Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Gamma Glutamyl Transferase

Facility

$158.00

Service Code	CPT 82977
Hospital Charge Code	633733
Hospital Revenue Code	301
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Arizona Complete Health Allwell	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$107.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.28
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$102.70
Rate for Payer: Devoted Health Medicare	$28.44
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Seven Corners Travel Insurance	$10.44
Rate for Payer: Southwest Service Administrators UFCW	$107.44
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: United Healthcare Commercial	$90.38
Rate for Payer: United Healthcare Medicare	$25.28
Rate for Payer: Veterans Affairs TRICARE	$25.03

GAS SAMPLING LINE CANNULA CO2

Facility

$21.00

Hospital Charge Code	22354273
Hospital Revenue Code	270
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of AZ Commercial	$18.90
Rate for Payer: Cash Price	$16.80

GAS SAMPLING LINE CANNULA CO2

Facility

$21.00

Hospital Charge Code	22354273
Hospital Revenue Code	270
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of AZ Commercial	$18.90
Rate for Payer: Arizona Complete Health Allwell	$3.36
Rate for Payer: Banner UC Health Medicare	$3.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.36
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cigna of AZ Commercial	$14.70
Rate for Payer: Devoted Health Medicare	$3.78
Rate for Payer: Humana of AZ Medicare	$3.36
Rate for Payer: Southwest Service Administrators UFCW	$14.28
Rate for Payer: TriWest Medicare	$3.36
Rate for Payer: United Healthcare Commercial	$12.01
Rate for Payer: United Healthcare Medicare	$3.36
Rate for Payer: Veterans Affairs TRICARE	$3.33

Gastric Fundoplication

Facility

$6,459.19

Service Code	APR-DRG 2321
Hospital Charge Code	APRDRG2323
Min. Negotiated Rate	$6,459.19
Max. Negotiated Rate	$6,459.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,459.19
Rate for Payer: Mercy Care Medicaid	$6,459.19
Rate for Payer: NaphCare Correctional Healthcare	$6,459.19

Gastric Fundoplication

Facility

$6,459.19

Service Code	APR-DRG 2321
Hospital Charge Code	APRDRG2324
Min. Negotiated Rate	$6,459.19
Max. Negotiated Rate	$6,459.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,459.19
Rate for Payer: Mercy Care Medicaid	$6,459.19
Rate for Payer: NaphCare Correctional Healthcare	$6,459.19

Gastric Fundoplication

Facility

$46,303.62

Service Code	APR-DRG 2324
Hospital Charge Code	APRDRG2324
Min. Negotiated Rate	$46,303.62
Max. Negotiated Rate	$46,303.62
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,303.62
Rate for Payer: Mercy Care Medicaid	$46,303.62
Rate for Payer: NaphCare Correctional Healthcare	$46,303.62

Gastric Fundoplication

Facility

$6,459.19

Service Code	APR-DRG 2321
Hospital Charge Code	APRDRG2321
Min. Negotiated Rate	$6,459.19
Max. Negotiated Rate	$6,459.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,459.19
Rate for Payer: Mercy Care Medicaid	$6,459.19
Rate for Payer: NaphCare Correctional Healthcare	$6,459.19

Gastric Fundoplication

Facility

$6,459.19

Service Code	APR-DRG 2321
Hospital Charge Code	APRDRG2322
Min. Negotiated Rate	$6,459.19
Max. Negotiated Rate	$6,459.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,459.19
Rate for Payer: Mercy Care Medicaid	$6,459.19
Rate for Payer: NaphCare Correctional Healthcare	$6,459.19

Gastric Fundoplication

Facility

$46,303.62

Service Code	APR-DRG 2324
Hospital Charge Code	APRDRG2322
Min. Negotiated Rate	$46,303.62
Max. Negotiated Rate	$46,303.62
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,303.62
Rate for Payer: Mercy Care Medicaid	$46,303.62
Rate for Payer: NaphCare Correctional Healthcare	$46,303.62

Gastric Fundoplication

Facility

$13,458.46

Service Code	APR-DRG 2323
Hospital Charge Code	APRDRG2324
Min. Negotiated Rate	$13,458.46
Max. Negotiated Rate	$13,458.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,458.46
Rate for Payer: Mercy Care Medicaid	$13,458.46
Rate for Payer: NaphCare Correctional Healthcare	$13,458.46

Gastric Fundoplication

Facility

$8,538.84

Service Code	APR-DRG 2322
Hospital Charge Code	APRDRG2321
Min. Negotiated Rate	$8,538.84
Max. Negotiated Rate	$8,538.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,538.84
Rate for Payer: Mercy Care Medicaid	$8,538.84
Rate for Payer: NaphCare Correctional Healthcare	$8,538.84

Gastric Fundoplication

Facility

$13,458.46

Service Code	APR-DRG 2323
Hospital Charge Code	APRDRG2321
Min. Negotiated Rate	$13,458.46
Max. Negotiated Rate	$13,458.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,458.46
Rate for Payer: Mercy Care Medicaid	$13,458.46
Rate for Payer: NaphCare Correctional Healthcare	$13,458.46

Gastric Fundoplication

Facility

$8,538.84

Service Code	APR-DRG 2322
Hospital Charge Code	APRDRG2323
Min. Negotiated Rate	$8,538.84
Max. Negotiated Rate	$8,538.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,538.84
Rate for Payer: Mercy Care Medicaid	$8,538.84
Rate for Payer: NaphCare Correctional Healthcare	$8,538.84

Gastric Fundoplication

Facility

$46,303.62

Service Code	APR-DRG 2324
Hospital Charge Code	APRDRG2321
Min. Negotiated Rate	$46,303.62
Max. Negotiated Rate	$46,303.62
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,303.62
Rate for Payer: Mercy Care Medicaid	$46,303.62
Rate for Payer: NaphCare Correctional Healthcare	$46,303.62

Gastric Fundoplication

Facility

$13,458.46

Service Code	APR-DRG 2323
Hospital Charge Code	APRDRG2322
Min. Negotiated Rate	$13,458.46
Max. Negotiated Rate	$13,458.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,458.46
Rate for Payer: Mercy Care Medicaid	$13,458.46
Rate for Payer: NaphCare Correctional Healthcare	$13,458.46

Gastric Fundoplication

Facility

$8,538.84

Service Code	APR-DRG 2322
Hospital Charge Code	APRDRG2322
Min. Negotiated Rate	$8,538.84
Max. Negotiated Rate	$8,538.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,538.84
Rate for Payer: Mercy Care Medicaid	$8,538.84
Rate for Payer: NaphCare Correctional Healthcare	$8,538.84

Gastric Fundoplication

Facility

$46,303.62

Service Code	APR-DRG 2324
Hospital Charge Code	APRDRG2323
Min. Negotiated Rate	$46,303.62
Max. Negotiated Rate	$46,303.62
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,303.62
Rate for Payer: Mercy Care Medicaid	$46,303.62
Rate for Payer: NaphCare Correctional Healthcare	$46,303.62

Gastric Fundoplication

Facility

$13,458.46

Service Code	APR-DRG 2323
Hospital Charge Code	APRDRG2323
Min. Negotiated Rate	$13,458.46
Max. Negotiated Rate	$13,458.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,458.46
Rate for Payer: Mercy Care Medicaid	$13,458.46
Rate for Payer: NaphCare Correctional Healthcare	$13,458.46

Gastric Fundoplication

Facility

$8,538.84

Service Code	APR-DRG 2322
Hospital Charge Code	APRDRG2324
Min. Negotiated Rate	$8,538.84
Max. Negotiated Rate	$8,538.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,538.84
Rate for Payer: Mercy Care Medicaid	$8,538.84
Rate for Payer: NaphCare Correctional Healthcare	$8,538.84

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$12,782.07

Service Code	MSDRG 378
Min. Negotiated Rate	$12,782.07
Max. Negotiated Rate	$12,782.07
Rate for Payer: Seven Corners Travel Insurance	$12,782.07

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$23,625.34

Service Code	MSDRG 377
Min. Negotiated Rate	$23,625.34
Max. Negotiated Rate	$23,625.34
Rate for Payer: Seven Corners Travel Insurance	$23,625.34

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$8,343.33

Service Code	MSDRG 379
Min. Negotiated Rate	$8,343.33
Max. Negotiated Rate	$8,343.33
Rate for Payer: Seven Corners Travel Insurance	$8,343.33

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$10,363.12

Service Code	MSDRG 389
Min. Negotiated Rate	$10,363.12
Max. Negotiated Rate	$10,363.12
Rate for Payer: Seven Corners Travel Insurance	$10,363.12

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$19,086.36

Service Code	MSDRG 388
Min. Negotiated Rate	$19,086.36
Max. Negotiated Rate	$19,086.36
Rate for Payer: Seven Corners Travel Insurance	$19,086.36

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$7,248.56

Service Code	MSDRG 390
Min. Negotiated Rate	$7,248.56
Max. Negotiated Rate	$7,248.56
Rate for Payer: Seven Corners Travel Insurance	$7,248.56

Know your out-of-pocket cost for care.

All Charges