Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Mental Illness Diagnosis With O.R. Procedure

Facility

$23,982.97

Service Code	APR-DRG 7404
Hospital Charge Code	APRDRG7404
Min. Negotiated Rate	$23,982.97
Max. Negotiated Rate	$23,982.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,982.97
Rate for Payer: Mercy Care Medicaid	$23,982.97
Rate for Payer: NaphCare Correctional Healthcare	$23,982.97

meperidine 25 mg/ 1 mL Inj Sol [CQCH]

Facility

$1.88

Service Code	HCPCS J2175
Hospital Charge Code	105930690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna of AZ Commercial	$1.69
Rate for Payer: Arizona Complete Health Allwell	$0.30
Rate for Payer: Banner UC Health Medicare	$0.30
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.30
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.30
Rate for Payer: Cash Price	$1.50
Rate for Payer: Cigna of AZ Commercial	$1.22
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Humana of AZ Medicare	$0.30
Rate for Payer: Southwest Service Administrators UFCW	$1.28
Rate for Payer: TriWest Medicare	$0.30
Rate for Payer: United Healthcare Commercial	$1.08
Rate for Payer: United Healthcare Medicare	$0.30
Rate for Payer: Veterans Affairs TRICARE	$0.30

meperidine 25 mg/ 1 mL Inj Sol [CQCH]

Facility

$1.88

Service Code	HCPCS J2175
Hospital Charge Code	105930690
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Aetna of AZ Commercial	$1.69
Rate for Payer: Cash Price	$1.50

meperidine 300 mg/30 mL PCA vial [CQCH]

Facility

$0.24

Service Code	HCPCS J2175
Hospital Charge Code	105930836
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Cash Price	$0.19

meperidine 300 mg/30 mL PCA vial [CQCH]

Facility

$0.24

Service Code	HCPCS J2175
Hospital Charge Code	105930836
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.16
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.14
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

meperidine 50 mg/1 mL Inj Sol [CQCH]

Facility

$5.45

Service Code	HCPCS J2175
Hospital Charge Code	105930763
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$4.91
Rate for Payer: Aetna of AZ Commercial	$4.91
Rate for Payer: Arizona Complete Health Allwell	$0.87
Rate for Payer: Banner UC Health Medicare	$0.87
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.71
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.87
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.87
Rate for Payer: Cash Price	$4.36
Rate for Payer: Cigna of AZ Commercial	$3.54
Rate for Payer: Devoted Health Medicare	$0.98
Rate for Payer: Humana of AZ Medicare	$0.87
Rate for Payer: Southwest Service Administrators UFCW	$3.71
Rate for Payer: TriWest Medicare	$0.87
Rate for Payer: United Healthcare Commercial	$3.12
Rate for Payer: United Healthcare Medicare	$0.87
Rate for Payer: Veterans Affairs TRICARE	$0.86

meperidine 50 mg/1 mL Inj Sol [CQCH]

Facility

$5.45

Service Code	HCPCS J2175
Hospital Charge Code	105930763
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$4.91
Rate for Payer: Aetna of AZ Commercial	$4.91
Rate for Payer: Cash Price	$4.36

MERCURY BLOOD

Facility

$464.00

Service Code	CPT 83825
Hospital Charge Code	22481493
Hospital Revenue Code	301
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$74.24
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Seven Corners Travel Insurance	$23.58
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

MERCURY BLOOD

Facility

$464.00

Service Code	CPT 83825
Hospital Charge Code	22481493
Hospital Revenue Code	301
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

Mercury, Blood LC

Facility

$428.00

Service Code	CPT 83825
Hospital Charge Code	1285592
Hospital Revenue Code	301
Min. Negotiated Rate	$385.20
Max. Negotiated Rate	$385.20
Rate for Payer: Aetna of AZ Commercial	$385.20
Rate for Payer: Cash Price	$342.40

Mercury, Blood LC

Facility

$428.00

Service Code	CPT 83825
Hospital Charge Code	1285592
Hospital Revenue Code	301
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$385.20
Rate for Payer: Aetna of AZ Commercial	$385.20
Rate for Payer: Arizona Complete Health Allwell	$68.48
Rate for Payer: Banner UC Health Medicare	$68.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$291.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$68.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$68.48
Rate for Payer: Cash Price	$342.40
Rate for Payer: Cash Price	$342.40
Rate for Payer: Cigna of AZ Commercial	$278.20
Rate for Payer: Devoted Health Medicare	$77.04
Rate for Payer: Humana of AZ Medicare	$68.48
Rate for Payer: Seven Corners Travel Insurance	$23.58
Rate for Payer: Southwest Service Administrators UFCW	$291.04
Rate for Payer: TriWest Medicare	$68.48
Rate for Payer: United Healthcare Commercial	$244.82
Rate for Payer: United Healthcare Medicare	$68.48
Rate for Payer: Veterans Affairs TRICARE	$67.80

.Mercury, Comment LC

Facility

$442.00

Service Code	CPT 83825
Hospital Charge Code	22311159
Hospital Revenue Code	306
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$397.80
Rate for Payer: Aetna of AZ Commercial	$397.80
Rate for Payer: Arizona Complete Health Allwell	$70.72
Rate for Payer: Banner UC Health Medicare	$70.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$300.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$70.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$70.72
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cigna of AZ Commercial	$287.30
Rate for Payer: Devoted Health Medicare	$79.56
Rate for Payer: Humana of AZ Medicare	$70.72
Rate for Payer: Seven Corners Travel Insurance	$23.58
Rate for Payer: Southwest Service Administrators UFCW	$300.56
Rate for Payer: TriWest Medicare	$70.72
Rate for Payer: United Healthcare Commercial	$252.82
Rate for Payer: United Healthcare Medicare	$70.72
Rate for Payer: Veterans Affairs TRICARE	$70.01

.Mercury, Comment LC

Facility

$442.00

Service Code	CPT 83825
Hospital Charge Code	22311159
Hospital Revenue Code	306
Min. Negotiated Rate	$397.80
Max. Negotiated Rate	$397.80
Rate for Payer: Aetna of AZ Commercial	$397.80
Rate for Payer: Cash Price	$353.60

MEROCEL POPE EPISTAXIS 10CM

Facility

$171.00

Hospital Charge Code	27555206
Hospital Revenue Code	270
Min. Negotiated Rate	$27.09
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Arizona Complete Health Allwell	$27.36
Rate for Payer: Banner UC Health Medicare	$27.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.36
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna of AZ Commercial	$119.70
Rate for Payer: Devoted Health Medicare	$30.78
Rate for Payer: Humana of AZ Medicare	$27.36
Rate for Payer: Southwest Service Administrators UFCW	$116.28
Rate for Payer: TriWest Medicare	$27.36
Rate for Payer: United Healthcare Commercial	$97.81
Rate for Payer: United Healthcare Medicare	$27.36
Rate for Payer: Veterans Affairs TRICARE	$27.09

MEROCEL POPE EPISTAXIS 10CM

Facility

$171.00

Hospital Charge Code	27555206
Hospital Revenue Code	270
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Cash Price	$136.80

mesalamine 1000 mg Supp [CQCH]

Facility

$22.72

Service Code	NDC 58914050156
Hospital Charge Code	105930976
Hospital Revenue Code	251
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Aetna of AZ Commercial	$20.45
Rate for Payer: Cash Price	$18.18

mesalamine 1000 mg Supp [CQCH]

Facility

$22.72

Service Code	NDC 58914050156
Hospital Charge Code	105930976
Hospital Revenue Code	251
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$20.45
Rate for Payer: Aetna of AZ Commercial	$20.45
Rate for Payer: Arizona Complete Health Allwell	$3.64
Rate for Payer: Banner UC Health Medicare	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$15.45
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.64
Rate for Payer: Cash Price	$18.18
Rate for Payer: Cigna of AZ Commercial	$14.77
Rate for Payer: Devoted Health Medicare	$4.09
Rate for Payer: Humana of AZ Medicare	$3.64
Rate for Payer: Southwest Service Administrators UFCW	$15.45
Rate for Payer: TriWest Medicare	$3.64
Rate for Payer: United Healthcare Commercial	$13.00
Rate for Payer: United Healthcare Medicare	$3.64
Rate for Payer: Veterans Affairs TRICARE	$3.60

mesalamine 400 mg DR [CQCH]

Facility

$3.30

Service Code	NDC 23585318
Hospital Charge Code	105930911
Hospital Revenue Code	251
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Aetna of AZ Commercial	$2.97
Rate for Payer: Cash Price	$2.64

mesalamine 400 mg DR [CQCH]

Facility

$3.30

Service Code	NDC 23585318
Hospital Charge Code	105930911
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.97
Rate for Payer: Aetna of AZ Commercial	$2.97
Rate for Payer: Arizona Complete Health Allwell	$0.53
Rate for Payer: Banner UC Health Medicare	$0.53
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.53
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.53
Rate for Payer: Cash Price	$2.64
Rate for Payer: Cigna of AZ Commercial	$2.15
Rate for Payer: Devoted Health Medicare	$0.59
Rate for Payer: Humana of AZ Medicare	$0.53
Rate for Payer: Southwest Service Administrators UFCW	$2.24
Rate for Payer: TriWest Medicare	$0.53
Rate for Payer: United Healthcare Commercial	$1.89
Rate for Payer: United Healthcare Medicare	$0.53
Rate for Payer: Veterans Affairs TRICARE	$0.52

MESH 3D MAX LEFT EXTRA LARGE

Facility

$1,103.00

Hospital Charge Code	27750234
Hospital Revenue Code	270
Min. Negotiated Rate	$992.70
Max. Negotiated Rate	$992.70
Rate for Payer: Aetna of AZ Commercial	$992.70
Rate for Payer: Cash Price	$882.40

MESH 3D MAX LEFT EXTRA LARGE

Facility

$1,103.00

Hospital Charge Code	27750234
Hospital Revenue Code	270
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$992.70
Rate for Payer: Aetna of AZ Commercial	$992.70
Rate for Payer: Arizona Complete Health Allwell	$176.48
Rate for Payer: Banner UC Health Medicare	$176.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$750.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$176.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$176.48
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cigna of AZ Commercial	$772.10
Rate for Payer: Devoted Health Medicare	$198.54
Rate for Payer: Humana of AZ Medicare	$176.48
Rate for Payer: Southwest Service Administrators UFCW	$750.04
Rate for Payer: TriWest Medicare	$176.48
Rate for Payer: United Healthcare Commercial	$630.92
Rate for Payer: United Healthcare Medicare	$176.48
Rate for Payer: Veterans Affairs TRICARE	$174.72

MESH ONLAY PATCH SURGIMESH T613-8S

Facility

$861.00

Hospital Charge Code	22714383
Hospital Revenue Code	272
Min. Negotiated Rate	$774.90
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Cash Price	$688.80

MESH ONLAY PATCH SURGIMESH T613-8S

Facility

$861.00

Hospital Charge Code	22714383
Hospital Revenue Code	272
Min. Negotiated Rate	$136.38
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Arizona Complete Health Allwell	$137.76
Rate for Payer: Banner UC Health Medicare	$137.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$585.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$137.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$137.76
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cigna of AZ Commercial	$602.70
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Humana of AZ Medicare	$137.76
Rate for Payer: Southwest Service Administrators UFCW	$585.48
Rate for Payer: TriWest Medicare	$137.76
Rate for Payer: United Healthcare Commercial	$492.49
Rate for Payer: United Healthcare Medicare	$137.76
Rate for Payer: Veterans Affairs TRICARE	$136.38

MESH TINTRA C15

Facility

$2,280.00

Hospital Charge Code	22354769
Hospital Revenue Code	270
Min. Negotiated Rate	$2,052.00
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna of AZ Commercial	$2,052.00
Rate for Payer: Cash Price	$1,824.00

MESH TINTRA C15

Facility

$2,280.00

Hospital Charge Code	22354769
Hospital Revenue Code	270
Min. Negotiated Rate	$361.15
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna of AZ Commercial	$2,052.00
Rate for Payer: Arizona Complete Health Allwell	$364.80
Rate for Payer: Banner UC Health Medicare	$364.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,550.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$364.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$364.80
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Cigna of AZ Commercial	$1,596.00
Rate for Payer: Devoted Health Medicare	$410.40
Rate for Payer: Humana of AZ Medicare	$364.80
Rate for Payer: Southwest Service Administrators UFCW	$1,550.40
Rate for Payer: TriWest Medicare	$364.80
Rate for Payer: United Healthcare Commercial	$1,304.16
Rate for Payer: United Healthcare Medicare	$364.80
Rate for Payer: Veterans Affairs TRICARE	$361.15

Know your out-of-pocket cost for care.

All Charges