Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58
Rate for Payer: NaphCare Correctional Healthcare	$7,503.58

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68
Rate for Payer: NaphCare Correctional Healthcare	$16,471.68

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58
Rate for Payer: NaphCare Correctional Healthcare	$7,503.58

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68
Rate for Payer: NaphCare Correctional Healthcare	$16,471.68

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29
Rate for Payer: NaphCare Correctional Healthcare	$3,701.29

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68
Rate for Payer: NaphCare Correctional Healthcare	$16,471.68

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29
Rate for Payer: NaphCare Correctional Healthcare	$3,701.29

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29
Rate for Payer: NaphCare Correctional Healthcare	$3,701.29

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72
Rate for Payer: NaphCare Correctional Healthcare	$4,968.72

Sickle Cell Anemia Crisis

Facility

$16,471.68

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG6622
Min. Negotiated Rate	$16,471.68
Max. Negotiated Rate	$16,471.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,471.68
Rate for Payer: Mercy Care Medicaid	$16,471.68
Rate for Payer: NaphCare Correctional Healthcare	$16,471.68

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58
Rate for Payer: NaphCare Correctional Healthcare	$7,503.58

Sickle Cell Anemia Crisis

Facility

$7,503.58

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$7,503.58
Max. Negotiated Rate	$7,503.58
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,503.58
Rate for Payer: Mercy Care Medicaid	$7,503.58
Rate for Payer: NaphCare Correctional Healthcare	$7,503.58

Sickle Cell Anemia Crisis

Facility

$3,701.29

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$3,701.29
Max. Negotiated Rate	$3,701.29
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,701.29
Rate for Payer: Mercy Care Medicaid	$3,701.29
Rate for Payer: NaphCare Correctional Healthcare	$3,701.29

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6621
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72
Rate for Payer: NaphCare Correctional Healthcare	$4,968.72

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6623
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72
Rate for Payer: NaphCare Correctional Healthcare	$4,968.72

Sickle Cell Anemia Crisis

Facility

$4,968.72

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG6624
Min. Negotiated Rate	$4,968.72
Max. Negotiated Rate	$4,968.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,968.72
Rate for Payer: Mercy Care Medicaid	$4,968.72
Rate for Payer: NaphCare Correctional Healthcare	$4,968.72

SIGMOIDOSCOPY

Facility

$379.00

Service Code	CPT 45330
Hospital Charge Code	1015557
Hospital Revenue Code	750
Min. Negotiated Rate	$341.10
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Cash Price	$303.20

SIGMOIDOSCOPY

Facility

$379.00

Service Code	CPT 45330
Hospital Charge Code	1015557
Hospital Revenue Code	750
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$3,098.00
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Arizona Complete Health Allwell	$60.64
Rate for Payer: Banner UC Health Medicare	$101.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$257.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$131.45
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.64
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$265.30
Rate for Payer: Devoted Health Medicare	$68.22
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Mercy Care Medicaid	$131.45
Rate for Payer: NaphCare Correctional Healthcare	$101.20
Rate for Payer: Seven Corners Travel Insurance	$1,438.89
Rate for Payer: Southwest Service Administrators UFCW	$257.72
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$60.64
Rate for Payer: United Healthcare New Mexico Commercial	$72.01
Rate for Payer: Veterans Affairs TRICARE	$60.03

Sigmoidoscopy, flexible; with biopsy, single or multiple

Facility

$3,098.00

Service Code	CPT 45331
Hospital Revenue Code	750
Min. Negotiated Rate	$212.34
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$297.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$212.34
Rate for Payer: Mercy Care Medicaid	$212.34
Rate for Payer: NaphCare Correctional Healthcare	$297.60
Rate for Payer: Seven Corners Travel Insurance	$1,438.89
Rate for Payer: United Healthcare Commercial	$3,098.00

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$17,104.21

Service Code	MSDRG 555
Min. Negotiated Rate	$17,104.21
Max. Negotiated Rate	$17,104.21
Rate for Payer: Seven Corners Travel Insurance	$17,104.21

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$10,880.12

Service Code	MSDRG 556
Min. Negotiated Rate	$10,880.12
Max. Negotiated Rate	$10,880.12
Rate for Payer: Seven Corners Travel Insurance	$10,880.12

SIGNS AND SYMPTOMS WITH MCC

Facility

$16,440.22

Service Code	MSDRG 947
Min. Negotiated Rate	$16,440.22
Max. Negotiated Rate	$16,440.22
Rate for Payer: Seven Corners Travel Insurance	$16,440.22

SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$10,498.70

Service Code	MSDRG 948
Min. Negotiated Rate	$10,498.70
Max. Negotiated Rate	$10,498.70
Rate for Payer: Seven Corners Travel Insurance	$10,498.70

Signs, Symptoms And Other Factors Influencing Health Status

Facility

$4,167.02

Service Code	APR-DRG 8612
Hospital Charge Code	APRDRG8612
Min. Negotiated Rate	$4,167.02
Max. Negotiated Rate	$4,167.02
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,167.02
Rate for Payer: Mercy Care Medicaid	$4,167.02
Rate for Payer: NaphCare Correctional Healthcare	$4,167.02

Signs, Symptoms And Other Factors Influencing Health Status

Facility

$9,865.19

Service Code	APR-DRG 8614
Hospital Charge Code	APRDRG8611
Min. Negotiated Rate	$9,865.19
Max. Negotiated Rate	$9,865.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,865.19
Rate for Payer: Mercy Care Medicaid	$9,865.19
Rate for Payer: NaphCare Correctional Healthcare	$9,865.19

Know your out-of-pocket cost for care.

All Charges