Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ENDOPOUCH RETRIEVER

Facility

$896.00

Hospital Charge Code	22560772
Hospital Revenue Code	272
Min. Negotiated Rate	$806.40
Max. Negotiated Rate	$806.40
Rate for Payer: Aetna of AZ Commercial	$806.40
Rate for Payer: Cash Price	$716.80

ENDOPOUCH RETRIEVER

Facility

$896.00

Hospital Charge Code	22560772
Hospital Revenue Code	272
Min. Negotiated Rate	$141.93
Max. Negotiated Rate	$806.40
Rate for Payer: Aetna of AZ Commercial	$806.40
Rate for Payer: Arizona Complete Health Allwell	$143.36
Rate for Payer: Banner UC Health Medicare	$143.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$609.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$143.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$143.36
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cigna of AZ Commercial	$627.20
Rate for Payer: Devoted Health Medicare	$161.28
Rate for Payer: Humana of AZ Medicare	$143.36
Rate for Payer: Southwest Service Administrators UFCW	$609.28
Rate for Payer: TriWest Medicare	$143.36
Rate for Payer: United Healthcare Commercial	$512.51
Rate for Payer: United Healthcare Medicare	$143.36
Rate for Payer: Veterans Affairs TRICARE	$141.93

Endoscopic linear cutter Reloads 35mm Standard

Facility

$791.00

Hospital Charge Code	22926414
Hospital Revenue Code	272
Min. Negotiated Rate	$125.29
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna of AZ Commercial	$711.90
Rate for Payer: Arizona Complete Health Allwell	$126.56
Rate for Payer: Banner UC Health Medicare	$126.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$537.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$126.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$126.56
Rate for Payer: Cash Price	$632.80
Rate for Payer: Cigna of AZ Commercial	$553.70
Rate for Payer: Devoted Health Medicare	$142.38
Rate for Payer: Humana of AZ Medicare	$126.56
Rate for Payer: Southwest Service Administrators UFCW	$537.88
Rate for Payer: TriWest Medicare	$126.56
Rate for Payer: United Healthcare Commercial	$452.45
Rate for Payer: United Healthcare Medicare	$126.56
Rate for Payer: Veterans Affairs TRICARE	$125.29

Endoscopic linear cutter Reloads 35mm Standard

Facility

$791.00

Hospital Charge Code	22926414
Hospital Revenue Code	272
Min. Negotiated Rate	$711.90
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna of AZ Commercial	$711.90
Rate for Payer: Cash Price	$632.80

Endoscopic linear cutter Reloads 45mm VASCULAR THIN

Facility

$671.00

Hospital Charge Code	22926415
Hospital Revenue Code	272
Min. Negotiated Rate	$106.29
Max. Negotiated Rate	$603.90
Rate for Payer: Aetna of AZ Commercial	$603.90
Rate for Payer: Arizona Complete Health Allwell	$107.36
Rate for Payer: Banner UC Health Medicare	$107.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$456.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$107.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$107.36
Rate for Payer: Cash Price	$536.80
Rate for Payer: Cigna of AZ Commercial	$469.70
Rate for Payer: Devoted Health Medicare	$120.78
Rate for Payer: Humana of AZ Medicare	$107.36
Rate for Payer: Southwest Service Administrators UFCW	$456.28
Rate for Payer: TriWest Medicare	$107.36
Rate for Payer: United Healthcare Commercial	$383.81
Rate for Payer: United Healthcare Medicare	$107.36
Rate for Payer: Veterans Affairs TRICARE	$106.29

Endoscopic linear cutter Reloads 45mm VASCULAR THIN

Facility

$671.00

Hospital Charge Code	22926415
Hospital Revenue Code	272
Min. Negotiated Rate	$603.90
Max. Negotiated Rate	$603.90
Rate for Payer: Aetna of AZ Commercial	$603.90
Rate for Payer: Cash Price	$536.80

ENDOSCOPIC PLANTAR FASCIOTOMY - Tech

Facility

$2,092.00

Service Code	CPT 29893
Hospital Charge Code	24043272
Hospital Revenue Code	360
Min. Negotiated Rate	$220.01
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,882.80
Rate for Payer: Arizona Complete Health Allwell	$334.72
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,422.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$220.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$334.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$334.72
Rate for Payer: Cash Price	$1,673.60
Rate for Payer: Cash Price	$1,673.60
Rate for Payer: Cash Price	$1,673.60
Rate for Payer: Cigna of AZ Commercial	$1,046.00
Rate for Payer: Devoted Health Medicare	$376.56
Rate for Payer: Humana of AZ Medicare	$334.72
Rate for Payer: Mercy Care Medicaid	$220.01
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$1,422.56
Rate for Payer: TriWest Medicare	$334.72
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$334.72
Rate for Payer: Veterans Affairs TRICARE	$331.37

ENDOSCOPIC PLANTAR FASCIOTOMY - Tech

Facility

$2,092.00

Service Code	CPT 29893
Hospital Charge Code	24043272
Hospital Revenue Code	360
Min. Negotiated Rate	$1,882.80
Max. Negotiated Rate	$1,882.80
Rate for Payer: Aetna of AZ Commercial	$1,882.80
Rate for Payer: Cash Price	$1,673.60

ENDOTRACHEAL TUBE BOUGIE PEDIATRIC 10FRX70CM

Facility

$59.00

Hospital Charge Code	27704488
Hospital Revenue Code	270
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Arizona Complete Health Allwell	$9.44
Rate for Payer: Banner UC Health Medicare	$9.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.44
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cigna of AZ Commercial	$41.30
Rate for Payer: Devoted Health Medicare	$10.62
Rate for Payer: Humana of AZ Medicare	$9.44
Rate for Payer: Southwest Service Administrators UFCW	$40.12
Rate for Payer: TriWest Medicare	$9.44
Rate for Payer: United Healthcare Commercial	$33.75
Rate for Payer: United Healthcare Medicare	$9.44
Rate for Payer: Veterans Affairs TRICARE	$9.35

ENDOTRACHEAL TUBE BOUGIE PEDIATRIC 10FRX70CM

Facility

$59.00

Hospital Charge Code	27704488
Hospital Revenue Code	270
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Cash Price	$47.20

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$73,756.76

Service Code	MSDRG 213
Min. Negotiated Rate	$73,756.76
Max. Negotiated Rate	$73,756.76
Rate for Payer: Seven Corners Travel Insurance	$73,756.76

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$79,204.31

Service Code	MSDRG 266
Min. Negotiated Rate	$79,204.31
Max. Negotiated Rate	$79,204.31
Rate for Payer: Seven Corners Travel Insurance	$79,204.31

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$61,529.26

Service Code	MSDRG 267
Min. Negotiated Rate	$61,529.26
Max. Negotiated Rate	$61,529.26
Rate for Payer: Seven Corners Travel Insurance	$61,529.26

enoxaparin 100 mg/mL SC [CQCH]

Facility

$7.31

Service Code	HCPCS J1650
Hospital Charge Code	108072705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$6.58
Rate for Payer: Aetna of AZ Commercial	$6.58
Rate for Payer: Arizona Complete Health Allwell	$1.17
Rate for Payer: Banner UC Health Medicare	$1.17
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.17
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.17
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of AZ Commercial	$4.75
Rate for Payer: Devoted Health Medicare	$1.32
Rate for Payer: Humana of AZ Medicare	$1.17
Rate for Payer: Southwest Service Administrators UFCW	$4.97
Rate for Payer: TriWest Medicare	$1.17
Rate for Payer: United Healthcare Commercial	$4.18
Rate for Payer: United Healthcare Medicare	$1.17
Rate for Payer: Veterans Affairs TRICARE	$1.16

enoxaparin 100 mg/mL SC [CQCH]

Facility

$7.31

Service Code	HCPCS J1650
Hospital Charge Code	108072705
Hospital Revenue Code	250
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$6.58
Rate for Payer: Aetna of AZ Commercial	$6.58
Rate for Payer: Cash Price	$5.85

enoxaparin 120 mg/0.8 mL SC [CQCH]

Facility

$10.68

Service Code	HCPCS J1650
Hospital Charge Code	108072834
Hospital Revenue Code	250
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna of AZ Commercial	$9.61
Rate for Payer: Cash Price	$8.55

enoxaparin 120 mg/0.8 mL SC [CQCH]

Facility

$10.68

Service Code	HCPCS J1650
Hospital Charge Code	108072834
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna of AZ Commercial	$9.61
Rate for Payer: Arizona Complete Health Allwell	$1.71
Rate for Payer: Banner UC Health Medicare	$1.71
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7.26
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.71
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.71
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cigna of AZ Commercial	$6.94
Rate for Payer: Devoted Health Medicare	$1.92
Rate for Payer: Humana of AZ Medicare	$1.71
Rate for Payer: Southwest Service Administrators UFCW	$7.26
Rate for Payer: TriWest Medicare	$1.71
Rate for Payer: United Healthcare Commercial	$6.11
Rate for Payer: United Healthcare Medicare	$1.71
Rate for Payer: Veterans Affairs TRICARE	$1.69

enoxaparin 30 mg/0.3 mL SC [CQCH]

Facility

$2.10

Service Code	HCPCS J1650
Hospital Charge Code	105920357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.89
Rate for Payer: Aetna of AZ Commercial	$1.89
Rate for Payer: Arizona Complete Health Allwell	$0.34
Rate for Payer: Banner UC Health Medicare	$0.34
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.43
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.34
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.34
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cigna of AZ Commercial	$1.36
Rate for Payer: Devoted Health Medicare	$0.38
Rate for Payer: Humana of AZ Medicare	$0.34
Rate for Payer: Southwest Service Administrators UFCW	$1.43
Rate for Payer: TriWest Medicare	$0.34
Rate for Payer: United Healthcare Commercial	$1.20
Rate for Payer: United Healthcare Medicare	$0.34
Rate for Payer: Veterans Affairs TRICARE	$0.33

enoxaparin 30 mg/0.3 mL SC [CQCH]

Facility

$2.10

Service Code	HCPCS J1650
Hospital Charge Code	105920357
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$1.89
Rate for Payer: Aetna of AZ Commercial	$1.89
Rate for Payer: Cash Price	$1.68

enoxaparin 40 mg/0.4 mL SC [CQCH]

Facility

$3.10

Service Code	HCPCS J1650
Hospital Charge Code	105920582
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of AZ Commercial	$2.79
Rate for Payer: Cash Price	$2.48

enoxaparin 40 mg/0.4 mL SC [CQCH]

Facility

$3.10

Service Code	HCPCS J1650
Hospital Charge Code	105920582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of AZ Commercial	$2.79
Rate for Payer: Arizona Complete Health Allwell	$0.50
Rate for Payer: Banner UC Health Medicare	$0.50
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.11
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.50
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.50
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cigna of AZ Commercial	$2.02
Rate for Payer: Devoted Health Medicare	$0.56
Rate for Payer: Humana of AZ Medicare	$0.50
Rate for Payer: Southwest Service Administrators UFCW	$2.11
Rate for Payer: TriWest Medicare	$0.50
Rate for Payer: United Healthcare Commercial	$1.77
Rate for Payer: United Healthcare Medicare	$0.50
Rate for Payer: Veterans Affairs TRICARE	$0.49

enoxaparin 60 mg/0.6 mL SC [CQCH]

Facility

$4.40

Service Code	HCPCS J1650
Hospital Charge Code	105920507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna of AZ Commercial	$3.96
Rate for Payer: Arizona Complete Health Allwell	$0.70
Rate for Payer: Banner UC Health Medicare	$0.70
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.99
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.70
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.70
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cigna of AZ Commercial	$2.86
Rate for Payer: Devoted Health Medicare	$0.79
Rate for Payer: Humana of AZ Medicare	$0.70
Rate for Payer: Southwest Service Administrators UFCW	$2.99
Rate for Payer: TriWest Medicare	$0.70
Rate for Payer: United Healthcare Commercial	$2.52
Rate for Payer: United Healthcare Medicare	$0.70
Rate for Payer: Veterans Affairs TRICARE	$0.70

enoxaparin 60 mg/0.6 mL SC [CQCH]

Facility

$4.40

Service Code	HCPCS J1650
Hospital Charge Code	105920507
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna of AZ Commercial	$3.96
Rate for Payer: Cash Price	$3.52

enoxaparin 80 mg/0.8 mL SC [CQCH]

Facility

$5.63

Service Code	HCPCS J1650
Hospital Charge Code	105920432
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna of AZ Commercial	$5.07
Rate for Payer: Arizona Complete Health Allwell	$0.90
Rate for Payer: Banner UC Health Medicare	$0.90
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.83
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.90
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.90
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of AZ Commercial	$3.66
Rate for Payer: Devoted Health Medicare	$1.01
Rate for Payer: Humana of AZ Medicare	$0.90
Rate for Payer: Southwest Service Administrators UFCW	$3.83
Rate for Payer: TriWest Medicare	$0.90
Rate for Payer: United Healthcare Commercial	$3.22
Rate for Payer: United Healthcare Medicare	$0.90
Rate for Payer: Veterans Affairs TRICARE	$0.89

enoxaparin 80 mg/0.8 mL SC [CQCH]

Facility

$5.63

Service Code	HCPCS J1650
Hospital Charge Code	105920432
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna of AZ Commercial	$5.07
Rate for Payer: Cash Price	$4.50

Know your out-of-pocket cost for care.

All Charges