Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82
Rate for Payer: NaphCare Correctional Healthcare	$3,415.82

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14
Rate for Payer: NaphCare Correctional Healthcare	$2,675.14

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82
Rate for Payer: NaphCare Correctional Healthcare	$3,415.82

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71
Rate for Payer: NaphCare Correctional Healthcare	$6,018.71

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97
Rate for Payer: NaphCare Correctional Healthcare	$9,254.97

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14
Rate for Payer: NaphCare Correctional Healthcare	$2,675.14

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97
Rate for Payer: NaphCare Correctional Healthcare	$9,254.97

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71
Rate for Payer: NaphCare Correctional Healthcare	$6,018.71

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82
Rate for Payer: NaphCare Correctional Healthcare	$3,415.82

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71
Rate for Payer: NaphCare Correctional Healthcare	$6,018.71

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97
Rate for Payer: NaphCare Correctional Healthcare	$9,254.97

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14
Rate for Payer: NaphCare Correctional Healthcare	$2,675.14

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97
Rate for Payer: NaphCare Correctional Healthcare	$9,254.97

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14
Rate for Payer: NaphCare Correctional Healthcare	$2,675.14

belimumab 120 mg REC[CQCH]

Facility

$580.80

Service Code	HCPCS J0490
Hospital Charge Code	202718790
Hospital Revenue Code	250
Min. Negotiated Rate	$84.53
Max. Negotiated Rate	$522.72
Rate for Payer: Aetna of AZ Commercial	$522.72
Rate for Payer: Arizona Complete Health Allwell	$92.93
Rate for Payer: Banner UC Health Medicare	$92.93
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$394.94
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$92.93
Rate for Payer: Care1st Health Plan Arizona Medicare	$92.93
Rate for Payer: Cash Price	$464.64
Rate for Payer: Cash Price	$464.64
Rate for Payer: Cigna of AZ Commercial	$377.52
Rate for Payer: Devoted Health Medicare	$104.54
Rate for Payer: Humana of AZ Medicare	$92.93
Rate for Payer: Seven Corners Travel Insurance	$84.53
Rate for Payer: Southwest Service Administrators UFCW	$394.94
Rate for Payer: TriWest Medicare	$92.93
Rate for Payer: United Healthcare Commercial	$332.22
Rate for Payer: United Healthcare Medicare	$92.93
Rate for Payer: Veterans Affairs TRICARE	$92.00

belimumab 120 mg REC[CQCH]

Facility

$580.80

Service Code	HCPCS J0490
Hospital Charge Code	202718790
Hospital Revenue Code	250
Min. Negotiated Rate	$522.72
Max. Negotiated Rate	$522.72
Rate for Payer: Aetna of AZ Commercial	$522.72
Rate for Payer: Cash Price	$464.64

belimumab 400 mg REC[CQCH]

Facility

$1,482.80

Service Code	HCPCS J0490
Hospital Charge Code	212085212
Hospital Revenue Code	250
Min. Negotiated Rate	$84.53
Max. Negotiated Rate	$1,334.52
Rate for Payer: Aetna of AZ Commercial	$1,334.52
Rate for Payer: Arizona Complete Health Allwell	$237.25
Rate for Payer: Banner UC Health Medicare	$237.25
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,008.30
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$237.25
Rate for Payer: Care1st Health Plan Arizona Medicare	$237.25
Rate for Payer: Cash Price	$1,186.24
Rate for Payer: Cash Price	$1,186.24
Rate for Payer: Cigna of AZ Commercial	$963.82
Rate for Payer: Devoted Health Medicare	$266.90
Rate for Payer: Humana of AZ Medicare	$237.25
Rate for Payer: Seven Corners Travel Insurance	$84.53
Rate for Payer: Southwest Service Administrators UFCW	$1,008.30
Rate for Payer: TriWest Medicare	$237.25
Rate for Payer: United Healthcare Commercial	$848.16
Rate for Payer: United Healthcare Medicare	$237.25
Rate for Payer: Veterans Affairs TRICARE	$234.88

belimumab 400 mg REC[CQCH]

Facility

$1,482.80

Service Code	HCPCS J0490
Hospital Charge Code	212085212
Hospital Revenue Code	250
Min. Negotiated Rate	$1,334.52
Max. Negotiated Rate	$1,334.52
Rate for Payer: Aetna of AZ Commercial	$1,334.52
Rate for Payer: Cash Price	$1,186.24

benazepril 10 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 43547033610
Hospital Charge Code	105912642
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
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	$0.04
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	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.03
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

benazepril 10 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 43547033610
Hospital Charge Code	105912642
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Cash Price	$0.05

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$15,183.24

Service Code	MSDRG 725
Min. Negotiated Rate	$15,183.24
Max. Negotiated Rate	$15,183.24
Rate for Payer: Seven Corners Travel Insurance	$15,183.24

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$9,504.01

Service Code	MSDRG 726
Min. Negotiated Rate	$9,504.01
Max. Negotiated Rate	$9,504.01
Rate for Payer: Seven Corners Travel Insurance	$9,504.01

Bent Beaver Blade

Facility

$176.00

Hospital Charge Code	22926410
Hospital Revenue Code	272
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Arizona Complete Health Allwell	$28.16
Rate for Payer: Banner UC Health Medicare	$28.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$119.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.16
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cigna of AZ Commercial	$123.20
Rate for Payer: Devoted Health Medicare	$31.68
Rate for Payer: Humana of AZ Medicare	$28.16
Rate for Payer: Southwest Service Administrators UFCW	$119.68
Rate for Payer: TriWest Medicare	$28.16
Rate for Payer: United Healthcare Commercial	$100.67
Rate for Payer: United Healthcare Medicare	$28.16
Rate for Payer: Veterans Affairs TRICARE	$27.88

Bent Beaver Blade

Facility

$176.00

Hospital Charge Code	22926410
Hospital Revenue Code	272
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Cash Price	$140.80

benzocaine top 20% 0.5mL oral anesthetic

Facility

$18.24

Service Code	NDC 283061043
Hospital Charge Code	112661648
Hospital Revenue Code	251
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$16.42
Rate for Payer: Aetna of AZ Commercial	$16.42
Rate for Payer: Arizona Complete Health Allwell	$2.92
Rate for Payer: Banner UC Health Medicare	$2.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.92
Rate for Payer: Cash Price	$14.59
Rate for Payer: Cigna of AZ Commercial	$11.86
Rate for Payer: Devoted Health Medicare	$3.28
Rate for Payer: Humana of AZ Medicare	$2.92
Rate for Payer: Southwest Service Administrators UFCW	$12.40
Rate for Payer: TriWest Medicare	$2.92
Rate for Payer: United Healthcare Commercial	$10.43
Rate for Payer: United Healthcare Medicare	$2.92
Rate for Payer: Veterans Affairs TRICARE	$2.89

Know your out-of-pocket cost for care.

All Charges