Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	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

$30,254.19

Service Code	APR-DRG 6903
Hospital Charge Code	APRDRG6904
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

$14,831.80

Service Code	APR-DRG 6902
Hospital Charge Code	APRDRG6901
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	APRDRG6902
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

$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

$8,829.92

Service Code	APR-DRG 6901
Hospital Charge Code	APRDRG6901
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

$48,504.62

Service Code	APR-DRG 6904
Hospital Charge Code	APRDRG6902
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	APRDRG6903
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 Measles Panel, IgM Antibody and PCR LC

Facility

$76.00

Service Code	CPT 86765
Hospital Charge Code	28059749
Hospital Revenue Code	302
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$12.16
Rate for Payer: Amerigroup Medicare	$12.16
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

Acute Measles Panel, IgM Antibody and PCR LC

Facility

$76.00

Service Code	CPT 86765
Hospital Charge Code	28059749
Hospital Revenue Code	302
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

Acute Myocardial Infarction

Facility

$7,646.66

Service Code	APR-DRG 1903
Hospital Charge Code	APRDRG1904
Min. Negotiated Rate	$7,646.66
Max. Negotiated Rate	$7,646.66
Rate for Payer: AHCCCS Medicaid	$7,646.66
Rate for Payer: Allwell Medicaid	$7,646.66
Rate for Payer: AZCH Complete Medicaid	$7,646.66
Rate for Payer: Banner UC Health Medicaid	$7,646.66
Rate for Payer: Mercy Care Medicaid	$7,646.66

Acute Myocardial Infarction

Facility

$11,936.43

Service Code	APR-DRG 1904
Hospital Charge Code	APRDRG1901
Min. Negotiated Rate	$11,936.43
Max. Negotiated Rate	$11,936.43
Rate for Payer: AHCCCS Medicaid	$11,936.43
Rate for Payer: Allwell Medicaid	$11,936.43
Rate for Payer: AZCH Complete Medicaid	$11,936.43
Rate for Payer: Banner UC Health Medicaid	$11,936.43
Rate for Payer: Mercy Care Medicaid	$11,936.43

Acute Myocardial Infarction

Facility

$7,646.66

Service Code	APR-DRG 1903
Hospital Charge Code	APRDRG1901
Min. Negotiated Rate	$7,646.66
Max. Negotiated Rate	$7,646.66
Rate for Payer: AHCCCS Medicaid	$7,646.66
Rate for Payer: Allwell Medicaid	$7,646.66
Rate for Payer: AZCH Complete Medicaid	$7,646.66
Rate for Payer: Banner UC Health Medicaid	$7,646.66
Rate for Payer: Mercy Care Medicaid	$7,646.66

Acute Myocardial Infarction

Facility

$5,099.18

Service Code	APR-DRG 1901
Hospital Charge Code	APRDRG1904
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Acute Myocardial Infarction

Facility

$5,750.78

Service Code	APR-DRG 1902
Hospital Charge Code	APRDRG1904
Min. Negotiated Rate	$5,750.78
Max. Negotiated Rate	$5,750.78
Rate for Payer: AHCCCS Medicaid	$5,750.78
Rate for Payer: Allwell Medicaid	$5,750.78
Rate for Payer: AZCH Complete Medicaid	$5,750.78
Rate for Payer: Banner UC Health Medicaid	$5,750.78
Rate for Payer: Mercy Care Medicaid	$5,750.78

Acute Myocardial Infarction

Facility

$7,646.66

Service Code	APR-DRG 1903
Hospital Charge Code	APRDRG1903
Min. Negotiated Rate	$7,646.66
Max. Negotiated Rate	$7,646.66
Rate for Payer: AHCCCS Medicaid	$7,646.66
Rate for Payer: Allwell Medicaid	$7,646.66
Rate for Payer: AZCH Complete Medicaid	$7,646.66
Rate for Payer: Banner UC Health Medicaid	$7,646.66
Rate for Payer: Mercy Care Medicaid	$7,646.66

Acute Myocardial Infarction

Facility

$11,936.43

Service Code	APR-DRG 1904
Hospital Charge Code	APRDRG1903
Min. Negotiated Rate	$11,936.43
Max. Negotiated Rate	$11,936.43
Rate for Payer: AHCCCS Medicaid	$11,936.43
Rate for Payer: Allwell Medicaid	$11,936.43
Rate for Payer: AZCH Complete Medicaid	$11,936.43
Rate for Payer: Banner UC Health Medicaid	$11,936.43
Rate for Payer: Mercy Care Medicaid	$11,936.43

Acute Myocardial Infarction

Facility

$5,099.18

Service Code	APR-DRG 1901
Hospital Charge Code	APRDRG1901
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Acute Myocardial Infarction

Facility

$5,099.18

Service Code	APR-DRG 1901
Hospital Charge Code	APRDRG1902
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Acute Myocardial Infarction

Facility

$7,646.66

Service Code	APR-DRG 1903
Hospital Charge Code	APRDRG1902
Min. Negotiated Rate	$7,646.66
Max. Negotiated Rate	$7,646.66
Rate for Payer: AHCCCS Medicaid	$7,646.66
Rate for Payer: Allwell Medicaid	$7,646.66
Rate for Payer: AZCH Complete Medicaid	$7,646.66
Rate for Payer: Banner UC Health Medicaid	$7,646.66
Rate for Payer: Mercy Care Medicaid	$7,646.66

Acute Myocardial Infarction

Facility

$5,750.78

Service Code	APR-DRG 1902
Hospital Charge Code	APRDRG1902
Min. Negotiated Rate	$5,750.78
Max. Negotiated Rate	$5,750.78
Rate for Payer: AHCCCS Medicaid	$5,750.78
Rate for Payer: Allwell Medicaid	$5,750.78
Rate for Payer: AZCH Complete Medicaid	$5,750.78
Rate for Payer: Banner UC Health Medicaid	$5,750.78
Rate for Payer: Mercy Care Medicaid	$5,750.78

Acute Myocardial Infarction

Facility

$11,936.43

Service Code	APR-DRG 1904
Hospital Charge Code	APRDRG1904
Min. Negotiated Rate	$11,936.43
Max. Negotiated Rate	$11,936.43
Rate for Payer: AHCCCS Medicaid	$11,936.43
Rate for Payer: Allwell Medicaid	$11,936.43
Rate for Payer: AZCH Complete Medicaid	$11,936.43
Rate for Payer: Banner UC Health Medicaid	$11,936.43
Rate for Payer: Mercy Care Medicaid	$11,936.43

Acute Myocardial Infarction

Facility

$11,936.43

Service Code	APR-DRG 1904
Hospital Charge Code	APRDRG1902
Min. Negotiated Rate	$11,936.43
Max. Negotiated Rate	$11,936.43
Rate for Payer: AHCCCS Medicaid	$11,936.43
Rate for Payer: Allwell Medicaid	$11,936.43
Rate for Payer: AZCH Complete Medicaid	$11,936.43
Rate for Payer: Banner UC Health Medicaid	$11,936.43
Rate for Payer: Mercy Care Medicaid	$11,936.43

Acute Myocardial Infarction

Facility

$5,099.18

Service Code	APR-DRG 1901
Hospital Charge Code	APRDRG1903
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Know your out-of-pocket cost for care.

All Charges