Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Carbon Monoxide, Blood LC

Facility

$62.00

Service Code	CPT 82375
Hospital Charge Code	2029215
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

CARBON MONOXIDE DIFFUSING CAPACITY

Facility

$871.00

Service Code	CPT 94729
Hospital Charge Code	1886870
Hospital Revenue Code	410
Min. Negotiated Rate	$137.97
Max. Negotiated Rate	$783.90
Rate for Payer: Aetna of AZ Commercial	$783.90
Rate for Payer: Arizona Complete Health Allwell	$139.36
Rate for Payer: Banner UC Health Medicare	$139.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$592.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$139.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$139.36
Rate for Payer: Cash Price	$696.80
Rate for Payer: Cigna of AZ Commercial	$609.70
Rate for Payer: Devoted Health Medicare	$156.78
Rate for Payer: Humana of AZ Medicare	$139.36
Rate for Payer: Southwest Service Administrators UFCW	$592.28
Rate for Payer: TriWest Medicare	$139.36
Rate for Payer: United Healthcare Commercial	$498.21
Rate for Payer: United Healthcare Medicare	$139.36
Rate for Payer: United Healthcare New Mexico Commercial	$165.49
Rate for Payer: Veterans Affairs TRICARE	$137.97

CARBON MONOXIDE DIFFUSING CAPACITY

Facility

$871.00

Service Code	CPT 94729
Hospital Charge Code	1886870
Hospital Revenue Code	410
Min. Negotiated Rate	$783.90
Max. Negotiated Rate	$783.90
Rate for Payer: Aetna of AZ Commercial	$783.90
Rate for Payer: Cash Price	$696.80

Cardiac Arrest And Shock

Facility

$11,544.34

Service Code	APR-DRG 1964
Hospital Charge Code	APRDRG1961
Min. Negotiated Rate	$11,544.34
Max. Negotiated Rate	$11,544.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,544.34
Rate for Payer: Mercy Care Medicaid	$11,544.34
Rate for Payer: NaphCare Correctional Healthcare	$11,544.34

Cardiac Arrest And Shock

Facility

$11,544.34

Service Code	APR-DRG 1964
Hospital Charge Code	APRDRG1964
Min. Negotiated Rate	$11,544.34
Max. Negotiated Rate	$11,544.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,544.34
Rate for Payer: Mercy Care Medicaid	$11,544.34
Rate for Payer: NaphCare Correctional Healthcare	$11,544.34

Cardiac Arrest And Shock

Facility

$5,661.00

Service Code	APR-DRG 1963
Hospital Charge Code	APRDRG1964
Min. Negotiated Rate	$5,661.00
Max. Negotiated Rate	$5,661.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,661.00
Rate for Payer: Mercy Care Medicaid	$5,661.00
Rate for Payer: NaphCare Correctional Healthcare	$5,661.00

Cardiac Arrest And Shock

Facility

$11,544.34

Service Code	APR-DRG 1964
Hospital Charge Code	APRDRG1962
Min. Negotiated Rate	$11,544.34
Max. Negotiated Rate	$11,544.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,544.34
Rate for Payer: Mercy Care Medicaid	$11,544.34
Rate for Payer: NaphCare Correctional Healthcare	$11,544.34

Cardiac Arrest And Shock

Facility

$2,874.34

Service Code	APR-DRG 1961
Hospital Charge Code	APRDRG1963
Min. Negotiated Rate	$2,874.34
Max. Negotiated Rate	$2,874.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,874.34
Rate for Payer: Mercy Care Medicaid	$2,874.34
Rate for Payer: NaphCare Correctional Healthcare	$2,874.34

Cardiac Arrest And Shock

Facility

$11,544.34

Service Code	APR-DRG 1964
Hospital Charge Code	APRDRG1963
Min. Negotiated Rate	$11,544.34
Max. Negotiated Rate	$11,544.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,544.34
Rate for Payer: Mercy Care Medicaid	$11,544.34
Rate for Payer: NaphCare Correctional Healthcare	$11,544.34

Cardiac Arrest And Shock

Facility

$3,941.17

Service Code	APR-DRG 1962
Hospital Charge Code	APRDRG1963
Min. Negotiated Rate	$3,941.17
Max. Negotiated Rate	$3,941.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,941.17
Rate for Payer: Mercy Care Medicaid	$3,941.17
Rate for Payer: NaphCare Correctional Healthcare	$3,941.17

Cardiac Arrest And Shock

Facility

$3,941.17

Service Code	APR-DRG 1962
Hospital Charge Code	APRDRG1964
Min. Negotiated Rate	$3,941.17
Max. Negotiated Rate	$3,941.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,941.17
Rate for Payer: Mercy Care Medicaid	$3,941.17
Rate for Payer: NaphCare Correctional Healthcare	$3,941.17

Cardiac Arrest And Shock

Facility

$2,874.34

Service Code	APR-DRG 1961
Hospital Charge Code	APRDRG1962
Min. Negotiated Rate	$2,874.34
Max. Negotiated Rate	$2,874.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,874.34
Rate for Payer: Mercy Care Medicaid	$2,874.34
Rate for Payer: NaphCare Correctional Healthcare	$2,874.34

Cardiac Arrest And Shock

Facility

$5,661.00

Service Code	APR-DRG 1963
Hospital Charge Code	APRDRG1962
Min. Negotiated Rate	$5,661.00
Max. Negotiated Rate	$5,661.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,661.00
Rate for Payer: Mercy Care Medicaid	$5,661.00
Rate for Payer: NaphCare Correctional Healthcare	$5,661.00

Cardiac Arrest And Shock

Facility

$3,941.17

Service Code	APR-DRG 1962
Hospital Charge Code	APRDRG1962
Min. Negotiated Rate	$3,941.17
Max. Negotiated Rate	$3,941.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,941.17
Rate for Payer: Mercy Care Medicaid	$3,941.17
Rate for Payer: NaphCare Correctional Healthcare	$3,941.17

Cardiac Arrest And Shock

Facility

$3,941.17

Service Code	APR-DRG 1962
Hospital Charge Code	APRDRG1961
Min. Negotiated Rate	$3,941.17
Max. Negotiated Rate	$3,941.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,941.17
Rate for Payer: Mercy Care Medicaid	$3,941.17
Rate for Payer: NaphCare Correctional Healthcare	$3,941.17

Cardiac Arrest And Shock

Facility

$2,874.34

Service Code	APR-DRG 1961
Hospital Charge Code	APRDRG1964
Min. Negotiated Rate	$2,874.34
Max. Negotiated Rate	$2,874.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,874.34
Rate for Payer: Mercy Care Medicaid	$2,874.34
Rate for Payer: NaphCare Correctional Healthcare	$2,874.34

Cardiac Arrest And Shock

Facility

$2,874.34

Service Code	APR-DRG 1961
Hospital Charge Code	APRDRG1961
Min. Negotiated Rate	$2,874.34
Max. Negotiated Rate	$2,874.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,874.34
Rate for Payer: Mercy Care Medicaid	$2,874.34
Rate for Payer: NaphCare Correctional Healthcare	$2,874.34

Cardiac Arrest And Shock

Facility

$5,661.00

Service Code	APR-DRG 1963
Hospital Charge Code	APRDRG1961
Min. Negotiated Rate	$5,661.00
Max. Negotiated Rate	$5,661.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,661.00
Rate for Payer: Mercy Care Medicaid	$5,661.00
Rate for Payer: NaphCare Correctional Healthcare	$5,661.00

Cardiac Arrest And Shock

Facility

$5,661.00

Service Code	APR-DRG 1963
Hospital Charge Code	APRDRG1963
Min. Negotiated Rate	$5,661.00
Max. Negotiated Rate	$5,661.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,661.00
Rate for Payer: Mercy Care Medicaid	$5,661.00
Rate for Payer: NaphCare Correctional Healthcare	$5,661.00

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$8,388.98

Service Code	MSDRG 297
Min. Negotiated Rate	$8,388.98
Max. Negotiated Rate	$8,388.98
Rate for Payer: Seven Corners Travel Insurance	$8,388.98

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$20,186.22

Service Code	MSDRG 296
Min. Negotiated Rate	$20,186.22
Max. Negotiated Rate	$20,186.22
Rate for Payer: Seven Corners Travel Insurance	$20,186.22

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$6,122.09

Service Code	MSDRG 298
Min. Negotiated Rate	$6,122.09
Max. Negotiated Rate	$6,122.09
Rate for Payer: Seven Corners Travel Insurance	$6,122.09

Cardiac Arrhythmia And Conduction Disorders

Facility

$2,940.27

Service Code	APR-DRG 2011
Hospital Charge Code	APRDRG2014
Min. Negotiated Rate	$2,940.27
Max. Negotiated Rate	$2,940.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,940.27
Rate for Payer: Mercy Care Medicaid	$2,940.27
Rate for Payer: NaphCare Correctional Healthcare	$2,940.27

Cardiac Arrhythmia And Conduction Disorders

Facility

$2,940.27

Service Code	APR-DRG 2011
Hospital Charge Code	APRDRG2011
Min. Negotiated Rate	$2,940.27
Max. Negotiated Rate	$2,940.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,940.27
Rate for Payer: Mercy Care Medicaid	$2,940.27
Rate for Payer: NaphCare Correctional Healthcare	$2,940.27

Cardiac Arrhythmia And Conduction Disorders

Facility

$3,864.01

Service Code	APR-DRG 2012
Hospital Charge Code	APRDRG2014
Min. Negotiated Rate	$3,864.01
Max. Negotiated Rate	$3,864.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,864.01
Rate for Payer: Mercy Care Medicaid	$3,864.01
Rate for Payer: NaphCare Correctional Healthcare	$3,864.01

Know your out-of-pocket cost for care.

All Charges