56
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$12.32
Rate for Payer: Amerigroup Medicare	$12.32
Rate for Payer: APIPA Medicare/Medicaid	$28.76
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$12.32
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$12.32
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$52.36
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Copperpoint Commercial	$19.06
Rate for Payer: Health Net of AZ Commercial	$46.20
Rate for Payer: Health Net of AZ Medicare	$21.56
Rate for Payer: Humana of AZ Medicare	$12.32
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$61.60
Rate for Payer: TriWest Medicare	$12.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.86

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN

Facility

$109.00

Service Code	CPT 11056
Hospital Charge Code	24049517
Hospital Revenue Code	360
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$54.50
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN

Facility

$148.00

Service Code	CPT 11057
Hospital Charge Code	24049518
Hospital Revenue Code	360
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN

Facility

$109.00

Service Code	CPT 11056
Hospital Charge Code	24049517
Hospital Revenue Code	360
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

Know your out-of-pocket cost for care.

All Charges