Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

SLEEVE ALP CALF

Facility

$98.00

Hospital Charge Code	22354965
Hospital Revenue Code	270
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Cash Price	$78.40
Rate for Payer: Self Pay Self Pay	$78.40

SLEEVE ALP CALF

Facility

$98.00

Hospital Charge Code	22354965
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Aetna of AZ Medicare	$27.44
Rate for Payer: Allwell Medicare	$14.70
Rate for Payer: Amerigroup Medicare	$14.70
Rate for Payer: APIPA Medicare/Medicaid	$36.60
Rate for Payer: AZCH Complete Medicare	$14.70
Rate for Payer: Banner UC Health Medicare	$14.70
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$66.64
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Copperpoint Commercial	$24.26
Rate for Payer: Health Net of AZ Commercial	$58.80
Rate for Payer: Health Net of AZ Medicare	$27.44
Rate for Payer: Humana of AZ Medicare	$14.70
Rate for Payer: Self Pay Self Pay	$78.40
Rate for Payer: TriWest Medicare	$14.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.64

SLEEVE TROCARE 5CM STR REFLEX

Facility

$106.00

Hospital Charge Code	22706520
Hospital Revenue Code	272
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

SLEEVE TROCARE 5CM STR REFLEX

Facility

$106.00

Hospital Charge Code	22706520
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$15.90
Rate for Payer: Amerigroup Medicare	$15.90
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$15.90
Rate for Payer: Banner UC Health Medicare	$15.90
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$74.20
Rate for Payer: Copperpoint Commercial	$26.24
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$15.90
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$15.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

Slide Coagulase

Facility

$35.00

Service Code	CPT 87147
Hospital Charge Code	634041
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Aetna of AZ Medicare	$9.80
Rate for Payer: AHCCCS Medicaid	$5.18
Rate for Payer: Allwell Medicaid	$5.18
Rate for Payer: Allwell Medicare	$5.25
Rate for Payer: Amerigroup Medicare	$5.25
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicaid	$5.18
Rate for Payer: AZCH Complete Medicare	$5.25
Rate for Payer: Banner UC Health Medicaid	$5.18
Rate for Payer: Banner UC Health Medicare	$5.25
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$22.75
Rate for Payer: Copperpoint Commercial	$8.66
Rate for Payer: Health Net of AZ Commercial	$21.00
Rate for Payer: Health Net of AZ Medicare	$9.80
Rate for Payer: Humana of AZ Medicare	$5.25
Rate for Payer: Mercy Care Medicaid	$5.18
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

Slide Coagulase

Facility

$35.00

Service Code	CPT 87147
Hospital Charge Code	634041
Hospital Revenue Code	301
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Cash Price	$28.00
Rate for Payer: Self Pay Self Pay	$28.00

SLING ARM LARGE

Facility

$30.00

Service Code	CPT A4565
Hospital Charge Code	22354278
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

SLING ARM LARGE

Facility

$30.00

Service Code	CPT A4565
Hospital Charge Code	22354278
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: AHCCCS Medicaid	$13.44
Rate for Payer: Allwell Medicaid	$13.44
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicaid	$13.44
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicaid	$13.44
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Mercy Care Medicaid	$13.44
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

SLING ARM LG

Facility

$25.00

Hospital Charge Code	22354133
Hospital Revenue Code	270
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Cash Price	$20.00
Rate for Payer: Self Pay Self Pay	$20.00

Know your out-of-pocket cost for care.

All Charges