Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Chest Pain

Facility

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2032
Min. Negotiated Rate	$7,157.09
Max. Negotiated Rate	$7,157.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,157.09
Rate for Payer: Mercy Care Medicaid	$7,157.09
Rate for Payer: NaphCare Correctional Healthcare	$7,157.09

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2032
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40
Rate for Payer: NaphCare Correctional Healthcare	$4,107.40

Chest Pain

Facility

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2031
Min. Negotiated Rate	$7,157.09
Max. Negotiated Rate	$7,157.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,157.09
Rate for Payer: Mercy Care Medicaid	$7,157.09
Rate for Payer: NaphCare Correctional Healthcare	$7,157.09

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2031
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40
Rate for Payer: NaphCare Correctional Healthcare	$4,107.40

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2032
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07
Rate for Payer: NaphCare Correctional Healthcare	$5,097.07

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2031
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02
Rate for Payer: NaphCare Correctional Healthcare	$3,615.02

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2031
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07
Rate for Payer: NaphCare Correctional Healthcare	$5,097.07

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2032
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02
Rate for Payer: NaphCare Correctional Healthcare	$3,615.02

Chest Pain

Facility

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$7,157.09
Max. Negotiated Rate	$7,157.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,157.09
Rate for Payer: Mercy Care Medicaid	$7,157.09
Rate for Payer: NaphCare Correctional Healthcare	$7,157.09

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07
Rate for Payer: NaphCare Correctional Healthcare	$5,097.07

Chest Pain

Facility

$7,157.09

Service Code	APR-DRG 2034
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$7,157.09
Max. Negotiated Rate	$7,157.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,157.09
Rate for Payer: Mercy Care Medicaid	$7,157.09
Rate for Payer: NaphCare Correctional Healthcare	$7,157.09

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02
Rate for Payer: NaphCare Correctional Healthcare	$3,615.02

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40
Rate for Payer: NaphCare Correctional Healthcare	$4,107.40

Chest Pain

Facility

$3,615.02

Service Code	APR-DRG 2031
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$3,615.02
Max. Negotiated Rate	$3,615.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,615.02
Rate for Payer: Mercy Care Medicaid	$3,615.02
Rate for Payer: NaphCare Correctional Healthcare	$3,615.02

Chest Pain

Facility

$5,097.07

Service Code	APR-DRG 2033
Hospital Charge Code	APRDRG2033
Min. Negotiated Rate	$5,097.07
Max. Negotiated Rate	$5,097.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,097.07
Rate for Payer: Mercy Care Medicaid	$5,097.07
Rate for Payer: NaphCare Correctional Healthcare	$5,097.07

Chest Pain

Facility

$4,107.40

Service Code	APR-DRG 2032
Hospital Charge Code	APRDRG2034
Min. Negotiated Rate	$4,107.40
Max. Negotiated Rate	$4,107.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,107.40
Rate for Payer: Mercy Care Medicaid	$4,107.40
Rate for Payer: NaphCare Correctional Healthcare	$4,107.40

CHEST PAIN

Facility

$9,478.66

Service Code	MSDRG 313
Min. Negotiated Rate	$9,478.66
Max. Negotiated Rate	$9,478.66
Rate for Payer: Seven Corners Travel Insurance	$9,478.66

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$558,100.59

Service Code	MSDRG 018
Min. Negotiated Rate	$558,100.59
Max. Negotiated Rate	$558,100.59
Rate for Payer: Seven Corners Travel Insurance	$558,100.59

Chlamydia/GC Amplification LC

Facility

$412.00

Service Code	CPT 87491
Hospital Charge Code	1285827
Hospital Revenue Code	300
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Arizona Complete Health Allwell	$63.20
Rate for Payer: Arizona Complete Health Allwell	$65.92
Rate for Payer: Banner UC Health Medicare	$63.20
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$280.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$268.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$63.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$63.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.92
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cigna of AZ Commercial	$267.80
Rate for Payer: Cigna of AZ Commercial	$256.75
Rate for Payer: Devoted Health Medicare	$74.16
Rate for Payer: Devoted Health Medicare	$71.10
Rate for Payer: Humana of AZ Medicare	$63.20
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$268.60
Rate for Payer: Southwest Service Administrators UFCW	$280.16
Rate for Payer: TriWest Medicare	$63.20
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: United Healthcare Commercial	$235.66
Rate for Payer: United Healthcare Commercial	$225.94
Rate for Payer: United Healthcare Medicare	$63.20
Rate for Payer: United Healthcare Medicare	$65.92
Rate for Payer: Veterans Affairs TRICARE	$65.26
Rate for Payer: Veterans Affairs TRICARE	$62.57

Chlamydia/GC Amplification LC

Facility

$395.00

Service Code	CPT 87491
Hospital Charge Code	1285827
Hospital Revenue Code	300
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cash Price	$329.60

Chlamydia trachomatis, NAA LC

Facility

$412.00

Service Code	CPT 87491
Hospital Charge Code	7314701
Hospital Revenue Code	300
Min. Negotiated Rate	$370.80
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Aetna of AZ Commercial	$349.20
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$310.40

Chlamydia trachomatis, NAA LC

Facility

$388.00

Service Code	CPT 87491
Hospital Charge Code	7314701
Hospital Revenue Code	300
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$349.20
Rate for Payer: Aetna of AZ Commercial	$349.20
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Arizona Complete Health Allwell	$65.92
Rate for Payer: Arizona Complete Health Allwell	$62.08
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Banner UC Health Medicare	$62.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$263.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$280.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$62.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$62.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.92
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cigna of AZ Commercial	$267.80
Rate for Payer: Cigna of AZ Commercial	$252.20
Rate for Payer: Devoted Health Medicare	$74.16
Rate for Payer: Devoted Health Medicare	$69.84
Rate for Payer: Humana of AZ Medicare	$62.08
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$280.16
Rate for Payer: Southwest Service Administrators UFCW	$263.84
Rate for Payer: TriWest Medicare	$62.08
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: United Healthcare Commercial	$221.94
Rate for Payer: United Healthcare Commercial	$235.66
Rate for Payer: United Healthcare Medicare	$62.08
Rate for Payer: United Healthcare Medicare	$65.92
Rate for Payer: Veterans Affairs TRICARE	$65.26
Rate for Payer: Veterans Affairs TRICARE	$61.46

CHLORAPREP SKIN PREP 26ML

Facility

$44.00

Hospital Charge Code	22355403
Hospital Revenue Code	270
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Arizona Complete Health Allwell	$7.04
Rate for Payer: Banner UC Health Medicare	$7.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$29.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.04
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Devoted Health Medicare	$7.92
Rate for Payer: Humana of AZ Medicare	$7.04
Rate for Payer: Southwest Service Administrators UFCW	$29.92
Rate for Payer: TriWest Medicare	$7.04
Rate for Payer: United Healthcare Commercial	$25.17
Rate for Payer: United Healthcare Medicare	$7.04
Rate for Payer: Veterans Affairs TRICARE	$6.97

CHLORAPREP SKIN PREP 26ML

Facility

$44.00

Hospital Charge Code	22355403
Hospital Revenue Code	270
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Cash Price	$35.20

chlordiazePOXIDE 25 mg Cap [CQCH]

Facility

$0.52

Service Code	NDC 555015902
Hospital Charge Code	105916113
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of AZ Commercial	$0.47
Rate for Payer: Arizona Complete Health Allwell	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.35
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.08
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of AZ Commercial	$0.34
Rate for Payer: Devoted Health Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Southwest Service Administrators UFCW	$0.35
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: United Healthcare Commercial	$0.30
Rate for Payer: United Healthcare Medicare	$0.08
Rate for Payer: Veterans Affairs TRICARE	$0.08

Know your out-of-pocket cost for care.

All Charges