Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25
Rate for Payer: NaphCare Correctional Healthcare	$9,792.25

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02
Rate for Payer: NaphCare Correctional Healthcare	$15,792.02

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02
Rate for Payer: NaphCare Correctional Healthcare	$15,792.02

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78
Rate for Payer: NaphCare Correctional Healthcare	$7,453.78

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81
Rate for Payer: NaphCare Correctional Healthcare	$12,529.81

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78
Rate for Payer: NaphCare Correctional Healthcare	$7,453.78

Rehabilitation

Facility

$15,792.02

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$15,792.02
Max. Negotiated Rate	$15,792.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,792.02
Rate for Payer: Mercy Care Medicaid	$15,792.02
Rate for Payer: NaphCare Correctional Healthcare	$15,792.02

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8602
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81
Rate for Payer: NaphCare Correctional Healthcare	$12,529.81

Rehabilitation

Facility

$7,453.78

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG8604
Min. Negotiated Rate	$7,453.78
Max. Negotiated Rate	$7,453.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,453.78
Rate for Payer: Mercy Care Medicaid	$7,453.78
Rate for Payer: NaphCare Correctional Healthcare	$7,453.78

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25
Rate for Payer: NaphCare Correctional Healthcare	$9,792.25

Rehabilitation

Facility

$12,529.81

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG8601
Min. Negotiated Rate	$12,529.81
Max. Negotiated Rate	$12,529.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,529.81
Rate for Payer: Mercy Care Medicaid	$12,529.81
Rate for Payer: NaphCare Correctional Healthcare	$12,529.81

Rehabilitation

Facility

$9,792.25

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG8603
Min. Negotiated Rate	$9,792.25
Max. Negotiated Rate	$9,792.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,792.25
Rate for Payer: Mercy Care Medicaid	$9,792.25
Rate for Payer: NaphCare Correctional Healthcare	$9,792.25

REHABILITATION WITH CC/MCC

Facility

$20,014.31

Service Code	MSDRG 945
Min. Negotiated Rate	$20,014.31
Max. Negotiated Rate	$20,014.31
Rate for Payer: Seven Corners Travel Insurance	$20,014.31

REHABILITATION WITHOUT CC/MCC

Facility

$14,886.76

Service Code	MSDRG 946
Min. Negotiated Rate	$14,886.76
Max. Negotiated Rate	$14,886.76
Rate for Payer: Seven Corners Travel Insurance	$14,886.76

RELEASE OF SCAR TISSUE OF URETHRA USING AN ENDOSCOPE

Facility

$3,841.00

Service Code	CPT 53500
Hospital Charge Code	28259371
Hospital Revenue Code	360
Min. Negotiated Rate	$3,456.90
Max. Negotiated Rate	$3,456.90
Rate for Payer: Aetna of AZ Commercial	$3,456.90
Rate for Payer: Cash Price	$3,072.80

RELEASE OF SCAR TISSUE OF URETHRA USING AN ENDOSCOPE

Facility

$3,841.00

Service Code	CPT 53500
Hospital Charge Code	28259371
Hospital Revenue Code	360
Min. Negotiated Rate	$608.41
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$3,456.90
Rate for Payer: Arizona Complete Health Allwell	$614.56
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,611.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$614.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$614.56
Rate for Payer: Cash Price	$3,072.80
Rate for Payer: Cash Price	$3,072.80
Rate for Payer: Cash Price	$3,072.80
Rate for Payer: Cigna of AZ Commercial	$1,920.50
Rate for Payer: Devoted Health Medicare	$691.38
Rate for Payer: Humana of AZ Medicare	$614.56
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$2,611.88
Rate for Payer: TriWest Medicare	$614.56
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$614.56
Rate for Payer: Veterans Affairs TRICARE	$608.41

RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

Facility

$1,737.00

Service Code	CPT 28035
Hospital Charge Code	24043317
Hospital Revenue Code	360
Min. Negotiated Rate	$167.36
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,563.30
Rate for Payer: Arizona Complete Health Allwell	$277.92
Rate for Payer: Banner UC Health Medicare	$556.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,181.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$167.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$277.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$277.92
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cigna of AZ Commercial	$868.50
Rate for Payer: Devoted Health Medicare	$312.66
Rate for Payer: Humana of AZ Medicare	$277.92
Rate for Payer: Mercy Care Medicaid	$167.36
Rate for Payer: NaphCare Correctional Healthcare	$556.61
Rate for Payer: Seven Corners Travel Insurance	$3,021.39
Rate for Payer: Southwest Service Administrators UFCW	$1,181.16
Rate for Payer: TriWest Medicare	$277.92
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$277.92
Rate for Payer: Veterans Affairs TRICARE	$275.14

RELEASE TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

Facility

$1,737.00

Service Code	CPT 28035
Hospital Charge Code	24043317
Hospital Revenue Code	360
Min. Negotiated Rate	$1,563.30
Max. Negotiated Rate	$1,563.30
Rate for Payer: Aetna of AZ Commercial	$1,563.30
Rate for Payer: Cash Price	$1,389.60

Remdesivir injection 100 mg/20 ml Inj [CQCH]

Facility

$520.00

Service Code	NDC 61958290210
Hospital Charge Code	168146661
Hospital Revenue Code	250
Min. Negotiated Rate	$82.37
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Arizona Complete Health Allwell	$83.20
Rate for Payer: Banner UC Health Medicare	$83.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$353.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$83.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$83.20
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cigna of AZ Commercial	$338.00
Rate for Payer: Devoted Health Medicare	$93.60
Rate for Payer: Humana of AZ Medicare	$83.20
Rate for Payer: Southwest Service Administrators UFCW	$353.60
Rate for Payer: TriWest Medicare	$83.20
Rate for Payer: United Healthcare Commercial	$297.44
Rate for Payer: United Healthcare Medicare	$83.20
Rate for Payer: Veterans Affairs TRICARE	$82.37

Remdesivir injection 100 mg/20 ml Inj [CQCH]

Facility

$520.00

Service Code	NDC 61958290210
Hospital Charge Code	168146661
Hospital Revenue Code	250
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Cash Price	$416.00

Removal foreign body, intranasal; procedure charge

Facility

$477.00

Service Code	CPT 30300
Hospital Charge Code	749800
Hospital Revenue Code	521
Min. Negotiated Rate	$75.56
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of AZ Commercial	$429.30
Rate for Payer: Arizona Complete Health Allwell	$76.32
Rate for Payer: Banner UC Health Medicare	$76.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$324.36
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$91.55
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.32
Rate for Payer: Cash Price	$381.60
Rate for Payer: Cash Price	$381.60
Rate for Payer: Cigna of AZ Commercial	$333.90
Rate for Payer: Devoted Health Medicare	$85.86
Rate for Payer: Humana of AZ Medicare	$76.32
Rate for Payer: Mercy Care Medicaid	$91.55
Rate for Payer: NaphCare Correctional Healthcare	$91.55
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$324.36
Rate for Payer: TriWest Medicare	$76.32
Rate for Payer: United Healthcare Commercial	$272.84
Rate for Payer: United Healthcare Medicare	$76.32
Rate for Payer: Veterans Affairs TRICARE	$75.56

Removal foreign body, intranasal; procedure charge

Facility

$477.00

Service Code	CPT 30300
Hospital Charge Code	749800
Hospital Revenue Code	521
Min. Negotiated Rate	$429.30
Max. Negotiated Rate	$429.30
Rate for Payer: Aetna of AZ Commercial	$429.30
Rate for Payer: Cash Price	$381.60

REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES

Facility

$518.00

Service Code	CPT 11976
Hospital Charge Code	2609559
Min. Negotiated Rate	$466.20
Max. Negotiated Rate	$466.20
Rate for Payer: Aetna of AZ Commercial	$466.20
Rate for Payer: Cash Price	$414.40

REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES

Facility

$518.00

Service Code	CPT 11976
Hospital Charge Code	2609559
Min. Negotiated Rate	$55.79
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$466.20
Rate for Payer: Arizona Complete Health Allwell	$82.88
Rate for Payer: Banner UC Health Medicare	$82.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$352.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55.79
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$82.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$82.88
Rate for Payer: Cash Price	$414.40
Rate for Payer: Cash Price	$414.40
Rate for Payer: Cigna of AZ Commercial	$362.60
Rate for Payer: Devoted Health Medicare	$93.24
Rate for Payer: Humana of AZ Medicare	$82.88
Rate for Payer: Mercy Care Medicaid	$55.79
Rate for Payer: NaphCare Correctional Healthcare	$55.79
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$352.24
Rate for Payer: TriWest Medicare	$82.88
Rate for Payer: United Healthcare Commercial	$296.30
Rate for Payer: United Healthcare Medicare	$82.88
Rate for Payer: Veterans Affairs TRICARE	$82.05

Removal, non-biodegradable drug delivery implant

Facility

$2,671.00

Service Code	CPT 11982
Hospital Revenue Code	360
Min. Negotiated Rate	$40.41
Max. Negotiated Rate	$2,671.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40.41
Rate for Payer: Mercy Care Medicaid	$40.41
Rate for Payer: NaphCare Correctional Healthcare	$40.41
Rate for Payer: Seven Corners Travel Insurance	$691.20
Rate for Payer: United Healthcare Commercial	$2,671.00

Know your out-of-pocket cost for care.

All Charges