Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80
Rate for Payer: NaphCare Correctional Healthcare	$9,069.80

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80
Rate for Payer: NaphCare Correctional Healthcare	$9,069.80

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46
Rate for Payer: NaphCare Correctional Healthcare	$4,438.46

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90
Rate for Payer: NaphCare Correctional Healthcare	$3,955.90

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90
Rate for Payer: NaphCare Correctional Healthcare	$3,955.90

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80
Rate for Payer: NaphCare Correctional Healthcare	$9,069.80

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90
Rate for Payer: NaphCare Correctional Healthcare	$3,955.90

Syncope And Collapse

Facility

$5,625.23

Service Code	APR-DRG 2043
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$5,625.23
Max. Negotiated Rate	$5,625.23
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23
Rate for Payer: NaphCare Correctional Healthcare	$5,625.23

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46
Rate for Payer: NaphCare Correctional Healthcare	$4,438.46

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46
Rate for Payer: NaphCare Correctional Healthcare	$4,438.46

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46
Rate for Payer: NaphCare Correctional Healthcare	$4,438.46

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90
Rate for Payer: NaphCare Correctional Healthcare	$3,955.90

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80
Rate for Payer: NaphCare Correctional Healthcare	$9,069.80

SYNCOPE AND COLLAPSE

Facility

$11,399.64

Service Code	MSDRG 312
Min. Negotiated Rate	$11,399.64
Max. Negotiated Rate	$11,399.64
Rate for Payer: Seven Corners Travel Insurance	$11,399.64

Synovial Fluid Cell Count Standard

Facility

$95.00

Service Code	CPT 89051
Hospital Charge Code	22309857
Hospital Revenue Code	309
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Arizona Complete Health Allwell	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$64.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.20
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$61.75
Rate for Payer: Devoted Health Medicare	$17.10
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Seven Corners Travel Insurance	$8.12
Rate for Payer: Southwest Service Administrators UFCW	$64.60
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: United Healthcare Commercial	$54.34
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: Veterans Affairs TRICARE	$15.05

Synovial Fluid Cell Count Standard

Facility

$95.00

Service Code	CPT 89051
Hospital Charge Code	22309857
Hospital Revenue Code	309
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Cash Price	$76.00

SYR ASEPTO

Facility

$7.00

Service Code	HCPCS A4322
Hospital Charge Code	22354240
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Cash Price	$5.60

SYR ASEPTO

Facility

$7.00

Service Code	HCPCS A4322
Hospital Charge Code	22354240
Hospital Revenue Code	270
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Arizona Complete Health Allwell	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.12
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cigna of AZ Commercial	$4.90
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Southwest Service Administrators UFCW	$4.76
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: United Healthcare Commercial	$4.00
Rate for Payer: United Healthcare Medicare	$1.12
Rate for Payer: Veterans Affairs TRICARE	$1.11

.T3Free LC

Facility

$475.00

Service Code	CPT 84481
Hospital Charge Code	22531069
Hospital Revenue Code	302
Min. Negotiated Rate	$427.50
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Cash Price	$380.00

.T3Free LC

Facility

$475.00

Service Code	CPT 84481
Hospital Charge Code	22531069
Hospital Revenue Code	302
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Arizona Complete Health Allwell	$76.00
Rate for Payer: Banner UC Health Medicare	$76.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$323.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cigna of AZ Commercial	$308.75
Rate for Payer: Devoted Health Medicare	$85.50
Rate for Payer: Humana of AZ Medicare	$76.00
Rate for Payer: Seven Corners Travel Insurance	$24.56
Rate for Payer: Southwest Service Administrators UFCW	$323.00
Rate for Payer: TriWest Medicare	$76.00
Rate for Payer: United Healthcare Commercial	$271.70
Rate for Payer: United Healthcare Medicare	$76.00
Rate for Payer: Veterans Affairs TRICARE	$75.24

T3, Total

Facility

$245.00

Service Code	CPT 84480
Hospital Charge Code	1281222
Hospital Revenue Code	301
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Cash Price	$196.00

T3, Total

Facility

$245.00

Service Code	CPT 84480
Hospital Charge Code	1281222
Hospital Revenue Code	301
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Arizona Complete Health Allwell	$39.20
Rate for Payer: Banner UC Health Medicare	$39.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$166.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.20
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cigna of AZ Commercial	$159.25
Rate for Payer: Devoted Health Medicare	$44.10
Rate for Payer: Humana of AZ Medicare	$39.20
Rate for Payer: Seven Corners Travel Insurance	$20.56
Rate for Payer: Southwest Service Administrators UFCW	$166.60
Rate for Payer: TriWest Medicare	$39.20
Rate for Payer: United Healthcare Commercial	$140.14
Rate for Payer: United Healthcare Medicare	$39.20
Rate for Payer: Veterans Affairs TRICARE	$38.81

T3 Uptake LC

Facility

$175.00

Service Code	CPT 84479
Hospital Charge Code	1285538
Hospital Revenue Code	301
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Arizona Complete Health Allwell	$28.00
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Banner UC Health Medicare	$28.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$119.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$113.75
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Devoted Health Medicare	$31.50
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Humana of AZ Medicare	$28.00
Rate for Payer: Seven Corners Travel Insurance	$9.38
Rate for Payer: Seven Corners Travel Insurance	$9.38
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: Southwest Service Administrators UFCW	$119.00
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: TriWest Medicare	$28.00
Rate for Payer: United Healthcare Commercial	$100.10
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: United Healthcare Medicare	$28.00
Rate for Payer: Veterans Affairs TRICARE	$27.72
Rate for Payer: Veterans Affairs TRICARE	$19.64

T3 Uptake LC

Facility

$124.00

Service Code	CPT 84479
Hospital Charge Code	1285538
Hospital Revenue Code	301
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$140.00

T4, Total

Facility

$116.00

Service Code	CPT 84436
Hospital Charge Code	1281223
Hospital Revenue Code	301
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Cash Price	$92.80

Know your out-of-pocket cost for care.

All Charges