Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Digestive Malignancy

Facility

$5,986.45

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG2401
Min. Negotiated Rate	$5,986.45
Max. Negotiated Rate	$5,986.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,986.45
Rate for Payer: Mercy Care Medicaid	$5,986.45
Rate for Payer: NaphCare Correctional Healthcare	$5,986.45

Digestive Malignancy

Facility

$5,198.78

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG2401
Min. Negotiated Rate	$5,198.78
Max. Negotiated Rate	$5,198.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,198.78
Rate for Payer: Mercy Care Medicaid	$5,198.78
Rate for Payer: NaphCare Correctional Healthcare	$5,198.78

Digestive Malignancy

Facility

$8,453.27

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG2402
Min. Negotiated Rate	$8,453.27
Max. Negotiated Rate	$8,453.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,453.27
Rate for Payer: Mercy Care Medicaid	$8,453.27
Rate for Payer: NaphCare Correctional Healthcare	$8,453.27

Digestive Malignancy

Facility

$15,754.85

Service Code	APR-DRG 2404
Hospital Charge Code	APRDRG2402
Min. Negotiated Rate	$15,754.85
Max. Negotiated Rate	$15,754.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,754.85
Rate for Payer: Mercy Care Medicaid	$15,754.85
Rate for Payer: NaphCare Correctional Healthcare	$15,754.85

Digestive Malignancy

Facility

$5,986.45

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$5,986.45
Max. Negotiated Rate	$5,986.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,986.45
Rate for Payer: Mercy Care Medicaid	$5,986.45
Rate for Payer: NaphCare Correctional Healthcare	$5,986.45

Digestive Malignancy

Facility

$5,198.78

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$5,198.78
Max. Negotiated Rate	$5,198.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,198.78
Rate for Payer: Mercy Care Medicaid	$5,198.78
Rate for Payer: NaphCare Correctional Healthcare	$5,198.78

Digestive Malignancy

Facility

$5,198.78

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG2403
Min. Negotiated Rate	$5,198.78
Max. Negotiated Rate	$5,198.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,198.78
Rate for Payer: Mercy Care Medicaid	$5,198.78
Rate for Payer: NaphCare Correctional Healthcare	$5,198.78

DIGESTIVE MALIGNANCY WITH CC

Facility

$15,682.52

Service Code	MSDRG 375
Min. Negotiated Rate	$15,682.52
Max. Negotiated Rate	$15,682.52
Rate for Payer: Seven Corners Travel Insurance	$15,682.52

DIGESTIVE MALIGNANCY WITH MCC

Facility

$27,640.86

Service Code	MSDRG 374
Min. Negotiated Rate	$27,640.86
Max. Negotiated Rate	$27,640.86
Rate for Payer: Seven Corners Travel Insurance	$27,640.86

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$12,067.38

Service Code	MSDRG 376
Min. Negotiated Rate	$12,067.38
Max. Negotiated Rate	$12,067.38
Rate for Payer: Seven Corners Travel Insurance	$12,067.38

DIGIFUSE GUIDE WIRE SMOOTH .80 X 70MM

Facility

$89.00

Hospital Charge Code	24127791
Hospital Revenue Code	270
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Cash Price	$71.20

DIGIFUSE GUIDE WIRE SMOOTH .80 X 70MM

Facility

$89.00

Hospital Charge Code	24127791
Hospital Revenue Code	270
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Arizona Complete Health Allwell	$14.24
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$60.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.24
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$62.30
Rate for Payer: Devoted Health Medicare	$16.02
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Southwest Service Administrators UFCW	$60.52
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: United Healthcare Commercial	$50.91
Rate for Payer: United Healthcare Medicare	$14.24
Rate for Payer: Veterans Affairs TRICARE	$14.10

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24127789
Hospital Revenue Code	270
Min. Negotiated Rate	$5,181.30
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Cash Price	$4,605.60

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24127789
Hospital Revenue Code	270
Min. Negotiated Rate	$911.91
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Arizona Complete Health Allwell	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,914.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$921.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$921.12
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Devoted Health Medicare	$1,036.26
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Southwest Service Administrators UFCW	$3,914.76
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: United Healthcare Commercial	$3,293.00
Rate for Payer: United Healthcare Medicare	$921.12
Rate for Payer: Veterans Affairs TRICARE	$911.91

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE MINI BLADE

Facility

$5,757.00

Hospital Charge Code	24127793
Hospital Revenue Code	270
Min. Negotiated Rate	$911.91
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Arizona Complete Health Allwell	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,914.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$921.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$921.12
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Devoted Health Medicare	$1,036.26
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Southwest Service Administrators UFCW	$3,914.76
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: United Healthcare Commercial	$3,293.00
Rate for Payer: United Healthcare Medicare	$921.12
Rate for Payer: Veterans Affairs TRICARE	$911.91

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE MINI BLADE

Facility

$5,757.00

Hospital Charge Code	24127793
Hospital Revenue Code	270
Min. Negotiated Rate	$5,181.30
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Cash Price	$4,605.60

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE SHORT

Facility

$5,757.00

Hospital Charge Code	24129271
Hospital Revenue Code	270
Min. Negotiated Rate	$911.91
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Arizona Complete Health Allwell	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,914.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$921.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$921.12
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Devoted Health Medicare	$1,036.26
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Southwest Service Administrators UFCW	$3,914.76
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: United Healthcare Commercial	$3,293.00
Rate for Payer: United Healthcare Medicare	$921.12
Rate for Payer: Veterans Affairs TRICARE	$911.91

DIGIFUSE IMPLANT 2.0MM 0 DEGREE ANGLE SHORT

Facility

$5,757.00

Hospital Charge Code	24129271
Hospital Revenue Code	270
Min. Negotiated Rate	$5,181.30
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Cash Price	$4,605.60

DIGIFUSE IMPLANT 2.5MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24129272
Hospital Revenue Code	270
Min. Negotiated Rate	$5,181.30
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Cash Price	$4,605.60

DIGIFUSE IMPLANT 2.5MM 0 DEGREE ANGLE

Facility

$5,757.00

Hospital Charge Code	24129272
Hospital Revenue Code	270
Min. Negotiated Rate	$911.91
Max. Negotiated Rate	$5,181.30
Rate for Payer: Aetna of AZ Commercial	$5,181.30
Rate for Payer: Arizona Complete Health Allwell	$921.12
Rate for Payer: Banner UC Health Medicare	$921.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,914.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$921.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$921.12
Rate for Payer: Cash Price	$4,605.60
Rate for Payer: Cigna of AZ Commercial	$4,029.90
Rate for Payer: Devoted Health Medicare	$1,036.26
Rate for Payer: Humana of AZ Medicare	$921.12
Rate for Payer: Southwest Service Administrators UFCW	$3,914.76
Rate for Payer: TriWest Medicare	$921.12
Rate for Payer: United Healthcare Commercial	$3,293.00
Rate for Payer: United Healthcare Medicare	$921.12
Rate for Payer: Veterans Affairs TRICARE	$911.91

DIGITAL SCREW SZ 2MM X 40MM

Facility

$2,180.00

Hospital Charge Code	27595622
Hospital Revenue Code	270
Min. Negotiated Rate	$345.31
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Arizona Complete Health Allwell	$348.80
Rate for Payer: Banner UC Health Medicare	$348.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,482.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$348.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$348.80
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Cigna of AZ Commercial	$1,526.00
Rate for Payer: Devoted Health Medicare	$392.40
Rate for Payer: Humana of AZ Medicare	$348.80
Rate for Payer: Southwest Service Administrators UFCW	$1,482.40
Rate for Payer: TriWest Medicare	$348.80
Rate for Payer: United Healthcare Commercial	$1,246.96
Rate for Payer: United Healthcare Medicare	$348.80
Rate for Payer: Veterans Affairs TRICARE	$345.31

DIGITAL SCREW SZ 2MM X 40MM

Facility

$2,180.00

Hospital Charge Code	27595622
Hospital Revenue Code	270
Min. Negotiated Rate	$1,962.00
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Cash Price	$1,744.00

DIGITAL SCREW SZ 2MM X 44MM

Facility

$2,180.00

Hospital Charge Code	27595623
Hospital Revenue Code	270
Min. Negotiated Rate	$345.31
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Arizona Complete Health Allwell	$348.80
Rate for Payer: Banner UC Health Medicare	$348.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,482.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$348.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$348.80
Rate for Payer: Cash Price	$1,744.00
Rate for Payer: Cigna of AZ Commercial	$1,526.00
Rate for Payer: Devoted Health Medicare	$392.40
Rate for Payer: Humana of AZ Medicare	$348.80
Rate for Payer: Southwest Service Administrators UFCW	$1,482.40
Rate for Payer: TriWest Medicare	$348.80
Rate for Payer: United Healthcare Commercial	$1,246.96
Rate for Payer: United Healthcare Medicare	$348.80
Rate for Payer: Veterans Affairs TRICARE	$345.31

DIGITAL SCREW SZ 2MM X 44MM

Facility

$2,180.00

Hospital Charge Code	27595623
Hospital Revenue Code	270
Min. Negotiated Rate	$1,962.00
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna of AZ Commercial	$1,962.00
Rate for Payer: Cash Price	$1,744.00

digoxin 125 mcg (0.125 mg) Tab [CQCH]

Facility

$1.23

Service Code	NDC 904592161
Hospital Charge Code	105918974
Hospital Revenue Code	251
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Aetna of AZ Commercial	$1.11
Rate for Payer: Cash Price	$0.98

Know your out-of-pocket cost for care.

All Charges