Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Biopsy, prostate; needle or punch, single or multiple, any approach

Facility

$3,596.00

Service Code	CPT 55700
Hospital Revenue Code	360
Min. Negotiated Rate	$3,596.00
Max. Negotiated Rate	$3,596.00
Rate for Payer: United Healthcare Commercial	$3,596.00

Biopsy, Skin Add-On

Facility

$129.00

Service Code	CPT 11101
Hospital Charge Code	22051828
Hospital Revenue Code	521
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Cash Price	$103.20

Biopsy, Skin Add-On

Facility

$129.00

Service Code	CPT 11101
Hospital Charge Code	22051828
Hospital Revenue Code	521
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$90.30
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: Veterans Affairs TRICARE	$20.43

BIPAP SET-UP

Facility

$1,987.00

Service Code	CPT 94002
Hospital Charge Code	1886931
Hospital Revenue Code	410
Min. Negotiated Rate	$1,788.30
Max. Negotiated Rate	$1,788.30
Rate for Payer: Aetna of AZ Commercial	$1,788.30
Rate for Payer: Cash Price	$1,589.60

BIPAP SET-UP

Facility

$1,987.00

Service Code	CPT 94002
Hospital Charge Code	1886931
Hospital Revenue Code	410
Min. Negotiated Rate	$314.74
Max. Negotiated Rate	$1,788.30
Rate for Payer: Aetna of AZ Commercial	$1,788.30
Rate for Payer: Arizona Complete Health Allwell	$317.92
Rate for Payer: Banner UC Health Medicare	$317.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,351.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$317.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$317.92
Rate for Payer: Cash Price	$1,589.60
Rate for Payer: Cash Price	$1,589.60
Rate for Payer: Cigna of AZ Commercial	$1,390.90
Rate for Payer: Devoted Health Medicare	$357.66
Rate for Payer: Humana of AZ Medicare	$317.92
Rate for Payer: Seven Corners Travel Insurance	$955.88
Rate for Payer: Southwest Service Administrators UFCW	$1,351.16
Rate for Payer: TriWest Medicare	$317.92
Rate for Payer: United Healthcare Commercial	$1,136.56
Rate for Payer: United Healthcare Medicare	$317.92
Rate for Payer: United Healthcare New Mexico Commercial	$377.53
Rate for Payer: Veterans Affairs TRICARE	$314.74

BIPAP SUBSEQUENT DAY

Facility

$1,704.00

Service Code	CPT 94003
Hospital Charge Code	1886932
Hospital Revenue Code	410
Min. Negotiated Rate	$269.91
Max. Negotiated Rate	$1,533.60
Rate for Payer: Aetna of AZ Commercial	$1,533.60
Rate for Payer: Arizona Complete Health Allwell	$272.64
Rate for Payer: Banner UC Health Medicare	$272.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,158.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$272.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$272.64
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cigna of AZ Commercial	$1,192.80
Rate for Payer: Devoted Health Medicare	$306.72
Rate for Payer: Humana of AZ Medicare	$272.64
Rate for Payer: Seven Corners Travel Insurance	$955.88
Rate for Payer: Southwest Service Administrators UFCW	$1,158.72
Rate for Payer: TriWest Medicare	$272.64
Rate for Payer: United Healthcare Commercial	$974.69
Rate for Payer: United Healthcare Medicare	$272.64
Rate for Payer: United Healthcare New Mexico Commercial	$323.76
Rate for Payer: Veterans Affairs TRICARE	$269.91

BIPAP SUBSEQUENT DAY

Facility

$1,704.00

Service Code	CPT 94003
Hospital Charge Code	1886932
Hospital Revenue Code	410
Min. Negotiated Rate	$1,533.60
Max. Negotiated Rate	$1,533.60
Rate for Payer: Aetna of AZ Commercial	$1,533.60
Rate for Payer: Cash Price	$1,363.20

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03
Rate for Payer: NaphCare Correctional Healthcare	$12,588.03

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51
Rate for Payer: NaphCare Correctional Healthcare	$2,662.51

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51
Rate for Payer: NaphCare Correctional Healthcare	$2,662.51

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64
Rate for Payer: NaphCare Correctional Healthcare	$6,434.64

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64
Rate for Payer: NaphCare Correctional Healthcare	$6,434.64

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03
Rate for Payer: NaphCare Correctional Healthcare	$12,588.03

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03
Rate for Payer: NaphCare Correctional Healthcare	$12,588.03

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51
Rate for Payer: NaphCare Correctional Healthcare	$2,662.51

Bipolar Disorders

Facility

$2,662.51

Service Code	APR-DRG 7531
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$2,662.51
Max. Negotiated Rate	$2,662.51
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,662.51
Rate for Payer: Mercy Care Medicaid	$2,662.51
Rate for Payer: NaphCare Correctional Healthcare	$2,662.51

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91
Rate for Payer: NaphCare Correctional Healthcare	$3,659.91

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64
Rate for Payer: NaphCare Correctional Healthcare	$6,434.64

Bipolar Disorders

Facility

$6,434.64

Service Code	APR-DRG 7533
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$6,434.64
Max. Negotiated Rate	$6,434.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,434.64
Rate for Payer: Mercy Care Medicaid	$6,434.64
Rate for Payer: NaphCare Correctional Healthcare	$6,434.64

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7534
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91
Rate for Payer: NaphCare Correctional Healthcare	$3,659.91

Bipolar Disorders

Facility

$12,588.03

Service Code	APR-DRG 7534
Hospital Charge Code	APRDRG7532
Min. Negotiated Rate	$12,588.03
Max. Negotiated Rate	$12,588.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,588.03
Rate for Payer: Mercy Care Medicaid	$12,588.03
Rate for Payer: NaphCare Correctional Healthcare	$12,588.03

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7533
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91
Rate for Payer: NaphCare Correctional Healthcare	$3,659.91

Bipolar Disorders

Facility

$3,659.91

Service Code	APR-DRG 7532
Hospital Charge Code	APRDRG7531
Min. Negotiated Rate	$3,659.91
Max. Negotiated Rate	$3,659.91
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,659.91
Rate for Payer: Mercy Care Medicaid	$3,659.91
Rate for Payer: NaphCare Correctional Healthcare	$3,659.91

bisacodyl 10 mg Supp [CQCH]

Facility

$0.08

Service Code	NDC 713010912
Hospital Charge Code	105913109
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Cash Price	$0.06

bisacodyl 10 mg Supp [CQCH]

Facility

$0.08

Service Code	NDC 713010912
Hospital Charge Code	105913109
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: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.05
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

Know your out-of-pocket cost for care.

All Charges