Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41
Rate for Payer: NaphCare Correctional Healthcare	$17,489.41

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39
Rate for Payer: NaphCare Correctional Healthcare	$14,776.39

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34
Rate for Payer: NaphCare Correctional Healthcare	$11,591.34

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3622
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39
Rate for Payer: NaphCare Correctional Healthcare	$14,776.39

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3622
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34
Rate for Payer: NaphCare Correctional Healthcare	$11,591.34

Mastectomy Procedures

Facility

$8,417.50

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG3622
Min. Negotiated Rate	$8,417.50
Max. Negotiated Rate	$8,417.50
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,417.50
Rate for Payer: Mercy Care Medicaid	$8,417.50
Rate for Payer: NaphCare Correctional Healthcare	$8,417.50

Mastectomy Procedures

Facility

$8,417.50

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG3621
Min. Negotiated Rate	$8,417.50
Max. Negotiated Rate	$8,417.50
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,417.50
Rate for Payer: Mercy Care Medicaid	$8,417.50
Rate for Payer: NaphCare Correctional Healthcare	$8,417.50

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39
Rate for Payer: NaphCare Correctional Healthcare	$14,776.39

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34
Rate for Payer: NaphCare Correctional Healthcare	$11,591.34

Mastectomy Procedures

Facility

$8,417.50

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$8,417.50
Max. Negotiated Rate	$8,417.50
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,417.50
Rate for Payer: Mercy Care Medicaid	$8,417.50
Rate for Payer: NaphCare Correctional Healthcare	$8,417.50

Mastectomy Procedures

Facility

$11,591.34

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG3621
Min. Negotiated Rate	$11,591.34
Max. Negotiated Rate	$11,591.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,591.34
Rate for Payer: Mercy Care Medicaid	$11,591.34
Rate for Payer: NaphCare Correctional Healthcare	$11,591.34

Mastectomy Procedures

Facility

$14,776.39

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG3621
Min. Negotiated Rate	$14,776.39
Max. Negotiated Rate	$14,776.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,776.39
Rate for Payer: Mercy Care Medicaid	$14,776.39
Rate for Payer: NaphCare Correctional Healthcare	$14,776.39

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3623
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41
Rate for Payer: NaphCare Correctional Healthcare	$17,489.41

Mastectomy Procedures

Facility

$8,417.50

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG3624
Min. Negotiated Rate	$8,417.50
Max. Negotiated Rate	$8,417.50
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,417.50
Rate for Payer: Mercy Care Medicaid	$8,417.50
Rate for Payer: NaphCare Correctional Healthcare	$8,417.50

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3621
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41
Rate for Payer: NaphCare Correctional Healthcare	$17,489.41

M D I INSTRUCT/INIT

Facility

$224.00

Service Code	CPT 94664
Hospital Charge Code	2158628
Hospital Revenue Code	460
Min. Negotiated Rate	$35.48
Max. Negotiated Rate	$338.82
Rate for Payer: Aetna of AZ Commercial	$201.60
Rate for Payer: Arizona Complete Health Allwell	$35.84
Rate for Payer: Banner UC Health Medicare	$35.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$152.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.84
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cigna of AZ Commercial	$156.80
Rate for Payer: Devoted Health Medicare	$40.32
Rate for Payer: Humana of AZ Medicare	$35.84
Rate for Payer: Seven Corners Travel Insurance	$338.82
Rate for Payer: Southwest Service Administrators UFCW	$152.32
Rate for Payer: TriWest Medicare	$35.84
Rate for Payer: United Healthcare Commercial	$128.13
Rate for Payer: United Healthcare Medicare	$35.84
Rate for Payer: United Healthcare New Mexico Commercial	$42.56
Rate for Payer: Veterans Affairs TRICARE	$35.48

M D I INSTRUCT/INIT

Facility

$150.00

Service Code	CPT 94664
Hospital Charge Code	1886939
Hospital Revenue Code	460
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$338.82
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Arizona Complete Health Allwell	$24.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cigna of AZ Commercial	$105.00
Rate for Payer: Devoted Health Medicare	$27.00
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Seven Corners Travel Insurance	$338.82
Rate for Payer: Southwest Service Administrators UFCW	$102.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: United Healthcare Commercial	$85.80
Rate for Payer: United Healthcare Medicare	$24.00
Rate for Payer: United Healthcare New Mexico Commercial	$28.50
Rate for Payer: Veterans Affairs TRICARE	$23.76

M D I INSTRUCT/INIT

Facility

$150.00

Service Code	CPT 94664
Hospital Charge Code	1886939
Hospital Revenue Code	460
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Cash Price	$120.00

M D I INSTRUCT/INIT

Facility

$224.00

Service Code	CPT 94664
Hospital Charge Code	2158628
Hospital Revenue Code	460
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna of AZ Commercial	$201.60
Rate for Payer: Cash Price	$179.20

Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous us

Facility

$588.00

Service Code	CPT 90710
Hospital Charge Code	749831
Hospital Revenue Code	636
Min. Negotiated Rate	$93.14
Max. Negotiated Rate	$529.20
Rate for Payer: Aetna of AZ Commercial	$529.20
Rate for Payer: Arizona Complete Health Allwell	$94.08
Rate for Payer: Banner UC Health Medicare	$94.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$399.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$94.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$94.08
Rate for Payer: Cash Price	$470.40
Rate for Payer: Cigna of AZ Commercial	$411.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Humana of AZ Medicare	$94.08
Rate for Payer: Southwest Service Administrators UFCW	$399.84
Rate for Payer: TriWest Medicare	$94.08
Rate for Payer: United Healthcare Commercial	$336.34
Rate for Payer: United Healthcare Medicare	$94.08
Rate for Payer: United Healthcare New Mexico Commercial	$111.72
Rate for Payer: Veterans Affairs TRICARE	$93.14

Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous us

Facility

$588.00

Service Code	CPT 90710
Hospital Charge Code	749831
Hospital Revenue Code	636
Min. Negotiated Rate	$529.20
Max. Negotiated Rate	$529.20
Rate for Payer: Aetna of AZ Commercial	$529.20
Rate for Payer: Cash Price	$470.40

Measles/Mumps/Rubella Immunity LC

Facility

$165.00

Service Code	CPT 86735
Hospital Charge Code	2269429
Hospital Revenue Code	302
Min. Negotiated Rate	$18.92
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of AZ Commercial	$148.50
Rate for Payer: Arizona Complete Health Allwell	$26.40
Rate for Payer: Banner UC Health Medicare	$26.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$112.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.40
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cigna of AZ Commercial	$107.25
Rate for Payer: Devoted Health Medicare	$29.70
Rate for Payer: Humana of AZ Medicare	$26.40
Rate for Payer: Seven Corners Travel Insurance	$18.92
Rate for Payer: Southwest Service Administrators UFCW	$112.20
Rate for Payer: TriWest Medicare	$26.40
Rate for Payer: United Healthcare Commercial	$94.38
Rate for Payer: United Healthcare Medicare	$26.40
Rate for Payer: Veterans Affairs TRICARE	$26.14

Measles/Mumps/Rubella Immunity LC

Facility

$165.00

Service Code	CPT 86735
Hospital Charge Code	2269429
Hospital Revenue Code	302
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of AZ Commercial	$148.50
Rate for Payer: Cash Price	$132.00

Measles (Rubeola), PCR, Swab LC

Facility

$175.00

Service Code	CPT 87798
Hospital Charge Code	27537339
Hospital Revenue Code	306
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Arizona Complete Health Allwell	$28.00
Rate for Payer: Banner UC Health Medicare	$28.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$119.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cigna of AZ Commercial	$113.75
Rate for Payer: Devoted Health Medicare	$31.50
Rate for Payer: Humana of AZ Medicare	$28.00
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$119.00
Rate for Payer: TriWest Medicare	$28.00
Rate for Payer: United Healthcare Commercial	$100.10
Rate for Payer: United Healthcare Medicare	$28.00
Rate for Payer: Veterans Affairs TRICARE	$27.72

Measles (Rubeola), PCR, Swab LC

Facility

$175.00

Service Code	CPT 87798
Hospital Charge Code	27537339
Hospital Revenue Code	306
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Cash Price	$140.00

Know your out-of-pocket cost for care.

All Charges