Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

D-Dimer 2

Facility

$311.00

Service Code	CPT 85379
Hospital Charge Code	18323368
Hospital Revenue Code	305
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Arizona Complete Health Allwell	$49.76
Rate for Payer: Banner UC Health Medicare	$49.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$211.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.76
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Devoted Health Medicare	$55.98
Rate for Payer: Humana of AZ Medicare	$49.76
Rate for Payer: Seven Corners Travel Insurance	$14.76
Rate for Payer: Southwest Service Administrators UFCW	$211.48
Rate for Payer: TriWest Medicare	$49.76
Rate for Payer: United Healthcare Commercial	$177.89
Rate for Payer: United Healthcare Medicare	$49.76
Rate for Payer: Veterans Affairs TRICARE	$49.26

D-Dimer 2

Facility

$311.00

Service Code	CPT 85379
Hospital Charge Code	18323368
Hospital Revenue Code	305
Min. Negotiated Rate	$279.90
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Cash Price	$248.80

DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION

Facility

$29.00

Service Code	CPT 97598
Hospital Charge Code	24090026
Hospital Revenue Code	521
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Cash Price	$23.20

DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION

Facility

$29.00

Service Code	CPT 97598
Hospital Charge Code	24090026
Hospital Revenue Code	521
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Arizona Complete Health Allwell	$4.64
Rate for Payer: Banner UC Health Medicare	$4.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$19.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$20.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.64
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$20.30
Rate for Payer: Devoted Health Medicare	$5.22
Rate for Payer: Humana of AZ Medicare	$4.64
Rate for Payer: Mercy Care Medicaid	$20.92
Rate for Payer: NaphCare Correctional Healthcare	$20.92
Rate for Payer: Southwest Service Administrators UFCW	$19.72
Rate for Payer: TriWest Medicare	$4.64
Rate for Payer: United Healthcare Commercial	$16.59
Rate for Payer: United Healthcare Medicare	$4.64
Rate for Payer: Veterans Affairs TRICARE	$4.59

Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less

Facility

$2,671.00

Service Code	CPT 11042
Hospital Revenue Code	360
Min. Negotiated Rate	$69.74
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$123.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$69.74
Rate for Payer: Mercy Care Medicaid	$69.74
Rate for Payer: NaphCare Correctional Healthcare	$123.04
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: United Healthcare Commercial	$2,671.00

Debride Skin/Soft Tissue Charge

Facility

$338.00

Service Code	CPT 11042
Hospital Charge Code	714313
Hospital Revenue Code	521
Min. Negotiated Rate	$304.20
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Cash Price	$270.40

Debride Skin/Soft Tissue Charge

Facility

$338.00

Service Code	CPT 11042
Hospital Charge Code	714313
Hospital Revenue Code	521
Min. Negotiated Rate	$53.54
Max. Negotiated Rate	$629.00
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Arizona Complete Health Allwell	$54.08
Rate for Payer: Banner UC Health Medicare	$54.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$229.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$69.74
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$54.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$54.08
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cigna of AZ Commercial	$236.60
Rate for Payer: Devoted Health Medicare	$60.84
Rate for Payer: Humana of AZ Medicare	$54.08
Rate for Payer: Mercy Care Medicaid	$69.74
Rate for Payer: NaphCare Correctional Healthcare	$69.74
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: Southwest Service Administrators UFCW	$229.84
Rate for Payer: TriWest Medicare	$54.08
Rate for Payer: United Healthcare Commercial	$193.34
Rate for Payer: United Healthcare Medicare	$54.08
Rate for Payer: Veterans Affairs TRICARE	$53.54

DECALCIFICATION PROCEDURE

Facility

$611.00

Service Code	CPT 88311
Hospital Charge Code	22545717
Hospital Revenue Code	310
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$549.90
Rate for Payer: Aetna of AZ Commercial	$549.90
Rate for Payer: Arizona Complete Health Allwell	$97.76
Rate for Payer: Banner UC Health Medicare	$97.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$415.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$97.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.38
Rate for Payer: Cash Price	$488.80
Rate for Payer: Cash Price	$488.80
Rate for Payer: Cigna of AZ Commercial	$397.15
Rate for Payer: Devoted Health Medicare	$109.98
Rate for Payer: Humana of AZ Medicare	$97.76
Rate for Payer: Southwest Service Administrators UFCW	$415.48
Rate for Payer: TriWest Medicare	$97.76
Rate for Payer: United Healthcare Commercial	$349.49
Rate for Payer: United Healthcare Medicare	$97.76
Rate for Payer: Veterans Affairs TRICARE	$96.78

DECALCIFICATION PROCEDURE

Facility

$611.00

Service Code	CPT 88311
Hospital Charge Code	22545717
Hospital Revenue Code	310
Min. Negotiated Rate	$549.90
Max. Negotiated Rate	$549.90
Rate for Payer: Aetna of AZ Commercial	$549.90
Rate for Payer: Cash Price	$488.80

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40
Rate for Payer: NaphCare Correctional Healthcare	$26,401.40

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97
Rate for Payer: NaphCare Correctional Healthcare	$43,469.97

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40
Rate for Payer: NaphCare Correctional Healthcare	$26,401.40

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97
Rate for Payer: NaphCare Correctional Healthcare	$43,469.97

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79
Rate for Payer: NaphCare Correctional Healthcare	$32,110.79

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40
Rate for Payer: NaphCare Correctional Healthcare	$26,401.40

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21
Rate for Payer: NaphCare Correctional Healthcare	$23,301.21

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79
Rate for Payer: NaphCare Correctional Healthcare	$32,110.79

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1793
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21
Rate for Payer: NaphCare Correctional Healthcare	$23,301.21

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21
Rate for Payer: NaphCare Correctional Healthcare	$23,301.21

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79
Rate for Payer: NaphCare Correctional Healthcare	$32,110.79

Defibrillator Implants

Facility

$23,301.21

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$23,301.21
Max. Negotiated Rate	$23,301.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,301.21
Rate for Payer: Mercy Care Medicaid	$23,301.21
Rate for Payer: NaphCare Correctional Healthcare	$23,301.21

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1791
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97
Rate for Payer: NaphCare Correctional Healthcare	$43,469.97

Defibrillator Implants

Facility

$26,401.40

Service Code	APR-DRG 1792
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$26,401.40
Max. Negotiated Rate	$26,401.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,401.40
Rate for Payer: Mercy Care Medicaid	$26,401.40
Rate for Payer: NaphCare Correctional Healthcare	$26,401.40

Defibrillator Implants

Facility

$43,469.97

Service Code	APR-DRG 1794
Hospital Charge Code	APRDRG1792
Min. Negotiated Rate	$43,469.97
Max. Negotiated Rate	$43,469.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43,469.97
Rate for Payer: Mercy Care Medicaid	$43,469.97
Rate for Payer: NaphCare Correctional Healthcare	$43,469.97

Defibrillator Implants

Facility

$32,110.79

Service Code	APR-DRG 1793
Hospital Charge Code	APRDRG1794
Min. Negotiated Rate	$32,110.79
Max. Negotiated Rate	$32,110.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,110.79
Rate for Payer: Mercy Care Medicaid	$32,110.79
Rate for Payer: NaphCare Correctional Healthcare	$32,110.79

Know your out-of-pocket cost for care.

All Charges