Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07
Rate for Payer: NaphCare Correctional Healthcare	$7,850.07

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77
Rate for Payer: NaphCare Correctional Healthcare	$21,326.77

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87
Rate for Payer: NaphCare Correctional Healthcare	$11,056.87

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77
Rate for Payer: NaphCare Correctional Healthcare	$21,326.77

Foot And Toe Procedures

Facility

$7,268.61

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$7,268.61
Max. Negotiated Rate	$7,268.61
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,268.61
Rate for Payer: Mercy Care Medicaid	$7,268.61
Rate for Payer: NaphCare Correctional Healthcare	$7,268.61

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77
Rate for Payer: NaphCare Correctional Healthcare	$21,326.77

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87
Rate for Payer: NaphCare Correctional Healthcare	$11,056.87

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3144
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77
Rate for Payer: NaphCare Correctional Healthcare	$21,326.77

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87
Rate for Payer: NaphCare Correctional Healthcare	$11,056.87

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07
Rate for Payer: NaphCare Correctional Healthcare	$7,850.07

FOOT PROCEDURES WITH CC

Facility

$24,157.83

Service Code	MSDRG 504
Min. Negotiated Rate	$24,157.83
Max. Negotiated Rate	$24,157.83
Rate for Payer: Seven Corners Travel Insurance	$24,157.83

FOOT PROCEDURES WITH MCC

Facility

$36,072.59

Service Code	MSDRG 503
Min. Negotiated Rate	$36,072.59
Max. Negotiated Rate	$36,072.59
Rate for Payer: Seven Corners Travel Insurance	$36,072.59

FOOT PROCEDURES WITHOUT CC/MCC

Facility

$23,170.39

Service Code	MSDRG 505
Min. Negotiated Rate	$23,170.39
Max. Negotiated Rate	$23,170.39
Rate for Payer: Seven Corners Travel Insurance	$23,170.39

FORCEP BIOPSY RADIAL JAW 4 W/INDL 2.8MM STANDARD

Facility

$35.18

Hospital Charge Code	23589473
Hospital Revenue Code	272
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$31.66
Rate for Payer: Aetna of AZ Commercial	$31.66
Rate for Payer: Arizona Complete Health Allwell	$5.63
Rate for Payer: Banner UC Health Medicare	$5.63
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.63
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.63
Rate for Payer: Cash Price	$28.14
Rate for Payer: Cigna of AZ Commercial	$24.63
Rate for Payer: Devoted Health Medicare	$6.33
Rate for Payer: Humana of AZ Medicare	$5.63
Rate for Payer: Southwest Service Administrators UFCW	$23.92
Rate for Payer: TriWest Medicare	$5.63
Rate for Payer: United Healthcare Commercial	$20.12
Rate for Payer: United Healthcare Medicare	$5.63
Rate for Payer: Veterans Affairs TRICARE	$5.57

FORCEP BIOPSY RADIAL JAW 4 W/INDL 2.8MM STANDARD

Facility

$35.18

Hospital Charge Code	23589473
Hospital Revenue Code	272
Min. Negotiated Rate	$31.66
Max. Negotiated Rate	$31.66
Rate for Payer: Aetna of AZ Commercial	$31.66
Rate for Payer: Cash Price	$28.14

FORCEP BIOPSY RADIAL JAW 4 W/NDL 2.8MM

Facility

$51.00

Hospital Charge Code	22354836
Hospital Revenue Code	270
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Cash Price	$40.80

FORCEP BIOPSY RADIAL JAW 4 W/NDL 2.8MM

Facility

$51.00

Hospital Charge Code	22354836
Hospital Revenue Code	270
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Arizona Complete Health Allwell	$8.16
Rate for Payer: Banner UC Health Medicare	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$34.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.16
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$35.70
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Humana of AZ Medicare	$8.16
Rate for Payer: Southwest Service Administrators UFCW	$34.68
Rate for Payer: TriWest Medicare	$8.16
Rate for Payer: United Healthcare Commercial	$29.17
Rate for Payer: United Healthcare Medicare	$8.16
Rate for Payer: Veterans Affairs TRICARE	$8.08

FORCEP BIOPSY RADIAL JAW WITH NEEDLE

Facility

$246.00

Hospital Charge Code	22354837
Hospital Revenue Code	270
Min. Negotiated Rate	$221.40
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Cash Price	$196.80

FORCEP BIOPSY RADIAL JAW WITH NEEDLE

Facility

$246.00

Hospital Charge Code	22354837
Hospital Revenue Code	270
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Arizona Complete Health Allwell	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$167.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.36
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$172.20
Rate for Payer: Devoted Health Medicare	$44.28
Rate for Payer: Humana of AZ Medicare	$39.36
Rate for Payer: Southwest Service Administrators UFCW	$167.28
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: United Healthcare Commercial	$140.71
Rate for Payer: United Healthcare Medicare	$39.36
Rate for Payer: Veterans Affairs TRICARE	$38.97

FORCEP BIOPSY W/O NEEDLE

Facility

$1,307.00

Hospital Charge Code	22354311
Hospital Revenue Code	270
Min. Negotiated Rate	$1,176.30
Max. Negotiated Rate	$1,176.30
Rate for Payer: Aetna of AZ Commercial	$1,176.30
Rate for Payer: Cash Price	$1,045.60

FORCEP BIOPSY W/O NEEDLE

Facility

$1,307.00

Hospital Charge Code	22354311
Hospital Revenue Code	270
Min. Negotiated Rate	$207.03
Max. Negotiated Rate	$1,176.30
Rate for Payer: Aetna of AZ Commercial	$1,176.30
Rate for Payer: Arizona Complete Health Allwell	$209.12
Rate for Payer: Banner UC Health Medicare	$209.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$888.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$209.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$209.12
Rate for Payer: Cash Price	$1,045.60
Rate for Payer: Cigna of AZ Commercial	$914.90
Rate for Payer: Devoted Health Medicare	$235.26
Rate for Payer: Humana of AZ Medicare	$209.12
Rate for Payer: Southwest Service Administrators UFCW	$888.76
Rate for Payer: TriWest Medicare	$209.12
Rate for Payer: United Healthcare Commercial	$747.60
Rate for Payer: United Healthcare Medicare	$209.12
Rate for Payer: Veterans Affairs TRICARE	$207.03

FORCEPS GRASPING STONE RETR BSKT 2.8F

Facility

$1,377.00

Hospital Charge Code	22354261
Hospital Revenue Code	270
Min. Negotiated Rate	$1,239.30
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Cash Price	$1,101.60

FORCEPS GRASPING STONE RETR BSKT 2.8F

Facility

$1,377.00

Hospital Charge Code	22354261
Hospital Revenue Code	270
Min. Negotiated Rate	$218.12
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Arizona Complete Health Allwell	$220.32
Rate for Payer: Banner UC Health Medicare	$220.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$936.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$220.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$220.32
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Cigna of AZ Commercial	$963.90
Rate for Payer: Devoted Health Medicare	$247.86
Rate for Payer: Humana of AZ Medicare	$220.32
Rate for Payer: Southwest Service Administrators UFCW	$936.36
Rate for Payer: TriWest Medicare	$220.32
Rate for Payer: United Healthcare Commercial	$787.64
Rate for Payer: United Healthcare Medicare	$220.32
Rate for Payer: Veterans Affairs TRICARE	$218.12

FORCEPS GRASPING TRICEP 2.4FR

Facility

$886.00

Hospital Charge Code	22354313
Hospital Revenue Code	270
Min. Negotiated Rate	$797.40
Max. Negotiated Rate	$797.40
Rate for Payer: Aetna of AZ Commercial	$797.40
Rate for Payer: Cash Price	$708.80

FORCEPS GRASPING TRICEP 2.4FR

Facility

$886.00

Hospital Charge Code	22354313
Hospital Revenue Code	270
Min. Negotiated Rate	$140.34
Max. Negotiated Rate	$797.40
Rate for Payer: Aetna of AZ Commercial	$797.40
Rate for Payer: Arizona Complete Health Allwell	$141.76
Rate for Payer: Banner UC Health Medicare	$141.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$602.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$141.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$141.76
Rate for Payer: Cash Price	$708.80
Rate for Payer: Cigna of AZ Commercial	$620.20
Rate for Payer: Devoted Health Medicare	$159.48
Rate for Payer: Humana of AZ Medicare	$141.76
Rate for Payer: Southwest Service Administrators UFCW	$602.48
Rate for Payer: TriWest Medicare	$141.76
Rate for Payer: United Healthcare Commercial	$506.79
Rate for Payer: United Healthcare Medicare	$141.76
Rate for Payer: Veterans Affairs TRICARE	$140.34

Know your out-of-pocket cost for care.

All Charges