Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Seizure

Facility

$14,885.11

Service Code	APR-DRG 0534
Hospital Charge Code	APRDRG0532
Min. Negotiated Rate	$14,885.11
Max. Negotiated Rate	$14,885.11
Rate for Payer: AHCCCS Medicaid	$14,885.11
Rate for Payer: Allwell Medicaid	$14,885.11
Rate for Payer: AZCH Complete Medicaid	$14,885.11
Rate for Payer: Banner UC Health Medicaid	$14,885.11
Rate for Payer: Mercy Care Medicaid	$14,885.11

Seizure

Facility

$4,510.70

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG0533
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Seizure

Facility

$4,510.70

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG0531
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Seizure

Facility

$4,510.70

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG0534
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Seizure

Facility

$5,959.80

Service Code	APR-DRG 0533
Hospital Charge Code	APRDRG0534
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

Seizure

Facility

$5,959.80

Service Code	APR-DRG 0533
Hospital Charge Code	APRDRG0532
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

Seizure

Facility

$3,695.68

Service Code	APR-DRG 0531
Hospital Charge Code	APRDRG0531
Min. Negotiated Rate	$3,695.68
Max. Negotiated Rate	$3,695.68
Rate for Payer: AHCCCS Medicaid	$3,695.68
Rate for Payer: Allwell Medicaid	$3,695.68
Rate for Payer: AZCH Complete Medicaid	$3,695.68
Rate for Payer: Banner UC Health Medicaid	$3,695.68
Rate for Payer: Mercy Care Medicaid	$3,695.68

Seizure

Facility

$14,885.11

Service Code	APR-DRG 0534
Hospital Charge Code	APRDRG0533
Min. Negotiated Rate	$14,885.11
Max. Negotiated Rate	$14,885.11
Rate for Payer: AHCCCS Medicaid	$14,885.11
Rate for Payer: Allwell Medicaid	$14,885.11
Rate for Payer: AZCH Complete Medicaid	$14,885.11
Rate for Payer: Banner UC Health Medicaid	$14,885.11
Rate for Payer: Mercy Care Medicaid	$14,885.11

Seizure

Facility

$14,885.11

Service Code	APR-DRG 0534
Hospital Charge Code	APRDRG0531
Min. Negotiated Rate	$14,885.11
Max. Negotiated Rate	$14,885.11
Rate for Payer: AHCCCS Medicaid	$14,885.11
Rate for Payer: Allwell Medicaid	$14,885.11
Rate for Payer: AZCH Complete Medicaid	$14,885.11
Rate for Payer: Banner UC Health Medicaid	$14,885.11
Rate for Payer: Mercy Care Medicaid	$14,885.11

Seizure

Facility

$3,695.68

Service Code	APR-DRG 0531
Hospital Charge Code	APRDRG0534
Min. Negotiated Rate	$3,695.68
Max. Negotiated Rate	$3,695.68
Rate for Payer: AHCCCS Medicaid	$3,695.68
Rate for Payer: Allwell Medicaid	$3,695.68
Rate for Payer: AZCH Complete Medicaid	$3,695.68
Rate for Payer: Banner UC Health Medicaid	$3,695.68
Rate for Payer: Mercy Care Medicaid	$3,695.68

Seizure

Facility

$4,510.70

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG0532
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Seizure

Facility

$3,695.68

Service Code	APR-DRG 0531
Hospital Charge Code	APRDRG0532
Min. Negotiated Rate	$3,695.68
Max. Negotiated Rate	$3,695.68
Rate for Payer: AHCCCS Medicaid	$3,695.68
Rate for Payer: Allwell Medicaid	$3,695.68
Rate for Payer: AZCH Complete Medicaid	$3,695.68
Rate for Payer: Banner UC Health Medicaid	$3,695.68
Rate for Payer: Mercy Care Medicaid	$3,695.68

Seizure

Facility

$3,695.68

Service Code	APR-DRG 0531
Hospital Charge Code	APRDRG0533
Min. Negotiated Rate	$3,695.68
Max. Negotiated Rate	$3,695.68
Rate for Payer: AHCCCS Medicaid	$3,695.68
Rate for Payer: Allwell Medicaid	$3,695.68
Rate for Payer: AZCH Complete Medicaid	$3,695.68
Rate for Payer: Banner UC Health Medicaid	$3,695.68
Rate for Payer: Mercy Care Medicaid	$3,695.68

Seizure

Facility

$5,959.80

Service Code	APR-DRG 0533
Hospital Charge Code	APRDRG0531
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

Seizure

Facility

$14,885.11

Service Code	APR-DRG 0534
Hospital Charge Code	APRDRG0534
Min. Negotiated Rate	$14,885.11
Max. Negotiated Rate	$14,885.11
Rate for Payer: AHCCCS Medicaid	$14,885.11
Rate for Payer: Allwell Medicaid	$14,885.11
Rate for Payer: AZCH Complete Medicaid	$14,885.11
Rate for Payer: Banner UC Health Medicaid	$14,885.11
Rate for Payer: Mercy Care Medicaid	$14,885.11

senna 8.6 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 904725261
Hospital Charge Code	105940042
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

senna 8.6 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 904725261
Hospital Charge Code	105940042
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.03

SENSATION SHORT THROW 13MM

Facility

$47.00

Hospital Charge Code	27497394
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

SENSATION SHORT THROW 13MM

Facility

$47.00

Hospital Charge Code	27497394
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

SENSOR, NEONATAL/ADLT,OXIMAX

Facility

$117.00

Hospital Charge Code	23290390
Hospital Revenue Code	272
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of AZ Commercial	$105.30
Rate for Payer: Bisbee Police All Plans	$30.42
Rate for Payer: Cash Price	$93.60
Rate for Payer: Self Pay Self Pay	$93.60

SENSOR, NEONATAL/ADLT,OXIMAX

Facility

$117.00

Hospital Charge Code	23290390
Hospital Revenue Code	272
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of AZ Commercial	$105.30
Rate for Payer: Aetna of AZ Medicare	$32.76
Rate for Payer: Allwell Medicare	$17.55
Rate for Payer: Amerigroup Medicare	$17.55
Rate for Payer: APIPA Medicare/Medicaid	$43.70
Rate for Payer: AZCH Complete Medicare	$17.55
Rate for Payer: Banner UC Health Medicare	$17.55
Rate for Payer: Bisbee Police All Plans	$30.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$79.56
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna of AZ Commercial	$81.90
Rate for Payer: Copperpoint Commercial	$28.96
Rate for Payer: Health Net of AZ Commercial	$70.20
Rate for Payer: Health Net of AZ Medicare	$32.76
Rate for Payer: Humana of AZ Medicare	$17.55
Rate for Payer: Self Pay Self Pay	$93.60
Rate for Payer: TriWest Medicare	$17.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.06

SENSOR SPO2 INFANT NELLCOR

Facility

$54.00

Hospital Charge Code	22546699
Hospital Revenue Code	272
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Bisbee Police All Plans	$14.04
Rate for Payer: Cash Price	$43.20
Rate for Payer: Self Pay Self Pay	$43.20

SENSOR SPO2 INFANT NELLCOR

Facility

$54.00

Hospital Charge Code	22546699
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Aetna of AZ Medicare	$15.12
Rate for Payer: Allwell Medicare	$8.10
Rate for Payer: Amerigroup Medicare	$8.10
Rate for Payer: APIPA Medicare/Medicaid	$20.17
Rate for Payer: AZCH Complete Medicare	$8.10
Rate for Payer: Banner UC Health Medicare	$8.10
Rate for Payer: Bisbee Police All Plans	$14.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$36.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of AZ Commercial	$37.80
Rate for Payer: Copperpoint Commercial	$13.36
Rate for Payer: Health Net of AZ Commercial	$32.40
Rate for Payer: Health Net of AZ Medicare	$15.12
Rate for Payer: Humana of AZ Medicare	$8.10
Rate for Payer: Self Pay Self Pay	$43.20
Rate for Payer: TriWest Medicare	$8.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$31.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.72

SENSOR SPO2 PEDIATRIC NELLCOR

Facility

$46.00

Hospital Charge Code	22546697
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$6.90
Rate for Payer: Amerigroup Medicare	$6.90
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$6.90
Rate for Payer: Banner UC Health Medicare	$6.90
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$6.90
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$6.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

SENSOR SPO2 PEDIATRIC NELLCOR

Facility

$46.00

Hospital Charge Code	22546697
Hospital Revenue Code	272
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

Know your out-of-pocket cost for care.

All Charges