Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1343
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18
Rate for Payer: NaphCare Correctional Healthcare	$7,455.18

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1342
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68
Rate for Payer: NaphCare Correctional Healthcare	$5,001.68

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1342
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32
Rate for Payer: NaphCare Correctional Healthcare	$3,769.32

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32
Rate for Payer: NaphCare Correctional Healthcare	$3,769.32

Pulmonary Embolism

Facility

$3,769.32

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$3,769.32
Max. Negotiated Rate	$3,769.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,769.32
Rate for Payer: Mercy Care Medicaid	$3,769.32
Rate for Payer: NaphCare Correctional Healthcare	$3,769.32

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68
Rate for Payer: NaphCare Correctional Healthcare	$5,001.68

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18
Rate for Payer: NaphCare Correctional Healthcare	$7,455.18

Pulmonary Embolism

Facility

$11,397.75

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$11,397.75
Max. Negotiated Rate	$11,397.75
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,397.75
Rate for Payer: Mercy Care Medicaid	$11,397.75
Rate for Payer: NaphCare Correctional Healthcare	$11,397.75

Pulmonary Embolism

Facility

$11,397.75

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$11,397.75
Max. Negotiated Rate	$11,397.75
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,397.75
Rate for Payer: Mercy Care Medicaid	$11,397.75
Rate for Payer: NaphCare Correctional Healthcare	$11,397.75

Pulmonary Embolism

Facility

$7,455.18

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$7,455.18
Max. Negotiated Rate	$7,455.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,455.18
Rate for Payer: Mercy Care Medicaid	$7,455.18
Rate for Payer: NaphCare Correctional Healthcare	$7,455.18

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$17,760.57

Service Code	MSDRG 175
Min. Negotiated Rate	$17,760.57
Max. Negotiated Rate	$17,760.57
Rate for Payer: Seven Corners Travel Insurance	$17,760.57

PULMONARY EMBOLISM WITHOUT MCC

Facility

$10,555.75

Service Code	MSDRG 176
Min. Negotiated Rate	$10,555.75
Max. Negotiated Rate	$10,555.75
Rate for Payer: Seven Corners Travel Insurance	$10,555.75

Pulmonary Function Test

Facility

$898.00

Service Code	CPT 94060
Hospital Charge Code	23591076
Hospital Revenue Code	460
Min. Negotiated Rate	$808.20
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Cash Price	$718.40

Pulmonary Function Test

Facility

$898.00

Service Code	CPT 94060
Hospital Charge Code	23591076
Hospital Revenue Code	460
Min. Negotiated Rate	$142.24
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Arizona Complete Health Allwell	$143.68
Rate for Payer: Banner UC Health Medicare	$143.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$610.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$143.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$143.68
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cigna of AZ Commercial	$628.60
Rate for Payer: Devoted Health Medicare	$161.64
Rate for Payer: Humana of AZ Medicare	$143.68
Rate for Payer: Seven Corners Travel Insurance	$577.38
Rate for Payer: Southwest Service Administrators UFCW	$610.64
Rate for Payer: TriWest Medicare	$143.68
Rate for Payer: United Healthcare Commercial	$513.66
Rate for Payer: United Healthcare Medicare	$143.68
Rate for Payer: United Healthcare New Mexico Commercial	$170.62
Rate for Payer: Veterans Affairs TRICARE	$142.24

Pulmonary Stress Test 6 Minute Walk

Facility

$300.00

Service Code	CPT 94618
Hospital Charge Code	22409369
Hospital Revenue Code	482
Min. Negotiated Rate	$47.52
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Arizona Complete Health Allwell	$48.00
Rate for Payer: Banner UC Health Medicare	$48.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$204.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cigna of AZ Commercial	$210.00
Rate for Payer: Devoted Health Medicare	$54.00
Rate for Payer: Humana of AZ Medicare	$48.00
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$204.00
Rate for Payer: TriWest Medicare	$48.00
Rate for Payer: United Healthcare Commercial	$171.60
Rate for Payer: United Healthcare Medicare	$48.00
Rate for Payer: United Healthcare New Mexico Commercial	$57.00
Rate for Payer: Veterans Affairs TRICARE	$47.52

Pulmonary Stress Test 6 Minute Walk

Facility

$300.00

Service Code	CPT 94618
Hospital Charge Code	22409369
Hospital Revenue Code	482
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Cash Price	$240.00

PULSE OX

Facility

$55.00

Service Code	CPT 94760
Hospital Charge Code	22331465
Hospital Revenue Code	460
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: United Healthcare New Mexico Commercial	$10.45
Rate for Payer: Veterans Affairs TRICARE	$8.71

PULSE OX

Facility

$55.00

Service Code	CPT 94760
Hospital Charge Code	22331465
Hospital Revenue Code	460
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

PUMP TUBING INFUSION LINE

Facility

$121.20

Hospital Charge Code	27747576
Hospital Revenue Code	270
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$109.08
Rate for Payer: Aetna of AZ Commercial	$109.08
Rate for Payer: Arizona Complete Health Allwell	$19.39
Rate for Payer: Banner UC Health Medicare	$19.39
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$82.42
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.39
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.39
Rate for Payer: Cash Price	$96.96
Rate for Payer: Cigna of AZ Commercial	$84.84
Rate for Payer: Devoted Health Medicare	$21.82
Rate for Payer: Humana of AZ Medicare	$19.39
Rate for Payer: Southwest Service Administrators UFCW	$82.42
Rate for Payer: TriWest Medicare	$19.39
Rate for Payer: United Healthcare Commercial	$69.33
Rate for Payer: United Healthcare Medicare	$19.39
Rate for Payer: Veterans Affairs TRICARE	$19.20

PUMP TUBING INFUSION LINE

Facility

$121.20

Hospital Charge Code	27747576
Hospital Revenue Code	270
Min. Negotiated Rate	$109.08
Max. Negotiated Rate	$109.08
Rate for Payer: Aetna of AZ Commercial	$109.08
Rate for Payer: Cash Price	$96.96

PUNCH BIOPSY, FIRST SKIN GROWTH

Facility

$253.00

Service Code	CPT 11104
Hospital Charge Code	30512445
Hospital Revenue Code	360
Min. Negotiated Rate	$40.08
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$227.70
Rate for Payer: Arizona Complete Health Allwell	$40.48
Rate for Payer: Banner UC Health Medicare	$50.14
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$172.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$82.61
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.48
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cigna of AZ Commercial	$126.50
Rate for Payer: Devoted Health Medicare	$45.54
Rate for Payer: Humana of AZ Medicare	$40.48
Rate for Payer: Mercy Care Medicaid	$82.61
Rate for Payer: NaphCare Correctional Healthcare	$50.14
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: Southwest Service Administrators UFCW	$172.04
Rate for Payer: TriWest Medicare	$40.48
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$40.48
Rate for Payer: Veterans Affairs TRICARE	$40.08

PUNCH BIOPSY, FIRST SKIN GROWTH

Facility

$253.00

Service Code	CPT 11104
Hospital Charge Code	30512445
Hospital Revenue Code	360
Min. Negotiated Rate	$227.70
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of AZ Commercial	$227.70
Rate for Payer: Cash Price	$202.40

PURAFORCE COM 6X2

Facility

$6,563.00

Hospital Charge Code	27393136
Hospital Revenue Code	270
Min. Negotiated Rate	$1,039.58
Max. Negotiated Rate	$5,906.70
Rate for Payer: Aetna of AZ Commercial	$5,906.70
Rate for Payer: Arizona Complete Health Allwell	$1,050.08
Rate for Payer: Banner UC Health Medicare	$1,050.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,462.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,050.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,050.08
Rate for Payer: Cash Price	$5,250.40
Rate for Payer: Cigna of AZ Commercial	$4,594.10
Rate for Payer: Devoted Health Medicare	$1,181.34
Rate for Payer: Humana of AZ Medicare	$1,050.08
Rate for Payer: Southwest Service Administrators UFCW	$4,462.84
Rate for Payer: TriWest Medicare	$1,050.08
Rate for Payer: United Healthcare Commercial	$3,754.04
Rate for Payer: United Healthcare Medicare	$1,050.08
Rate for Payer: Veterans Affairs TRICARE	$1,039.58

PURAFORCE COM 6X2

Facility

$6,563.00

Hospital Charge Code	27393136
Hospital Revenue Code	270
Min. Negotiated Rate	$5,906.70
Max. Negotiated Rate	$5,906.70
Rate for Payer: Aetna of AZ Commercial	$5,906.70
Rate for Payer: Cash Price	$5,250.40

PURAPLAY AM 3X4 FENESTRATED

Facility

$880.00

Service Code	HCPCS Q4196
Hospital Charge Code	24358090
Hospital Revenue Code	636
Min. Negotiated Rate	$139.39
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna of AZ Commercial	$792.00
Rate for Payer: Arizona Complete Health Allwell	$140.80
Rate for Payer: Banner UC Health Medicare	$140.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$598.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$140.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$140.80
Rate for Payer: Cash Price	$704.00
Rate for Payer: Cash Price	$704.00
Rate for Payer: Cigna of AZ Commercial	$616.00
Rate for Payer: Devoted Health Medicare	$158.40
Rate for Payer: Humana of AZ Medicare	$140.80
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$598.40
Rate for Payer: TriWest Medicare	$140.80
Rate for Payer: United Healthcare Commercial	$503.36
Rate for Payer: United Healthcare Medicare	$140.80
Rate for Payer: United Healthcare New Mexico Commercial	$167.20
Rate for Payer: Veterans Affairs TRICARE	$139.39

Know your out-of-pocket cost for care.

All Charges