Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis

Facility

$26,241.48

Service Code	APR-DRG 1632
Hospital Charge Code	APRDRG1633
Min. Negotiated Rate	$26,241.48
Max. Negotiated Rate	$26,241.48
Rate for Payer: AHCCCS Medicaid	$26,241.48
Rate for Payer: Allwell Medicaid	$26,241.48
Rate for Payer: AZCH Complete Medicaid	$26,241.48
Rate for Payer: Banner UC Health Medicaid	$26,241.48
Rate for Payer: Mercy Care Medicaid	$26,241.48

Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis

Facility

$54,932.95

Service Code	APR-DRG 1634
Hospital Charge Code	APRDRG1632
Min. Negotiated Rate	$54,932.95
Max. Negotiated Rate	$54,932.95
Rate for Payer: AHCCCS Medicaid	$54,932.95
Rate for Payer: Allwell Medicaid	$54,932.95
Rate for Payer: AZCH Complete Medicaid	$54,932.95
Rate for Payer: Banner UC Health Medicaid	$54,932.95
Rate for Payer: Mercy Care Medicaid	$54,932.95

Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis

Facility

$23,736.78

Service Code	APR-DRG 1631
Hospital Charge Code	APRDRG1631
Min. Negotiated Rate	$23,736.78
Max. Negotiated Rate	$23,736.78
Rate for Payer: AHCCCS Medicaid	$23,736.78
Rate for Payer: Allwell Medicaid	$23,736.78
Rate for Payer: AZCH Complete Medicaid	$23,736.78
Rate for Payer: Banner UC Health Medicaid	$23,736.78
Rate for Payer: Mercy Care Medicaid	$23,736.78

Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis

Facility

$34,985.83

Service Code	APR-DRG 1633
Hospital Charge Code	APRDRG1634
Min. Negotiated Rate	$34,985.83
Max. Negotiated Rate	$34,985.83
Rate for Payer: AHCCCS Medicaid	$34,985.83
Rate for Payer: Allwell Medicaid	$34,985.83
Rate for Payer: AZCH Complete Medicaid	$34,985.83
Rate for Payer: Banner UC Health Medicaid	$34,985.83
Rate for Payer: Mercy Care Medicaid	$34,985.83

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

$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

$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

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

$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

$13,234.02

Service Code	APR-DRG 2054
Hospital Charge Code	APRDRG2051
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	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

$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

$3,612.91

Service Code	APR-DRG 2051
Hospital Charge Code	APRDRG2051
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

$3,612.91

Service Code	APR-DRG 2051
Hospital Charge Code	APRDRG2054
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	APRDRG2053
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

$13,234.02

Service Code	APR-DRG 2054
Hospital Charge Code	APRDRG2053
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

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	$48.80
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: Allwell Medicare	$48.80
Rate for Payer: Amerigroup Medicare	$48.80
Rate for Payer: APIPA Medicare/Medicaid	$113.92
Rate for Payer: AZCH Complete Medicare	$48.80
Rate for Payer: Banner UC Health Medicare	$48.80
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: 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	$48.80
Rate for Payer: Self Pay Self Pay	$244.00
Rate for Payer: TriWest Medicare	$48.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$177.81
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	$0.02
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

Know your out-of-pocket cost for care.

All Charges