Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cardiomyopathy

Facility

$13,234.02

Service Code	APR-DRG 2054
Hospital Charge Code	APRDRG2052
Min. Negotiated Rate	$13,234.02
Max. Negotiated Rate	$13,234.02
Rate for Payer: AHCCCS Medicaid	$13,234.02
Rate for Payer: Allwell Medicaid	$13,234.02
Rate for Payer: AZCH Complete Medicaid	$13,234.02
Rate for Payer: Banner UC Health Medicaid	$13,234.02
Rate for Payer: Mercy Care Medicaid	$13,234.02

Cardiomyopathy

Facility

$6,686.45

Service Code	APR-DRG 2053
Hospital Charge Code	APRDRG2052
Min. Negotiated Rate	$6,686.45
Max. Negotiated Rate	$6,686.45
Rate for Payer: AHCCCS Medicaid	$6,686.45
Rate for Payer: Allwell Medicaid	$6,686.45
Rate for Payer: AZCH Complete Medicaid	$6,686.45
Rate for Payer: Banner UC Health Medicaid	$6,686.45
Rate for Payer: Mercy Care Medicaid	$6,686.45

Cardiomyopathy

Facility

$4,557.00

Service Code	APR-DRG 2052
Hospital Charge Code	APRDRG2054
Min. Negotiated Rate	$4,557.00
Max. Negotiated Rate	$4,557.00
Rate for Payer: AHCCCS Medicaid	$4,557.00
Rate for Payer: Allwell Medicaid	$4,557.00
Rate for Payer: AZCH Complete Medicaid	$4,557.00
Rate for Payer: Banner UC Health Medicaid	$4,557.00
Rate for Payer: Mercy Care Medicaid	$4,557.00

Cardiomyopathy

Facility

$4,557.00

Service Code	APR-DRG 2052
Hospital Charge Code	APRDRG2051
Min. Negotiated Rate	$4,557.00
Max. Negotiated Rate	$4,557.00
Rate for Payer: AHCCCS Medicaid	$4,557.00
Rate for Payer: Allwell Medicaid	$4,557.00
Rate for Payer: AZCH Complete Medicaid	$4,557.00
Rate for Payer: Banner UC Health Medicaid	$4,557.00
Rate for Payer: Mercy Care Medicaid	$4,557.00

Cardiomyopathy

Facility

$6,686.45

Service Code	APR-DRG 2053
Hospital Charge Code	APRDRG2051
Min. Negotiated Rate	$6,686.45
Max. Negotiated Rate	$6,686.45
Rate for Payer: AHCCCS Medicaid	$6,686.45
Rate for Payer: Allwell Medicaid	$6,686.45
Rate for Payer: AZCH Complete Medicaid	$6,686.45
Rate for Payer: Banner UC Health Medicaid	$6,686.45
Rate for Payer: Mercy Care Medicaid	$6,686.45

Cardiomyopathy

Facility

$3,612.91

Service Code	APR-DRG 2051
Hospital Charge Code	APRDRG2053
Min. Negotiated Rate	$3,612.91
Max. Negotiated Rate	$3,612.91
Rate for Payer: AHCCCS Medicaid	$3,612.91
Rate for Payer: Allwell Medicaid	$3,612.91
Rate for Payer: AZCH Complete Medicaid	$3,612.91
Rate for Payer: Banner UC Health Medicaid	$3,612.91
Rate for Payer: Mercy Care Medicaid	$3,612.91

Cardiomyopathy

Facility

$6,686.45

Service Code	APR-DRG 2053
Hospital Charge Code	APRDRG2054
Min. Negotiated Rate	$6,686.45
Max. Negotiated Rate	$6,686.45
Rate for Payer: AHCCCS Medicaid	$6,686.45
Rate for Payer: Allwell Medicaid	$6,686.45
Rate for Payer: AZCH Complete Medicaid	$6,686.45
Rate for Payer: Banner UC Health Medicaid	$6,686.45
Rate for Payer: Mercy Care Medicaid	$6,686.45

Cardiomyopathy

Facility

$3,612.91

Service Code	APR-DRG 2051
Hospital Charge Code	APRDRG2052
Min. Negotiated Rate	$3,612.91
Max. Negotiated Rate	$3,612.91
Rate for Payer: AHCCCS Medicaid	$3,612.91
Rate for Payer: Allwell Medicaid	$3,612.91
Rate for Payer: AZCH Complete Medicaid	$3,612.91
Rate for Payer: Banner UC Health Medicaid	$3,612.91
Rate for Payer: Mercy Care Medicaid	$3,612.91

Cardiomyopathy

Facility

$13,234.02

Service Code	APR-DRG 2054
Hospital Charge Code	APRDRG2054
Min. Negotiated Rate	$13,234.02
Max. Negotiated Rate	$13,234.02
Rate for Payer: AHCCCS Medicaid	$13,234.02
Rate for Payer: Allwell Medicaid	$13,234.02
Rate for Payer: AZCH Complete Medicaid	$13,234.02
Rate for Payer: Banner UC Health Medicaid	$13,234.02
Rate for Payer: Mercy Care Medicaid	$13,234.02

Cardiomyopathy

Facility

$4,557.00

Service Code	APR-DRG 2052
Hospital Charge Code	APRDRG2053
Min. Negotiated Rate	$4,557.00
Max. Negotiated Rate	$4,557.00
Rate for Payer: AHCCCS Medicaid	$4,557.00
Rate for Payer: Allwell Medicaid	$4,557.00
Rate for Payer: AZCH Complete Medicaid	$4,557.00
Rate for Payer: Banner UC Health Medicaid	$4,557.00
Rate for Payer: Mercy Care Medicaid	$4,557.00

Cardiomyopathy

Facility

$4,557.00

Service Code	APR-DRG 2052
Hospital Charge Code	APRDRG2052
Min. Negotiated Rate	$4,557.00
Max. Negotiated Rate	$4,557.00
Rate for Payer: AHCCCS Medicaid	$4,557.00
Rate for Payer: Allwell Medicaid	$4,557.00
Rate for Payer: AZCH Complete Medicaid	$4,557.00
Rate for Payer: Banner UC Health Medicaid	$4,557.00
Rate for Payer: Mercy Care Medicaid	$4,557.00

carisoprodol 350 mg Tab [CQCH]

Facility

$0.10

Service Code	NDC 63739004910
Hospital Charge Code	105914652
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of AZ Commercial	$0.09
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.08
Rate for Payer: Self Pay Self Pay	$0.08

carisoprodol 350 mg Tab [CQCH]

Facility

$0.10

Service Code	NDC 63739004910
Hospital Charge Code	105914652
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of AZ Commercial	$0.09
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.07
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.06
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.08
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

Carnitine, Total and Free LC

Facility

$305.00

Service Code	CPT 82379
Hospital Charge Code	2029258
Hospital Revenue Code	301
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Aetna of AZ Medicare	$85.40
Rate for Payer: AHCCCS Medicaid	$16.87
Rate for Payer: Allwell Medicaid	$16.87
Rate for Payer: Allwell Medicare	$45.75
Rate for Payer: Amerigroup Medicare	$45.75
Rate for Payer: APIPA Medicare/Medicaid	$113.92
Rate for Payer: AZCH Complete Medicaid	$16.87
Rate for Payer: AZCH Complete Medicare	$45.75
Rate for Payer: Banner UC Health Medicaid	$16.87
Rate for Payer: Banner UC Health Medicare	$45.75
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$207.40
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cigna of AZ Commercial	$198.25
Rate for Payer: Copperpoint Commercial	$75.49
Rate for Payer: Health Net of AZ Commercial	$183.00
Rate for Payer: Health Net of AZ Medicare	$85.40
Rate for Payer: Humana of AZ Medicare	$45.75
Rate for Payer: Mercy Care Medicaid	$16.87
Rate for Payer: Self Pay Self Pay	$244.00
Rate for Payer: TriWest Medicare	$45.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$177.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.90

Carnitine, Total and Free LC

Facility

$305.00

Service Code	CPT 82379
Hospital Charge Code	2029258
Hospital Revenue Code	301
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Cash Price	$244.00
Rate for Payer: Self Pay Self Pay	$244.00

carvedilol 12.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904630261
Hospital Charge Code	105914717
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

carvedilol 12.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904630261
Hospital Charge Code	105914717
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

carvedilol 3.125 mg Tab UD [CQCH]

Facility

$0.08

Service Code	NDC 904630061
Hospital Charge Code	107994520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

carvedilol 3.125 mg Tab UD [CQCH]

Facility

$0.08

Service Code	NDC 904630061
Hospital Charge Code	107994520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

carvedilol 6.25 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 904630161
Hospital Charge Code	105914782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

carvedilol 6.25 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 904630161
Hospital Charge Code	105914782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

Catalase

Facility

$83.00

Service Code	CPT 86403
Hospital Charge Code	634031
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Cash Price	$66.40
Rate for Payer: Self Pay Self Pay	$66.40

Catalase

Facility

$83.00

Service Code	CPT 86403
Hospital Charge Code	634031
Hospital Revenue Code	301
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Aetna of AZ Medicare	$23.24
Rate for Payer: AHCCCS Medicaid	$11.54
Rate for Payer: Allwell Medicaid	$11.54
Rate for Payer: Allwell Medicare	$12.45
Rate for Payer: Amerigroup Medicare	$12.45
Rate for Payer: APIPA Medicare/Medicaid	$31.00
Rate for Payer: AZCH Complete Medicaid	$11.54
Rate for Payer: AZCH Complete Medicare	$12.45
Rate for Payer: Banner UC Health Medicaid	$11.54
Rate for Payer: Banner UC Health Medicare	$12.45
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$56.44
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Copperpoint Commercial	$20.54
Rate for Payer: Health Net of AZ Commercial	$49.80
Rate for Payer: Health Net of AZ Medicare	$23.24
Rate for Payer: Humana of AZ Medicare	$12.45
Rate for Payer: Mercy Care Medicaid	$11.54
Rate for Payer: Self Pay Self Pay	$66.40
Rate for Payer: TriWest Medicare	$12.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.94

CATCHER BAGS

Facility

$62.00

Hospital Charge Code	22354919
Hospital Revenue Code	270
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

CATCHER BAGS

Facility

$62.00

Hospital Charge Code	22354919
Hospital Revenue Code	270
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.30
Rate for Payer: Amerigroup Medicare	$9.30
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.30
Rate for Payer: Banner UC Health Medicare	$9.30
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.34
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.30
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

Know your out-of-pocket cost for care.

All Charges