Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 7.6 cm t

Facility

$414.00

Service Code	CPT 12004
Hospital Charge Code	713871
Hospital Revenue Code	521
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$372.60
Rate for Payer: Aetna of AZ Commercial	$372.60
Rate for Payer: Arizona Complete Health Allwell	$66.24
Rate for Payer: Banner UC Health Medicare	$66.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$281.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$62.94
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.24
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cigna of AZ Commercial	$289.80
Rate for Payer: Devoted Health Medicare	$74.52
Rate for Payer: Humana of AZ Medicare	$66.24
Rate for Payer: Mercy Care Medicaid	$62.94
Rate for Payer: NaphCare Correctional Healthcare	$62.94
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$281.52
Rate for Payer: TriWest Medicare	$66.24
Rate for Payer: United Healthcare Commercial	$236.81
Rate for Payer: United Healthcare Medicare	$66.24
Rate for Payer: Veterans Affairs TRICARE	$65.58

RESCUENET RETRIEVAL NET

Facility

$446.00

Hospital Charge Code	27497393
Hospital Revenue Code	270
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$401.40
Rate for Payer: Aetna of AZ Commercial	$401.40
Rate for Payer: Arizona Complete Health Allwell	$71.36
Rate for Payer: Banner UC Health Medicare	$71.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$303.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$71.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$71.36
Rate for Payer: Cash Price	$356.80
Rate for Payer: Cigna of AZ Commercial	$312.20
Rate for Payer: Devoted Health Medicare	$80.28
Rate for Payer: Humana of AZ Medicare	$71.36
Rate for Payer: Southwest Service Administrators UFCW	$303.28
Rate for Payer: TriWest Medicare	$71.36
Rate for Payer: United Healthcare Commercial	$255.11
Rate for Payer: United Healthcare Medicare	$71.36
Rate for Payer: Veterans Affairs TRICARE	$70.65

RESCUENET RETRIEVAL NET

Facility

$349.00

Hospital Charge Code	23839570
Hospital Revenue Code	270
Min. Negotiated Rate	$314.10
Max. Negotiated Rate	$314.10
Rate for Payer: Aetna of AZ Commercial	$314.10
Rate for Payer: Cash Price	$279.20

RESCUENET RETRIEVAL NET

Facility

$446.00

Hospital Charge Code	27497393
Hospital Revenue Code	270
Min. Negotiated Rate	$401.40
Max. Negotiated Rate	$401.40
Rate for Payer: Aetna of AZ Commercial	$401.40
Rate for Payer: Cash Price	$356.80

RESCUENET RETRIEVAL NET

Facility

$349.00

Hospital Charge Code	23839570
Hospital Revenue Code	270
Min. Negotiated Rate	$55.28
Max. Negotiated Rate	$314.10
Rate for Payer: Aetna of AZ Commercial	$314.10
Rate for Payer: Arizona Complete Health Allwell	$55.84
Rate for Payer: Banner UC Health Medicare	$55.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$237.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$55.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$55.84
Rate for Payer: Cash Price	$279.20
Rate for Payer: Cigna of AZ Commercial	$244.30
Rate for Payer: Devoted Health Medicare	$62.82
Rate for Payer: Humana of AZ Medicare	$55.84
Rate for Payer: Southwest Service Administrators UFCW	$237.32
Rate for Payer: TriWest Medicare	$55.84
Rate for Payer: United Healthcare Commercial	$199.63
Rate for Payer: United Healthcare Medicare	$55.84
Rate for Payer: Veterans Affairs TRICARE	$55.28

RESECTOR SHAVER BLADE 3MM

Facility

$236.00

Hospital Charge Code	25519687
Hospital Revenue Code	270
Min. Negotiated Rate	$212.40
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Cash Price	$188.80

RESECTOR SHAVER BLADE 3MM

Facility

$236.00

Hospital Charge Code	25519687
Hospital Revenue Code	270
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Arizona Complete Health Allwell	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$160.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.76
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$165.20
Rate for Payer: Devoted Health Medicare	$42.48
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Southwest Service Administrators UFCW	$160.48
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: United Healthcare Commercial	$134.99
Rate for Payer: United Healthcare Medicare	$37.76
Rate for Payer: Veterans Affairs TRICARE	$37.38

RESECTOR SHAVER BLADE 4MM

Facility

$236.00

Hospital Charge Code	25519688
Hospital Revenue Code	270
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Arizona Complete Health Allwell	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$160.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.76
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$165.20
Rate for Payer: Devoted Health Medicare	$42.48
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Southwest Service Administrators UFCW	$160.48
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: United Healthcare Commercial	$134.99
Rate for Payer: United Healthcare Medicare	$37.76
Rate for Payer: Veterans Affairs TRICARE	$37.38

RESECTOR SHAVER BLADE 4MM

Facility

$236.00

Hospital Charge Code	25519688
Hospital Revenue Code	270
Min. Negotiated Rate	$212.40
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Cash Price	$188.80

RESOLUTION 360 CLIP

Facility

$676.00

Hospital Charge Code	23635627
Min. Negotiated Rate	$107.08
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Arizona Complete Health Allwell	$108.16
Rate for Payer: Banner UC Health Medicare	$108.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$459.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$108.16
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cigna of AZ Commercial	$473.20
Rate for Payer: Devoted Health Medicare	$121.68
Rate for Payer: Humana of AZ Medicare	$108.16
Rate for Payer: Southwest Service Administrators UFCW	$459.68
Rate for Payer: TriWest Medicare	$108.16
Rate for Payer: United Healthcare Commercial	$386.67
Rate for Payer: United Healthcare Medicare	$108.16
Rate for Payer: Veterans Affairs TRICARE	$107.08

RESOLUTION 360 CLIP

Facility

$676.00

Hospital Charge Code	23635627
Min. Negotiated Rate	$608.40
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Cash Price	$540.80

Resolution Clip

Facility

$838.00

Hospital Charge Code	22926472
Hospital Revenue Code	272
Min. Negotiated Rate	$754.20
Max. Negotiated Rate	$754.20
Rate for Payer: Aetna of AZ Commercial	$754.20
Rate for Payer: Cash Price	$670.40

Resolution Clip

Facility

$838.00

Hospital Charge Code	22926472
Hospital Revenue Code	272
Min. Negotiated Rate	$132.74
Max. Negotiated Rate	$754.20
Rate for Payer: Aetna of AZ Commercial	$754.20
Rate for Payer: Arizona Complete Health Allwell	$134.08
Rate for Payer: Banner UC Health Medicare	$134.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$569.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$134.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$134.08
Rate for Payer: Cash Price	$670.40
Rate for Payer: Cigna of AZ Commercial	$586.60
Rate for Payer: Devoted Health Medicare	$150.84
Rate for Payer: Humana of AZ Medicare	$134.08
Rate for Payer: Southwest Service Administrators UFCW	$569.84
Rate for Payer: TriWest Medicare	$134.08
Rate for Payer: United Healthcare Commercial	$479.34
Rate for Payer: United Healthcare Medicare	$134.08
Rate for Payer: Veterans Affairs TRICARE	$132.74

Respiratory Failure

Facility

$12,428.81

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG1332
Min. Negotiated Rate	$12,428.81
Max. Negotiated Rate	$12,428.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,428.81
Rate for Payer: Mercy Care Medicaid	$12,428.81
Rate for Payer: NaphCare Correctional Healthcare	$12,428.81

Respiratory Failure

Facility

$7,082.04

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$7,082.04
Max. Negotiated Rate	$7,082.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,082.04
Rate for Payer: Mercy Care Medicaid	$7,082.04
Rate for Payer: NaphCare Correctional Healthcare	$7,082.04

Respiratory Failure

Facility

$4,633.45

Service Code	APR-DRG 1332
Hospital Charge Code	APRDRG1332
Min. Negotiated Rate	$4,633.45
Max. Negotiated Rate	$4,633.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,633.45
Rate for Payer: Mercy Care Medicaid	$4,633.45
Rate for Payer: NaphCare Correctional Healthcare	$4,633.45

Respiratory Failure

Facility

$12,428.81

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$12,428.81
Max. Negotiated Rate	$12,428.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,428.81
Rate for Payer: Mercy Care Medicaid	$12,428.81
Rate for Payer: NaphCare Correctional Healthcare	$12,428.81

Respiratory Failure

Facility

$2,807.70

Service Code	APR-DRG 1331
Hospital Charge Code	APRDRG1333
Min. Negotiated Rate	$2,807.70
Max. Negotiated Rate	$2,807.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,807.70
Rate for Payer: Mercy Care Medicaid	$2,807.70
Rate for Payer: NaphCare Correctional Healthcare	$2,807.70

Respiratory Failure

Facility

$7,082.04

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG1331
Min. Negotiated Rate	$7,082.04
Max. Negotiated Rate	$7,082.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,082.04
Rate for Payer: Mercy Care Medicaid	$7,082.04
Rate for Payer: NaphCare Correctional Healthcare	$7,082.04

Respiratory Failure

Facility

$4,633.45

Service Code	APR-DRG 1332
Hospital Charge Code	APRDRG1331
Min. Negotiated Rate	$4,633.45
Max. Negotiated Rate	$4,633.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,633.45
Rate for Payer: Mercy Care Medicaid	$4,633.45
Rate for Payer: NaphCare Correctional Healthcare	$4,633.45

Respiratory Failure

Facility

$2,807.70

Service Code	APR-DRG 1331
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$2,807.70
Max. Negotiated Rate	$2,807.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,807.70
Rate for Payer: Mercy Care Medicaid	$2,807.70
Rate for Payer: NaphCare Correctional Healthcare	$2,807.70

Respiratory Failure

Facility

$2,807.70

Service Code	APR-DRG 1331
Hospital Charge Code	APRDRG1332
Min. Negotiated Rate	$2,807.70
Max. Negotiated Rate	$2,807.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,807.70
Rate for Payer: Mercy Care Medicaid	$2,807.70
Rate for Payer: NaphCare Correctional Healthcare	$2,807.70

Respiratory Failure

Facility

$7,082.04

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG1333
Min. Negotiated Rate	$7,082.04
Max. Negotiated Rate	$7,082.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,082.04
Rate for Payer: Mercy Care Medicaid	$7,082.04
Rate for Payer: NaphCare Correctional Healthcare	$7,082.04

Respiratory Failure

Facility

$12,428.81

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG1333
Min. Negotiated Rate	$12,428.81
Max. Negotiated Rate	$12,428.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,428.81
Rate for Payer: Mercy Care Medicaid	$12,428.81
Rate for Payer: NaphCare Correctional Healthcare	$12,428.81

Respiratory Failure

Facility

$4,633.45

Service Code	APR-DRG 1332
Hospital Charge Code	APRDRG1334
Min. Negotiated Rate	$4,633.45
Max. Negotiated Rate	$4,633.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,633.45
Rate for Payer: Mercy Care Medicaid	$4,633.45
Rate for Payer: NaphCare Correctional Healthcare	$4,633.45

Know your out-of-pocket cost for care.

All Charges