Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7592
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47
Rate for Payer: NaphCare Correctional Healthcare	$28,590.47

Eating Disorders

Facility

$8,143.96

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$8,143.96
Max. Negotiated Rate	$8,143.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,143.96
Rate for Payer: Mercy Care Medicaid	$8,143.96
Rate for Payer: NaphCare Correctional Healthcare	$8,143.96

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04
Rate for Payer: NaphCare Correctional Healthcare	$11,545.04

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7594
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81
Rate for Payer: NaphCare Correctional Healthcare	$7,972.81

Eating Disorders

Facility

$28,590.47

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG7593
Min. Negotiated Rate	$28,590.47
Max. Negotiated Rate	$28,590.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,590.47
Rate for Payer: Mercy Care Medicaid	$28,590.47
Rate for Payer: NaphCare Correctional Healthcare	$28,590.47

Eating Disorders

Facility

$7,972.81

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG7591
Min. Negotiated Rate	$7,972.81
Max. Negotiated Rate	$7,972.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,972.81
Rate for Payer: Mercy Care Medicaid	$7,972.81
Rate for Payer: NaphCare Correctional Healthcare	$7,972.81

Eating Disorders

Facility

$11,545.04

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG7592
Min. Negotiated Rate	$11,545.04
Max. Negotiated Rate	$11,545.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,545.04
Rate for Payer: Mercy Care Medicaid	$11,545.04
Rate for Payer: NaphCare Correctional Healthcare	$11,545.04

EBv ab VCA, IGG

Facility

$148.00

Service Code	CPT 86665
Hospital Charge Code	23143918
Hospital Revenue Code	301
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Arizona Complete Health Allwell	$23.68
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$100.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.68
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$96.20
Rate for Payer: Devoted Health Medicare	$26.64
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Seven Corners Travel Insurance	$26.30
Rate for Payer: Southwest Service Administrators UFCW	$100.64
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: United Healthcare Commercial	$84.66
Rate for Payer: United Healthcare Medicare	$23.68
Rate for Payer: Veterans Affairs TRICARE	$23.44

EBv ab VCA, IGG

Facility

$148.00

Service Code	CPT 86665
Hospital Charge Code	23143918
Hospital Revenue Code	301
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Cash Price	$118.40

EBV Acute Infection Antibodies LC

Facility

$926.00

Service Code	CPT 87799
Hospital Charge Code	1285649
Hospital Revenue Code	301
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$833.40
Rate for Payer: Aetna of AZ Commercial	$833.40
Rate for Payer: Arizona Complete Health Allwell	$148.16
Rate for Payer: Banner UC Health Medicare	$148.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$629.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$148.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$148.16
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cigna of AZ Commercial	$601.90
Rate for Payer: Devoted Health Medicare	$166.68
Rate for Payer: Humana of AZ Medicare	$148.16
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Southwest Service Administrators UFCW	$629.68
Rate for Payer: TriWest Medicare	$148.16
Rate for Payer: United Healthcare Commercial	$529.67
Rate for Payer: United Healthcare Medicare	$148.16
Rate for Payer: Veterans Affairs TRICARE	$146.68

EBV Acute Infection Antibodies LC

Facility

$926.00

Service Code	CPT 87799
Hospital Charge Code	1285649
Hospital Revenue Code	301
Min. Negotiated Rate	$833.40
Max. Negotiated Rate	$833.40
Rate for Payer: Aetna of AZ Commercial	$833.40
Rate for Payer: Cash Price	$740.80

EBV Early AG aB igg

Facility

$163.00

Service Code	CPT 86663
Hospital Charge Code	23143917
Hospital Revenue Code	301
Min. Negotiated Rate	$146.70
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Cash Price	$130.40

EBV Early AG aB igg

Facility

$163.00

Service Code	CPT 86663
Hospital Charge Code	23143917
Hospital Revenue Code	301
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Arizona Complete Health Allwell	$26.08
Rate for Payer: Banner UC Health Medicare	$26.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$110.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.08
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cigna of AZ Commercial	$105.95
Rate for Payer: Devoted Health Medicare	$29.34
Rate for Payer: Humana of AZ Medicare	$26.08
Rate for Payer: Seven Corners Travel Insurance	$19.02
Rate for Payer: Southwest Service Administrators UFCW	$110.84
Rate for Payer: TriWest Medicare	$26.08
Rate for Payer: United Healthcare Commercial	$93.24
Rate for Payer: United Healthcare Medicare	$26.08
Rate for Payer: Veterans Affairs TRICARE	$25.82

EBV Nuclear Ag AB Igg

Facility

$118.00

Service Code	CPT 86664
Hospital Charge Code	23143919
Hospital Revenue Code	301
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Arizona Complete Health Allwell	$18.88
Rate for Payer: Banner UC Health Medicare	$18.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$80.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.88
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$76.70
Rate for Payer: Devoted Health Medicare	$21.24
Rate for Payer: Humana of AZ Medicare	$18.88
Rate for Payer: Seven Corners Travel Insurance	$22.17
Rate for Payer: Southwest Service Administrators UFCW	$80.24
Rate for Payer: TriWest Medicare	$18.88
Rate for Payer: United Healthcare Commercial	$67.50
Rate for Payer: United Healthcare Medicare	$18.88
Rate for Payer: Veterans Affairs TRICARE	$18.69

EBV Nuclear Ag AB Igg

Facility

$118.00

Service Code	CPT 86664
Hospital Charge Code	23143919
Hospital Revenue Code	301
Min. Negotiated Rate	$106.20
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Cash Price	$94.40

ECHELON 3000 45MM STANDARD STAPLER

Facility

$21,929.75

Hospital Charge Code	29870428
Hospital Revenue Code	270
Min. Negotiated Rate	$19,736.78
Max. Negotiated Rate	$19,736.78
Rate for Payer: Aetna of AZ Commercial	$19,736.78
Rate for Payer: Cash Price	$17,543.80

ECHELON 3000 45MM STANDARD STAPLER

Facility

$21,929.75

Hospital Charge Code	29870428
Hospital Revenue Code	270
Min. Negotiated Rate	$3,473.67
Max. Negotiated Rate	$19,736.78
Rate for Payer: Aetna of AZ Commercial	$19,736.78
Rate for Payer: Arizona Complete Health Allwell	$3,508.76
Rate for Payer: Banner UC Health Medicare	$3,508.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14,912.23
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3,508.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$3,508.76
Rate for Payer: Cash Price	$17,543.80
Rate for Payer: Cigna of AZ Commercial	$15,350.83
Rate for Payer: Devoted Health Medicare	$3,947.36
Rate for Payer: Humana of AZ Medicare	$3,508.76
Rate for Payer: Southwest Service Administrators UFCW	$14,912.23
Rate for Payer: TriWest Medicare	$3,508.76
Rate for Payer: United Healthcare Commercial	$12,543.82
Rate for Payer: United Healthcare Medicare	$3,508.76
Rate for Payer: Veterans Affairs TRICARE	$3,473.67

Echocardiography interp

Facility

$401.00

Service Code	CPT 93662
Hospital Charge Code	23877901
Hospital Revenue Code	982
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$360.90
Rate for Payer: Aetna of AZ Commercial	$360.90
Rate for Payer: Cash Price	$320.80

Echocardiography interp

Facility

$401.00

Service Code	CPT 93662
Hospital Charge Code	23877901
Hospital Revenue Code	982
Min. Negotiated Rate	$63.52
Max. Negotiated Rate	$360.90
Rate for Payer: Aetna of AZ Commercial	$360.90
Rate for Payer: Arizona Complete Health Allwell	$64.16
Rate for Payer: Banner UC Health Medicare	$64.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$272.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$64.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$64.16
Rate for Payer: Cash Price	$320.80
Rate for Payer: Cigna of AZ Commercial	$280.70
Rate for Payer: Devoted Health Medicare	$72.18
Rate for Payer: Humana of AZ Medicare	$64.16
Rate for Payer: Southwest Service Administrators UFCW	$272.68
Rate for Payer: TriWest Medicare	$64.16
Rate for Payer: United Healthcare Commercial	$229.37
Rate for Payer: United Healthcare Medicare	$64.16
Rate for Payer: United Healthcare New Mexico Commercial	$76.19
Rate for Payer: Veterans Affairs TRICARE	$63.52

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$274,317.48

Service Code	MSDRG 003
Min. Negotiated Rate	$274,317.48
Max. Negotiated Rate	$274,317.48
Rate for Payer: Seven Corners Travel Insurance	$274,317.48

eculizumab 10 mg/mL Sol[CQCH]

Facility

$217.43

Service Code	HCPCS J1300
Hospital Charge Code	189306752
Hospital Revenue Code	250
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$195.69
Rate for Payer: Aetna of AZ Commercial	$195.69
Rate for Payer: Arizona Complete Health Allwell	$34.79
Rate for Payer: Banner UC Health Medicare	$34.79
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$147.85
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.79
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.79
Rate for Payer: Cash Price	$173.95
Rate for Payer: Cigna of AZ Commercial	$141.33
Rate for Payer: Devoted Health Medicare	$39.14
Rate for Payer: Humana of AZ Medicare	$34.79
Rate for Payer: Southwest Service Administrators UFCW	$147.85
Rate for Payer: TriWest Medicare	$34.79
Rate for Payer: United Healthcare Commercial	$124.37
Rate for Payer: United Healthcare Medicare	$34.79
Rate for Payer: Veterans Affairs TRICARE	$34.44

eculizumab 10 mg/mL Sol[CQCH]

Facility

$217.43

Service Code	HCPCS J1300
Hospital Charge Code	189306752
Hospital Revenue Code	250
Min. Negotiated Rate	$195.69
Max. Negotiated Rate	$195.69
Rate for Payer: Aetna of AZ Commercial	$195.69
Rate for Payer: Cash Price	$173.95

Edometrial Sampling (biopsy) w/ or w/o Endo

Facility

$186.00

Service Code	CPT 58100
Hospital Charge Code	22692053
Hospital Revenue Code	360
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Cash Price	$148.80

Edometrial Sampling (biopsy) w/ or w/o Endo

Facility

$186.00

Service Code	CPT 58100
Hospital Charge Code	22692053
Hospital Revenue Code	360
Min. Negotiated Rate	$28.47
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Arizona Complete Health Allwell	$29.76
Rate for Payer: Banner UC Health Medicare	$28.47
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$126.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.76
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$93.00
Rate for Payer: Devoted Health Medicare	$33.48
Rate for Payer: Humana of AZ Medicare	$29.76
Rate for Payer: Mercy Care Medicaid	$38.01
Rate for Payer: NaphCare Correctional Healthcare	$28.47
Rate for Payer: Seven Corners Travel Insurance	$312.81
Rate for Payer: Southwest Service Administrators UFCW	$126.48
Rate for Payer: TriWest Medicare	$29.76
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$29.76
Rate for Payer: Veterans Affairs TRICARE	$29.46

EGD

Facility

$1,956.00

Service Code	CPT 43235
Hospital Charge Code	885915
Hospital Revenue Code	750
Min. Negotiated Rate	$1,760.40
Max. Negotiated Rate	$1,760.40
Rate for Payer: Aetna of AZ Commercial	$1,760.40
Rate for Payer: Cash Price	$1,564.80

Know your out-of-pocket cost for care.

All Charges