Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16
Rate for Payer: NaphCare Correctional Healthcare	$12,557.16

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55
Rate for Payer: NaphCare Correctional Healthcare	$1,828.55

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34
Rate for Payer: NaphCare Correctional Healthcare	$4,880.34

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16
Rate for Payer: NaphCare Correctional Healthcare	$12,557.16

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16
Rate for Payer: NaphCare Correctional Healthcare	$12,557.16

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55
Rate for Payer: NaphCare Correctional Healthcare	$1,828.55

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55
Rate for Payer: NaphCare Correctional Healthcare	$1,828.55

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63
Rate for Payer: NaphCare Correctional Healthcare	$2,570.63

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7734
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34
Rate for Payer: NaphCare Correctional Healthcare	$4,880.34

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63
Rate for Payer: NaphCare Correctional Healthcare	$2,570.63

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34
Rate for Payer: NaphCare Correctional Healthcare	$4,880.34

Opioid Abuse And Dependence

Facility

$12,557.16

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG7733
Min. Negotiated Rate	$12,557.16
Max. Negotiated Rate	$12,557.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,557.16
Rate for Payer: Mercy Care Medicaid	$12,557.16
Rate for Payer: NaphCare Correctional Healthcare	$12,557.16

Opioid Abuse And Dependence

Facility

$1,828.55

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$1,828.55
Max. Negotiated Rate	$1,828.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$1,828.55
Rate for Payer: Mercy Care Medicaid	$1,828.55
Rate for Payer: NaphCare Correctional Healthcare	$1,828.55

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63
Rate for Payer: NaphCare Correctional Healthcare	$2,570.63

Opioid Abuse And Dependence

Facility

$4,880.34

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG7732
Min. Negotiated Rate	$4,880.34
Max. Negotiated Rate	$4,880.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,880.34
Rate for Payer: Mercy Care Medicaid	$4,880.34
Rate for Payer: NaphCare Correctional Healthcare	$4,880.34

Opioid Abuse And Dependence

Facility

$2,570.63

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG7731
Min. Negotiated Rate	$2,570.63
Max. Negotiated Rate	$2,570.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,570.63
Rate for Payer: Mercy Care Medicaid	$2,570.63
Rate for Payer: NaphCare Correctional Healthcare	$2,570.63

OPTICELL AG+ SILVER ANTIBACTERIAL WOUND DRESSING

Facility

$23.00

Hospital Charge Code	27567554
Hospital Revenue Code	270
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Cash Price	$18.40

OPTICELL AG+ SILVER ANTIBACTERIAL WOUND DRESSING

Facility

$23.00

Hospital Charge Code	27567554
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Arizona Complete Health Allwell	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$15.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.68
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Devoted Health Medicare	$4.14
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Southwest Service Administrators UFCW	$15.64
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: United Healthcare Commercial	$13.16
Rate for Payer: United Healthcare Medicare	$3.68
Rate for Payer: Veterans Affairs TRICARE	$3.64

OPTIFLOW JUNIOR 2 NASAL CANNUAL SIZE XL

Facility

$189.00

Hospital Charge Code	24154234
Hospital Revenue Code	270
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Arizona Complete Health Allwell	$30.24
Rate for Payer: Banner UC Health Medicare	$30.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$128.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$30.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.24
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna of AZ Commercial	$132.30
Rate for Payer: Devoted Health Medicare	$34.02
Rate for Payer: Humana of AZ Medicare	$30.24
Rate for Payer: Southwest Service Administrators UFCW	$128.52
Rate for Payer: TriWest Medicare	$30.24
Rate for Payer: United Healthcare Commercial	$108.11
Rate for Payer: United Healthcare Medicare	$30.24
Rate for Payer: Veterans Affairs TRICARE	$29.94

OPTIFLOW JUNIOR 2 NASAL CANNUAL SIZE XL

Facility

$189.00

Hospital Charge Code	24154234
Hospital Revenue Code	270
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Cash Price	$151.20

OPTIFLOW JUNIOR 2 NASAL CANNUAL SIZE XXL

Facility

$185.00

Hospital Charge Code	24154235
Hospital Revenue Code	270
Min. Negotiated Rate	$29.30
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Arizona Complete Health Allwell	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.60
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$129.50
Rate for Payer: Devoted Health Medicare	$33.30
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Southwest Service Administrators UFCW	$125.80
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: United Healthcare Commercial	$105.82
Rate for Payer: United Healthcare Medicare	$29.60
Rate for Payer: Veterans Affairs TRICARE	$29.30

OPTIFLOW JUNIOR 2 NASAL CANNUAL SIZE XXL

Facility

$185.00

Hospital Charge Code	24154235
Hospital Revenue Code	270
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Cash Price	$148.00

OPTIFLOW JUNIOR 2 NASAL CANNULA SIZE L

Facility

$189.00

Hospital Charge Code	24154233
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Arizona Complete Health Allwell	$30.24
Rate for Payer: Banner UC Health Medicare	$30.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$128.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$30.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.24
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna of AZ Commercial	$132.30
Rate for Payer: Devoted Health Medicare	$34.02
Rate for Payer: Humana of AZ Medicare	$30.24
Rate for Payer: Southwest Service Administrators UFCW	$128.52
Rate for Payer: TriWest Medicare	$30.24
Rate for Payer: United Healthcare Commercial	$108.11
Rate for Payer: United Healthcare Medicare	$30.24
Rate for Payer: Veterans Affairs TRICARE	$29.94

OPTIFLOW JUNIOR 2 NASAL CANNULA SIZE L

Facility

$189.00

Hospital Charge Code	24154233
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Cash Price	$151.20

OPTIFLOW PLUS CANNULA SIZE L

Facility

$97.00

Hospital Charge Code	24154232
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

Know your out-of-pocket cost for care.

All Charges