Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Schizophrenia

Facility

$17,732.79

Service Code	APR-DRG 7504
Hospital Charge Code	APRDRG7502
Min. Negotiated Rate	$17,732.79
Max. Negotiated Rate	$17,732.79
Rate for Payer: AHCCCS Medicaid	$17,732.79
Rate for Payer: Allwell Medicaid	$17,732.79
Rate for Payer: AZCH Complete Medicaid	$17,732.79
Rate for Payer: Banner UC Health Medicaid	$17,732.79
Rate for Payer: Mercy Care Medicaid	$17,732.79

Schizophrenia

Facility

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7502
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

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7504
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

$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

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

$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

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7501
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

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7504
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

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7502
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

$17,732.79

Service Code	APR-DRG 7504
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$17,732.79
Max. Negotiated Rate	$17,732.79
Rate for Payer: AHCCCS Medicaid	$17,732.79
Rate for Payer: Allwell Medicaid	$17,732.79
Rate for Payer: AZCH Complete Medicaid	$17,732.79
Rate for Payer: Banner UC Health Medicaid	$17,732.79
Rate for Payer: Mercy Care Medicaid	$17,732.79

Schizophrenia

Facility

$17,732.79

Service Code	APR-DRG 7504
Hospital Charge Code	APRDRG7504
Min. Negotiated Rate	$17,732.79
Max. Negotiated Rate	$17,732.79
Rate for Payer: AHCCCS Medicaid	$17,732.79
Rate for Payer: Allwell Medicaid	$17,732.79
Rate for Payer: AZCH Complete Medicaid	$17,732.79
Rate for Payer: Banner UC Health Medicaid	$17,732.79
Rate for Payer: Mercy Care Medicaid	$17,732.79

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	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

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7501
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

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

SCOPE VALET PULL THRU

Facility

$9.00

Hospital Charge Code	22619551
Hospital Revenue Code	272
Min. Negotiated Rate	$1.44
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	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
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	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

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

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	$1.58
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	$1.58
Rate for Payer: Amerigroup Medicare	$1.58
Rate for Payer: APIPA Medicare/Medicaid	$3.68
Rate for Payer: AZCH Complete Medicare	$1.58
Rate for Payer: Banner UC Health Medicare	$1.58
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	$1.58
Rate for Payer: Self Pay Self Pay	$7.89
Rate for Payer: TriWest Medicare	$1.58
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.77

S CURVE URETHERAL DILATOR SET

Facility

$1,175.00

Hospital Charge Code	27748909
Hospital Revenue Code	270
Min. Negotiated Rate	$188.00
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	$188.00
Rate for Payer: Amerigroup Medicare	$188.00
Rate for Payer: APIPA Medicare/Medicaid	$438.86
Rate for Payer: AZCH Complete Medicare	$188.00
Rate for Payer: Banner UC Health Medicare	$188.00
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	$188.00
Rate for Payer: Self Pay Self Pay	$940.00
Rate for Payer: TriWest Medicare	$188.00
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	$12.64
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	$12.64
Rate for Payer: Amerigroup Medicare	$12.64
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicare	$12.64
Rate for Payer: Banner UC Health Medicare	$12.64
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	$12.64
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$12.64
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

$34.00

Service Code	CPT 85652
Hospital Charge Code	633830
Hospital Revenue Code	300
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Aetna of AZ Medicare	$9.52
Rate for Payer: Allwell Medicare	$5.44
Rate for Payer: Amerigroup Medicare	$5.44
Rate for Payer: APIPA Medicare/Medicaid	$12.70
Rate for Payer: AZCH Complete Medicare	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Bisbee Police All Plans	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.12
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$22.10
Rate for Payer: Copperpoint Commercial	$8.41
Rate for Payer: Health Net of AZ Commercial	$20.40
Rate for Payer: Health Net of AZ Medicare	$9.52
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Self Pay Self Pay	$27.20
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.12

Sedimentation Rate

Facility

$34.00

Service Code	CPT 85652
Hospital Charge Code	633830
Hospital Revenue Code	300
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Bisbee Police All Plans	$8.84
Rate for Payer: Cash Price	$27.20
Rate for Payer: Self Pay Self Pay	$27.20

Know your out-of-pocket cost for care.

All Charges