Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$22,553.94

Service Code	MSDRG 896
Min. Negotiated Rate	$22,553.94
Max. Negotiated Rate	$22,553.94
Rate for Payer: Seven Corners Travel Insurance	$22,553.94

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$11,541.55

Service Code	MSDRG 897
Min. Negotiated Rate	$11,541.55
Max. Negotiated Rate	$11,541.55
Rate for Payer: Seven Corners Travel Insurance	$11,541.55

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$18,295.43

Service Code	MSDRG 895
Min. Negotiated Rate	$18,295.43
Max. Negotiated Rate	$18,295.43
Rate for Payer: Seven Corners Travel Insurance	$18,295.43

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44
Rate for Payer: NaphCare Correctional Healthcare	$3,475.44

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20
Rate for Payer: NaphCare Correctional Healthcare	$17,034.20

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45
Rate for Payer: NaphCare Correctional Healthcare	$7,137.45

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20
Rate for Payer: NaphCare Correctional Healthcare	$17,034.20

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20
Rate for Payer: NaphCare Correctional Healthcare	$17,034.20

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44
Rate for Payer: NaphCare Correctional Healthcare	$3,475.44

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44
Rate for Payer: NaphCare Correctional Healthcare	$3,475.44

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45
Rate for Payer: NaphCare Correctional Healthcare	$7,137.45

Alcoholic Liver Disease

Facility

$3,475.44

Service Code	APR-DRG 2801
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$3,475.44
Max. Negotiated Rate	$3,475.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,475.44
Rate for Payer: Mercy Care Medicaid	$3,475.44
Rate for Payer: NaphCare Correctional Healthcare	$3,475.44

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95
Rate for Payer: NaphCare Correctional Healthcare	$4,535.95

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2803
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95
Rate for Payer: NaphCare Correctional Healthcare	$4,535.95

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45
Rate for Payer: NaphCare Correctional Healthcare	$7,137.45

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2804
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95
Rate for Payer: NaphCare Correctional Healthcare	$4,535.95

Alcoholic Liver Disease

Facility

$4,535.95

Service Code	APR-DRG 2802
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$4,535.95
Max. Negotiated Rate	$4,535.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,535.95
Rate for Payer: Mercy Care Medicaid	$4,535.95
Rate for Payer: NaphCare Correctional Healthcare	$4,535.95

Alcoholic Liver Disease

Facility

$17,034.20

Service Code	APR-DRG 2804
Hospital Charge Code	APRDRG2801
Min. Negotiated Rate	$17,034.20
Max. Negotiated Rate	$17,034.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,034.20
Rate for Payer: Mercy Care Medicaid	$17,034.20
Rate for Payer: NaphCare Correctional Healthcare	$17,034.20

Alcoholic Liver Disease

Facility

$7,137.45

Service Code	APR-DRG 2803
Hospital Charge Code	APRDRG2802
Min. Negotiated Rate	$7,137.45
Max. Negotiated Rate	$7,137.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,137.45
Rate for Payer: Mercy Care Medicaid	$7,137.45
Rate for Payer: NaphCare Correctional Healthcare	$7,137.45

Alcohol Level

Facility

$312.00

Service Code	CPT 80320
Hospital Charge Code	1279592
Hospital Revenue Code	301
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Arizona Complete Health Allwell	$49.92
Rate for Payer: Banner UC Health Medicare	$49.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$212.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.56
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cigna of AZ Commercial	$202.80
Rate for Payer: Devoted Health Medicare	$56.16
Rate for Payer: Humana of AZ Medicare	$49.92
Rate for Payer: Southwest Service Administrators UFCW	$212.16
Rate for Payer: TriWest Medicare	$49.92
Rate for Payer: United Healthcare Commercial	$178.46
Rate for Payer: United Healthcare Medicare	$49.92
Rate for Payer: Veterans Affairs TRICARE	$49.42

Alcohol Level

Facility

$312.00

Service Code	CPT 80320
Hospital Charge Code	1279592
Hospital Revenue Code	301
Min. Negotiated Rate	$280.80
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Cash Price	$249.60

Alder Tree

Facility

$74.00

Service Code	CPT 86003
Hospital Charge Code	23168775
Hospital Revenue Code	301
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Arizona Complete Health Allwell	$11.84
Rate for Payer: Banner UC Health Medicare	$11.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$50.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.84
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$48.10
Rate for Payer: Devoted Health Medicare	$13.32
Rate for Payer: Humana of AZ Medicare	$11.84
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$50.32
Rate for Payer: TriWest Medicare	$11.84
Rate for Payer: United Healthcare Commercial	$42.33
Rate for Payer: United Healthcare Medicare	$11.84
Rate for Payer: Veterans Affairs TRICARE	$11.72

Alder Tree

Facility

$74.00

Service Code	CPT 86003
Hospital Charge Code	23168775
Hospital Revenue Code	301
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Cash Price	$59.20

Aldolase LC

Facility

$280.00

Service Code	CPT 82085
Hospital Charge Code	1285776
Hospital Revenue Code	301
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Arizona Complete Health Allwell	$44.80
Rate for Payer: Banner UC Health Medicare	$44.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$190.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.80
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cigna of AZ Commercial	$182.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$44.80
Rate for Payer: Seven Corners Travel Insurance	$14.08
Rate for Payer: Southwest Service Administrators UFCW	$190.40
Rate for Payer: TriWest Medicare	$44.80
Rate for Payer: United Healthcare Commercial	$160.16
Rate for Payer: United Healthcare Medicare	$44.80
Rate for Payer: Veterans Affairs TRICARE	$44.35

Aldolase LC

Facility

$280.00

Service Code	CPT 82085
Hospital Charge Code	1285776
Hospital Revenue Code	301
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Cash Price	$224.00

Know your out-of-pocket cost for care.

All Charges