Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Transient Ischemia

Facility

$11,383.72

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG0472
Min. Negotiated Rate	$11,383.72
Max. Negotiated Rate	$11,383.72
Rate for Payer: AHCCCS Medicaid	$11,383.72
Rate for Payer: Allwell Medicaid	$11,383.72
Rate for Payer: AZCH Complete Medicaid	$11,383.72
Rate for Payer: Banner UC Health Medicaid	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72

Transient Ischemia

Facility

$11,383.72

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG0473
Min. Negotiated Rate	$11,383.72
Max. Negotiated Rate	$11,383.72
Rate for Payer: AHCCCS Medicaid	$11,383.72
Rate for Payer: Allwell Medicaid	$11,383.72
Rate for Payer: AZCH Complete Medicaid	$11,383.72
Rate for Payer: Banner UC Health Medicaid	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72

Transient Ischemia

Facility

$4,765.31

Service Code	APR-DRG 0472
Hospital Charge Code	APRDRG0472
Min. Negotiated Rate	$4,765.31
Max. Negotiated Rate	$4,765.31
Rate for Payer: AHCCCS Medicaid	$4,765.31
Rate for Payer: Allwell Medicaid	$4,765.31
Rate for Payer: AZCH Complete Medicaid	$4,765.31
Rate for Payer: Banner UC Health Medicaid	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31

Transurethral Prostatectomy

Facility

$5,847.57

Service Code	APR-DRG 4822
Hospital Charge Code	APRDRG4822
Min. Negotiated Rate	$5,847.57
Max. Negotiated Rate	$5,847.57
Rate for Payer: AHCCCS Medicaid	$5,847.57
Rate for Payer: Allwell Medicaid	$5,847.57
Rate for Payer: AZCH Complete Medicaid	$5,847.57
Rate for Payer: Banner UC Health Medicaid	$5,847.57
Rate for Payer: Mercy Care Medicaid	$5,847.57

Transurethral Prostatectomy

Facility

$22,298.91

Service Code	APR-DRG 4824
Hospital Charge Code	APRDRG4824
Min. Negotiated Rate	$22,298.91
Max. Negotiated Rate	$22,298.91
Rate for Payer: AHCCCS Medicaid	$22,298.91
Rate for Payer: Allwell Medicaid	$22,298.91
Rate for Payer: AZCH Complete Medicaid	$22,298.91
Rate for Payer: Banner UC Health Medicaid	$22,298.91
Rate for Payer: Mercy Care Medicaid	$22,298.91

Transurethral Prostatectomy

Facility

$11,878.21

Service Code	APR-DRG 4823
Hospital Charge Code	APRDRG4824
Min. Negotiated Rate	$11,878.21
Max. Negotiated Rate	$11,878.21
Rate for Payer: AHCCCS Medicaid	$11,878.21
Rate for Payer: Allwell Medicaid	$11,878.21
Rate for Payer: AZCH Complete Medicaid	$11,878.21
Rate for Payer: Banner UC Health Medicaid	$11,878.21
Rate for Payer: Mercy Care Medicaid	$11,878.21

Transurethral Prostatectomy

Facility

$22,298.91

Service Code	APR-DRG 4824
Hospital Charge Code	APRDRG4823
Min. Negotiated Rate	$22,298.91
Max. Negotiated Rate	$22,298.91
Rate for Payer: AHCCCS Medicaid	$22,298.91
Rate for Payer: Allwell Medicaid	$22,298.91
Rate for Payer: AZCH Complete Medicaid	$22,298.91
Rate for Payer: Banner UC Health Medicaid	$22,298.91
Rate for Payer: Mercy Care Medicaid	$22,298.91

Transurethral Prostatectomy

Facility

$11,878.21

Service Code	APR-DRG 4823
Hospital Charge Code	APRDRG4821
Min. Negotiated Rate	$11,878.21
Max. Negotiated Rate	$11,878.21
Rate for Payer: AHCCCS Medicaid	$11,878.21
Rate for Payer: Allwell Medicaid	$11,878.21
Rate for Payer: AZCH Complete Medicaid	$11,878.21
Rate for Payer: Banner UC Health Medicaid	$11,878.21
Rate for Payer: Mercy Care Medicaid	$11,878.21

Transurethral Prostatectomy

Facility

$5,847.57

Service Code	APR-DRG 4822
Hospital Charge Code	APRDRG4823
Min. Negotiated Rate	$5,847.57
Max. Negotiated Rate	$5,847.57
Rate for Payer: AHCCCS Medicaid	$5,847.57
Rate for Payer: Allwell Medicaid	$5,847.57
Rate for Payer: AZCH Complete Medicaid	$5,847.57
Rate for Payer: Banner UC Health Medicaid	$5,847.57
Rate for Payer: Mercy Care Medicaid	$5,847.57

Transurethral Prostatectomy

Facility

$11,878.21

Service Code	APR-DRG 4823
Hospital Charge Code	APRDRG4822
Min. Negotiated Rate	$11,878.21
Max. Negotiated Rate	$11,878.21
Rate for Payer: AHCCCS Medicaid	$11,878.21
Rate for Payer: Allwell Medicaid	$11,878.21
Rate for Payer: AZCH Complete Medicaid	$11,878.21
Rate for Payer: Banner UC Health Medicaid	$11,878.21
Rate for Payer: Mercy Care Medicaid	$11,878.21

Transurethral Prostatectomy

Facility

$11,878.21

Service Code	APR-DRG 4823
Hospital Charge Code	APRDRG4823
Min. Negotiated Rate	$11,878.21
Max. Negotiated Rate	$11,878.21
Rate for Payer: AHCCCS Medicaid	$11,878.21
Rate for Payer: Allwell Medicaid	$11,878.21
Rate for Payer: AZCH Complete Medicaid	$11,878.21
Rate for Payer: Banner UC Health Medicaid	$11,878.21
Rate for Payer: Mercy Care Medicaid	$11,878.21

Transurethral Prostatectomy

Facility

$5,847.57

Service Code	APR-DRG 4822
Hospital Charge Code	APRDRG4824
Min. Negotiated Rate	$5,847.57
Max. Negotiated Rate	$5,847.57
Rate for Payer: AHCCCS Medicaid	$5,847.57
Rate for Payer: Allwell Medicaid	$5,847.57
Rate for Payer: AZCH Complete Medicaid	$5,847.57
Rate for Payer: Banner UC Health Medicaid	$5,847.57
Rate for Payer: Mercy Care Medicaid	$5,847.57

Transurethral Prostatectomy

Facility

$22,298.91

Service Code	APR-DRG 4824
Hospital Charge Code	APRDRG4821
Min. Negotiated Rate	$22,298.91
Max. Negotiated Rate	$22,298.91
Rate for Payer: AHCCCS Medicaid	$22,298.91
Rate for Payer: Allwell Medicaid	$22,298.91
Rate for Payer: AZCH Complete Medicaid	$22,298.91
Rate for Payer: Banner UC Health Medicaid	$22,298.91
Rate for Payer: Mercy Care Medicaid	$22,298.91

Transurethral Prostatectomy

Facility

$5,016.41

Service Code	APR-DRG 4821
Hospital Charge Code	APRDRG4822
Min. Negotiated Rate	$5,016.41
Max. Negotiated Rate	$5,016.41
Rate for Payer: AHCCCS Medicaid	$5,016.41
Rate for Payer: Allwell Medicaid	$5,016.41
Rate for Payer: AZCH Complete Medicaid	$5,016.41
Rate for Payer: Banner UC Health Medicaid	$5,016.41
Rate for Payer: Mercy Care Medicaid	$5,016.41

Transurethral Prostatectomy

Facility

$5,016.41

Service Code	APR-DRG 4821
Hospital Charge Code	APRDRG4823
Min. Negotiated Rate	$5,016.41
Max. Negotiated Rate	$5,016.41
Rate for Payer: AHCCCS Medicaid	$5,016.41
Rate for Payer: Allwell Medicaid	$5,016.41
Rate for Payer: AZCH Complete Medicaid	$5,016.41
Rate for Payer: Banner UC Health Medicaid	$5,016.41
Rate for Payer: Mercy Care Medicaid	$5,016.41

Transurethral Prostatectomy

Facility

$22,298.91

Service Code	APR-DRG 4824
Hospital Charge Code	APRDRG4822
Min. Negotiated Rate	$22,298.91
Max. Negotiated Rate	$22,298.91
Rate for Payer: AHCCCS Medicaid	$22,298.91
Rate for Payer: Allwell Medicaid	$22,298.91
Rate for Payer: AZCH Complete Medicaid	$22,298.91
Rate for Payer: Banner UC Health Medicaid	$22,298.91
Rate for Payer: Mercy Care Medicaid	$22,298.91

Transurethral Prostatectomy

Facility

$5,016.41

Service Code	APR-DRG 4821
Hospital Charge Code	APRDRG4821
Min. Negotiated Rate	$5,016.41
Max. Negotiated Rate	$5,016.41
Rate for Payer: AHCCCS Medicaid	$5,016.41
Rate for Payer: Allwell Medicaid	$5,016.41
Rate for Payer: AZCH Complete Medicaid	$5,016.41
Rate for Payer: Banner UC Health Medicaid	$5,016.41
Rate for Payer: Mercy Care Medicaid	$5,016.41

Transurethral Prostatectomy

Facility

$5,847.57

Service Code	APR-DRG 4822
Hospital Charge Code	APRDRG4821
Min. Negotiated Rate	$5,847.57
Max. Negotiated Rate	$5,847.57
Rate for Payer: AHCCCS Medicaid	$5,847.57
Rate for Payer: Allwell Medicaid	$5,847.57
Rate for Payer: AZCH Complete Medicaid	$5,847.57
Rate for Payer: Banner UC Health Medicaid	$5,847.57
Rate for Payer: Mercy Care Medicaid	$5,847.57

Transurethral Prostatectomy

Facility

$5,016.41

Service Code	APR-DRG 4821
Hospital Charge Code	APRDRG4824
Min. Negotiated Rate	$5,016.41
Max. Negotiated Rate	$5,016.41
Rate for Payer: AHCCCS Medicaid	$5,016.41
Rate for Payer: Allwell Medicaid	$5,016.41
Rate for Payer: AZCH Complete Medicaid	$5,016.41
Rate for Payer: Banner UC Health Medicaid	$5,016.41
Rate for Payer: Mercy Care Medicaid	$5,016.41

TRAP SPECIMEN 80CC

Facility

$9.00

Hospital Charge Code	22926449
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

TRAP SPECIMEN 80CC

Facility

$9.00

Hospital Charge Code	22926449
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

TRAY BASIC 30CC

Facility

$14.00

Hospital Charge Code	22355321
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Cash Price	$11.20
Rate for Payer: Self Pay Self Pay	$11.20

TRAY BASIC 30CC

Facility

$14.00

Hospital Charge Code	22355321
Hospital Revenue Code	270
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Aetna of AZ Medicare	$3.92
Rate for Payer: Allwell Medicare	$2.24
Rate for Payer: Amerigroup Medicare	$2.24
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.24
Rate for Payer: Banner UC Health Medicare	$2.24
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$9.52
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Copperpoint Commercial	$3.46
Rate for Payer: Health Net of AZ Commercial	$8.40
Rate for Payer: Health Net of AZ Medicare	$3.92
Rate for Payer: Humana of AZ Medicare	$2.24
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

TRAY DRESSING CHANGE

Facility

$23.00

Hospital Charge Code	22531720
Hospital Revenue Code	272
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Aetna of AZ Medicare	$6.44
Rate for Payer: Allwell Medicare	$3.68
Rate for Payer: Amerigroup Medicare	$3.68
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.64
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Copperpoint Commercial	$5.69
Rate for Payer: Health Net of AZ Commercial	$13.80
Rate for Payer: Health Net of AZ Medicare	$6.44
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.14

TRAY DRESSING CHANGE

Facility

$23.00

Hospital Charge Code	22531720
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Cash Price	$18.40
Rate for Payer: Self Pay Self Pay	$18.40

Know your out-of-pocket cost for care.

All Charges