Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

DARTFIRE EDGE COMP SCREW D1130014

Facility

$2,777.05

Hospital Charge Code	28265122
Hospital Revenue Code	270
Min. Negotiated Rate	$439.88
Max. Negotiated Rate	$2,499.34
Rate for Payer: Aetna of AZ Commercial	$2,499.34
Rate for Payer: Arizona Complete Health Allwell	$444.33
Rate for Payer: Banner UC Health Medicare	$444.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,888.39
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$444.33
Rate for Payer: Care1st Health Plan Arizona Medicare	$444.33
Rate for Payer: Cash Price	$2,221.64
Rate for Payer: Cigna of AZ Commercial	$1,943.93
Rate for Payer: Devoted Health Medicare	$499.87
Rate for Payer: Humana of AZ Medicare	$444.33
Rate for Payer: Southwest Service Administrators UFCW	$1,888.39
Rate for Payer: TriWest Medicare	$444.33
Rate for Payer: United Healthcare Commercial	$1,588.47
Rate for Payer: United Healthcare Medicare	$444.33
Rate for Payer: Veterans Affairs TRICARE	$439.88

DARTFIRE EDGE COMP SCREW HEADED SHORT 3MMX26MM

Facility

$2,777.05

Hospital Charge Code	28243778
Hospital Revenue Code	270
Min. Negotiated Rate	$2,499.34
Max. Negotiated Rate	$2,499.34
Rate for Payer: Aetna of AZ Commercial	$2,499.34
Rate for Payer: Cash Price	$2,221.64

DARTFIRE EDGE COMP SCREW HEADED SHORT 3MMX26MM

Facility

$2,777.05

Hospital Charge Code	28243778
Hospital Revenue Code	270
Min. Negotiated Rate	$439.88
Max. Negotiated Rate	$2,499.34
Rate for Payer: Aetna of AZ Commercial	$2,499.34
Rate for Payer: Arizona Complete Health Allwell	$444.33
Rate for Payer: Banner UC Health Medicare	$444.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,888.39
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$444.33
Rate for Payer: Care1st Health Plan Arizona Medicare	$444.33
Rate for Payer: Cash Price	$2,221.64
Rate for Payer: Cigna of AZ Commercial	$1,943.93
Rate for Payer: Devoted Health Medicare	$499.87
Rate for Payer: Humana of AZ Medicare	$444.33
Rate for Payer: Southwest Service Administrators UFCW	$1,888.39
Rate for Payer: TriWest Medicare	$444.33
Rate for Payer: United Healthcare Commercial	$1,588.47
Rate for Payer: United Healthcare Medicare	$444.33
Rate for Payer: Veterans Affairs TRICARE	$439.88

DARTFIRE EDGE INST PACK 3MM HEADED

Facility

$8,512.40

Hospital Charge Code	28283369
Hospital Revenue Code	270
Min. Negotiated Rate	$7,661.16
Max. Negotiated Rate	$7,661.16
Rate for Payer: Aetna of AZ Commercial	$7,661.16
Rate for Payer: Cash Price	$6,809.92

DARTFIRE EDGE INST PACK 3MM HEADED

Facility

$8,512.40

Hospital Charge Code	28283369
Hospital Revenue Code	270
Min. Negotiated Rate	$1,348.36
Max. Negotiated Rate	$7,661.16
Rate for Payer: Aetna of AZ Commercial	$7,661.16
Rate for Payer: Arizona Complete Health Allwell	$1,361.98
Rate for Payer: Banner UC Health Medicare	$1,361.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5,788.43
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,361.98
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,361.98
Rate for Payer: Cash Price	$6,809.92
Rate for Payer: Cigna of AZ Commercial	$5,958.68
Rate for Payer: Devoted Health Medicare	$1,532.23
Rate for Payer: Humana of AZ Medicare	$1,361.98
Rate for Payer: Southwest Service Administrators UFCW	$5,788.43
Rate for Payer: TriWest Medicare	$1,361.98
Rate for Payer: United Healthcare Commercial	$4,869.09
Rate for Payer: United Healthcare Medicare	$1,361.98
Rate for Payer: Veterans Affairs TRICARE	$1,348.36

DART FIRE EDGE INST PACK 3MM HEADED SHORT

Facility

$2,777.05

Hospital Charge Code	29522608
Hospital Revenue Code	270
Min. Negotiated Rate	$2,499.34
Max. Negotiated Rate	$2,499.34
Rate for Payer: Aetna of AZ Commercial	$2,499.34
Rate for Payer: Cash Price	$2,221.64

DART FIRE EDGE INST PACK 3MM HEADED SHORT

Facility

$2,777.05

Hospital Charge Code	29522608
Hospital Revenue Code	270
Min. Negotiated Rate	$439.88
Max. Negotiated Rate	$2,499.34
Rate for Payer: Aetna of AZ Commercial	$2,499.34
Rate for Payer: Arizona Complete Health Allwell	$444.33
Rate for Payer: Banner UC Health Medicare	$444.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,888.39
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$444.33
Rate for Payer: Care1st Health Plan Arizona Medicare	$444.33
Rate for Payer: Cash Price	$2,221.64
Rate for Payer: Cigna of AZ Commercial	$1,943.93
Rate for Payer: Devoted Health Medicare	$499.87
Rate for Payer: Humana of AZ Medicare	$444.33
Rate for Payer: Southwest Service Administrators UFCW	$1,888.39
Rate for Payer: TriWest Medicare	$444.33
Rate for Payer: United Healthcare Commercial	$1,588.47
Rate for Payer: United Healthcare Medicare	$444.33
Rate for Payer: Veterans Affairs TRICARE	$439.88

DARTFIRE EDGE SCREWSNAP 2MM X 11MM

Facility

$3,471.10

Hospital Charge Code	28167070
Hospital Revenue Code	270
Min. Negotiated Rate	$3,123.99
Max. Negotiated Rate	$3,123.99
Rate for Payer: Aetna of AZ Commercial	$3,123.99
Rate for Payer: Cash Price	$2,776.88

DARTFIRE EDGE SCREWSNAP 2MM X 11MM

Facility

$3,471.10

Hospital Charge Code	28167070
Hospital Revenue Code	270
Min. Negotiated Rate	$549.82
Max. Negotiated Rate	$3,123.99
Rate for Payer: Aetna of AZ Commercial	$3,123.99
Rate for Payer: Arizona Complete Health Allwell	$555.38
Rate for Payer: Banner UC Health Medicare	$555.38
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,360.35
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$555.38
Rate for Payer: Care1st Health Plan Arizona Medicare	$555.38
Rate for Payer: Cash Price	$2,776.88
Rate for Payer: Cigna of AZ Commercial	$2,429.77
Rate for Payer: Devoted Health Medicare	$624.80
Rate for Payer: Humana of AZ Medicare	$555.38
Rate for Payer: Southwest Service Administrators UFCW	$2,360.35
Rate for Payer: TriWest Medicare	$555.38
Rate for Payer: United Healthcare Commercial	$1,985.47
Rate for Payer: United Healthcare Medicare	$555.38
Rate for Payer: Veterans Affairs TRICARE	$549.82

DARTFIRE EDGE SCREWSNAP 2MM X 12MM

Facility

$3,471.10

Hospital Charge Code	28167069
Hospital Revenue Code	270
Min. Negotiated Rate	$3,123.99
Max. Negotiated Rate	$3,123.99
Rate for Payer: Aetna of AZ Commercial	$3,123.99
Rate for Payer: Cash Price	$2,776.88

DARTFIRE EDGE SCREWSNAP 2MM X 12MM

Facility

$3,471.10

Hospital Charge Code	28167069
Hospital Revenue Code	270
Min. Negotiated Rate	$549.82
Max. Negotiated Rate	$3,123.99
Rate for Payer: Aetna of AZ Commercial	$3,123.99
Rate for Payer: Arizona Complete Health Allwell	$555.38
Rate for Payer: Banner UC Health Medicare	$555.38
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,360.35
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$555.38
Rate for Payer: Care1st Health Plan Arizona Medicare	$555.38
Rate for Payer: Cash Price	$2,776.88
Rate for Payer: Cigna of AZ Commercial	$2,429.77
Rate for Payer: Devoted Health Medicare	$624.80
Rate for Payer: Humana of AZ Medicare	$555.38
Rate for Payer: Southwest Service Administrators UFCW	$2,360.35
Rate for Payer: TriWest Medicare	$555.38
Rate for Payer: United Healthcare Commercial	$1,985.47
Rate for Payer: United Healthcare Medicare	$555.38
Rate for Payer: Veterans Affairs TRICARE	$549.82

DART FIRE EDGE SCREW SNAP OFF 2.7MMX15MM

Facility

$3,592.60

Hospital Charge Code	29572666
Hospital Revenue Code	270
Min. Negotiated Rate	$3,233.34
Max. Negotiated Rate	$3,233.34
Rate for Payer: Aetna of AZ Commercial	$3,233.34
Rate for Payer: Cash Price	$2,874.08

DART FIRE EDGE SCREW SNAP OFF 2.7MMX15MM

Facility

$3,592.60

Hospital Charge Code	29572666
Hospital Revenue Code	270
Min. Negotiated Rate	$569.07
Max. Negotiated Rate	$3,233.34
Rate for Payer: Aetna of AZ Commercial	$3,233.34
Rate for Payer: Arizona Complete Health Allwell	$574.82
Rate for Payer: Banner UC Health Medicare	$574.82
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,442.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$574.82
Rate for Payer: Care1st Health Plan Arizona Medicare	$574.82
Rate for Payer: Cash Price	$2,874.08
Rate for Payer: Cigna of AZ Commercial	$2,514.82
Rate for Payer: Devoted Health Medicare	$646.67
Rate for Payer: Humana of AZ Medicare	$574.82
Rate for Payer: Southwest Service Administrators UFCW	$2,442.97
Rate for Payer: TriWest Medicare	$574.82
Rate for Payer: United Healthcare Commercial	$2,054.97
Rate for Payer: United Healthcare Medicare	$574.82
Rate for Payer: Veterans Affairs TRICARE	$569.07

DAT Complement

Facility

$74.00

Service Code	CPT 86880
Hospital Charge Code	22244675
Hospital Revenue Code	302
Min. Negotiated Rate	$7.82
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	$7.82
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

DAT Complement

Facility

$74.00

Service Code	CPT 86880
Hospital Charge Code	22244675
Hospital Revenue Code	302
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

DAT IgG

Facility

$74.00

Service Code	CPT 86880
Hospital Charge Code	14018312
Hospital Revenue Code	302
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

DAT IgG

Facility

$74.00

Service Code	CPT 86880
Hospital Charge Code	14018312
Hospital Revenue Code	302
Min. Negotiated Rate	$7.82
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	$7.82
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

DAT Poly

Facility

$70.00

Service Code	CPT 86880
Hospital Charge Code	14018311
Hospital Revenue Code	302
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Cash Price	$56.00

DAT Poly

Facility

$70.00

Service Code	CPT 86880
Hospital Charge Code	14018311
Hospital Revenue Code	302
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Arizona Complete Health Allwell	$11.20
Rate for Payer: Banner UC Health Medicare	$11.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$47.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.20
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$11.20
Rate for Payer: Seven Corners Travel Insurance	$7.82
Rate for Payer: Southwest Service Administrators UFCW	$47.60
Rate for Payer: TriWest Medicare	$11.20
Rate for Payer: United Healthcare Commercial	$40.04
Rate for Payer: United Healthcare Medicare	$11.20
Rate for Payer: Veterans Affairs TRICARE	$11.09

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$26,482.86

Service Code	MSDRG 744
Min. Negotiated Rate	$26,482.86
Max. Negotiated Rate	$26,482.86
Rate for Payer: Seven Corners Travel Insurance	$26,482.86

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$14,768.92

Service Code	MSDRG 745
Min. Negotiated Rate	$14,768.92
Max. Negotiated Rate	$14,768.92
Rate for Payer: Seven Corners Travel Insurance	$14,768.92

DCP

Facility

$334.00

Service Code	CPT 83951
Hospital Charge Code	23185839
Hospital Revenue Code	302
Min. Negotiated Rate	$52.91
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Arizona Complete Health Allwell	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$227.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.44
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Devoted Health Medicare	$60.12
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Seven Corners Travel Insurance	$93.39
Rate for Payer: Southwest Service Administrators UFCW	$227.12
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: United Healthcare Commercial	$191.05
Rate for Payer: United Healthcare Medicare	$53.44
Rate for Payer: Veterans Affairs TRICARE	$52.91

DCP

Facility

$334.00

Service Code	CPT 83951
Hospital Charge Code	23185839
Hospital Revenue Code	302
Min. Negotiated Rate	$300.60
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Cash Price	$267.20

D-Dimer

Facility

$295.00

Service Code	CPT 85379
Hospital Charge Code	633718
Hospital Revenue Code	305
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Cash Price	$236.00

D-Dimer

Facility

$295.00

Service Code	CPT 85379
Hospital Charge Code	633718
Hospital Revenue Code	305
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Arizona Complete Health Allwell	$47.20
Rate for Payer: Banner UC Health Medicare	$47.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$200.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.20
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Devoted Health Medicare	$53.10
Rate for Payer: Humana of AZ Medicare	$47.20
Rate for Payer: Seven Corners Travel Insurance	$14.76
Rate for Payer: Southwest Service Administrators UFCW	$200.60
Rate for Payer: TriWest Medicare	$47.20
Rate for Payer: United Healthcare Commercial	$168.74
Rate for Payer: United Healthcare Medicare	$47.20
Rate for Payer: Veterans Affairs TRICARE	$46.73

Know your out-of-pocket cost for care.

All Charges