Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Pulmonary Embolism

Facility

$11,397.75

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$11,397.75
Max. Negotiated Rate	$11,397.75
Rate for Payer: AHCCCS Medicaid	$11,397.75
Rate for Payer: Allwell Medicaid	$11,397.75
Rate for Payer: AZCH Complete Medicaid	$11,397.75
Rate for Payer: Banner UC Health Medicaid	$11,397.75
Rate for Payer: Mercy Care Medicaid	$11,397.75

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1342
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: AHCCCS Medicaid	$3,769.32
Rate for Payer: Allwell Medicaid	$3,769.32
Rate for Payer: AZCH Complete Medicaid	$3,769.32
Rate for Payer: Banner UC Health Medicaid	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1343
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: AHCCCS Medicaid	$7,455.18
Rate for Payer: Allwell Medicaid	$7,455.18
Rate for Payer: AZCH Complete Medicaid	$7,455.18
Rate for Payer: Banner UC Health Medicaid	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: AHCCCS Medicaid	$5,001.68
Rate for Payer: Allwell Medicaid	$5,001.68
Rate for Payer: AZCH Complete Medicaid	$5,001.68
Rate for Payer: Banner UC Health Medicaid	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1343
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: AHCCCS Medicaid	$3,769.32
Rate for Payer: Allwell Medicaid	$3,769.32
Rate for Payer: AZCH Complete Medicaid	$3,769.32
Rate for Payer: Banner UC Health Medicaid	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1342
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: AHCCCS Medicaid	$5,001.68
Rate for Payer: Allwell Medicaid	$5,001.68
Rate for Payer: AZCH Complete Medicaid	$5,001.68
Rate for Payer: Banner UC Health Medicaid	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68

Pulmonary Embolism

Facility

$11,397.75

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$11,397.75
Max. Negotiated Rate	$11,397.75
Rate for Payer: AHCCCS Medicaid	$11,397.75
Rate for Payer: Allwell Medicaid	$11,397.75
Rate for Payer: AZCH Complete Medicaid	$11,397.75
Rate for Payer: Banner UC Health Medicaid	$11,397.75
Rate for Payer: Mercy Care Medicaid	$11,397.75

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1342
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: AHCCCS Medicaid	$7,455.18
Rate for Payer: Allwell Medicaid	$7,455.18
Rate for Payer: AZCH Complete Medicaid	$7,455.18
Rate for Payer: Banner UC Health Medicaid	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1343
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: AHCCCS Medicaid	$5,001.68
Rate for Payer: Allwell Medicaid	$5,001.68
Rate for Payer: AZCH Complete Medicaid	$5,001.68
Rate for Payer: Banner UC Health Medicaid	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: AHCCCS Medicaid	$3,769.32
Rate for Payer: Allwell Medicaid	$3,769.32
Rate for Payer: AZCH Complete Medicaid	$3,769.32
Rate for Payer: Banner UC Health Medicaid	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32

Pulmonary Embolism

Facility

$11,397.75

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG1343
Min. Negotiated Rate	$11,397.75
Max. Negotiated Rate	$11,397.75
Rate for Payer: AHCCCS Medicaid	$11,397.75
Rate for Payer: Allwell Medicaid	$11,397.75
Rate for Payer: AZCH Complete Medicaid	$11,397.75
Rate for Payer: Banner UC Health Medicaid	$11,397.75
Rate for Payer: Mercy Care Medicaid	$11,397.75

Pulmonary Embolism

Facility

$11,397.75

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG1342
Min. Negotiated Rate	$11,397.75
Max. Negotiated Rate	$11,397.75
Rate for Payer: AHCCCS Medicaid	$11,397.75
Rate for Payer: Allwell Medicaid	$11,397.75
Rate for Payer: AZCH Complete Medicaid	$11,397.75
Rate for Payer: Banner UC Health Medicaid	$11,397.75
Rate for Payer: Mercy Care Medicaid	$11,397.75

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: AHCCCS Medicaid	$7,455.18
Rate for Payer: Allwell Medicaid	$7,455.18
Rate for Payer: AZCH Complete Medicaid	$7,455.18
Rate for Payer: Banner UC Health Medicaid	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: AHCCCS Medicaid	$7,455.18
Rate for Payer: Allwell Medicaid	$7,455.18
Rate for Payer: AZCH Complete Medicaid	$7,455.18
Rate for Payer: Banner UC Health Medicaid	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: AHCCCS Medicaid	$3,769.32
Rate for Payer: Allwell Medicaid	$3,769.32
Rate for Payer: AZCH Complete Medicaid	$3,769.32
Rate for Payer: Banner UC Health Medicaid	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: AHCCCS Medicaid	$5,001.68
Rate for Payer: Allwell Medicaid	$5,001.68
Rate for Payer: AZCH Complete Medicaid	$5,001.68
Rate for Payer: Banner UC Health Medicaid	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68

Pulmonary Function Test

Facility

$898.00

Service Code	CPT 94060
Hospital Charge Code	23591076
Hospital Revenue Code	460
Min. Negotiated Rate	$233.48
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Bisbee Police All Plans	$233.48
Rate for Payer: Cash Price	$718.40
Rate for Payer: Self Pay Self Pay	$718.40

Pulmonary Function Test

Facility

$898.00

Service Code	CPT 94060
Hospital Charge Code	23591076
Hospital Revenue Code	460
Min. Negotiated Rate	$134.70
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Aetna of AZ Medicare	$251.44
Rate for Payer: AHCCCS Medicaid	$383.46
Rate for Payer: Allwell Medicaid	$383.46
Rate for Payer: Allwell Medicare	$134.70
Rate for Payer: Amerigroup Medicare	$134.70
Rate for Payer: APIPA Medicare/Medicaid	$335.40
Rate for Payer: AZCH Complete Medicaid	$383.46
Rate for Payer: AZCH Complete Medicare	$134.70
Rate for Payer: Banner UC Health Medicaid	$383.46
Rate for Payer: Banner UC Health Medicare	$134.70
Rate for Payer: Bisbee Police All Plans	$233.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$610.64
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cigna of AZ Commercial	$628.60
Rate for Payer: Copperpoint Commercial	$222.26
Rate for Payer: Health Net of AZ Commercial	$538.80
Rate for Payer: Health Net of AZ Medicare	$251.44
Rate for Payer: Humana of AZ Medicare	$134.70
Rate for Payer: Mercy Care Medicaid	$383.46
Rate for Payer: Self Pay Self Pay	$718.40
Rate for Payer: TriWest Medicare	$134.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$523.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$161.64

Pulmonary Stress Test 6 Minute Walk

Facility

$300.00

Service Code	CPT 94618
Hospital Charge Code	22409369
Hospital Revenue Code	482
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Aetna of AZ Medicare	$84.00
Rate for Payer: AHCCCS Medicaid	$162.32
Rate for Payer: Allwell Medicaid	$162.32
Rate for Payer: Allwell Medicare	$45.00
Rate for Payer: Amerigroup Medicare	$45.00
Rate for Payer: APIPA Medicare/Medicaid	$112.05
Rate for Payer: AZCH Complete Medicaid	$162.32
Rate for Payer: AZCH Complete Medicare	$45.00
Rate for Payer: Banner UC Health Medicaid	$162.32
Rate for Payer: Banner UC Health Medicare	$45.00
Rate for Payer: Bisbee Police All Plans	$78.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$204.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cigna of AZ Commercial	$210.00
Rate for Payer: Copperpoint Commercial	$74.25
Rate for Payer: Health Net of AZ Commercial	$180.00
Rate for Payer: Health Net of AZ Medicare	$84.00
Rate for Payer: Humana of AZ Medicare	$45.00
Rate for Payer: Mercy Care Medicaid	$162.32
Rate for Payer: Self Pay Self Pay	$240.00
Rate for Payer: TriWest Medicare	$45.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.00

Pulmonary Stress Test 6 Minute Walk

Facility

$300.00

Service Code	CPT 94618
Hospital Charge Code	22409369
Hospital Revenue Code	482
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Bisbee Police All Plans	$78.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Self Pay Self Pay	$240.00

PULSE OX

Facility

$55.00

Service Code	CPT 94760
Hospital Charge Code	22331465
Hospital Revenue Code	460
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

PULSE OX

Facility

$49.00

Service Code	CPT 94760
Hospital Charge Code	1886888
Hospital Revenue Code	460
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Aetna of AZ Medicare	$13.72
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$7.35
Rate for Payer: Amerigroup Medicare	$7.35
Rate for Payer: APIPA Medicare/Medicaid	$18.30
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$7.35
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$7.35
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$33.32
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$34.30
Rate for Payer: Copperpoint Commercial	$12.13
Rate for Payer: Health Net of AZ Commercial	$29.40
Rate for Payer: Health Net of AZ Medicare	$13.72
Rate for Payer: Humana of AZ Medicare	$7.35
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$39.20
Rate for Payer: TriWest Medicare	$7.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.82

PULSE OX

Facility

$55.00

Service Code	CPT 94760
Hospital Charge Code	22331465
Hospital Revenue Code	460
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$8.25
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.25
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

PULSE OX

Facility

$49.00

Service Code	CPT 94760
Hospital Charge Code	1886888
Hospital Revenue Code	460
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Self Pay Self Pay	$39.20

PULSE OX PROBE ADULT DISP

Facility

$74.00

Hospital Charge Code	22355395
Hospital Revenue Code	272
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Aetna of AZ Medicare	$20.72
Rate for Payer: Allwell Medicare	$11.10
Rate for Payer: Amerigroup Medicare	$11.10
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.10
Rate for Payer: Banner UC Health Medicare	$11.10
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.32
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$51.80
Rate for Payer: Copperpoint Commercial	$18.32
Rate for Payer: Health Net of AZ Commercial	$44.40
Rate for Payer: Health Net of AZ Medicare	$20.72
Rate for Payer: Humana of AZ Medicare	$11.10
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

Know your out-of-pocket cost for care.

All Charges