Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

DELUXE PNEUMATIC LEG WALKER M

Facility

$228.10

Hospital Charge Code	28054650
Hospital Revenue Code	270
Min. Negotiated Rate	$205.29
Max. Negotiated Rate	$205.29
Rate for Payer: Aetna of AZ Commercial	$205.29
Rate for Payer: Cash Price	$182.48

DELUXE PNEUMATIC LEG WALKER XL

Facility

$375.97

Hospital Charge Code	28054649
Hospital Revenue Code	270
Min. Negotiated Rate	$338.37
Max. Negotiated Rate	$338.37
Rate for Payer: Aetna of AZ Commercial	$338.37
Rate for Payer: Cash Price	$300.78

DELUXE PNEUMATIC LEG WALKER XL

Facility

$375.97

Hospital Charge Code	28054649
Hospital Revenue Code	270
Min. Negotiated Rate	$59.55
Max. Negotiated Rate	$338.37
Rate for Payer: Aetna of AZ Commercial	$338.37
Rate for Payer: Arizona Complete Health Allwell	$60.16
Rate for Payer: Banner UC Health Medicare	$60.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$255.66
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.16
Rate for Payer: Cash Price	$300.78
Rate for Payer: Cigna of AZ Commercial	$263.18
Rate for Payer: Devoted Health Medicare	$67.67
Rate for Payer: Humana of AZ Medicare	$60.16
Rate for Payer: Southwest Service Administrators UFCW	$255.66
Rate for Payer: TriWest Medicare	$60.16
Rate for Payer: United Healthcare Commercial	$215.05
Rate for Payer: United Healthcare Medicare	$60.16
Rate for Payer: Veterans Affairs TRICARE	$59.55

denosumab 60 mg/mL Sol[CQCH]

Facility

$1,391.12

Service Code	HCPCS J0897
Hospital Charge Code	187942023
Hospital Revenue Code	250
Min. Negotiated Rate	$1,252.01
Max. Negotiated Rate	$1,252.01
Rate for Payer: Aetna of AZ Commercial	$1,252.01
Rate for Payer: Cash Price	$1,112.90

denosumab 60 mg/mL Sol[CQCH]

Facility

$1,391.12

Service Code	HCPCS J0897
Hospital Charge Code	187942023
Hospital Revenue Code	250
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$1,252.01
Rate for Payer: Aetna of AZ Commercial	$1,252.01
Rate for Payer: Arizona Complete Health Allwell	$222.58
Rate for Payer: Banner UC Health Medicare	$222.58
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$945.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$222.58
Rate for Payer: Care1st Health Plan Arizona Medicare	$222.58
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Cigna of AZ Commercial	$904.23
Rate for Payer: Devoted Health Medicare	$250.40
Rate for Payer: Humana of AZ Medicare	$222.58
Rate for Payer: Seven Corners Travel Insurance	$43.65
Rate for Payer: Southwest Service Administrators UFCW	$945.96
Rate for Payer: TriWest Medicare	$222.58
Rate for Payer: United Healthcare Commercial	$795.72
Rate for Payer: United Healthcare Medicare	$222.58
Rate for Payer: Veterans Affairs TRICARE	$220.35

DENTAL AND ORAL DISEASES WITH CC

Facility

$11,883.68

Service Code	MSDRG 158
Min. Negotiated Rate	$11,883.68
Max. Negotiated Rate	$11,883.68
Rate for Payer: Seven Corners Travel Insurance	$11,883.68

DENTAL AND ORAL DISEASES WITH MCC

Facility

$22,188.16

Service Code	MSDRG 157
Min. Negotiated Rate	$22,188.16
Max. Negotiated Rate	$22,188.16
Rate for Payer: Seven Corners Travel Insurance	$22,188.16

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$9,332.95

Service Code	MSDRG 159
Min. Negotiated Rate	$9,332.95
Max. Negotiated Rate	$9,332.95
Rate for Payer: Seven Corners Travel Insurance	$9,332.95

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73
Rate for Payer: NaphCare Correctional Healthcare	$3,871.73

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20
Rate for Payer: NaphCare Correctional Healthcare	$6,513.20

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34
Rate for Payer: NaphCare Correctional Healthcare	$15,899.34

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88
Rate for Payer: NaphCare Correctional Healthcare	$2,844.88

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20
Rate for Payer: NaphCare Correctional Healthcare	$6,513.20

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34
Rate for Payer: NaphCare Correctional Healthcare	$15,899.34

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73
Rate for Payer: NaphCare Correctional Healthcare	$3,871.73

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20
Rate for Payer: NaphCare Correctional Healthcare	$6,513.20

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73
Rate for Payer: NaphCare Correctional Healthcare	$3,871.73

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1142
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88
Rate for Payer: NaphCare Correctional Healthcare	$2,844.88

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1143
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88
Rate for Payer: NaphCare Correctional Healthcare	$2,844.88

Dental Diseases And Disorders

Facility

$2,844.88

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$2,844.88
Max. Negotiated Rate	$2,844.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,844.88
Rate for Payer: Mercy Care Medicaid	$2,844.88
Rate for Payer: NaphCare Correctional Healthcare	$2,844.88

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34
Rate for Payer: NaphCare Correctional Healthcare	$15,899.34

Dental Diseases And Disorders

Facility

$6,513.20

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$6,513.20
Max. Negotiated Rate	$6,513.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,513.20
Rate for Payer: Mercy Care Medicaid	$6,513.20
Rate for Payer: NaphCare Correctional Healthcare	$6,513.20

Dental Diseases And Disorders

Facility

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34
Rate for Payer: NaphCare Correctional Healthcare	$15,899.34

Dental Diseases And Disorders

Facility

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1144
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73
Rate for Payer: NaphCare Correctional Healthcare	$3,871.73

DENTURE ADHESIVE

Facility

$14.00

Hospital Charge Code	22781968
Hospital Revenue Code	272
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Arizona Complete Health Allwell	$2.24
Rate for Payer: Banner UC Health Medicare	$2.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$9.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.24
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$2.24
Rate for Payer: Southwest Service Administrators UFCW	$9.52
Rate for Payer: TriWest Medicare	$2.24
Rate for Payer: United Healthcare Commercial	$8.01
Rate for Payer: United Healthcare Medicare	$2.24
Rate for Payer: Veterans Affairs TRICARE	$2.22

Know your out-of-pocket cost for care.

All Charges