Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	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

$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	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

$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

$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

$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

$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

$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

$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

$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	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

$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

$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 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	$143.68
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	$191.73
Rate for Payer: Allwell Medicaid	$191.73
Rate for Payer: Allwell Medicare	$143.68
Rate for Payer: Amerigroup Medicare	$143.68
Rate for Payer: APIPA Medicare/Medicaid	$335.40
Rate for Payer: AZCH Complete Medicaid	$191.73
Rate for Payer: AZCH Complete Medicare	$143.68
Rate for Payer: Banner UC Health Medicaid	$191.73
Rate for Payer: Banner UC Health Medicare	$143.68
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	$222.25
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	$143.68
Rate for Payer: Mercy Care Medicaid	$191.73
Rate for Payer: Self Pay Self Pay	$718.40
Rate for Payer: TriWest Medicare	$143.68
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	$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

Pulmonary Stress Test 6 Minute Walk

Facility

$300.00

Service Code	CPT 94618
Hospital Charge Code	22409369
Hospital Revenue Code	482
Min. Negotiated Rate	$48.00
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: Allwell Medicare	$48.00
Rate for Payer: Amerigroup Medicare	$48.00
Rate for Payer: APIPA Medicare/Medicaid	$112.05
Rate for Payer: AZCH Complete Medicare	$48.00
Rate for Payer: Banner UC Health Medicare	$48.00
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: 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	$48.00
Rate for Payer: Self Pay Self Pay	$240.00
Rate for Payer: TriWest Medicare	$48.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.00

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

$55.00

Service Code	CPT 94760
Hospital Charge Code	22331465
Hospital Revenue Code	460
Min. Negotiated Rate	$8.80
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: Allwell Medicare	$8.80
Rate for Payer: Amerigroup Medicare	$8.80
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
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: 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	$8.80
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

PUMP TUBING INFUSION LINE

Facility

$121.20

Hospital Charge Code	27747576
Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$109.08
Rate for Payer: Aetna of AZ Commercial	$109.08
Rate for Payer: Aetna of AZ Medicare	$33.94
Rate for Payer: Allwell Medicare	$19.39
Rate for Payer: Amerigroup Medicare	$19.39
Rate for Payer: APIPA Medicare/Medicaid	$45.27
Rate for Payer: AZCH Complete Medicare	$19.39
Rate for Payer: Banner UC Health Medicare	$19.39
Rate for Payer: Bisbee Police All Plans	$31.51
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$82.42
Rate for Payer: Cash Price	$96.96
Rate for Payer: Cigna of AZ Commercial	$84.84
Rate for Payer: Copperpoint Commercial	$30.00
Rate for Payer: Health Net of AZ Commercial	$72.72
Rate for Payer: Health Net of AZ Medicare	$33.94
Rate for Payer: Humana of AZ Medicare	$19.39
Rate for Payer: Self Pay Self Pay	$96.96
Rate for Payer: TriWest Medicare	$19.39
Rate for Payer: UnitedHealth Group of AZ Commercial	$70.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.82

PUMP TUBING INFUSION LINE

Facility

$121.20

Hospital Charge Code	27747576
Hospital Revenue Code	270
Min. Negotiated Rate	$31.51
Max. Negotiated Rate	$109.08
Rate for Payer: Aetna of AZ Commercial	$109.08
Rate for Payer: Bisbee Police All Plans	$31.51
Rate for Payer: Cash Price	$96.96
Rate for Payer: Self Pay Self Pay	$96.96

PURAFORCE COM 6X2

Facility

$6,563.00

Hospital Charge Code	27393136
Hospital Revenue Code	270
Min. Negotiated Rate	$1,050.08
Max. Negotiated Rate	$5,906.70
Rate for Payer: Aetna of AZ Commercial	$5,906.70
Rate for Payer: Aetna of AZ Medicare	$1,837.64
Rate for Payer: Allwell Medicare	$1,050.08
Rate for Payer: Amerigroup Medicare	$1,050.08
Rate for Payer: APIPA Medicare/Medicaid	$2,451.28
Rate for Payer: AZCH Complete Medicare	$1,050.08
Rate for Payer: Banner UC Health Medicare	$1,050.08
Rate for Payer: Bisbee Police All Plans	$1,706.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,462.84
Rate for Payer: Cash Price	$5,250.40
Rate for Payer: Cigna of AZ Commercial	$4,594.10
Rate for Payer: Copperpoint Commercial	$1,624.34
Rate for Payer: Health Net of AZ Commercial	$3,937.80
Rate for Payer: Health Net of AZ Medicare	$1,837.64
Rate for Payer: Humana of AZ Medicare	$1,050.08
Rate for Payer: Self Pay Self Pay	$5,250.40
Rate for Payer: TriWest Medicare	$1,050.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,826.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,181.34

PURAFORCE COM 6X2

Facility

$6,563.00

Hospital Charge Code	27393136
Hospital Revenue Code	270
Min. Negotiated Rate	$1,706.38
Max. Negotiated Rate	$5,906.70
Rate for Payer: Aetna of AZ Commercial	$5,906.70
Rate for Payer: Bisbee Police All Plans	$1,706.38
Rate for Payer: Cash Price	$5,250.40
Rate for Payer: Self Pay Self Pay	$5,250.40

PURAPLAY AM 3X4 FENESTRATED

Facility

$880.00

Service Code	CPT Q4196
Hospital Charge Code	24358090
Hospital Revenue Code	636
Min. Negotiated Rate	$228.80
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna of AZ Commercial	$792.00
Rate for Payer: Bisbee Police All Plans	$228.80
Rate for Payer: Cash Price	$704.00
Rate for Payer: Self Pay Self Pay	$704.00

Know your out-of-pocket cost for care.

All Charges