Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67
Rate for Payer: NaphCare Correctional Healthcare	$8,952.67

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67
Rate for Payer: NaphCare Correctional Healthcare	$8,952.67

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39
Rate for Payer: NaphCare Correctional Healthcare	$4,753.39

Viral Meningitis

Facility

$15,529.00

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$15,529.00
Max. Negotiated Rate	$15,529.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,529.00
Rate for Payer: Mercy Care Medicaid	$15,529.00
Rate for Payer: NaphCare Correctional Healthcare	$15,529.00

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39
Rate for Payer: NaphCare Correctional Healthcare	$4,753.39

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39
Rate for Payer: NaphCare Correctional Healthcare	$4,753.39

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0514
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49
Rate for Payer: NaphCare Correctional Healthcare	$3,153.49

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49
Rate for Payer: NaphCare Correctional Healthcare	$3,153.49

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49
Rate for Payer: NaphCare Correctional Healthcare	$3,153.49

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67
Rate for Payer: NaphCare Correctional Healthcare	$8,952.67

Viral Meningitis

Facility

$8,952.67

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$8,952.67
Max. Negotiated Rate	$8,952.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,952.67
Rate for Payer: Mercy Care Medicaid	$8,952.67
Rate for Payer: NaphCare Correctional Healthcare	$8,952.67

Viral Meningitis

Facility

$3,153.49

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG0512
Min. Negotiated Rate	$3,153.49
Max. Negotiated Rate	$3,153.49
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,153.49
Rate for Payer: Mercy Care Medicaid	$3,153.49
Rate for Payer: NaphCare Correctional Healthcare	$3,153.49

Viral Meningitis

Facility

$15,529.00

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG0511
Min. Negotiated Rate	$15,529.00
Max. Negotiated Rate	$15,529.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,529.00
Rate for Payer: Mercy Care Medicaid	$15,529.00
Rate for Payer: NaphCare Correctional Healthcare	$15,529.00

Viral Meningitis

Facility

$4,753.39

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG0513
Min. Negotiated Rate	$4,753.39
Max. Negotiated Rate	$4,753.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,753.39
Rate for Payer: Mercy Care Medicaid	$4,753.39
Rate for Payer: NaphCare Correctional Healthcare	$4,753.39

VIRAL MENINGITIS WITH CC/MCC

Facility

$24,782.05

Service Code	MSDRG 075
Min. Negotiated Rate	$24,782.05
Max. Negotiated Rate	$24,782.05
Rate for Payer: Seven Corners Travel Insurance	$24,782.05

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$10,811.69

Service Code	MSDRG 076
Min. Negotiated Rate	$10,811.69
Max. Negotiated Rate	$10,811.69
Rate for Payer: Seven Corners Travel Insurance	$10,811.69

VITALE SILICONE 6X7 WOUND DRESSING

Facility

$32.00

Hospital Charge Code	27569207
Hospital Revenue Code	270
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Arizona Complete Health Allwell	$5.12
Rate for Payer: Banner UC Health Medicare	$5.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$21.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.12
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$22.40
Rate for Payer: Devoted Health Medicare	$5.76
Rate for Payer: Humana of AZ Medicare	$5.12
Rate for Payer: Southwest Service Administrators UFCW	$21.76
Rate for Payer: TriWest Medicare	$5.12
Rate for Payer: United Healthcare Commercial	$18.30
Rate for Payer: United Healthcare Medicare	$5.12
Rate for Payer: Veterans Affairs TRICARE	$5.07

VITALE SILICONE 6X7 WOUND DRESSING

Facility

$32.00

Hospital Charge Code	27569207
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Cash Price	$25.60

vitamin A & D Top Oint UD 5 gm [CQCH]

Facility

$0.02

Service Code	NDC 57896011214
Hospital Charge Code	105945204
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Cash Price	$0.01

vitamin A & D Top Oint UD 5 gm [CQCH]

Facility

$0.02

Service Code	NDC 57896011214
Hospital Charge Code	105945204
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

Vitamin A, Serum LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	2029227
Hospital Revenue Code	301
Min. Negotiated Rate	$199.80
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Cash Price	$177.60

Vitamin A, Serum LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	2029227
Hospital Revenue Code	301
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Arizona Complete Health Allwell	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$150.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.52
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$144.30
Rate for Payer: Devoted Health Medicare	$39.96
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Seven Corners Travel Insurance	$16.83
Rate for Payer: Southwest Service Administrators UFCW	$150.96
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: United Healthcare Commercial	$126.98
Rate for Payer: United Healthcare Medicare	$35.52
Rate for Payer: Veterans Affairs TRICARE	$35.16

Vitamin B12/Folate Panel

Facility

$180.00

Service Code	CPT 82607
Hospital Charge Code	20183520
Hospital Revenue Code	301
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Cash Price	$144.00

Vitamin B12/Folate Panel

Facility

$180.00

Service Code	CPT 82607
Hospital Charge Code	20183520
Hospital Revenue Code	301
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Arizona Complete Health Allwell	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$122.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$117.00
Rate for Payer: Devoted Health Medicare	$32.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Seven Corners Travel Insurance	$21.87
Rate for Payer: Southwest Service Administrators UFCW	$122.40
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: United Healthcare Commercial	$102.96
Rate for Payer: United Healthcare Medicare	$28.80
Rate for Payer: Veterans Affairs TRICARE	$28.51

Vitamin B12 Level

Facility

$108.00

Service Code	CPT 82607
Hospital Charge Code	21254686
Hospital Revenue Code	301
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Cash Price	$86.40

Know your out-of-pocket cost for care.

All Charges