Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89
Rate for Payer: NaphCare Correctional Healthcare	$5,557.89

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89
Rate for Payer: NaphCare Correctional Healthcare	$5,557.89

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18
Rate for Payer: NaphCare Correctional Healthcare	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89
Rate for Payer: NaphCare Correctional Healthcare	$5,557.89

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92
Rate for Payer: NaphCare Correctional Healthcare	$8,627.92

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78
Rate for Payer: NaphCare Correctional Healthcare	$19,327.78

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78
Rate for Payer: NaphCare Correctional Healthcare	$19,327.78

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92
Rate for Payer: NaphCare Correctional Healthcare	$8,627.92

CLIENT ABG STICK

Facility

$171.00

Service Code	CPT 36600
Hospital Charge Code	22331130
Hospital Revenue Code	460
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Cash Price	$136.80

CLIENT ABG STICK

Facility

$171.00

Service Code	CPT 36600
Hospital Charge Code	22331130
Hospital Revenue Code	460
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$205.86
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Arizona Complete Health Allwell	$27.36
Rate for Payer: Banner UC Health Medicare	$27.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.28
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.36
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna of AZ Commercial	$119.70
Rate for Payer: Devoted Health Medicare	$30.78
Rate for Payer: Humana of AZ Medicare	$27.36
Rate for Payer: Mercy Care Medicaid	$13.25
Rate for Payer: NaphCare Correctional Healthcare	$13.25
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$116.28
Rate for Payer: TriWest Medicare	$27.36
Rate for Payer: United Healthcare Commercial	$97.81
Rate for Payer: United Healthcare Medicare	$27.36
Rate for Payer: United Healthcare New Mexico Commercial	$32.49
Rate for Payer: Veterans Affairs TRICARE	$27.09

CLIENT ALCOHOL BREATH

Facility

$32.00

Service Code	CPT 82075
Hospital Charge Code	22331138
Hospital Revenue Code	301
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Arizona Complete Health Allwell	$5.12
Rate for Payer: Banner UC Health Medicare	$5.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$21.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.12
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$20.80
Rate for Payer: Devoted Health Medicare	$5.76
Rate for Payer: Humana of AZ Medicare	$5.12
Rate for Payer: Seven Corners Travel Insurance	$43.50
Rate for Payer: Southwest Service Administrators UFCW	$21.76
Rate for Payer: TriWest Medicare	$5.12
Rate for Payer: United Healthcare Commercial	$18.30
Rate for Payer: United Healthcare Medicare	$5.12
Rate for Payer: Veterans Affairs TRICARE	$5.07

CLIENT ALCOHOL BREATH

Facility

$32.00

Service Code	CPT 82075
Hospital Charge Code	22331138
Hospital Revenue Code	301
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Cash Price	$25.60

CLIENT AMYLASE

Facility

$20.00

Service Code	CPT 82150
Hospital Charge Code	22331142
Hospital Revenue Code	301
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Cash Price	$16.00

CLIENT AMYLASE

Facility

$20.00

Service Code	CPT 82150
Hospital Charge Code	22331142
Hospital Revenue Code	301
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Arizona Complete Health Allwell	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$13.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$13.00
Rate for Payer: Devoted Health Medicare	$3.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Seven Corners Travel Insurance	$9.40
Rate for Payer: Southwest Service Administrators UFCW	$13.60
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: United Healthcare Commercial	$11.44
Rate for Payer: United Healthcare Medicare	$3.20
Rate for Payer: Veterans Affairs TRICARE	$3.17

CLIENT AUDIOMETRY

Facility

$22.00

Hospital Charge Code	22331153
Hospital Revenue Code	301
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Arizona Complete Health Allwell	$3.52
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.52
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$14.30
Rate for Payer: Devoted Health Medicare	$3.96
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Southwest Service Administrators UFCW	$14.96
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: United Healthcare Commercial	$12.58
Rate for Payer: United Healthcare Medicare	$3.52
Rate for Payer: Veterans Affairs TRICARE	$3.48

CLIENT AUDIOMETRY

Facility

$22.00

Hospital Charge Code	22331153
Hospital Revenue Code	301
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Cash Price	$17.60

CLIENT BASIC PHYSICAL EXAM

Facility

$55.00

Hospital Charge Code	22331158
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

CLIENT BASIC PHYSICAL EXAM

Facility

$55.00

Hospital Charge Code	22331158
Hospital Revenue Code	301
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$35.75
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

CLIENT BLOOD COLLECTION

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331170
Hospital Revenue Code	300
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$13.54
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$7.80
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

CLIENT BLOOD COLLECTION

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331170
Hospital Revenue Code	300
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

CLIENT BLOOD COLLECT LC

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331168
Hospital Revenue Code	300
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

CLIENT BLOOD COLLECT LC

Facility

$12.00

Service Code	CPT 36415
Hospital Charge Code	22331168
Hospital Revenue Code	300
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$13.54
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$7.80
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

CLIENT BLOOD COLLECT SQ

Facility

$13.00

Service Code	CPT 36415
Hospital Charge Code	22331169
Hospital Revenue Code	300
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$13.54
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Arizona Complete Health Allwell	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.08
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$8.45
Rate for Payer: Devoted Health Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$8.84
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: United Healthcare Commercial	$7.44
Rate for Payer: United Healthcare Medicare	$2.08
Rate for Payer: Veterans Affairs TRICARE	$2.06

CLIENT BLOOD COLLECT SQ

Facility

$13.00

Service Code	CPT 36415
Hospital Charge Code	22331169
Hospital Revenue Code	300
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Cash Price	$10.40

CLIENT CARTRIDGE RESPIRATOR FIT TEST

Facility

$48.00

Hospital Charge Code	22331178
Hospital Revenue Code	999
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Arizona Complete Health Allwell	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.68
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Devoted Health Medicare	$8.64
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Southwest Service Administrators UFCW	$32.64
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: United Healthcare Commercial	$27.46
Rate for Payer: United Healthcare Medicare	$7.68
Rate for Payer: United Healthcare New Mexico Commercial	$9.12
Rate for Payer: Veterans Affairs TRICARE	$7.60

Know your out-of-pocket cost for care.

All Charges