Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Adrenal Procedures

Facility

$8,435.74

Service Code	APR-DRG 4011
Hospital Charge Code	APRDRG4014
Min. Negotiated Rate	$8,435.74
Max. Negotiated Rate	$8,435.74
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,435.74
Rate for Payer: Mercy Care Medicaid	$8,435.74
Rate for Payer: NaphCare Correctional Healthcare	$8,435.74

Adrenal Procedures

Facility

$16,455.55

Service Code	APR-DRG 4012
Hospital Charge Code	APRDRG4012
Min. Negotiated Rate	$16,455.55
Max. Negotiated Rate	$16,455.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,455.55
Rate for Payer: Mercy Care Medicaid	$16,455.55
Rate for Payer: NaphCare Correctional Healthcare	$16,455.55

Adrenal Procedures

Facility

$8,435.74

Service Code	APR-DRG 4011
Hospital Charge Code	APRDRG4013
Min. Negotiated Rate	$8,435.74
Max. Negotiated Rate	$8,435.74
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,435.74
Rate for Payer: Mercy Care Medicaid	$8,435.74
Rate for Payer: NaphCare Correctional Healthcare	$8,435.74

Adrenal Procedures

Facility

$27,535.56

Service Code	APR-DRG 4014
Hospital Charge Code	APRDRG4014
Min. Negotiated Rate	$27,535.56
Max. Negotiated Rate	$27,535.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,535.56
Rate for Payer: Mercy Care Medicaid	$27,535.56
Rate for Payer: NaphCare Correctional Healthcare	$27,535.56

Adrenal Procedures

Facility

$8,435.74

Service Code	APR-DRG 4011
Hospital Charge Code	APRDRG4011
Min. Negotiated Rate	$8,435.74
Max. Negotiated Rate	$8,435.74
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,435.74
Rate for Payer: Mercy Care Medicaid	$8,435.74
Rate for Payer: NaphCare Correctional Healthcare	$8,435.74

Adrenal Procedures

Facility

$22,228.77

Service Code	APR-DRG 4013
Hospital Charge Code	APRDRG4014
Min. Negotiated Rate	$22,228.77
Max. Negotiated Rate	$22,228.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,228.77
Rate for Payer: Mercy Care Medicaid	$22,228.77
Rate for Payer: NaphCare Correctional Healthcare	$22,228.77

ADULT AMBU BAG

Facility

$90.72

Hospital Charge Code	22354982
Hospital Revenue Code	270
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$81.65
Rate for Payer: Aetna of AZ Commercial	$81.65
Rate for Payer: Arizona Complete Health Allwell	$14.52
Rate for Payer: Banner UC Health Medicare	$14.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.52
Rate for Payer: Cash Price	$72.58
Rate for Payer: Cigna of AZ Commercial	$63.50
Rate for Payer: Devoted Health Medicare	$16.33
Rate for Payer: Humana of AZ Medicare	$14.52
Rate for Payer: Southwest Service Administrators UFCW	$61.69
Rate for Payer: TriWest Medicare	$14.52
Rate for Payer: United Healthcare Commercial	$51.89
Rate for Payer: United Healthcare Medicare	$14.52
Rate for Payer: Veterans Affairs TRICARE	$14.37

ADULT AMBU BAG

Facility

$90.72

Hospital Charge Code	22354982
Hospital Revenue Code	270
Min. Negotiated Rate	$81.65
Max. Negotiated Rate	$81.65
Rate for Payer: Aetna of AZ Commercial	$81.65
Rate for Payer: Cash Price	$72.58

Advanced care planning 1st 30min

Facility

$348.00

Service Code	CPT 99497
Hospital Charge Code	23063831
Hospital Revenue Code	521
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Arizona Complete Health Allwell	$55.68
Rate for Payer: Banner UC Health Medicare	$55.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$236.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$55.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$55.68
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cigna of AZ Commercial	$243.60
Rate for Payer: Devoted Health Medicare	$62.64
Rate for Payer: Humana of AZ Medicare	$55.68
Rate for Payer: Mercy Care Medicaid	$5.52
Rate for Payer: NaphCare Correctional Healthcare	$5.52
Rate for Payer: Seven Corners Travel Insurance	$157.18
Rate for Payer: Southwest Service Administrators UFCW	$236.64
Rate for Payer: TriWest Medicare	$55.68
Rate for Payer: United Healthcare Commercial	$199.06
Rate for Payer: United Healthcare Medicare	$55.68
Rate for Payer: Veterans Affairs TRICARE	$55.12

Advanced care planning 1st 30min

Facility

$348.00

Service Code	CPT 99497
Hospital Charge Code	23063831
Hospital Revenue Code	521
Min. Negotiated Rate	$313.20
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Cash Price	$278.40

Advanced care planning additional 30 min

Facility

$331.00

Service Code	CPT 99498
Hospital Charge Code	23063832
Hospital Revenue Code	521
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Arizona Complete Health Allwell	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$225.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$0.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.96
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$231.70
Rate for Payer: Devoted Health Medicare	$59.58
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Mercy Care Medicaid	$0.32
Rate for Payer: NaphCare Correctional Healthcare	$0.32
Rate for Payer: Southwest Service Administrators UFCW	$225.08
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: United Healthcare Commercial	$189.33
Rate for Payer: United Healthcare Medicare	$52.96
Rate for Payer: Veterans Affairs TRICARE	$52.43

Advanced care planning additional 30 min

Facility

$331.00

Service Code	CPT 99498
Hospital Charge Code	23063832
Hospital Revenue Code	521
Min. Negotiated Rate	$297.90
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Cash Price	$264.80

AEROSTAT CHOLANGIOGRAPHY CATH 6FR

Facility

$238.00

Hospital Charge Code	27465745
Hospital Revenue Code	270
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Arizona Complete Health Allwell	$38.08
Rate for Payer: Banner UC Health Medicare	$38.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.08
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$166.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Humana of AZ Medicare	$38.08
Rate for Payer: Southwest Service Administrators UFCW	$161.84
Rate for Payer: TriWest Medicare	$38.08
Rate for Payer: United Healthcare Commercial	$136.14
Rate for Payer: United Healthcare Medicare	$38.08
Rate for Payer: Veterans Affairs TRICARE	$37.70

AEROSTAT CHOLANGIOGRAPHY CATH 6FR

Facility

$238.00

Hospital Charge Code	27465745
Hospital Revenue Code	270
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Cash Price	$190.40

AFC GENERIC ADD-ON

Facility

$286.00

Service Code	CPT 86256
Hospital Charge Code	22543634
Hospital Revenue Code	302
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Arizona Complete Health Allwell	$45.76
Rate for Payer: Banner UC Health Medicare	$45.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$194.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.76
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cigna of AZ Commercial	$185.90
Rate for Payer: Devoted Health Medicare	$51.48
Rate for Payer: Humana of AZ Medicare	$45.76
Rate for Payer: Seven Corners Travel Insurance	$17.47
Rate for Payer: Southwest Service Administrators UFCW	$194.48
Rate for Payer: TriWest Medicare	$45.76
Rate for Payer: United Healthcare Commercial	$163.59
Rate for Payer: United Healthcare Medicare	$45.76
Rate for Payer: Veterans Affairs TRICARE	$45.30

AFC GENERIC ADD-ON

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22543271
Hospital Revenue Code	302
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Cash Price	$79.20

AFC GENERIC ADD-ON

Facility

$215.00

Service Code	CPT 84702
Hospital Charge Code	22543273
Hospital Revenue Code	301
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Cash Price	$172.00

AFC GENERIC ADD-ON

Facility

$246.00

Service Code	CPT 86336
Hospital Charge Code	22543274
Hospital Revenue Code	302
Min. Negotiated Rate	$22.61
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Arizona Complete Health Allwell	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$167.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.36
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$159.90
Rate for Payer: Devoted Health Medicare	$44.28
Rate for Payer: Humana of AZ Medicare	$39.36
Rate for Payer: Seven Corners Travel Insurance	$22.61
Rate for Payer: Southwest Service Administrators UFCW	$167.28
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: United Healthcare Commercial	$140.71
Rate for Payer: United Healthcare Medicare	$39.36
Rate for Payer: Veterans Affairs TRICARE	$38.97

AFC GENERIC ADD-ON

Facility

$361.00

Service Code	CPT 82677
Hospital Charge Code	22543272
Hospital Revenue Code	301
Min. Negotiated Rate	$35.06
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna of AZ Commercial	$324.90
Rate for Payer: Arizona Complete Health Allwell	$57.76
Rate for Payer: Banner UC Health Medicare	$57.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$245.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$57.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$57.76
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cigna of AZ Commercial	$234.65
Rate for Payer: Devoted Health Medicare	$64.98
Rate for Payer: Humana of AZ Medicare	$57.76
Rate for Payer: Seven Corners Travel Insurance	$35.06
Rate for Payer: Southwest Service Administrators UFCW	$245.48
Rate for Payer: TriWest Medicare	$57.76
Rate for Payer: United Healthcare Commercial	$206.49
Rate for Payer: United Healthcare Medicare	$57.76
Rate for Payer: Veterans Affairs TRICARE	$57.18

AFC GENERIC ADD-ON

Facility

$246.00

Service Code	CPT 86336
Hospital Charge Code	22543274
Hospital Revenue Code	302
Min. Negotiated Rate	$221.40
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Cash Price	$196.80

AFC GENERIC ADD-ON

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	22543270
Hospital Revenue Code	302
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Cash Price	$68.00

AFC GENERIC ADD-ON

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22543271
Hospital Revenue Code	302
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Arizona Complete Health Allwell	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$67.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.84
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Devoted Health Medicare	$17.82
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Seven Corners Travel Insurance	$4.34
Rate for Payer: Southwest Service Administrators UFCW	$67.32
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: United Healthcare Commercial	$56.63
Rate for Payer: United Healthcare Medicare	$15.84
Rate for Payer: Veterans Affairs TRICARE	$15.68

AFC GENERIC ADD-ON

Facility

$215.00

Service Code	CPT 84702
Hospital Charge Code	22543273
Hospital Revenue Code	301
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Arizona Complete Health Allwell	$34.40
Rate for Payer: Banner UC Health Medicare	$34.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$146.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.40
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cigna of AZ Commercial	$139.75
Rate for Payer: Devoted Health Medicare	$38.70
Rate for Payer: Humana of AZ Medicare	$34.40
Rate for Payer: Seven Corners Travel Insurance	$21.82
Rate for Payer: Southwest Service Administrators UFCW	$146.20
Rate for Payer: TriWest Medicare	$34.40
Rate for Payer: United Healthcare Commercial	$122.98
Rate for Payer: United Healthcare Medicare	$34.40
Rate for Payer: Veterans Affairs TRICARE	$34.06

AFC GENERIC ADD-ON

Facility

$361.00

Service Code	CPT 82677
Hospital Charge Code	22543272
Hospital Revenue Code	301
Min. Negotiated Rate	$324.90
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna of AZ Commercial	$324.90
Rate for Payer: Cash Price	$288.80

AFC GENERIC ADD-ON

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	22543270
Hospital Revenue Code	302
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Arizona Complete Health Allwell	$13.60
Rate for Payer: Banner UC Health Medicare	$13.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.60
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cigna of AZ Commercial	$55.25
Rate for Payer: Devoted Health Medicare	$15.30
Rate for Payer: Humana of AZ Medicare	$13.60
Rate for Payer: Seven Corners Travel Insurance	$4.34
Rate for Payer: Southwest Service Administrators UFCW	$57.80
Rate for Payer: TriWest Medicare	$13.60
Rate for Payer: United Healthcare Commercial	$48.62
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: Veterans Affairs TRICARE	$13.46

Know your out-of-pocket cost for care.

All Charges