Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Peritoneal Adhesiolysis

Facility

$7,725.92

Service Code	APR-DRG 2241
Hospital Charge Code	APRDRG2243
Min. Negotiated Rate	$7,725.92
Max. Negotiated Rate	$7,725.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,725.92
Rate for Payer: Mercy Care Medicaid	$7,725.92
Rate for Payer: NaphCare Correctional Healthcare	$7,725.92

Peritoneal Adhesiolysis

Facility

$10,072.81

Service Code	APR-DRG 2242
Hospital Charge Code	APRDRG2244
Min. Negotiated Rate	$10,072.81
Max. Negotiated Rate	$10,072.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,072.81
Rate for Payer: Mercy Care Medicaid	$10,072.81
Rate for Payer: NaphCare Correctional Healthcare	$10,072.81

Peritoneal Adhesiolysis

Facility

$7,725.92

Service Code	APR-DRG 2241
Hospital Charge Code	APRDRG2244
Min. Negotiated Rate	$7,725.92
Max. Negotiated Rate	$7,725.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,725.92
Rate for Payer: Mercy Care Medicaid	$7,725.92
Rate for Payer: NaphCare Correctional Healthcare	$7,725.92

Peritoneal Adhesiolysis

Facility

$7,725.92

Service Code	APR-DRG 2241
Hospital Charge Code	APRDRG2241
Min. Negotiated Rate	$7,725.92
Max. Negotiated Rate	$7,725.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,725.92
Rate for Payer: Mercy Care Medicaid	$7,725.92
Rate for Payer: NaphCare Correctional Healthcare	$7,725.92

Peritoneal Adhesiolysis

Facility

$26,638.47

Service Code	APR-DRG 2244
Hospital Charge Code	APRDRG2242
Min. Negotiated Rate	$26,638.47
Max. Negotiated Rate	$26,638.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,638.47
Rate for Payer: Mercy Care Medicaid	$26,638.47
Rate for Payer: NaphCare Correctional Healthcare	$26,638.47

Peritoneal Adhesiolysis

Facility

$10,072.81

Service Code	APR-DRG 2242
Hospital Charge Code	APRDRG2242
Min. Negotiated Rate	$10,072.81
Max. Negotiated Rate	$10,072.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,072.81
Rate for Payer: Mercy Care Medicaid	$10,072.81
Rate for Payer: NaphCare Correctional Healthcare	$10,072.81

Peritoneal Adhesiolysis

Facility

$26,638.47

Service Code	APR-DRG 2244
Hospital Charge Code	APRDRG2241
Min. Negotiated Rate	$26,638.47
Max. Negotiated Rate	$26,638.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,638.47
Rate for Payer: Mercy Care Medicaid	$26,638.47
Rate for Payer: NaphCare Correctional Healthcare	$26,638.47

Peritoneal Adhesiolysis

Facility

$26,638.47

Service Code	APR-DRG 2244
Hospital Charge Code	APRDRG2243
Min. Negotiated Rate	$26,638.47
Max. Negotiated Rate	$26,638.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,638.47
Rate for Payer: Mercy Care Medicaid	$26,638.47
Rate for Payer: NaphCare Correctional Healthcare	$26,638.47

Peritoneal Adhesiolysis

Facility

$10,072.81

Service Code	APR-DRG 2242
Hospital Charge Code	APRDRG2243
Min. Negotiated Rate	$10,072.81
Max. Negotiated Rate	$10,072.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,072.81
Rate for Payer: Mercy Care Medicaid	$10,072.81
Rate for Payer: NaphCare Correctional Healthcare	$10,072.81

Peritoneal Adhesiolysis

Facility

$14,502.85

Service Code	APR-DRG 2243
Hospital Charge Code	APRDRG2243
Min. Negotiated Rate	$14,502.85
Max. Negotiated Rate	$14,502.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,502.85
Rate for Payer: Mercy Care Medicaid	$14,502.85
Rate for Payer: NaphCare Correctional Healthcare	$14,502.85

Peritoneal Adhesiolysis

Facility

$7,725.92

Service Code	APR-DRG 2241
Hospital Charge Code	APRDRG2242
Min. Negotiated Rate	$7,725.92
Max. Negotiated Rate	$7,725.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,725.92
Rate for Payer: Mercy Care Medicaid	$7,725.92
Rate for Payer: NaphCare Correctional Healthcare	$7,725.92

Peritoneal Adhesiolysis

Facility

$26,638.47

Service Code	APR-DRG 2244
Hospital Charge Code	APRDRG2244
Min. Negotiated Rate	$26,638.47
Max. Negotiated Rate	$26,638.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,638.47
Rate for Payer: Mercy Care Medicaid	$26,638.47
Rate for Payer: NaphCare Correctional Healthcare	$26,638.47

Peritoneal Adhesiolysis

Facility

$14,502.85

Service Code	APR-DRG 2243
Hospital Charge Code	APRDRG2242
Min. Negotiated Rate	$14,502.85
Max. Negotiated Rate	$14,502.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,502.85
Rate for Payer: Mercy Care Medicaid	$14,502.85
Rate for Payer: NaphCare Correctional Healthcare	$14,502.85

Peritoneal Adhesiolysis

Facility

$10,072.81

Service Code	APR-DRG 2242
Hospital Charge Code	APRDRG2241
Min. Negotiated Rate	$10,072.81
Max. Negotiated Rate	$10,072.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,072.81
Rate for Payer: Mercy Care Medicaid	$10,072.81
Rate for Payer: NaphCare Correctional Healthcare	$10,072.81

Peritoneal Adhesiolysis

Facility

$14,502.85

Service Code	APR-DRG 2243
Hospital Charge Code	APRDRG2244
Min. Negotiated Rate	$14,502.85
Max. Negotiated Rate	$14,502.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,502.85
Rate for Payer: Mercy Care Medicaid	$14,502.85
Rate for Payer: NaphCare Correctional Healthcare	$14,502.85

Peritoneal Adhesiolysis

Facility

$14,502.85

Service Code	APR-DRG 2243
Hospital Charge Code	APRDRG2241
Min. Negotiated Rate	$14,502.85
Max. Negotiated Rate	$14,502.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,502.85
Rate for Payer: Mercy Care Medicaid	$14,502.85
Rate for Payer: NaphCare Correctional Healthcare	$14,502.85

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$27,253.16

Service Code	MSDRG 336
Min. Negotiated Rate	$27,253.16
Max. Negotiated Rate	$27,253.16
Rate for Payer: Seven Corners Travel Insurance	$27,253.16

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$46,150.80

Service Code	MSDRG 335
Min. Negotiated Rate	$46,150.80
Max. Negotiated Rate	$46,150.80
Rate for Payer: Seven Corners Travel Insurance	$46,150.80

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$19,838.57

Service Code	MSDRG 337
Min. Negotiated Rate	$19,838.57
Max. Negotiated Rate	$19,838.57
Rate for Payer: Seven Corners Travel Insurance	$19,838.57

PERITONEAL LAVAGE, INCLUDING IMAGING GUIDANCE, WHEN PERFORME

Facility

$546.00

Service Code	CPT 49084
Hospital Charge Code	28286991
Hospital Revenue Code	301
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Cash Price	$436.80

PERITONEAL LAVAGE, INCLUDING IMAGING GUIDANCE, WHEN PERFORME

Facility

$546.00

Service Code	CPT 49084
Hospital Charge Code	28286991
Hospital Revenue Code	301
Min. Negotiated Rate	$69.15
Max. Negotiated Rate	$1,403.35
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Arizona Complete Health Allwell	$87.36
Rate for Payer: Banner UC Health Medicare	$87.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$371.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$87.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$69.15
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cigna of AZ Commercial	$354.90
Rate for Payer: Devoted Health Medicare	$98.28
Rate for Payer: Humana of AZ Medicare	$87.36
Rate for Payer: Seven Corners Travel Insurance	$1,403.35
Rate for Payer: Southwest Service Administrators UFCW	$371.28
Rate for Payer: TriWest Medicare	$87.36
Rate for Payer: United Healthcare Commercial	$312.31
Rate for Payer: United Healthcare Medicare	$87.36
Rate for Payer: Veterans Affairs TRICARE	$86.49

Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock

Facility

$30,224.73

Service Code	APR-DRG 1704
Hospital Charge Code	APRDRG1702
Min. Negotiated Rate	$30,224.73
Max. Negotiated Rate	$30,224.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$30,224.73
Rate for Payer: Mercy Care Medicaid	$30,224.73
Rate for Payer: NaphCare Correctional Healthcare	$30,224.73

Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock

Facility

$13,306.26

Service Code	APR-DRG 1701
Hospital Charge Code	APRDRG1704
Min. Negotiated Rate	$13,306.26
Max. Negotiated Rate	$13,306.26
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,306.26
Rate for Payer: Mercy Care Medicaid	$13,306.26
Rate for Payer: NaphCare Correctional Healthcare	$13,306.26

Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock

Facility

$30,224.73

Service Code	APR-DRG 1704
Hospital Charge Code	APRDRG1703
Min. Negotiated Rate	$30,224.73
Max. Negotiated Rate	$30,224.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$30,224.73
Rate for Payer: Mercy Care Medicaid	$30,224.73
Rate for Payer: NaphCare Correctional Healthcare	$30,224.73

Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock

Facility

$13,306.26

Service Code	APR-DRG 1701
Hospital Charge Code	APRDRG1703
Min. Negotiated Rate	$13,306.26
Max. Negotiated Rate	$13,306.26
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,306.26
Rate for Payer: Mercy Care Medicaid	$13,306.26
Rate for Payer: NaphCare Correctional Healthcare	$13,306.26

Know your out-of-pocket cost for care.

All Charges