Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Asthma

Facility

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$2,741.07
Max. Negotiated Rate	$2,741.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,741.07
Rate for Payer: Mercy Care Medicaid	$2,741.07
Rate for Payer: NaphCare Correctional Healthcare	$2,741.07

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80
Rate for Payer: NaphCare Correctional Healthcare	$9,015.80

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80
Rate for Payer: NaphCare Correctional Healthcare	$9,015.80

Asthma

Facility

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$2,741.07
Max. Negotiated Rate	$2,741.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,741.07
Rate for Payer: Mercy Care Medicaid	$2,741.07
Rate for Payer: NaphCare Correctional Healthcare	$2,741.07

Asthma

Facility

$4,791.96

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$4,791.96
Max. Negotiated Rate	$4,791.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,791.96
Rate for Payer: Mercy Care Medicaid	$4,791.96
Rate for Payer: NaphCare Correctional Healthcare	$4,791.96

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35
Rate for Payer: NaphCare Correctional Healthcare	$3,985.35

Asthma

Facility

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$2,741.07
Max. Negotiated Rate	$2,741.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,741.07
Rate for Payer: Mercy Care Medicaid	$2,741.07
Rate for Payer: NaphCare Correctional Healthcare	$2,741.07

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35
Rate for Payer: NaphCare Correctional Healthcare	$3,985.35

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80
Rate for Payer: NaphCare Correctional Healthcare	$9,015.80

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35
Rate for Payer: NaphCare Correctional Healthcare	$3,985.35

Asthma

Facility

$4,791.96

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$4,791.96
Max. Negotiated Rate	$4,791.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,791.96
Rate for Payer: Mercy Care Medicaid	$4,791.96
Rate for Payer: NaphCare Correctional Healthcare	$4,791.96

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35
Rate for Payer: NaphCare Correctional Healthcare	$3,985.35

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80
Rate for Payer: NaphCare Correctional Healthcare	$9,015.80

atenolol 25 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 51079075920
Hospital Charge Code	105911831
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Cash Price	$0.13

atenolol 25 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 51079075920
Hospital Charge Code	105911831
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.11
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.12
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.10
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

atenolol 50 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 51079068420
Hospital Charge Code	105911766
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.05
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

atenolol 50 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 51079068420
Hospital Charge Code	105911766
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Cash Price	$0.07

ATHEROSCLEROSIS WITH MCC

Facility

$15,517.75

Service Code	MSDRG 302
Min. Negotiated Rate	$15,517.75
Max. Negotiated Rate	$15,517.75
Rate for Payer: Seven Corners Travel Insurance	$15,517.75

ATHEROSCLEROSIS WITHOUT MCC

Facility

$8,885.67

Service Code	MSDRG 303
Min. Negotiated Rate	$8,885.67
Max. Negotiated Rate	$8,885.67
Rate for Payer: Seven Corners Travel Insurance	$8,885.67

atorvastatin 20 mg Tab [CQCH]

Facility

$0.75

Service Code	NDC 904629161
Hospital Charge Code	105911897
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of AZ Commercial	$0.68
Rate for Payer: Cash Price	$0.60

atorvastatin 20 mg Tab [CQCH]

Facility

$0.75

Service Code	NDC 904629161
Hospital Charge Code	105911897
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of AZ Commercial	$0.68
Rate for Payer: Arizona Complete Health Allwell	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.51
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.12
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cigna of AZ Commercial	$0.49
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Southwest Service Administrators UFCW	$0.51
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: United Healthcare Commercial	$0.43
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: Veterans Affairs TRICARE	$0.12

atropine 0.1 mg/mL Inj PFS [CQCH]

Facility

$0.81

Service Code	HCPCS J0461
Hospital Charge Code	105912104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Aetna of AZ Commercial	$0.73
Rate for Payer: Cash Price	$0.64

atropine 0.1 mg/mL Inj PFS [CQCH]

Facility

$0.81

Service Code	HCPCS J0461
Hospital Charge Code	105912104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.73
Rate for Payer: Aetna of AZ Commercial	$0.73
Rate for Payer: Arizona Complete Health Allwell	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.55
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.13
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.13
Rate for Payer: Cash Price	$0.64
Rate for Payer: Cigna of AZ Commercial	$0.53
Rate for Payer: Devoted Health Medicare	$0.15
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Southwest Service Administrators UFCW	$0.55
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: United Healthcare Commercial	$0.46
Rate for Payer: United Healthcare Medicare	$0.13
Rate for Payer: Veterans Affairs TRICARE	$0.13

atropine 1 mg/mL Inj Sol [CQCH]

Facility

$5.97

Service Code	HCPCS J0461
Hospital Charge Code	105912035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna of AZ Commercial	$5.37
Rate for Payer: Arizona Complete Health Allwell	$0.96
Rate for Payer: Banner UC Health Medicare	$0.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.06
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.96
Rate for Payer: Cash Price	$4.78
Rate for Payer: Cigna of AZ Commercial	$3.88
Rate for Payer: Devoted Health Medicare	$1.07
Rate for Payer: Humana of AZ Medicare	$0.96
Rate for Payer: Southwest Service Administrators UFCW	$4.06
Rate for Payer: TriWest Medicare	$0.96
Rate for Payer: United Healthcare Commercial	$3.41
Rate for Payer: United Healthcare Medicare	$0.96
Rate for Payer: Veterans Affairs TRICARE	$0.95

atropine 1 mg/mL Inj Sol [CQCH]

Facility

$5.97

Service Code	HCPCS J0461
Hospital Charge Code	105912035
Hospital Revenue Code	250
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna of AZ Commercial	$5.37
Rate for Payer: Cash Price	$4.78

Know your out-of-pocket cost for care.

All Charges