Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy

Facility

$6,634.54

Service Code	APR-DRG 3432
Hospital Charge Code	APRDRG3431
Min. Negotiated Rate	$6,634.54
Max. Negotiated Rate	$6,634.54
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,634.54
Rate for Payer: Mercy Care Medicaid	$6,634.54
Rate for Payer: NaphCare Correctional Healthcare	$6,634.54

Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy

Facility

$6,634.54

Service Code	APR-DRG 3432
Hospital Charge Code	APRDRG3434
Min. Negotiated Rate	$6,634.54
Max. Negotiated Rate	$6,634.54
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,634.54
Rate for Payer: Mercy Care Medicaid	$6,634.54
Rate for Payer: NaphCare Correctional Healthcare	$6,634.54

Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy

Facility

$5,616.11

Service Code	APR-DRG 3431
Hospital Charge Code	APRDRG3431
Min. Negotiated Rate	$5,616.11
Max. Negotiated Rate	$5,616.11
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,616.11
Rate for Payer: Mercy Care Medicaid	$5,616.11
Rate for Payer: NaphCare Correctional Healthcare	$5,616.11

MUSTANG BALLOON 6X40X75

Facility

$1,400.00

Hospital Charge Code	27977962
Hospital Revenue Code	270
Min. Negotiated Rate	$221.76
Max. Negotiated Rate	$1,260.00
Rate for Payer: Aetna of AZ Commercial	$1,260.00
Rate for Payer: Arizona Complete Health Allwell	$224.00
Rate for Payer: Banner UC Health Medicare	$224.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$952.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$224.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$224.00
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Cigna of AZ Commercial	$980.00
Rate for Payer: Devoted Health Medicare	$252.00
Rate for Payer: Humana of AZ Medicare	$224.00
Rate for Payer: Southwest Service Administrators UFCW	$952.00
Rate for Payer: TriWest Medicare	$224.00
Rate for Payer: United Healthcare Commercial	$800.80
Rate for Payer: United Healthcare Medicare	$224.00
Rate for Payer: Veterans Affairs TRICARE	$221.76

MUSTANG BALLOON 6X40X75

Facility

$1,400.00

Hospital Charge Code	27977962
Hospital Revenue Code	270
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$1,260.00
Rate for Payer: Aetna of AZ Commercial	$1,260.00
Rate for Payer: Cash Price	$1,120.00

mycophenolate 500 mg Tab UD [CQCH]

Facility

$0.62

Service Code	HCPCS J7517
Hospital Charge Code	108074965
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Cash Price	$0.50

mycophenolate 500 mg Tab UD [CQCH]

Facility

$0.62

Service Code	HCPCS J7517
Hospital Charge Code	108074965
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Arizona Complete Health Allwell	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.42
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.10
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Southwest Service Administrators UFCW	$0.42
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: United Healthcare Commercial	$0.35
Rate for Payer: United Healthcare Medicare	$0.10
Rate for Payer: Veterans Affairs TRICARE	$0.10

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$29,870.26

Service Code	MSDRG 827
Min. Negotiated Rate	$29,870.26
Max. Negotiated Rate	$29,870.26
Rate for Payer: Seven Corners Travel Insurance	$29,870.26

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$60,456.55

Service Code	MSDRG 826
Min. Negotiated Rate	$60,456.55
Max. Negotiated Rate	$60,456.55
Rate for Payer: Seven Corners Travel Insurance	$60,456.55

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$22,020.13

Service Code	MSDRG 828
Min. Negotiated Rate	$22,020.13
Max. Negotiated Rate	$22,020.13
Rate for Payer: Seven Corners Travel Insurance	$22,020.13

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$40,840.29

Service Code	MSDRG 829
Min. Negotiated Rate	$40,840.29
Max. Negotiated Rate	$40,840.29
Rate for Payer: Seven Corners Travel Insurance	$40,840.29

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$19,450.84

Service Code	MSDRG 830
Min. Negotiated Rate	$19,450.84
Max. Negotiated Rate	$19,450.84
Rate for Payer: Seven Corners Travel Insurance	$19,450.84

MYOCARDIAL STRAIN IMAGING USING SPECKLE TRACKING-DERIVED ASS

Facility

$60.00

Service Code	CPT 93356
Hospital Charge Code	30538443
Hospital Revenue Code	480
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$25.46
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Mercy Care Medicaid	$25.46
Rate for Payer: NaphCare Correctional Healthcare	$25.46
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: United Healthcare New Mexico Commercial	$11.40
Rate for Payer: Veterans Affairs TRICARE	$9.50

MYOCARDIAL STRAIN IMAGING USING SPECKLE TRACKING-DERIVED ASS

Facility

$60.00

Service Code	CPT 93356
Hospital Charge Code	30538443
Hospital Revenue Code	480
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

Myoglobin, Serum LC

Facility

$301.00

Service Code	CPT 83874
Hospital Charge Code	2087628
Hospital Revenue Code	301
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$270.90
Rate for Payer: Aetna of AZ Commercial	$270.90
Rate for Payer: Cash Price	$240.80

Myoglobin, Serum LC

Facility

$301.00

Service Code	CPT 83874
Hospital Charge Code	2087628
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$270.90
Rate for Payer: Aetna of AZ Commercial	$270.90
Rate for Payer: Arizona Complete Health Allwell	$48.16
Rate for Payer: Banner UC Health Medicare	$48.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$204.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.16
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cigna of AZ Commercial	$195.65
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Humana of AZ Medicare	$48.16
Rate for Payer: Seven Corners Travel Insurance	$18.73
Rate for Payer: Southwest Service Administrators UFCW	$204.68
Rate for Payer: TriWest Medicare	$48.16
Rate for Payer: United Healthcare Commercial	$172.17
Rate for Payer: United Healthcare Medicare	$48.16
Rate for Payer: Veterans Affairs TRICARE	$47.68

Myoglobin, Urine LC

Facility

$308.00

Service Code	CPT 83874
Hospital Charge Code	2269443
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Arizona Complete Health Allwell	$49.28
Rate for Payer: Banner UC Health Medicare	$49.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$209.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.28
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cigna of AZ Commercial	$200.20
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Humana of AZ Medicare	$49.28
Rate for Payer: Seven Corners Travel Insurance	$18.73
Rate for Payer: Southwest Service Administrators UFCW	$209.44
Rate for Payer: TriWest Medicare	$49.28
Rate for Payer: United Healthcare Commercial	$176.18
Rate for Payer: United Healthcare Medicare	$49.28
Rate for Payer: Veterans Affairs TRICARE	$48.79

Myoglobin, Urine LC

Facility

$308.00

Service Code	CPT 83874
Hospital Charge Code	2269443
Hospital Revenue Code	301
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Cash Price	$246.40

Myomectomy abdominal

Facility

$5,082.00

Service Code	CPT 58140
Hospital Charge Code	27281892
Hospital Revenue Code	360
Min. Negotiated Rate	$4,573.80
Max. Negotiated Rate	$4,573.80
Rate for Payer: Aetna of AZ Commercial	$4,573.80
Rate for Payer: Cash Price	$4,065.60

Myomectomy abdominal

Facility

$5,082.00

Service Code	CPT 58140
Hospital Charge Code	27281892
Hospital Revenue Code	360
Min. Negotiated Rate	$804.99
Max. Negotiated Rate	$4,838.00
Rate for Payer: Aetna of AZ Commercial	$4,573.80
Rate for Payer: Arizona Complete Health Allwell	$813.12
Rate for Payer: Banner UC Health Medicare	$813.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,455.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$813.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$813.12
Rate for Payer: Cash Price	$4,065.60
Rate for Payer: Cash Price	$4,065.60
Rate for Payer: Cigna of AZ Commercial	$2,541.00
Rate for Payer: Devoted Health Medicare	$914.76
Rate for Payer: Humana of AZ Medicare	$813.12
Rate for Payer: Southwest Service Administrators UFCW	$3,455.76
Rate for Payer: TriWest Medicare	$813.12
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$813.12
Rate for Payer: Veterans Affairs TRICARE	$804.99

MYOSURE HYSTEROSCOPE TISSUE REMOVAL DEV

Facility

$3,713.00

Hospital Charge Code	22354782
Hospital Revenue Code	270
Min. Negotiated Rate	$3,341.70
Max. Negotiated Rate	$3,341.70
Rate for Payer: Aetna of AZ Commercial	$3,341.70
Rate for Payer: Cash Price	$2,970.40

MYOSURE HYSTEROSCOPE TISSUE REMOVAL DEV

Facility

$3,713.00

Hospital Charge Code	22354782
Hospital Revenue Code	270
Min. Negotiated Rate	$588.14
Max. Negotiated Rate	$3,341.70
Rate for Payer: Aetna of AZ Commercial	$3,341.70
Rate for Payer: Arizona Complete Health Allwell	$594.08
Rate for Payer: Banner UC Health Medicare	$594.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,524.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$594.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$594.08
Rate for Payer: Cash Price	$2,970.40
Rate for Payer: Cigna of AZ Commercial	$2,599.10
Rate for Payer: Devoted Health Medicare	$668.34
Rate for Payer: Humana of AZ Medicare	$594.08
Rate for Payer: Southwest Service Administrators UFCW	$2,524.84
Rate for Payer: TriWest Medicare	$594.08
Rate for Payer: United Healthcare Commercial	$2,123.84
Rate for Payer: United Healthcare Medicare	$594.08
Rate for Payer: Veterans Affairs TRICARE	$588.14

MYO SURE TISSURE REMOVEL DEVICE

Facility

$2,867.00

Hospital Charge Code	22354169
Hospital Revenue Code	270
Min. Negotiated Rate	$454.13
Max. Negotiated Rate	$2,580.30
Rate for Payer: Aetna of AZ Commercial	$2,580.30
Rate for Payer: Arizona Complete Health Allwell	$458.72
Rate for Payer: Banner UC Health Medicare	$458.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,949.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$458.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$458.72
Rate for Payer: Cash Price	$2,293.60
Rate for Payer: Cigna of AZ Commercial	$2,006.90
Rate for Payer: Devoted Health Medicare	$516.06
Rate for Payer: Humana of AZ Medicare	$458.72
Rate for Payer: Southwest Service Administrators UFCW	$1,949.56
Rate for Payer: TriWest Medicare	$458.72
Rate for Payer: United Healthcare Commercial	$1,639.92
Rate for Payer: United Healthcare Medicare	$458.72
Rate for Payer: Veterans Affairs TRICARE	$454.13

MYO SURE TISSURE REMOVEL DEVICE

Facility

$2,867.00

Hospital Charge Code	22354169
Hospital Revenue Code	270
Min. Negotiated Rate	$2,580.30
Max. Negotiated Rate	$2,580.30
Rate for Payer: Aetna of AZ Commercial	$2,580.30
Rate for Payer: Cash Price	$2,293.60

MYOSURE XL HYSTEROSCOPE TISSUE REMVL DEV

Facility

$3,673.00

Hospital Charge Code	22354783
Hospital Revenue Code	270
Min. Negotiated Rate	$581.80
Max. Negotiated Rate	$3,305.70
Rate for Payer: Aetna of AZ Commercial	$3,305.70
Rate for Payer: Arizona Complete Health Allwell	$587.68
Rate for Payer: Banner UC Health Medicare	$587.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,497.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$587.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$587.68
Rate for Payer: Cash Price	$2,938.40
Rate for Payer: Cigna of AZ Commercial	$2,571.10
Rate for Payer: Devoted Health Medicare	$661.14
Rate for Payer: Humana of AZ Medicare	$587.68
Rate for Payer: Southwest Service Administrators UFCW	$2,497.64
Rate for Payer: TriWest Medicare	$587.68
Rate for Payer: United Healthcare Commercial	$2,100.96
Rate for Payer: United Healthcare Medicare	$587.68
Rate for Payer: Veterans Affairs TRICARE	$581.80

Know your out-of-pocket cost for care.

All Charges