Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility

$6,777.63

Service Code	APR-DRG 3151
Hospital Charge Code	APRDRG3153
Min. Negotiated Rate	$6,777.63
Max. Negotiated Rate	$6,777.63
Rate for Payer: AHCCCS Medicaid	$6,777.63
Rate for Payer: Allwell Medicaid	$6,777.63
Rate for Payer: AZCH Complete Medicaid	$6,777.63
Rate for Payer: Banner UC Health Medicaid	$6,777.63
Rate for Payer: Mercy Care Medicaid	$6,777.63

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility

$15,478.50

Service Code	APR-DRG 3153
Hospital Charge Code	APRDRG3151
Min. Negotiated Rate	$15,478.50
Max. Negotiated Rate	$15,478.50
Rate for Payer: AHCCCS Medicaid	$15,478.50
Rate for Payer: Allwell Medicaid	$15,478.50
Rate for Payer: AZCH Complete Medicaid	$15,478.50
Rate for Payer: Banner UC Health Medicaid	$15,478.50
Rate for Payer: Mercy Care Medicaid	$15,478.50

Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement

Facility

$10,067.90

Service Code	APR-DRG 3152
Hospital Charge Code	APRDRG3153
Min. Negotiated Rate	$10,067.90
Max. Negotiated Rate	$10,067.90
Rate for Payer: AHCCCS Medicaid	$10,067.90
Rate for Payer: Allwell Medicaid	$10,067.90
Rate for Payer: AZCH Complete Medicaid	$10,067.90
Rate for Payer: Banner UC Health Medicaid	$10,067.90
Rate for Payer: Mercy Care Medicaid	$10,067.90

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: AHCCCS Medicaid	$16,471.68
Rate for Payer: Allwell Medicaid	$16,471.68
Rate for Payer: AZCH Complete Medicaid	$16,471.68
Rate for Payer: Banner UC Health Medicaid	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: AHCCCS Medicaid	$3,701.29
Rate for Payer: Allwell Medicaid	$3,701.29
Rate for Payer: AZCH Complete Medicaid	$3,701.29
Rate for Payer: Banner UC Health Medicaid	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: AHCCCS Medicaid	$16,471.68
Rate for Payer: Allwell Medicaid	$16,471.68
Rate for Payer: AZCH Complete Medicaid	$16,471.68
Rate for Payer: Banner UC Health Medicaid	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: AHCCCS Medicaid	$16,471.68
Rate for Payer: Allwell Medicaid	$16,471.68
Rate for Payer: AZCH Complete Medicaid	$16,471.68
Rate for Payer: Banner UC Health Medicaid	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: AHCCCS Medicaid	$4,968.72
Rate for Payer: Allwell Medicaid	$4,968.72
Rate for Payer: AZCH Complete Medicaid	$4,968.72
Rate for Payer: Banner UC Health Medicaid	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: AHCCCS Medicaid	$4,968.72
Rate for Payer: Allwell Medicaid	$4,968.72
Rate for Payer: AZCH Complete Medicaid	$4,968.72
Rate for Payer: Banner UC Health Medicaid	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: AHCCCS Medicaid	$7,503.58
Rate for Payer: Allwell Medicaid	$7,503.58
Rate for Payer: AZCH Complete Medicaid	$7,503.58
Rate for Payer: Banner UC Health Medicaid	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: AHCCCS Medicaid	$16,471.68
Rate for Payer: Allwell Medicaid	$16,471.68
Rate for Payer: AZCH Complete Medicaid	$16,471.68
Rate for Payer: Banner UC Health Medicaid	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: AHCCCS Medicaid	$3,701.29
Rate for Payer: Allwell Medicaid	$3,701.29
Rate for Payer: AZCH Complete Medicaid	$3,701.29
Rate for Payer: Banner UC Health Medicaid	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: AHCCCS Medicaid	$7,503.58
Rate for Payer: Allwell Medicaid	$7,503.58
Rate for Payer: AZCH Complete Medicaid	$7,503.58
Rate for Payer: Banner UC Health Medicaid	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: AHCCCS Medicaid	$4,968.72
Rate for Payer: Allwell Medicaid	$4,968.72
Rate for Payer: AZCH Complete Medicaid	$4,968.72
Rate for Payer: Banner UC Health Medicaid	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: AHCCCS Medicaid	$7,503.58
Rate for Payer: Allwell Medicaid	$7,503.58
Rate for Payer: AZCH Complete Medicaid	$7,503.58
Rate for Payer: Banner UC Health Medicaid	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: AHCCCS Medicaid	$7,503.58
Rate for Payer: Allwell Medicaid	$7,503.58
Rate for Payer: AZCH Complete Medicaid	$7,503.58
Rate for Payer: Banner UC Health Medicaid	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: AHCCCS Medicaid	$3,701.29
Rate for Payer: Allwell Medicaid	$3,701.29
Rate for Payer: AZCH Complete Medicaid	$3,701.29
Rate for Payer: Banner UC Health Medicaid	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: AHCCCS Medicaid	$3,701.29
Rate for Payer: Allwell Medicaid	$3,701.29
Rate for Payer: AZCH Complete Medicaid	$3,701.29
Rate for Payer: Banner UC Health Medicaid	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: AHCCCS Medicaid	$4,968.72
Rate for Payer: Allwell Medicaid	$4,968.72
Rate for Payer: AZCH Complete Medicaid	$4,968.72
Rate for Payer: Banner UC Health Medicaid	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72

SIGMOIDOSCOPY

Facility

$379.00

Service Code	CPT 45330
Hospital Charge Code	1015557
Hospital Revenue Code	750
Min. Negotiated Rate	$98.54
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Cash Price	$303.20
Rate for Payer: Self Pay Self Pay	$303.20

SIGMOIDOSCOPY

Facility

$379.00

Service Code	CPT 45330
Hospital Charge Code	1015557
Hospital Revenue Code	750
Min. Negotiated Rate	$60.64
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Aetna of AZ Medicare	$106.12
Rate for Payer: AHCCCS Medicaid	$575.40
Rate for Payer: Allwell Medicaid	$575.40
Rate for Payer: Allwell Medicare	$60.64
Rate for Payer: Amerigroup Medicare	$60.64
Rate for Payer: APIPA Medicare/Medicaid	$141.56
Rate for Payer: AZCH Complete Medicaid	$575.40
Rate for Payer: AZCH Complete Medicare	$60.64
Rate for Payer: Banner UC Health Medicaid	$575.40
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$257.72
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$265.30
Rate for Payer: Copperpoint Commercial	$93.80
Rate for Payer: Health Net of AZ Commercial	$227.40
Rate for Payer: Health Net of AZ Medicare	$106.12
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Mercy Care Medicaid	$575.40
Rate for Payer: Self Pay Self Pay	$303.20
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.22

Signs, Symptoms And Other Factors Influencing Health Status

Facility

$5,985.05

Service Code	APR-DRG 8613
Hospital Charge Code	APRDRG8612
Min. Negotiated Rate	$5,985.05
Max. Negotiated Rate	$5,985.05
Rate for Payer: AHCCCS Medicaid	$5,985.05
Rate for Payer: Allwell Medicaid	$5,985.05
Rate for Payer: AZCH Complete Medicaid	$5,985.05
Rate for Payer: Banner UC Health Medicaid	$5,985.05
Rate for Payer: Mercy Care Medicaid	$5,985.05

Signs, Symptoms And Other Factors Influencing Health Status

Facility

$3,340.07

Service Code	APR-DRG 8611
Hospital Charge Code	APRDRG8613
Min. Negotiated Rate	$3,340.07
Max. Negotiated Rate	$3,340.07
Rate for Payer: AHCCCS Medicaid	$3,340.07
Rate for Payer: Allwell Medicaid	$3,340.07
Rate for Payer: AZCH Complete Medicaid	$3,340.07
Rate for Payer: Banner UC Health Medicaid	$3,340.07
Rate for Payer: Mercy Care Medicaid	$3,340.07

Signs, Symptoms And Other Factors Influencing Health Status

Facility

$5,985.05

Service Code	APR-DRG 8613
Hospital Charge Code	APRDRG8611
Min. Negotiated Rate	$5,985.05
Max. Negotiated Rate	$5,985.05
Rate for Payer: AHCCCS Medicaid	$5,985.05
Rate for Payer: Allwell Medicaid	$5,985.05
Rate for Payer: AZCH Complete Medicaid	$5,985.05
Rate for Payer: Banner UC Health Medicaid	$5,985.05
Rate for Payer: Mercy Care Medicaid	$5,985.05

Signs, Symptoms And Other Factors Influencing Health Status

Facility

$3,340.07

Service Code	APR-DRG 8611
Hospital Charge Code	APRDRG8611
Min. Negotiated Rate	$3,340.07
Max. Negotiated Rate	$3,340.07
Rate for Payer: AHCCCS Medicaid	$3,340.07
Rate for Payer: Allwell Medicaid	$3,340.07
Rate for Payer: AZCH Complete Medicaid	$3,340.07
Rate for Payer: Banner UC Health Medicaid	$3,340.07
Rate for Payer: Mercy Care Medicaid	$3,340.07

Know your out-of-pocket cost for care.

All Charges