Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Viral Illness

Facility

$5,933.14

Service Code	APR-DRG 7233
Hospital Charge Code	APRDRG7232
Min. Negotiated Rate	$5,933.14
Max. Negotiated Rate	$5,933.14
Rate for Payer: AHCCCS Medicaid	$5,933.14
Rate for Payer: Allwell Medicaid	$5,933.14
Rate for Payer: AZCH Complete Medicaid	$5,933.14
Rate for Payer: Banner UC Health Medicaid	$5,933.14
Rate for Payer: Mercy Care Medicaid	$5,933.14

Viral Illness

Facility

$3,679.54

Service Code	APR-DRG 7232
Hospital Charge Code	APRDRG7231
Min. Negotiated Rate	$3,679.54
Max. Negotiated Rate	$3,679.54
Rate for Payer: AHCCCS Medicaid	$3,679.54
Rate for Payer: Allwell Medicaid	$3,679.54
Rate for Payer: AZCH Complete Medicaid	$3,679.54
Rate for Payer: Banner UC Health Medicaid	$3,679.54
Rate for Payer: Mercy Care Medicaid	$3,679.54

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: AHCCCS Medicaid	$4,753.39
Rate for Payer: Allwell Medicaid	$4,753.39
Rate for Payer: AZCH Complete Medicaid	$4,753.39
Rate for Payer: Banner UC Health Medicaid	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: AHCCCS Medicaid	$4,753.39
Rate for Payer: Allwell Medicaid	$4,753.39
Rate for Payer: AZCH Complete Medicaid	$4,753.39
Rate for Payer: Banner UC Health Medicaid	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39

Viral Meningitis

Facility

$15,529.00

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$15,529.00
Max. Negotiated Rate	$15,529.00
Rate for Payer: AHCCCS Medicaid	$15,529.00
Rate for Payer: Allwell Medicaid	$15,529.00
Rate for Payer: AZCH Complete Medicaid	$15,529.00
Rate for Payer: Banner UC Health Medicaid	$15,529.00
Rate for Payer: Mercy Care Medicaid	$15,529.00

Viral Meningitis

Facility

$15,529.00

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$15,529.00
Max. Negotiated Rate	$15,529.00
Rate for Payer: AHCCCS Medicaid	$15,529.00
Rate for Payer: Allwell Medicaid	$15,529.00
Rate for Payer: AZCH Complete Medicaid	$15,529.00
Rate for Payer: Banner UC Health Medicaid	$15,529.00
Rate for Payer: Mercy Care Medicaid	$15,529.00

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: AHCCCS Medicaid	$3,153.49
Rate for Payer: Allwell Medicaid	$3,153.49
Rate for Payer: AZCH Complete Medicaid	$3,153.49
Rate for Payer: Banner UC Health Medicaid	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: AHCCCS Medicaid	$8,952.67
Rate for Payer: Allwell Medicaid	$8,952.67
Rate for Payer: AZCH Complete Medicaid	$8,952.67
Rate for Payer: Banner UC Health Medicaid	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: AHCCCS Medicaid	$4,753.39
Rate for Payer: Allwell Medicaid	$4,753.39
Rate for Payer: AZCH Complete Medicaid	$4,753.39
Rate for Payer: Banner UC Health Medicaid	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: AHCCCS Medicaid	$8,952.67
Rate for Payer: Allwell Medicaid	$8,952.67
Rate for Payer: AZCH Complete Medicaid	$8,952.67
Rate for Payer: Banner UC Health Medicaid	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: AHCCCS Medicaid	$8,952.67
Rate for Payer: Allwell Medicaid	$8,952.67
Rate for Payer: AZCH Complete Medicaid	$8,952.67
Rate for Payer: Banner UC Health Medicaid	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: AHCCCS Medicaid	$3,153.49
Rate for Payer: Allwell Medicaid	$3,153.49
Rate for Payer: AZCH Complete Medicaid	$3,153.49
Rate for Payer: Banner UC Health Medicaid	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: AHCCCS Medicaid	$8,952.67
Rate for Payer: Allwell Medicaid	$8,952.67
Rate for Payer: AZCH Complete Medicaid	$8,952.67
Rate for Payer: Banner UC Health Medicaid	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: AHCCCS Medicaid	$3,153.49
Rate for Payer: Allwell Medicaid	$3,153.49
Rate for Payer: AZCH Complete Medicaid	$3,153.49
Rate for Payer: Banner UC Health Medicaid	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49

Viral Meningitis

Facility

$15,529.00

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$15,529.00
Max. Negotiated Rate	$15,529.00
Rate for Payer: AHCCCS Medicaid	$15,529.00
Rate for Payer: Allwell Medicaid	$15,529.00
Rate for Payer: AZCH Complete Medicaid	$15,529.00
Rate for Payer: Banner UC Health Medicaid	$15,529.00
Rate for Payer: Mercy Care Medicaid	$15,529.00

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: AHCCCS Medicaid	$3,153.49
Rate for Payer: Allwell Medicaid	$3,153.49
Rate for Payer: AZCH Complete Medicaid	$3,153.49
Rate for Payer: Banner UC Health Medicaid	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49

Viral Meningitis

Facility

$15,529.00

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$15,529.00
Max. Negotiated Rate	$15,529.00
Rate for Payer: AHCCCS Medicaid	$15,529.00
Rate for Payer: Allwell Medicaid	$15,529.00
Rate for Payer: AZCH Complete Medicaid	$15,529.00
Rate for Payer: Banner UC Health Medicaid	$15,529.00
Rate for Payer: Mercy Care Medicaid	$15,529.00

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: AHCCCS Medicaid	$4,753.39
Rate for Payer: Allwell Medicaid	$4,753.39
Rate for Payer: AZCH Complete Medicaid	$4,753.39
Rate for Payer: Banner UC Health Medicaid	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39

VITALE SILICONE 6X7 WOUND DRESSING

Facility

$32.00

Hospital Charge Code	27569207
Hospital Revenue Code	270
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Cash Price	$25.60
Rate for Payer: Self Pay Self Pay	$25.60

VITALE SILICONE 6X7 WOUND DRESSING

Facility

$32.00

Hospital Charge Code	27569207
Hospital Revenue Code	270
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Aetna of AZ Medicare	$8.96
Rate for Payer: Allwell Medicare	$5.12
Rate for Payer: Amerigroup Medicare	$5.12
Rate for Payer: APIPA Medicare/Medicaid	$11.95
Rate for Payer: AZCH Complete Medicare	$5.12
Rate for Payer: Banner UC Health Medicare	$5.12
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21.76
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$22.40
Rate for Payer: Copperpoint Commercial	$7.92
Rate for Payer: Health Net of AZ Commercial	$19.20
Rate for Payer: Health Net of AZ Medicare	$8.96
Rate for Payer: Humana of AZ Medicare	$5.12
Rate for Payer: Self Pay Self Pay	$25.60
Rate for Payer: TriWest Medicare	$5.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$18.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.76

vitamin A & D Top Oint UD 5 gm [CQCH]

Facility

$0.02

Service Code	NDC 57896011214
Hospital Charge Code	105945204
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

vitamin A & D Top Oint UD 5 gm [CQCH]

Facility

$0.02

Service Code	NDC 57896011214
Hospital Charge Code	105945204
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.02

Vitamin A, Serum LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	2029227
Hospital Revenue Code	301
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Cash Price	$177.60
Rate for Payer: Self Pay Self Pay	$177.60

Vitamin A, Serum LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	2029227
Hospital Revenue Code	301
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Aetna of AZ Medicare	$62.16
Rate for Payer: Allwell Medicare	$35.52
Rate for Payer: Amerigroup Medicare	$35.52
Rate for Payer: APIPA Medicare/Medicaid	$82.92
Rate for Payer: AZCH Complete Medicare	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$150.96
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$144.30
Rate for Payer: Copperpoint Commercial	$54.95
Rate for Payer: Health Net of AZ Commercial	$133.20
Rate for Payer: Health Net of AZ Medicare	$62.16
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Self Pay Self Pay	$177.60
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$129.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.96

Vitamin B12

Facility

$108.00

Service Code	CPT 82607
Hospital Charge Code	22050695
Hospital Revenue Code	301
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Aetna of AZ Medicare	$30.24
Rate for Payer: Allwell Medicare	$17.28
Rate for Payer: Amerigroup Medicare	$17.28
Rate for Payer: APIPA Medicare/Medicaid	$40.34
Rate for Payer: AZCH Complete Medicare	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$73.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$70.20
Rate for Payer: Copperpoint Commercial	$26.73
Rate for Payer: Health Net of AZ Commercial	$64.80
Rate for Payer: Health Net of AZ Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Self Pay Self Pay	$86.40
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.44

Know your out-of-pocket cost for care.

All Charges