Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Alteration In Consciousness

Facility

$4,026.04

Service Code	APR-DRG 0521
Hospital Charge Code	APRDRG0523
Min. Negotiated Rate	$4,026.04
Max. Negotiated Rate	$4,026.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,026.04
Rate for Payer: Mercy Care Medicaid	$4,026.04
Rate for Payer: NaphCare Correctional Healthcare	$4,026.04

Alteration In Consciousness

Facility

$4,026.04

Service Code	APR-DRG 0521
Hospital Charge Code	APRDRG0524
Min. Negotiated Rate	$4,026.04
Max. Negotiated Rate	$4,026.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,026.04
Rate for Payer: Mercy Care Medicaid	$4,026.04
Rate for Payer: NaphCare Correctional Healthcare	$4,026.04

Alteration In Consciousness

Facility

$5,836.35

Service Code	APR-DRG 0523
Hospital Charge Code	APRDRG0523
Min. Negotiated Rate	$5,836.35
Max. Negotiated Rate	$5,836.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,836.35
Rate for Payer: Mercy Care Medicaid	$5,836.35
Rate for Payer: NaphCare Correctional Healthcare	$5,836.35

Alteration In Consciousness

Facility

$4,026.04

Service Code	APR-DRG 0521
Hospital Charge Code	APRDRG0521
Min. Negotiated Rate	$4,026.04
Max. Negotiated Rate	$4,026.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,026.04
Rate for Payer: Mercy Care Medicaid	$4,026.04
Rate for Payer: NaphCare Correctional Healthcare	$4,026.04

Alteration In Consciousness

Facility

$4,524.03

Service Code	APR-DRG 0522
Hospital Charge Code	APRDRG0524
Min. Negotiated Rate	$4,524.03
Max. Negotiated Rate	$4,524.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,524.03
Rate for Payer: Mercy Care Medicaid	$4,524.03
Rate for Payer: NaphCare Correctional Healthcare	$4,524.03

Alteration In Consciousness

Facility

$5,836.35

Service Code	APR-DRG 0523
Hospital Charge Code	APRDRG0521
Min. Negotiated Rate	$5,836.35
Max. Negotiated Rate	$5,836.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,836.35
Rate for Payer: Mercy Care Medicaid	$5,836.35
Rate for Payer: NaphCare Correctional Healthcare	$5,836.35

Alteration In Consciousness

Facility

$4,524.03

Service Code	APR-DRG 0522
Hospital Charge Code	APRDRG0521
Min. Negotiated Rate	$4,524.03
Max. Negotiated Rate	$4,524.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,524.03
Rate for Payer: Mercy Care Medicaid	$4,524.03
Rate for Payer: NaphCare Correctional Healthcare	$4,524.03

Alteration In Consciousness

Facility

$13,677.30

Service Code	APR-DRG 0524
Hospital Charge Code	APRDRG0521
Min. Negotiated Rate	$13,677.30
Max. Negotiated Rate	$13,677.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,677.30
Rate for Payer: Mercy Care Medicaid	$13,677.30
Rate for Payer: NaphCare Correctional Healthcare	$13,677.30

Alteration In Consciousness

Facility

$5,836.35

Service Code	APR-DRG 0523
Hospital Charge Code	APRDRG0524
Min. Negotiated Rate	$5,836.35
Max. Negotiated Rate	$5,836.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,836.35
Rate for Payer: Mercy Care Medicaid	$5,836.35
Rate for Payer: NaphCare Correctional Healthcare	$5,836.35

Alteration In Consciousness

Facility

$4,524.03

Service Code	APR-DRG 0522
Hospital Charge Code	APRDRG0522
Min. Negotiated Rate	$4,524.03
Max. Negotiated Rate	$4,524.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,524.03
Rate for Payer: Mercy Care Medicaid	$4,524.03
Rate for Payer: NaphCare Correctional Healthcare	$4,524.03

Alteration In Consciousness

Facility

$4,026.04

Service Code	APR-DRG 0521
Hospital Charge Code	APRDRG0522
Min. Negotiated Rate	$4,026.04
Max. Negotiated Rate	$4,026.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,026.04
Rate for Payer: Mercy Care Medicaid	$4,026.04
Rate for Payer: NaphCare Correctional Healthcare	$4,026.04

Alteration In Consciousness

Facility

$13,677.30

Service Code	APR-DRG 0524
Hospital Charge Code	APRDRG0522
Min. Negotiated Rate	$13,677.30
Max. Negotiated Rate	$13,677.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,677.30
Rate for Payer: Mercy Care Medicaid	$13,677.30
Rate for Payer: NaphCare Correctional Healthcare	$13,677.30

Alteration In Consciousness

Facility

$4,524.03

Service Code	APR-DRG 0522
Hospital Charge Code	APRDRG0523
Min. Negotiated Rate	$4,524.03
Max. Negotiated Rate	$4,524.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,524.03
Rate for Payer: Mercy Care Medicaid	$4,524.03
Rate for Payer: NaphCare Correctional Healthcare	$4,524.03

Alteration In Consciousness

Facility

$13,677.30

Service Code	APR-DRG 0524
Hospital Charge Code	APRDRG0524
Min. Negotiated Rate	$13,677.30
Max. Negotiated Rate	$13,677.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,677.30
Rate for Payer: Mercy Care Medicaid	$13,677.30
Rate for Payer: NaphCare Correctional Healthcare	$13,677.30

Alteration In Consciousness

Facility

$13,677.30

Service Code	APR-DRG 0524
Hospital Charge Code	APRDRG0523
Min. Negotiated Rate	$13,677.30
Max. Negotiated Rate	$13,677.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,677.30
Rate for Payer: Mercy Care Medicaid	$13,677.30
Rate for Payer: NaphCare Correctional Healthcare	$13,677.30

ALTIS COLOPLAST SLING

Facility

$8,237.00

Hospital Charge Code	22729662
Hospital Revenue Code	272
Min. Negotiated Rate	$1,304.74
Max. Negotiated Rate	$7,413.30
Rate for Payer: Aetna of AZ Commercial	$7,413.30
Rate for Payer: Arizona Complete Health Allwell	$1,317.92
Rate for Payer: Banner UC Health Medicare	$1,317.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5,601.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,317.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,317.92
Rate for Payer: Cash Price	$6,589.60
Rate for Payer: Cigna of AZ Commercial	$5,765.90
Rate for Payer: Devoted Health Medicare	$1,482.66
Rate for Payer: Humana of AZ Medicare	$1,317.92
Rate for Payer: Southwest Service Administrators UFCW	$5,601.16
Rate for Payer: TriWest Medicare	$1,317.92
Rate for Payer: United Healthcare Commercial	$4,711.56
Rate for Payer: United Healthcare Medicare	$1,317.92
Rate for Payer: Veterans Affairs TRICARE	$1,304.74

ALTIS COLOPLAST SLING

Facility

$8,237.00

Hospital Charge Code	22729662
Hospital Revenue Code	272
Min. Negotiated Rate	$7,413.30
Max. Negotiated Rate	$7,413.30
Rate for Payer: Aetna of AZ Commercial	$7,413.30
Rate for Payer: Cash Price	$6,589.60

Alum Crutches All SZ Charge

Facility

$101.00

Service Code	HCPCS E0114
Hospital Charge Code	858293
Hospital Revenue Code	521
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Arizona Complete Health Allwell	$16.16
Rate for Payer: Banner UC Health Medicare	$16.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$68.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.16
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$70.70
Rate for Payer: Devoted Health Medicare	$18.18
Rate for Payer: Humana of AZ Medicare	$16.16
Rate for Payer: Southwest Service Administrators UFCW	$68.68
Rate for Payer: TriWest Medicare	$16.16
Rate for Payer: United Healthcare Commercial	$57.77
Rate for Payer: United Healthcare Medicare	$16.16
Rate for Payer: Veterans Affairs TRICARE	$16.00

Alum Crutches All SZ Charge

Facility

$101.00

Service Code	HCPCS E0114
Hospital Charge Code	858293
Hospital Revenue Code	521
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Cash Price	$80.80

amantadine 100 mg Cap UD [CQCH]

Facility

$1.04

Service Code	NDC 904663061
Hospital Charge Code	107993868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of AZ Commercial	$0.94
Rate for Payer: Arizona Complete Health Allwell	$0.17
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.71
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.17
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.17
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cigna of AZ Commercial	$0.68
Rate for Payer: Devoted Health Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Southwest Service Administrators UFCW	$0.71
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: United Healthcare Commercial	$0.59
Rate for Payer: United Healthcare Medicare	$0.17
Rate for Payer: Veterans Affairs TRICARE	$0.16

amantadine 100 mg Cap UD [CQCH]

Facility

$1.04

Service Code	NDC 904663061
Hospital Charge Code	107993868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of AZ Commercial	$0.94
Rate for Payer: Cash Price	$0.84

amiodarone 150 mg/3 mL IV Sol [CQCH]

Facility

$1.05

Service Code	HCPCS J0282
Hospital Charge Code	105910495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of AZ Commercial	$0.95
Rate for Payer: Arizona Complete Health Allwell	$0.17
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.71
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.17
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.17
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cigna of AZ Commercial	$0.68
Rate for Payer: Devoted Health Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Southwest Service Administrators UFCW	$0.71
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: United Healthcare Commercial	$0.60
Rate for Payer: United Healthcare Medicare	$0.17
Rate for Payer: Veterans Affairs TRICARE	$0.17

amiodarone 150 mg/3 mL IV Sol [CQCH]

Facility

$1.05

Service Code	HCPCS J0282
Hospital Charge Code	105910495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of AZ Commercial	$0.95
Rate for Payer: Cash Price	$0.84

amiodarone 200 mg Tab [CQCH]

Facility

$0.24

Service Code	NDC 245014701
Hospital Charge Code	105910355
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.16
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.14
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

amiodarone 200 mg Tab [CQCH]

Facility

$0.24

Service Code	NDC 245014701
Hospital Charge Code	105910355
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Cash Price	$0.20

Know your out-of-pocket cost for care.

All Charges