Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$37,482.59

Service Code	MSDRG 406
Min. Negotiated Rate	$37,482.59
Max. Negotiated Rate	$37,482.59
Rate for Payer: Seven Corners Travel Insurance	$37,482.59

PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$70,701.52

Service Code	MSDRG 405
Min. Negotiated Rate	$70,701.52
Max. Negotiated Rate	$70,701.52
Rate for Payer: Seven Corners Travel Insurance	$70,701.52

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$28,686.41

Service Code	MSDRG 407
Min. Negotiated Rate	$28,686.41
Max. Negotiated Rate	$28,686.41
Rate for Payer: Seven Corners Travel Insurance	$28,686.41

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06
Rate for Payer: NaphCare Correctional Healthcare	$97,322.06

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48
Rate for Payer: NaphCare Correctional Healthcare	$58,558.48

Pancreas Transplant

Facility

$52,492.07

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$52,492.07
Max. Negotiated Rate	$52,492.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,492.07
Rate for Payer: Mercy Care Medicaid	$52,492.07
Rate for Payer: NaphCare Correctional Healthcare	$52,492.07

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0064
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48
Rate for Payer: NaphCare Correctional Healthcare	$58,558.48

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0062
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06
Rate for Payer: NaphCare Correctional Healthcare	$97,322.06

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06
Rate for Payer: NaphCare Correctional Healthcare	$97,322.06

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0061
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48
Rate for Payer: NaphCare Correctional Healthcare	$58,558.48

Pancreas Transplant

Facility

$97,322.06

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$97,322.06
Max. Negotiated Rate	$97,322.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$97,322.06
Rate for Payer: Mercy Care Medicaid	$97,322.06
Rate for Payer: NaphCare Correctional Healthcare	$97,322.06

Pancreas Transplant

Facility

$58,558.48

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG0063
Min. Negotiated Rate	$58,558.48
Max. Negotiated Rate	$58,558.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$58,558.48
Rate for Payer: Mercy Care Medicaid	$58,558.48
Rate for Payer: NaphCare Correctional Healthcare	$58,558.48

PANCREAS TRANSPLANT

Facility

$92,739.78

Service Code	MSDRG 010
Min. Negotiated Rate	$92,739.78
Max. Negotiated Rate	$92,739.78
Rate for Payer: Seven Corners Travel Insurance	$92,739.78

Pancreatic Elastase, Fecal LC

Facility

$115.00

Service Code	CPT 82653
Hospital Charge Code	22201909
Hospital Revenue Code	301
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Cash Price	$92.00

Pancreatic Elastase, Fecal LC

Facility

$115.00

Service Code	CPT 82653
Hospital Charge Code	22201909
Hospital Revenue Code	301
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Arizona Complete Health Allwell	$18.40
Rate for Payer: Banner UC Health Medicare	$18.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$78.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.40
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cigna of AZ Commercial	$74.75
Rate for Payer: Devoted Health Medicare	$20.70
Rate for Payer: Humana of AZ Medicare	$18.40
Rate for Payer: Seven Corners Travel Insurance	$33.31
Rate for Payer: Southwest Service Administrators UFCW	$78.20
Rate for Payer: TriWest Medicare	$18.40
Rate for Payer: United Healthcare Commercial	$65.78
Rate for Payer: United Healthcare Medicare	$18.40
Rate for Payer: Veterans Affairs TRICARE	$18.22

pantoprazole 40 mg IV Inj [CQCH]

Facility

$3.42

Service Code	NDC 8092351
Hospital Charge Code	105969840
Hospital Revenue Code	251
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna of AZ Commercial	$3.08
Rate for Payer: Cash Price	$2.74

pantoprazole 40 mg IV Inj [CQCH]

Facility

$3.42

Service Code	NDC 8092351
Hospital Charge Code	105969840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna of AZ Commercial	$3.08
Rate for Payer: Arizona Complete Health Allwell	$0.55
Rate for Payer: Banner UC Health Medicare	$0.55
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.55
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.55
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cigna of AZ Commercial	$2.22
Rate for Payer: Devoted Health Medicare	$0.62
Rate for Payer: Humana of AZ Medicare	$0.55
Rate for Payer: Southwest Service Administrators UFCW	$2.33
Rate for Payer: TriWest Medicare	$0.55
Rate for Payer: United Healthcare Commercial	$1.96
Rate for Payer: United Healthcare Medicare	$0.55
Rate for Payer: Veterans Affairs TRICARE	$0.54

pantoprazole 40 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 51079005120
Hospital Charge Code	105935743
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.09
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

Know your out-of-pocket cost for care.

All Charges