Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Schizophrenia

Facility

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$4,857.20
Max. Negotiated Rate	$4,857.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,857.20
Rate for Payer: Mercy Care Medicaid	$4,857.20
Rate for Payer: NaphCare Correctional Healthcare	$4,857.20

Schizophrenia

Facility

$4,006.40

Service Code	APR-DRG 7501
Hospital Charge Code	APRDRG7502
Min. Negotiated Rate	$4,006.40
Max. Negotiated Rate	$4,006.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,006.40
Rate for Payer: Mercy Care Medicaid	$4,006.40
Rate for Payer: NaphCare Correctional Healthcare	$4,006.40

Schizophrenia

Facility

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7502
Min. Negotiated Rate	$8,111.69
Max. Negotiated Rate	$8,111.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,111.69
Rate for Payer: Mercy Care Medicaid	$8,111.69
Rate for Payer: NaphCare Correctional Healthcare	$8,111.69

Schizophrenia

Facility

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7501
Min. Negotiated Rate	$8,111.69
Max. Negotiated Rate	$8,111.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,111.69
Rate for Payer: Mercy Care Medicaid	$8,111.69
Rate for Payer: NaphCare Correctional Healthcare	$8,111.69

Schizophrenia

Facility

$17,732.79

Service Code	APR-DRG 7504
Hospital Charge Code	APRDRG7504
Min. Negotiated Rate	$17,732.79
Max. Negotiated Rate	$17,732.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,732.79
Rate for Payer: Mercy Care Medicaid	$17,732.79
Rate for Payer: NaphCare Correctional Healthcare	$17,732.79

Schizophrenia

Facility

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7504
Min. Negotiated Rate	$8,111.69
Max. Negotiated Rate	$8,111.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,111.69
Rate for Payer: Mercy Care Medicaid	$8,111.69
Rate for Payer: NaphCare Correctional Healthcare	$8,111.69

Schizophrenia

Facility

$17,732.79

Service Code	APR-DRG 7504
Hospital Charge Code	APRDRG7501
Min. Negotiated Rate	$17,732.79
Max. Negotiated Rate	$17,732.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,732.79
Rate for Payer: Mercy Care Medicaid	$17,732.79
Rate for Payer: NaphCare Correctional Healthcare	$17,732.79

Schizophrenia

Facility

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7501
Min. Negotiated Rate	$4,857.20
Max. Negotiated Rate	$4,857.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,857.20
Rate for Payer: Mercy Care Medicaid	$4,857.20
Rate for Payer: NaphCare Correctional Healthcare	$4,857.20

Schizophrenia

Facility

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7504
Min. Negotiated Rate	$4,857.20
Max. Negotiated Rate	$4,857.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,857.20
Rate for Payer: Mercy Care Medicaid	$4,857.20
Rate for Payer: NaphCare Correctional Healthcare	$4,857.20

Schizophrenia

Facility

$17,732.79

Service Code	APR-DRG 7504
Hospital Charge Code	APRDRG7502
Min. Negotiated Rate	$17,732.79
Max. Negotiated Rate	$17,732.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,732.79
Rate for Payer: Mercy Care Medicaid	$17,732.79
Rate for Payer: NaphCare Correctional Healthcare	$17,732.79

Schizophrenia

Facility

$8,111.69

Service Code	APR-DRG 7503
Hospital Charge Code	APRDRG7503
Min. Negotiated Rate	$8,111.69
Max. Negotiated Rate	$8,111.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,111.69
Rate for Payer: Mercy Care Medicaid	$8,111.69
Rate for Payer: NaphCare Correctional Healthcare	$8,111.69

Schizophrenia

Facility

$4,857.20

Service Code	APR-DRG 7502
Hospital Charge Code	APRDRG7502
Min. Negotiated Rate	$4,857.20
Max. Negotiated Rate	$4,857.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,857.20
Rate for Payer: Mercy Care Medicaid	$4,857.20
Rate for Payer: NaphCare Correctional Healthcare	$4,857.20

SCOPE VALET PULL THRU

Facility

$9.00

Hospital Charge Code	22619551
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

SCOPE VALET PULL THRU

Facility

$9.00

Hospital Charge Code	22619551
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

scopolamine transdermal 1.5 mg patch [CQCH]

Facility

$9.86

Service Code	NDC 10019055303
Hospital Charge Code	109866964
Hospital Revenue Code	250
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna of AZ Commercial	$8.87
Rate for Payer: Cash Price	$7.89

scopolamine transdermal 1.5 mg patch [CQCH]

Facility

$9.86

Service Code	NDC 10019055303
Hospital Charge Code	109866964
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna of AZ Commercial	$8.87
Rate for Payer: Arizona Complete Health Allwell	$1.58
Rate for Payer: Banner UC Health Medicare	$1.58
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.70
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.58
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.58
Rate for Payer: Cash Price	$7.89
Rate for Payer: Cigna of AZ Commercial	$6.41
Rate for Payer: Devoted Health Medicare	$1.77
Rate for Payer: Humana of AZ Medicare	$1.58
Rate for Payer: Southwest Service Administrators UFCW	$6.70
Rate for Payer: TriWest Medicare	$1.58
Rate for Payer: United Healthcare Commercial	$5.64
Rate for Payer: United Healthcare Medicare	$1.58
Rate for Payer: Veterans Affairs TRICARE	$1.56

S CURVE URETHERAL DILATOR SET

Facility

$1,175.00

Hospital Charge Code	27748909
Hospital Revenue Code	270
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,057.50
Rate for Payer: Aetna of AZ Commercial	$1,057.50
Rate for Payer: Cash Price	$940.00

S CURVE URETHERAL DILATOR SET

Facility

$1,175.00

Hospital Charge Code	27748909
Hospital Revenue Code	270
Min. Negotiated Rate	$186.12
Max. Negotiated Rate	$1,057.50
Rate for Payer: Aetna of AZ Commercial	$1,057.50
Rate for Payer: Arizona Complete Health Allwell	$188.00
Rate for Payer: Banner UC Health Medicare	$188.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$799.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$188.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$188.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cigna of AZ Commercial	$822.50
Rate for Payer: Devoted Health Medicare	$211.50
Rate for Payer: Humana of AZ Medicare	$188.00
Rate for Payer: Southwest Service Administrators UFCW	$799.00
Rate for Payer: TriWest Medicare	$188.00
Rate for Payer: United Healthcare Commercial	$672.10
Rate for Payer: United Healthcare Medicare	$188.00
Rate for Payer: Veterans Affairs TRICARE	$186.12

SEAL PORT BIOPSY ADJUSTABLE

Facility

$79.00

Hospital Charge Code	22354139
Hospital Revenue Code	270
Min. Negotiated Rate	$12.51
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Arizona Complete Health Allwell	$12.64
Rate for Payer: Banner UC Health Medicare	$12.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.64
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$55.30
Rate for Payer: Devoted Health Medicare	$14.22
Rate for Payer: Humana of AZ Medicare	$12.64
Rate for Payer: Southwest Service Administrators UFCW	$53.72
Rate for Payer: TriWest Medicare	$12.64
Rate for Payer: United Healthcare Commercial	$45.19
Rate for Payer: United Healthcare Medicare	$12.64
Rate for Payer: Veterans Affairs TRICARE	$12.51

SEAL PORT BIOPSY ADJUSTABLE

Facility

$79.00

Hospital Charge Code	22354139
Hospital Revenue Code	270
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Cash Price	$63.20

Sedimentation Rate

Facility

$30.00

Service Code	CPT 85652
Hospital Charge Code	633830
Hospital Revenue Code	300
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$27.20

Sedimentation Rate

Facility

$34.00

Service Code	CPT 85652
Hospital Charge Code	633830
Hospital Revenue Code	300
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Arizona Complete Health Allwell	$4.80
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$20.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.44
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$22.10
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Devoted Health Medicare	$5.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Seven Corners Travel Insurance	$3.92
Rate for Payer: Seven Corners Travel Insurance	$3.92
Rate for Payer: Southwest Service Administrators UFCW	$20.40
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Commercial	$17.16
Rate for Payer: United Healthcare Medicare	$4.80
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39
Rate for Payer: Veterans Affairs TRICARE	$4.75

Seizure

Facility

$4,510.70

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG0534
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70
Rate for Payer: NaphCare Correctional Healthcare	$4,510.70

Seizure

Facility

$4,510.70

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG0531
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70
Rate for Payer: NaphCare Correctional Healthcare	$4,510.70

Seizure

Facility

$3,695.68

Service Code	APR-DRG 0531
Hospital Charge Code	APRDRG0532
Min. Negotiated Rate	$3,695.68
Max. Negotiated Rate	$3,695.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,695.68
Rate for Payer: Mercy Care Medicaid	$3,695.68
Rate for Payer: NaphCare Correctional Healthcare	$3,695.68

Know your out-of-pocket cost for care.

All Charges