Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue

Facility

$4,782.85

Service Code	APR-DRG 3842
Hospital Charge Code	APRDRG3842
Min. Negotiated Rate	$4,782.85
Max. Negotiated Rate	$4,782.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,782.85
Rate for Payer: Mercy Care Medicaid	$4,782.85
Rate for Payer: NaphCare Correctional Healthcare	$4,782.85

Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue

Facility

$4,782.85

Service Code	APR-DRG 3842
Hospital Charge Code	APRDRG3841
Min. Negotiated Rate	$4,782.85
Max. Negotiated Rate	$4,782.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,782.85
Rate for Payer: Mercy Care Medicaid	$4,782.85
Rate for Payer: NaphCare Correctional Healthcare	$4,782.85

Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue

Facility

$7,002.78

Service Code	APR-DRG 3843
Hospital Charge Code	APRDRG3842
Min. Negotiated Rate	$7,002.78
Max. Negotiated Rate	$7,002.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,002.78
Rate for Payer: Mercy Care Medicaid	$7,002.78
Rate for Payer: NaphCare Correctional Healthcare	$7,002.78

Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue

Facility

$3,958.00

Service Code	APR-DRG 3841
Hospital Charge Code	APRDRG3844
Min. Negotiated Rate	$3,958.00
Max. Negotiated Rate	$3,958.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,958.00
Rate for Payer: Mercy Care Medicaid	$3,958.00
Rate for Payer: NaphCare Correctional Healthcare	$3,958.00

COOK FLEXOR URETERAL ACCESS SHEATH 28CM

Facility

$776.00

Hospital Charge Code	22354222
Hospital Revenue Code	270
Min. Negotiated Rate	$698.40
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Cash Price	$620.80

COOK FLEXOR URETERAL ACCESS SHEATH 28CM

Facility

$776.00

Hospital Charge Code	22354222
Hospital Revenue Code	270
Min. Negotiated Rate	$122.92
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Arizona Complete Health Allwell	$124.16
Rate for Payer: Banner UC Health Medicare	$124.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$527.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$124.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$124.16
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cigna of AZ Commercial	$543.20
Rate for Payer: Devoted Health Medicare	$139.68
Rate for Payer: Humana of AZ Medicare	$124.16
Rate for Payer: Southwest Service Administrators UFCW	$527.68
Rate for Payer: TriWest Medicare	$124.16
Rate for Payer: United Healthcare Commercial	$443.87
Rate for Payer: United Healthcare Medicare	$124.16
Rate for Payer: Veterans Affairs TRICARE	$122.92

COOK FLEX PARALLEL URETRL ACCESS SHTH 28

Facility

$534.00

Hospital Charge Code	22354209
Hospital Revenue Code	270
Min. Negotiated Rate	$84.59
Max. Negotiated Rate	$480.60
Rate for Payer: Aetna of AZ Commercial	$480.60
Rate for Payer: Arizona Complete Health Allwell	$85.44
Rate for Payer: Banner UC Health Medicare	$85.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$363.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$85.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$85.44
Rate for Payer: Cash Price	$427.20
Rate for Payer: Cigna of AZ Commercial	$373.80
Rate for Payer: Devoted Health Medicare	$96.12
Rate for Payer: Humana of AZ Medicare	$85.44
Rate for Payer: Southwest Service Administrators UFCW	$363.12
Rate for Payer: TriWest Medicare	$85.44
Rate for Payer: United Healthcare Commercial	$305.45
Rate for Payer: United Healthcare Medicare	$85.44
Rate for Payer: Veterans Affairs TRICARE	$84.59

COOK FLEX PARALLEL URETRL ACCESS SHTH 28

Facility

$534.00

Hospital Charge Code	22354209
Hospital Revenue Code	270
Min. Negotiated Rate	$480.60
Max. Negotiated Rate	$480.60
Rate for Payer: Aetna of AZ Commercial	$480.60
Rate for Payer: Cash Price	$427.20

COOK G14255

Facility

$90.00

Hospital Charge Code	22618969
Hospital Revenue Code	272
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

COOK G14255

Facility

$90.00

Hospital Charge Code	22618969
Hospital Revenue Code	272
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

COOK G14519

Facility

$155.00

Hospital Charge Code	22618967
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

COOK G14519

Facility

$155.00

Hospital Charge Code	22618967
Hospital Revenue Code	272
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.80
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: Veterans Affairs TRICARE	$24.55

COOK G17976

Facility

$123.00

Hospital Charge Code	22619412
Hospital Revenue Code	272
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$110.70
Rate for Payer: Aetna of AZ Commercial	$110.70
Rate for Payer: Cash Price	$98.40

COOK G17976

Facility

$123.00

Hospital Charge Code	22619412
Hospital Revenue Code	272
Min. Negotiated Rate	$19.48
Max. Negotiated Rate	$110.70
Rate for Payer: Aetna of AZ Commercial	$110.70
Rate for Payer: Arizona Complete Health Allwell	$19.68
Rate for Payer: Banner UC Health Medicare	$19.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$83.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.68
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cigna of AZ Commercial	$86.10
Rate for Payer: Devoted Health Medicare	$22.14
Rate for Payer: Humana of AZ Medicare	$19.68
Rate for Payer: Southwest Service Administrators UFCW	$83.64
Rate for Payer: TriWest Medicare	$19.68
Rate for Payer: United Healthcare Commercial	$70.36
Rate for Payer: United Healthcare Medicare	$19.68
Rate for Payer: Veterans Affairs TRICARE	$19.48

COOK G18063

Facility

$222.00

Hospital Charge Code	22619410
Hospital Revenue Code	272
Min. Negotiated Rate	$199.80
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Cash Price	$177.60

COOK G18063

Facility

$222.00

Hospital Charge Code	22619410
Hospital Revenue Code	272
Min. Negotiated Rate	$35.16
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Arizona Complete Health Allwell	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$150.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.52
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$155.40
Rate for Payer: Devoted Health Medicare	$39.96
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Southwest Service Administrators UFCW	$150.96
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: United Healthcare Commercial	$126.98
Rate for Payer: United Healthcare Medicare	$35.52
Rate for Payer: Veterans Affairs TRICARE	$35.16

COOK G30357

Facility

$948.00

Hospital Charge Code	22619312
Hospital Revenue Code	272
Min. Negotiated Rate	$150.16
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Arizona Complete Health Allwell	$151.68
Rate for Payer: Banner UC Health Medicare	$151.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$644.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$151.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$151.68
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cigna of AZ Commercial	$663.60
Rate for Payer: Devoted Health Medicare	$170.64
Rate for Payer: Humana of AZ Medicare	$151.68
Rate for Payer: Southwest Service Administrators UFCW	$644.64
Rate for Payer: TriWest Medicare	$151.68
Rate for Payer: United Healthcare Commercial	$542.26
Rate for Payer: United Healthcare Medicare	$151.68
Rate for Payer: Veterans Affairs TRICARE	$150.16

COOK G30357

Facility

$948.00

Hospital Charge Code	22619312
Hospital Revenue Code	272
Min. Negotiated Rate	$853.20
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Cash Price	$758.40

COOK G34931

Facility

$792.00

Hospital Charge Code	22619414
Hospital Revenue Code	272
Min. Negotiated Rate	$712.80
Max. Negotiated Rate	$712.80
Rate for Payer: Aetna of AZ Commercial	$712.80
Rate for Payer: Cash Price	$633.60

COOK G34931

Facility

$792.00

Hospital Charge Code	22619414
Hospital Revenue Code	272
Min. Negotiated Rate	$125.45
Max. Negotiated Rate	$712.80
Rate for Payer: Aetna of AZ Commercial	$712.80
Rate for Payer: Arizona Complete Health Allwell	$126.72
Rate for Payer: Banner UC Health Medicare	$126.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$538.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$126.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$126.72
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cigna of AZ Commercial	$554.40
Rate for Payer: Devoted Health Medicare	$142.56
Rate for Payer: Humana of AZ Medicare	$126.72
Rate for Payer: Southwest Service Administrators UFCW	$538.56
Rate for Payer: TriWest Medicare	$126.72
Rate for Payer: United Healthcare Commercial	$453.02
Rate for Payer: United Healthcare Medicare	$126.72
Rate for Payer: Veterans Affairs TRICARE	$125.45

COOK G53566

Facility

$142.00

Hospital Charge Code	22619314
Hospital Revenue Code	272
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Arizona Complete Health Allwell	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$96.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.72
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$99.40
Rate for Payer: Devoted Health Medicare	$25.56
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Southwest Service Administrators UFCW	$96.56
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: United Healthcare Commercial	$81.22
Rate for Payer: United Healthcare Medicare	$22.72
Rate for Payer: Veterans Affairs TRICARE	$22.49

COOK G53566

Facility

$142.00

Hospital Charge Code	22619314
Hospital Revenue Code	272
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Cash Price	$113.60

COOK ULTRAXX NEPHROSTOMY BALLOON SET 10M

Facility

$948.00

Hospital Charge Code	22354223
Hospital Revenue Code	270
Min. Negotiated Rate	$853.20
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Cash Price	$758.40

COOK ULTRAXX NEPHROSTOMY BALLOON SET 10M

Facility

$948.00

Hospital Charge Code	22354223
Hospital Revenue Code	270
Min. Negotiated Rate	$150.16
Max. Negotiated Rate	$853.20
Rate for Payer: Aetna of AZ Commercial	$853.20
Rate for Payer: Arizona Complete Health Allwell	$151.68
Rate for Payer: Banner UC Health Medicare	$151.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$644.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$151.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$151.68
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cigna of AZ Commercial	$663.60
Rate for Payer: Devoted Health Medicare	$170.64
Rate for Payer: Humana of AZ Medicare	$151.68
Rate for Payer: Southwest Service Administrators UFCW	$644.64
Rate for Payer: TriWest Medicare	$151.68
Rate for Payer: United Healthcare Commercial	$542.26
Rate for Payer: United Healthcare Medicare	$151.68
Rate for Payer: Veterans Affairs TRICARE	$150.16

COOLSEAL REVEAL

Facility

$2,575.00

Hospital Charge Code	29572944
Hospital Revenue Code	270
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$2,317.50
Rate for Payer: Aetna of AZ Commercial	$2,317.50
Rate for Payer: Cash Price	$2,060.00

Know your out-of-pocket cost for care.

All Charges