Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Inborn Errors Of Metabolism

Facility

$20,239.60

Service Code	APR-DRG 4234
Hospital Charge Code	APRDRG4234
Min. Negotiated Rate	$20,239.60
Max. Negotiated Rate	$20,239.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$20,239.60
Rate for Payer: Mercy Care Medicaid	$20,239.60
Rate for Payer: NaphCare Correctional Healthcare	$20,239.60

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83
Rate for Payer: NaphCare Correctional Healthcare	$3,920.83

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19
Rate for Payer: NaphCare Correctional Healthcare	$5,705.19

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4233
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83
Rate for Payer: NaphCare Correctional Healthcare	$3,920.83

Inborn Errors Of Metabolism

Facility

$20,239.60

Service Code	APR-DRG 4234
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$20,239.60
Max. Negotiated Rate	$20,239.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$20,239.60
Rate for Payer: Mercy Care Medicaid	$20,239.60
Rate for Payer: NaphCare Correctional Healthcare	$20,239.60

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4234
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83
Rate for Payer: NaphCare Correctional Healthcare	$3,920.83

Inborn Errors Of Metabolism

Facility

$8,634.23

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG4233
Min. Negotiated Rate	$8,634.23
Max. Negotiated Rate	$8,634.23
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,634.23
Rate for Payer: Mercy Care Medicaid	$8,634.23
Rate for Payer: NaphCare Correctional Healthcare	$8,634.23

Inborn Errors Of Metabolism

Facility

$20,239.60

Service Code	APR-DRG 4234
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$20,239.60
Max. Negotiated Rate	$20,239.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$20,239.60
Rate for Payer: Mercy Care Medicaid	$20,239.60
Rate for Payer: NaphCare Correctional Healthcare	$20,239.60

Inborn Errors Of Metabolism

Facility

$8,634.23

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$8,634.23
Max. Negotiated Rate	$8,634.23
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,634.23
Rate for Payer: Mercy Care Medicaid	$8,634.23
Rate for Payer: NaphCare Correctional Healthcare	$8,634.23

Inborn Errors Of Metabolism

Facility

$3,920.83

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$3,920.83
Max. Negotiated Rate	$3,920.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,920.83
Rate for Payer: Mercy Care Medicaid	$3,920.83
Rate for Payer: NaphCare Correctional Healthcare	$3,920.83

Inborn Errors Of Metabolism

Facility

$8,634.23

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG4232
Min. Negotiated Rate	$8,634.23
Max. Negotiated Rate	$8,634.23
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,634.23
Rate for Payer: Mercy Care Medicaid	$8,634.23
Rate for Payer: NaphCare Correctional Healthcare	$8,634.23

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4233
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19
Rate for Payer: NaphCare Correctional Healthcare	$5,705.19

Inborn Errors Of Metabolism

Facility

$5,705.19

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG4231
Min. Negotiated Rate	$5,705.19
Max. Negotiated Rate	$5,705.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,705.19
Rate for Payer: Mercy Care Medicaid	$5,705.19
Rate for Payer: NaphCare Correctional Healthcare	$5,705.19

INCENTIVE SPIROMTRY

Facility

$112.00

Service Code	CPT 94010
Hospital Charge Code	1886937
Hospital Revenue Code	412
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$334.09
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Arizona Complete Health Allwell	$17.92
Rate for Payer: Banner UC Health Medicare	$17.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$76.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.92
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cigna of AZ Commercial	$78.40
Rate for Payer: Devoted Health Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$17.92
Rate for Payer: Seven Corners Travel Insurance	$334.09
Rate for Payer: Southwest Service Administrators UFCW	$76.16
Rate for Payer: TriWest Medicare	$17.92
Rate for Payer: United Healthcare Commercial	$64.06
Rate for Payer: United Healthcare Medicare	$17.92
Rate for Payer: United Healthcare New Mexico Commercial	$21.28
Rate for Payer: Veterans Affairs TRICARE	$17.74

INCENTIVE SPIROMTRY

Facility

$112.00

Service Code	CPT 94010
Hospital Charge Code	1886937
Hospital Revenue Code	412
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Cash Price	$89.60

Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed); single lesion

Facility

$2,671.00

Service Code	CPT 11106
Hospital Revenue Code	360
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$63.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$104.06
Rate for Payer: Mercy Care Medicaid	$104.06
Rate for Payer: NaphCare Correctional Healthcare	$63.00
Rate for Payer: Seven Corners Travel Insurance	$1,143.54
Rate for Payer: United Healthcare Commercial	$2,671.00

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE

Facility

$874.00

Service Code	CPT 10061
Hospital Charge Code	24049283
Hospital Revenue Code	360
Min. Negotiated Rate	$786.60
Max. Negotiated Rate	$786.60
Rate for Payer: Aetna of AZ Commercial	$786.60
Rate for Payer: Cash Price	$699.20

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE

Facility

$874.00

Service Code	CPT 10061
Hospital Charge Code	24049283
Hospital Revenue Code	360
Min. Negotiated Rate	$31.83
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$786.60
Rate for Payer: Arizona Complete Health Allwell	$139.84
Rate for Payer: Banner UC Health Medicare	$71.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$594.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.83
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$139.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$139.84
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cigna of AZ Commercial	$437.00
Rate for Payer: Devoted Health Medicare	$157.32
Rate for Payer: Humana of AZ Medicare	$139.84
Rate for Payer: Mercy Care Medicaid	$31.83
Rate for Payer: NaphCare Correctional Healthcare	$71.08
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: Southwest Service Administrators UFCW	$594.32
Rate for Payer: TriWest Medicare	$139.84
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$139.84
Rate for Payer: Veterans Affairs TRICARE	$138.44

Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

Facility

$2,671.00

Service Code	CPT 10060
Hospital Revenue Code	360
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$46.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21.46
Rate for Payer: Mercy Care Medicaid	$21.46
Rate for Payer: NaphCare Correctional Healthcare	$46.47
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: United Healthcare Commercial	$2,671.00

INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS

Facility

$694.00

Service Code	CPT 56420
Hospital Charge Code	23008149
Hospital Revenue Code	360
Min. Negotiated Rate	$624.60
Max. Negotiated Rate	$624.60
Rate for Payer: Aetna of AZ Commercial	$624.60
Rate for Payer: Cash Price	$555.20

INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS

Facility

$694.00

Service Code	CPT 56420
Hospital Charge Code	23008149
Hospital Revenue Code	360
Min. Negotiated Rate	$61.71
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$624.60
Rate for Payer: Arizona Complete Health Allwell	$111.04
Rate for Payer: Banner UC Health Medicare	$61.71
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$471.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$75.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$111.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$111.04
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cigna of AZ Commercial	$347.00
Rate for Payer: Devoted Health Medicare	$124.92
Rate for Payer: Humana of AZ Medicare	$111.04
Rate for Payer: Mercy Care Medicaid	$75.31
Rate for Payer: NaphCare Correctional Healthcare	$61.71
Rate for Payer: Seven Corners Travel Insurance	$312.81
Rate for Payer: Southwest Service Administrators UFCW	$471.92
Rate for Payer: TriWest Medicare	$111.04
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$111.04
Rate for Payer: Veterans Affairs TRICARE	$109.93

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;

Facility

$901.00

Service Code	CPT 10121
Hospital Charge Code	24049284
Hospital Revenue Code	360
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Arizona Complete Health Allwell	$144.16
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$612.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$85.47
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$144.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$144.16
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cigna of AZ Commercial	$450.50
Rate for Payer: Devoted Health Medicare	$162.18
Rate for Payer: Humana of AZ Medicare	$144.16
Rate for Payer: Mercy Care Medicaid	$85.47
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$612.68
Rate for Payer: TriWest Medicare	$144.16
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$144.16
Rate for Payer: Veterans Affairs TRICARE	$142.72

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;

Facility

$901.00

Service Code	CPT 10121
Hospital Charge Code	24049284
Hospital Revenue Code	360
Min. Negotiated Rate	$810.90
Max. Negotiated Rate	$810.90
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Cash Price	$720.80

INCISION OF CONNECTIVE TISSUE OF FOOT AND/OR TOE

Facility

$1,541.00

Service Code	CPT 28008
Hospital Charge Code	30283551
Hospital Revenue Code	360
Min. Negotiated Rate	$1,386.90
Max. Negotiated Rate	$1,386.90
Rate for Payer: Aetna of AZ Commercial	$1,386.90
Rate for Payer: Cash Price	$1,232.80

INCISION OF CONNECTIVE TISSUE OF FOOT AND/OR TOE

Facility

$1,541.00

Service Code	CPT 28008
Hospital Charge Code	30283551
Hospital Revenue Code	360
Min. Negotiated Rate	$129.01
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,386.90
Rate for Payer: Arizona Complete Health Allwell	$246.56
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,047.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$129.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$246.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$246.56
Rate for Payer: Cash Price	$1,232.80
Rate for Payer: Cash Price	$1,232.80
Rate for Payer: Cash Price	$1,232.80
Rate for Payer: Cigna of AZ Commercial	$770.50
Rate for Payer: Devoted Health Medicare	$277.38
Rate for Payer: Humana of AZ Medicare	$246.56
Rate for Payer: Mercy Care Medicaid	$129.01
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$1,047.88
Rate for Payer: TriWest Medicare	$246.56
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$246.56
Rate for Payer: Veterans Affairs TRICARE	$244.09

Know your out-of-pocket cost for care.

All Charges