Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Aph Plt ACDA LR 2

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857740
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR 2

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857740
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR 3

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857741
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR 3

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857741
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR Irr

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857748
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR Irr

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857748
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR Irr 1

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857749
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR Irr 1

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857749
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR Irr 2

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857750
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR Irr 2

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857750
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR Irr 3

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857751
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR Irr 3

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857751
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR Irr <3 X log 11 1

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	22316432
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR Irr <3 X log 11 1

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	22316432
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph RBC ACDA AS1 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	1011918
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

Aph RBC ACDA AS1 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	1011918
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

Aph RBC ACDA AS1 LR 1

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	3566198
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

Aph RBC ACDA AS1 LR 1

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	3566198
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

Aph RBC ACDA AS1 LR Irr

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	8545368
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

Aph RBC ACDA AS1 LR Irr

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	8545368
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

Aph RBC CP2D AS3 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	1011914
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

Aph RBC CP2D AS3 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	1011914
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

Aph RBC CP2D AS3 LR 1

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	4004202
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

Aph RBC CP2D AS3 LR 1

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	4004202
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

Aph RBC CP2D AS3 LR 2

Facility

$761.00

Service Code	HCPCS P9016
Hospital Charge Code	4004201
Hospital Revenue Code	390
Min. Negotiated Rate	$684.90
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Cash Price	$608.80

Know your out-of-pocket cost for care.

All Charges