Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

External Heart Assist Systems

Facility

$33,150.97

Service Code	APR-DRG 1782
Hospital Charge Code	APRDRG1783
Min. Negotiated Rate	$33,150.97
Max. Negotiated Rate	$33,150.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,150.97
Rate for Payer: Mercy Care Medicaid	$33,150.97
Rate for Payer: NaphCare Correctional Healthcare	$33,150.97

External Heart Assist Systems

Facility

$38,914.37

Service Code	APR-DRG 1783
Hospital Charge Code	APRDRG1781
Min. Negotiated Rate	$38,914.37
Max. Negotiated Rate	$38,914.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,914.37
Rate for Payer: Mercy Care Medicaid	$38,914.37
Rate for Payer: NaphCare Correctional Healthcare	$38,914.37

External Heart Assist Systems

Facility

$33,150.97

Service Code	APR-DRG 1782
Hospital Charge Code	APRDRG1784
Min. Negotiated Rate	$33,150.97
Max. Negotiated Rate	$33,150.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,150.97
Rate for Payer: Mercy Care Medicaid	$33,150.97
Rate for Payer: NaphCare Correctional Healthcare	$33,150.97

External Heart Assist Systems

Facility

$55,484.95

Service Code	APR-DRG 1784
Hospital Charge Code	APRDRG1782
Min. Negotiated Rate	$55,484.95
Max. Negotiated Rate	$55,484.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,484.95
Rate for Payer: Mercy Care Medicaid	$55,484.95
Rate for Payer: NaphCare Correctional Healthcare	$55,484.95

External Heart Assist Systems

Facility

$55,484.95

Service Code	APR-DRG 1784
Hospital Charge Code	APRDRG1781
Min. Negotiated Rate	$55,484.95
Max. Negotiated Rate	$55,484.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,484.95
Rate for Payer: Mercy Care Medicaid	$55,484.95
Rate for Payer: NaphCare Correctional Healthcare	$55,484.95

External Heart Assist Systems

Facility

$29,471.43

Service Code	APR-DRG 1781
Hospital Charge Code	APRDRG1783
Min. Negotiated Rate	$29,471.43
Max. Negotiated Rate	$29,471.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,471.43
Rate for Payer: Mercy Care Medicaid	$29,471.43
Rate for Payer: NaphCare Correctional Healthcare	$29,471.43

External Heart Assist Systems

Facility

$33,150.97

Service Code	APR-DRG 1782
Hospital Charge Code	APRDRG1782
Min. Negotiated Rate	$33,150.97
Max. Negotiated Rate	$33,150.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,150.97
Rate for Payer: Mercy Care Medicaid	$33,150.97
Rate for Payer: NaphCare Correctional Healthcare	$33,150.97

External Heart Assist Systems

Facility

$29,471.43

Service Code	APR-DRG 1781
Hospital Charge Code	APRDRG1781
Min. Negotiated Rate	$29,471.43
Max. Negotiated Rate	$29,471.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,471.43
Rate for Payer: Mercy Care Medicaid	$29,471.43
Rate for Payer: NaphCare Correctional Healthcare	$29,471.43

External Heart Assist Systems

Facility

$38,914.37

Service Code	APR-DRG 1783
Hospital Charge Code	APRDRG1782
Min. Negotiated Rate	$38,914.37
Max. Negotiated Rate	$38,914.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,914.37
Rate for Payer: Mercy Care Medicaid	$38,914.37
Rate for Payer: NaphCare Correctional Healthcare	$38,914.37

External Heart Assist Systems

Facility

$55,484.95

Service Code	APR-DRG 1784
Hospital Charge Code	APRDRG1784
Min. Negotiated Rate	$55,484.95
Max. Negotiated Rate	$55,484.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,484.95
Rate for Payer: Mercy Care Medicaid	$55,484.95
Rate for Payer: NaphCare Correctional Healthcare	$55,484.95

External Heart Assist Systems

Facility

$55,484.95

Service Code	APR-DRG 1784
Hospital Charge Code	APRDRG1783
Min. Negotiated Rate	$55,484.95
Max. Negotiated Rate	$55,484.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,484.95
Rate for Payer: Mercy Care Medicaid	$55,484.95
Rate for Payer: NaphCare Correctional Healthcare	$55,484.95

External Heart Assist Systems

Facility

$38,914.37

Service Code	APR-DRG 1783
Hospital Charge Code	APRDRG1784
Min. Negotiated Rate	$38,914.37
Max. Negotiated Rate	$38,914.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,914.37
Rate for Payer: Mercy Care Medicaid	$38,914.37
Rate for Payer: NaphCare Correctional Healthcare	$38,914.37

External Heart Assist Systems

Facility

$33,150.97

Service Code	APR-DRG 1782
Hospital Charge Code	APRDRG1781
Min. Negotiated Rate	$33,150.97
Max. Negotiated Rate	$33,150.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,150.97
Rate for Payer: Mercy Care Medicaid	$33,150.97
Rate for Payer: NaphCare Correctional Healthcare	$33,150.97

External Heart Assist Systems

Facility

$38,914.37

Service Code	APR-DRG 1783
Hospital Charge Code	APRDRG1783
Min. Negotiated Rate	$38,914.37
Max. Negotiated Rate	$38,914.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,914.37
Rate for Payer: Mercy Care Medicaid	$38,914.37
Rate for Payer: NaphCare Correctional Healthcare	$38,914.37

External Heart Assist Systems

Facility

$29,471.43

Service Code	APR-DRG 1781
Hospital Charge Code	APRDRG1784
Min. Negotiated Rate	$29,471.43
Max. Negotiated Rate	$29,471.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,471.43
Rate for Payer: Mercy Care Medicaid	$29,471.43
Rate for Payer: NaphCare Correctional Healthcare	$29,471.43

External Heart Assist Systems

Facility

$29,471.43

Service Code	APR-DRG 1781
Hospital Charge Code	APRDRG1782
Min. Negotiated Rate	$29,471.43
Max. Negotiated Rate	$29,471.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,471.43
Rate for Payer: Mercy Care Medicaid	$29,471.43
Rate for Payer: NaphCare Correctional Healthcare	$29,471.43

EXTERNAL PACER

Facility

$905.00

Hospital Charge Code	22282951
Hospital Revenue Code	450
Min. Negotiated Rate	$143.35
Max. Negotiated Rate	$814.50
Rate for Payer: Aetna of AZ Commercial	$814.50
Rate for Payer: Arizona Complete Health Allwell	$144.80
Rate for Payer: Banner UC Health Medicare	$144.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$615.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$144.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$144.80
Rate for Payer: Cash Price	$724.00
Rate for Payer: Cigna of AZ Commercial	$633.50
Rate for Payer: Devoted Health Medicare	$162.90
Rate for Payer: Humana of AZ Medicare	$144.80
Rate for Payer: Southwest Service Administrators UFCW	$615.40
Rate for Payer: TriWest Medicare	$144.80
Rate for Payer: United Healthcare Commercial	$517.66
Rate for Payer: United Healthcare Medicare	$144.80
Rate for Payer: United Healthcare New Mexico Commercial	$171.95
Rate for Payer: Veterans Affairs TRICARE	$143.35

EXTERNAL PACER

Facility

$905.00

Hospital Charge Code	22282951
Hospital Revenue Code	450
Min. Negotiated Rate	$814.50
Max. Negotiated Rate	$814.50
Rate for Payer: Aetna of AZ Commercial	$814.50
Rate for Payer: Cash Price	$724.00

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$506.00

Service Code	CPT 93268
Hospital Charge Code	24275808
Hospital Revenue Code	521
Min. Negotiated Rate	$80.15
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Arizona Complete Health Allwell	$80.96
Rate for Payer: Banner UC Health Medicare	$80.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$344.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$80.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$80.96
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cigna of AZ Commercial	$354.20
Rate for Payer: Devoted Health Medicare	$91.08
Rate for Payer: Humana of AZ Medicare	$80.96
Rate for Payer: Southwest Service Administrators UFCW	$344.08
Rate for Payer: TriWest Medicare	$80.96
Rate for Payer: United Healthcare Commercial	$289.43
Rate for Payer: United Healthcare Medicare	$80.96
Rate for Payer: Veterans Affairs TRICARE	$80.15

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$506.00

Service Code	CPT 93268
Hospital Charge Code	24275808
Hospital Revenue Code	521
Min. Negotiated Rate	$455.40
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Cash Price	$404.80

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$417.00

Service Code	CPT 93271
Hospital Charge Code	24275810
Hospital Revenue Code	521
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$375.30
Rate for Payer: Aetna of AZ Commercial	$375.30
Rate for Payer: Arizona Complete Health Allwell	$66.72
Rate for Payer: Banner UC Health Medicare	$66.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$283.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.72
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cigna of AZ Commercial	$291.90
Rate for Payer: Devoted Health Medicare	$75.06
Rate for Payer: Humana of AZ Medicare	$66.72
Rate for Payer: Seven Corners Travel Insurance	$147.10
Rate for Payer: Southwest Service Administrators UFCW	$283.56
Rate for Payer: TriWest Medicare	$66.72
Rate for Payer: United Healthcare Commercial	$238.52
Rate for Payer: United Healthcare Medicare	$66.72
Rate for Payer: Veterans Affairs TRICARE	$66.05

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$417.00

Service Code	CPT 93271
Hospital Charge Code	24275810
Hospital Revenue Code	521
Min. Negotiated Rate	$375.30
Max. Negotiated Rate	$375.30
Rate for Payer: Aetna of AZ Commercial	$375.30
Rate for Payer: Cash Price	$333.60

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$24.00

Service Code	CPT 93270
Hospital Charge Code	24275809
Hospital Revenue Code	521
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Arizona Complete Health Allwell	$3.84
Rate for Payer: Banner UC Health Medicare	$3.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$16.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.84
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Devoted Health Medicare	$4.32
Rate for Payer: Humana of AZ Medicare	$3.84
Rate for Payer: Seven Corners Travel Insurance	$57.75
Rate for Payer: Southwest Service Administrators UFCW	$16.32
Rate for Payer: TriWest Medicare	$3.84
Rate for Payer: United Healthcare Commercial	$13.73
Rate for Payer: United Healthcare Medicare	$3.84
Rate for Payer: Veterans Affairs TRICARE	$3.80

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$24.00

Service Code	CPT 93270
Hospital Charge Code	24275809
Hospital Revenue Code	521
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Cash Price	$19.20

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

$66.00

Service Code	CPT 93272
Hospital Charge Code	24275811
Hospital Revenue Code	521
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Arizona Complete Health Allwell	$10.56
Rate for Payer: Banner UC Health Medicare	$10.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.56
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$46.20
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Humana of AZ Medicare	$10.56
Rate for Payer: Southwest Service Administrators UFCW	$44.88
Rate for Payer: TriWest Medicare	$10.56
Rate for Payer: United Healthcare Commercial	$37.75
Rate for Payer: United Healthcare Medicare	$10.56
Rate for Payer: Veterans Affairs TRICARE	$10.45

Know your out-of-pocket cost for care.

All Charges