Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Schizophrenia

Facility

$4,006.40

Service Code	APR-DRG 7501
Hospital Charge Code	APRDRG7502
Min. Negotiated Rate	$4,006.40
Max. Negotiated Rate	$4,006.40
Rate for Payer: AHCCCS Medicaid	$4,006.40
Rate for Payer: Allwell Medicaid	$4,006.40
Rate for Payer: AZCH Complete Medicaid	$4,006.40
Rate for Payer: Banner UC Health Medicaid	$4,006.40
Rate for Payer: Mercy Care Medicaid	$4,006.40

Schizophrenia

Facility

$4,006.40

Service Code	APR-DRG 7501
Hospital Charge Code	APRDRG7501
Min. Negotiated Rate	$4,006.40
Max. Negotiated Rate	$4,006.40
Rate for Payer: AHCCCS Medicaid	$4,006.40
Rate for Payer: Allwell Medicaid	$4,006.40
Rate for Payer: AZCH Complete Medicaid	$4,006.40
Rate for Payer: Banner UC Health Medicaid	$4,006.40
Rate for Payer: Mercy Care Medicaid	$4,006.40

Schizophrenia

Facility

$4,006.40

Service Code	APR-DRG 7501
Hospital Charge Code	APRDRG7504
Min. Negotiated Rate	$4,006.40
Max. Negotiated Rate	$4,006.40
Rate for Payer: AHCCCS Medicaid	$4,006.40
Rate for Payer: Allwell Medicaid	$4,006.40
Rate for Payer: AZCH Complete Medicaid	$4,006.40
Rate for Payer: Banner UC Health Medicaid	$4,006.40
Rate for Payer: Mercy Care Medicaid	$4,006.40

Schizophrenia

Facility

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$4,857.20
Max. Negotiated Rate	$4,857.20
Rate for Payer: AHCCCS Medicaid	$4,857.20
Rate for Payer: Allwell Medicaid	$4,857.20
Rate for Payer: AZCH Complete Medicaid	$4,857.20
Rate for Payer: Banner UC Health Medicaid	$4,857.20
Rate for Payer: Mercy Care Medicaid	$4,857.20

Schizophrenia

Facility

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$8,111.69
Max. Negotiated Rate	$8,111.69
Rate for Payer: AHCCCS Medicaid	$8,111.69
Rate for Payer: Allwell Medicaid	$8,111.69
Rate for Payer: AZCH Complete Medicaid	$8,111.69
Rate for Payer: Banner UC Health Medicaid	$8,111.69
Rate for Payer: Mercy Care Medicaid	$8,111.69

Schizophrenia

Facility

$4,006.40

Service Code	APR-DRG 7501
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$4,006.40
Max. Negotiated Rate	$4,006.40
Rate for Payer: AHCCCS Medicaid	$4,006.40
Rate for Payer: Allwell Medicaid	$4,006.40
Rate for Payer: AZCH Complete Medicaid	$4,006.40
Rate for Payer: Banner UC Health Medicaid	$4,006.40
Rate for Payer: Mercy Care Medicaid	$4,006.40

SCOPE VALET PULL THRU

Facility

$9.00

Hospital Charge Code	22619551
Hospital Revenue Code	272
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

SCOPE VALET PULL THRU

Facility

$9.00

Hospital Charge Code	22619551
Hospital Revenue Code	272
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

scopolamine transdermal 1.5 mg patch [CQCH]

Facility

$9.86

Service Code	NDC 10019055303
Hospital Charge Code	109866964
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna of AZ Commercial	$8.87
Rate for Payer: Aetna of AZ Medicare	$2.76
Rate for Payer: Allwell Medicare	$1.48
Rate for Payer: Amerigroup Medicare	$1.48
Rate for Payer: APIPA Medicare/Medicaid	$3.68
Rate for Payer: AZCH Complete Medicare	$1.48
Rate for Payer: Banner UC Health Medicare	$1.48
Rate for Payer: Bisbee Police All Plans	$2.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.70
Rate for Payer: Cash Price	$7.89
Rate for Payer: Cigna of AZ Commercial	$6.41
Rate for Payer: Copperpoint Commercial	$2.44
Rate for Payer: Health Net of AZ Commercial	$5.92
Rate for Payer: Health Net of AZ Medicare	$2.76
Rate for Payer: Humana of AZ Medicare	$1.48
Rate for Payer: Self Pay Self Pay	$7.89
Rate for Payer: TriWest Medicare	$1.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.77

scopolamine transdermal 1.5 mg patch [CQCH]

Facility

$9.86

Service Code	NDC 10019055303
Hospital Charge Code	109866964
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna of AZ Commercial	$8.87
Rate for Payer: Bisbee Police All Plans	$2.56
Rate for Payer: Cash Price	$7.89
Rate for Payer: Self Pay Self Pay	$7.89

SCREW AND WASHER STERILE TATANIUM DIA 3.0 L 12.0MM

Facility

$2,100.00

Hospital Charge Code	24415639
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Aetna of AZ Medicare	$588.00
Rate for Payer: Allwell Medicare	$315.00
Rate for Payer: Amerigroup Medicare	$315.00
Rate for Payer: APIPA Medicare/Medicaid	$784.35
Rate for Payer: AZCH Complete Medicare	$315.00
Rate for Payer: Banner UC Health Medicare	$315.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,428.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cigna of AZ Commercial	$1,470.00
Rate for Payer: Copperpoint Commercial	$519.75
Rate for Payer: Health Net of AZ Commercial	$1,260.00
Rate for Payer: Health Net of AZ Medicare	$588.00
Rate for Payer: Humana of AZ Medicare	$315.00
Rate for Payer: Self Pay Self Pay	$1,680.00
Rate for Payer: TriWest Medicare	$315.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,224.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$378.00

SCREW AND WASHER STERILE TATANIUM DIA 3.0 L 12.0MM

Facility

$2,100.00

Hospital Charge Code	24415639
Hospital Revenue Code	270
Min. Negotiated Rate	$546.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Self Pay Self Pay	$1,680.00

SCREW AND WASHER STERILE TATANIUM DIA 3.0 L 16MM

Facility

$2,100.00

Hospital Charge Code	24415640
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Aetna of AZ Medicare	$588.00
Rate for Payer: Allwell Medicare	$315.00
Rate for Payer: Amerigroup Medicare	$315.00
Rate for Payer: APIPA Medicare/Medicaid	$784.35
Rate for Payer: AZCH Complete Medicare	$315.00
Rate for Payer: Banner UC Health Medicare	$315.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,428.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cigna of AZ Commercial	$1,470.00
Rate for Payer: Copperpoint Commercial	$519.75
Rate for Payer: Health Net of AZ Commercial	$1,260.00
Rate for Payer: Health Net of AZ Medicare	$588.00
Rate for Payer: Humana of AZ Medicare	$315.00
Rate for Payer: Self Pay Self Pay	$1,680.00
Rate for Payer: TriWest Medicare	$315.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,224.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$378.00

SCREW AND WASHER STERILE TATANIUM DIA 3.0 L 16MM

Facility

$2,100.00

Hospital Charge Code	24415640
Hospital Revenue Code	270
Min. Negotiated Rate	$546.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Self Pay Self Pay	$1,680.00

SCREW AND WASHER STERILE TITANIUM DIA 3.0L 10MM

Facility

$2,100.00

Hospital Charge Code	24415439
Hospital Revenue Code	270
Min. Negotiated Rate	$546.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Self Pay Self Pay	$1,680.00

SCREW AND WASHER STERILE TITANIUM DIA 3.0L 10MM

Facility

$2,100.00

Hospital Charge Code	24415439
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Aetna of AZ Medicare	$588.00
Rate for Payer: Allwell Medicare	$315.00
Rate for Payer: Amerigroup Medicare	$315.00
Rate for Payer: APIPA Medicare/Medicaid	$784.35
Rate for Payer: AZCH Complete Medicare	$315.00
Rate for Payer: Banner UC Health Medicare	$315.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,428.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cigna of AZ Commercial	$1,470.00
Rate for Payer: Copperpoint Commercial	$519.75
Rate for Payer: Health Net of AZ Commercial	$1,260.00
Rate for Payer: Health Net of AZ Medicare	$588.00
Rate for Payer: Humana of AZ Medicare	$315.00
Rate for Payer: Self Pay Self Pay	$1,680.00
Rate for Payer: TriWest Medicare	$315.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,224.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$378.00

SCREW AND WASHER STERILE TITANIUM DIA 3.0L 14MM

Facility

$2,100.00

Hospital Charge Code	24415438
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Aetna of AZ Medicare	$588.00
Rate for Payer: Allwell Medicare	$315.00
Rate for Payer: Amerigroup Medicare	$315.00
Rate for Payer: APIPA Medicare/Medicaid	$784.35
Rate for Payer: AZCH Complete Medicare	$315.00
Rate for Payer: Banner UC Health Medicare	$315.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,428.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cigna of AZ Commercial	$1,470.00
Rate for Payer: Copperpoint Commercial	$519.75
Rate for Payer: Health Net of AZ Commercial	$1,260.00
Rate for Payer: Health Net of AZ Medicare	$588.00
Rate for Payer: Humana of AZ Medicare	$315.00
Rate for Payer: Self Pay Self Pay	$1,680.00
Rate for Payer: TriWest Medicare	$315.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,224.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$378.00

SCREW AND WASHER STERILE TITANIUM DIA 3.0L 14MM

Facility

$2,100.00

Hospital Charge Code	24415438
Hospital Revenue Code	270
Min. Negotiated Rate	$546.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna of AZ Commercial	$1,890.00
Rate for Payer: Bisbee Police All Plans	$546.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Self Pay Self Pay	$1,680.00

S CURVE URETHERAL DILATOR SET

Facility

$1,175.00

Hospital Charge Code	27748909
Hospital Revenue Code	270
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$1,057.50
Rate for Payer: Aetna of AZ Commercial	$1,057.50
Rate for Payer: Aetna of AZ Medicare	$329.00
Rate for Payer: Allwell Medicare	$176.25
Rate for Payer: Amerigroup Medicare	$176.25
Rate for Payer: APIPA Medicare/Medicaid	$438.86
Rate for Payer: AZCH Complete Medicare	$176.25
Rate for Payer: Banner UC Health Medicare	$176.25
Rate for Payer: Bisbee Police All Plans	$305.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$799.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cigna of AZ Commercial	$822.50
Rate for Payer: Copperpoint Commercial	$290.81
Rate for Payer: Health Net of AZ Commercial	$705.00
Rate for Payer: Health Net of AZ Medicare	$329.00
Rate for Payer: Humana of AZ Medicare	$176.25
Rate for Payer: Self Pay Self Pay	$940.00
Rate for Payer: TriWest Medicare	$176.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$685.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$211.50

S CURVE URETHERAL DILATOR SET

Facility

$1,175.00

Hospital Charge Code	27748909
Hospital Revenue Code	270
Min. Negotiated Rate	$305.50
Max. Negotiated Rate	$1,057.50
Rate for Payer: Aetna of AZ Commercial	$1,057.50
Rate for Payer: Bisbee Police All Plans	$305.50
Rate for Payer: Cash Price	$940.00
Rate for Payer: Self Pay Self Pay	$940.00

SEAL PORT BIOPSY ADJUSTABLE

Facility

$79.00

Hospital Charge Code	22354139
Hospital Revenue Code	270
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Aetna of AZ Medicare	$22.12
Rate for Payer: Allwell Medicare	$11.85
Rate for Payer: Amerigroup Medicare	$11.85
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicare	$11.85
Rate for Payer: Banner UC Health Medicare	$11.85
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.72
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$55.30
Rate for Payer: Copperpoint Commercial	$19.55
Rate for Payer: Health Net of AZ Commercial	$47.40
Rate for Payer: Health Net of AZ Medicare	$22.12
Rate for Payer: Humana of AZ Medicare	$11.85
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$11.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.22

SEAL PORT BIOPSY ADJUSTABLE

Facility

$79.00

Hospital Charge Code	22354139
Hospital Revenue Code	270
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Cash Price	$63.20
Rate for Payer: Self Pay Self Pay	$63.20

Sedimentation Rate

Facility

$36.00

Service Code	CPT 85652
Hospital Charge Code	633830
Hospital Revenue Code	300
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Bisbee Police All Plans	$9.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Self Pay Self Pay	$28.80

Sedimentation Rate

Facility

$36.00

Service Code	CPT 85652
Hospital Charge Code	633830
Hospital Revenue Code	300
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Aetna of AZ Medicare	$10.08
Rate for Payer: AHCCCS Medicaid	$2.70
Rate for Payer: Allwell Medicaid	$2.70
Rate for Payer: Allwell Medicare	$5.40
Rate for Payer: Amerigroup Medicare	$5.40
Rate for Payer: APIPA Medicare/Medicaid	$13.45
Rate for Payer: AZCH Complete Medicaid	$2.70
Rate for Payer: AZCH Complete Medicare	$5.40
Rate for Payer: Banner UC Health Medicaid	$2.70
Rate for Payer: Banner UC Health Medicare	$5.40
Rate for Payer: Bisbee Police All Plans	$9.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$24.48
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of AZ Commercial	$23.40
Rate for Payer: Copperpoint Commercial	$8.91
Rate for Payer: Health Net of AZ Commercial	$21.60
Rate for Payer: Health Net of AZ Medicare	$10.08
Rate for Payer: Humana of AZ Medicare	$5.40
Rate for Payer: Mercy Care Medicaid	$2.70
Rate for Payer: Self Pay Self Pay	$28.80
Rate for Payer: TriWest Medicare	$5.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.48

Seizure

Facility

$5,959.80

Service Code	APR-DRG 0533
Hospital Charge Code	APRDRG0533
Min. Negotiated Rate	$5,959.80
Max. Negotiated Rate	$5,959.80
Rate for Payer: AHCCCS Medicaid	$5,959.80
Rate for Payer: Allwell Medicaid	$5,959.80
Rate for Payer: AZCH Complete Medicaid	$5,959.80
Rate for Payer: Banner UC Health Medicaid	$5,959.80
Rate for Payer: Mercy Care Medicaid	$5,959.80

Know your out-of-pocket cost for care.

All Charges