Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ENSIZOR ENDOSCOPIC SCISSORS 235CM

Facility

$2,348.00

Hospital Charge Code	27758288
Hospital Revenue Code	270
Min. Negotiated Rate	$371.92
Max. Negotiated Rate	$2,113.20
Rate for Payer: Aetna of AZ Commercial	$2,113.20
Rate for Payer: Arizona Complete Health Allwell	$375.68
Rate for Payer: Banner UC Health Medicare	$375.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,596.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$375.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$375.68
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cigna of AZ Commercial	$1,643.60
Rate for Payer: Devoted Health Medicare	$422.64
Rate for Payer: Humana of AZ Medicare	$375.68
Rate for Payer: Southwest Service Administrators UFCW	$1,596.64
Rate for Payer: TriWest Medicare	$375.68
Rate for Payer: United Healthcare Commercial	$1,343.06
Rate for Payer: United Healthcare Medicare	$375.68
Rate for Payer: Veterans Affairs TRICARE	$371.92

ENSIZOR ENDOSCOPIC SCISSORS 235CM

Facility

$2,348.00

Hospital Charge Code	27758288
Hospital Revenue Code	270
Min. Negotiated Rate	$2,113.20
Max. Negotiated Rate	$2,113.20
Rate for Payer: Aetna of AZ Commercial	$2,113.20
Rate for Payer: Cash Price	$1,878.40

entacapone 200 mg Tab [CQCH]

Facility

$2.42

Service Code	NDC 51079027303
Hospital Charge Code	105920659
Hospital Revenue Code	251
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna of AZ Commercial	$2.18
Rate for Payer: Cash Price	$1.94

entacapone 200 mg Tab [CQCH]

Facility

$2.42

Service Code	NDC 51079027303
Hospital Charge Code	105920659
Hospital Revenue Code	251
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna of AZ Commercial	$2.18
Rate for Payer: Arizona Complete Health Allwell	$0.39
Rate for Payer: Banner UC Health Medicare	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.65
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.39
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.39
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cigna of AZ Commercial	$1.57
Rate for Payer: Devoted Health Medicare	$0.44
Rate for Payer: Humana of AZ Medicare	$0.39
Rate for Payer: Southwest Service Administrators UFCW	$1.65
Rate for Payer: TriWest Medicare	$0.39
Rate for Payer: United Healthcare Commercial	$1.38
Rate for Payer: United Healthcare Medicare	$0.39
Rate for Payer: Veterans Affairs TRICARE	$0.38

Enterocele Repair vaginal

Facility

$2,615.00

Service Code	CPT 57268
Hospital Charge Code	27267822
Hospital Revenue Code	360
Min. Negotiated Rate	$414.22
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$2,353.50
Rate for Payer: Arizona Complete Health Allwell	$418.40
Rate for Payer: Banner UC Health Medicare	$1,698.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,778.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$418.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$418.40
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Cash Price	$2,092.00
Rate for Payer: Cigna of AZ Commercial	$1,307.50
Rate for Payer: Devoted Health Medicare	$470.70
Rate for Payer: Humana of AZ Medicare	$418.40
Rate for Payer: NaphCare Correctional Healthcare	$1,698.98
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: Southwest Service Administrators UFCW	$1,778.20
Rate for Payer: TriWest Medicare	$418.40
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$418.40
Rate for Payer: Veterans Affairs TRICARE	$414.22

Enterocele Repair vaginal

Facility

$2,615.00

Service Code	CPT 57268
Hospital Charge Code	27267822
Hospital Revenue Code	360
Min. Negotiated Rate	$2,353.50
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna of AZ Commercial	$2,353.50
Rate for Payer: Cash Price	$2,092.00

ENTEROSCOPY SMALL BOWEL

Facility

$6,347.00

Service Code	CPT 44366
Hospital Charge Code	23598976
Hospital Revenue Code	750
Min. Negotiated Rate	$5,712.30
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Cash Price	$5,077.60

ENTEROSCOPY SMALL BOWEL

Facility

$6,347.00

Service Code	CPT 44366
Hospital Charge Code	23598976
Hospital Revenue Code	750
Min. Negotiated Rate	$617.94
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Arizona Complete Health Allwell	$1,015.52
Rate for Payer: Banner UC Health Medicare	$617.94
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,315.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,015.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,015.52
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cigna of AZ Commercial	$4,442.90
Rate for Payer: Devoted Health Medicare	$1,142.46
Rate for Payer: Humana of AZ Medicare	$1,015.52
Rate for Payer: NaphCare Correctional Healthcare	$617.94
Rate for Payer: Seven Corners Travel Insurance	$2,969.06
Rate for Payer: Southwest Service Administrators UFCW	$4,315.96
Rate for Payer: TriWest Medicare	$1,015.52
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$1,015.52
Rate for Payer: United Healthcare New Mexico Commercial	$1,205.93
Rate for Payer: Veterans Affairs TRICARE	$1,005.36

Eosinophil Count- Nasal

Facility

$92.00

Service Code	CPT 89190
Hospital Charge Code	22360630
Hospital Revenue Code	305
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Cash Price	$73.60

Eosinophil Count- Nasal

Facility

$92.00

Service Code	CPT 89190
Hospital Charge Code	22360630
Hospital Revenue Code	305
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Arizona Complete Health Allwell	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$62.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.72
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$59.80
Rate for Payer: Devoted Health Medicare	$16.56
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Seven Corners Travel Insurance	$8.40
Rate for Payer: Southwest Service Administrators UFCW	$62.56
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: United Healthcare Commercial	$52.62
Rate for Payer: United Healthcare Medicare	$14.72
Rate for Payer: Veterans Affairs TRICARE	$14.57

ePHEDrine 50 mg/mL Inj Sol [CQCH]

Facility

$16.30

Service Code	NDC 17478051500
Hospital Charge Code	105920724
Hospital Revenue Code	251
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$14.67
Rate for Payer: Aetna of AZ Commercial	$14.67
Rate for Payer: Cash Price	$13.04

ePHEDrine 50 mg/mL Inj Sol [CQCH]

Facility

$16.30

Service Code	NDC 17478051500
Hospital Charge Code	105920724
Hospital Revenue Code	251
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$14.67
Rate for Payer: Aetna of AZ Commercial	$14.67
Rate for Payer: Arizona Complete Health Allwell	$2.61
Rate for Payer: Banner UC Health Medicare	$2.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$11.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.61
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.61
Rate for Payer: Cash Price	$13.04
Rate for Payer: Cigna of AZ Commercial	$10.60
Rate for Payer: Devoted Health Medicare	$2.93
Rate for Payer: Humana of AZ Medicare	$2.61
Rate for Payer: Southwest Service Administrators UFCW	$11.08
Rate for Payer: TriWest Medicare	$2.61
Rate for Payer: United Healthcare Commercial	$9.32
Rate for Payer: United Healthcare Medicare	$2.61
Rate for Payer: Veterans Affairs TRICARE	$2.58

EPICORD EXPANDABLE 2X3CM

Facility

$1,621.67

Service Code	HCPCS Q4187
Hospital Charge Code	24403651
Hospital Revenue Code	636
Min. Negotiated Rate	$1,459.50
Max. Negotiated Rate	$1,459.50
Rate for Payer: Aetna of AZ Commercial	$1,459.50
Rate for Payer: Cash Price	$1,297.34

EPICORD EXPANDABLE 2X3CM

Facility

$1,621.67

Service Code	HCPCS Q4187
Hospital Charge Code	24403651
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$1,459.50
Rate for Payer: Aetna of AZ Commercial	$1,459.50
Rate for Payer: Arizona Complete Health Allwell	$259.47
Rate for Payer: Banner UC Health Medicare	$259.47
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,102.74
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$259.47
Rate for Payer: Care1st Health Plan Arizona Medicare	$259.47
Rate for Payer: Cash Price	$1,297.34
Rate for Payer: Cash Price	$1,297.34
Rate for Payer: Cigna of AZ Commercial	$1,135.17
Rate for Payer: Devoted Health Medicare	$291.90
Rate for Payer: Humana of AZ Medicare	$259.47
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$1,102.74
Rate for Payer: TriWest Medicare	$259.47
Rate for Payer: United Healthcare Commercial	$927.60
Rate for Payer: United Healthcare Medicare	$259.47
Rate for Payer: United Healthcare New Mexico Commercial	$308.12
Rate for Payer: Veterans Affairs TRICARE	$256.87

Epidural Blood Patch

Facility

$309.00

Hospital Charge Code	9310198
Hospital Revenue Code	360
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Arizona Complete Health Allwell	$49.44
Rate for Payer: Banner UC Health Medicare	$49.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$210.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.44
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cigna of AZ Commercial	$154.50
Rate for Payer: Devoted Health Medicare	$55.62
Rate for Payer: Humana of AZ Medicare	$49.44
Rate for Payer: Southwest Service Administrators UFCW	$210.12
Rate for Payer: TriWest Medicare	$49.44
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$49.44
Rate for Payer: Veterans Affairs TRICARE	$48.95

Epidural Blood Patch

Facility

$309.00

Hospital Charge Code	9310198
Hospital Revenue Code	360
Min. Negotiated Rate	$278.10
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Cash Price	$247.20

EPIEFFECT 2CMX3CM

Facility

$3,500.00

Service Code	HCPCS Q4278
Hospital Charge Code	27651348
Hospital Revenue Code	636
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna of AZ Commercial	$3,150.00
Rate for Payer: Cash Price	$2,800.00

EPIEFFECT 2CMX3CM

Facility

$3,500.00

Service Code	HCPCS Q4278
Hospital Charge Code	27651348
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna of AZ Commercial	$3,150.00
Rate for Payer: Arizona Complete Health Allwell	$560.00
Rate for Payer: Banner UC Health Medicare	$560.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,380.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$560.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$560.00
Rate for Payer: Cash Price	$2,800.00
Rate for Payer: Cash Price	$2,800.00
Rate for Payer: Cigna of AZ Commercial	$2,450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Humana of AZ Medicare	$560.00
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$2,380.00
Rate for Payer: TriWest Medicare	$560.00
Rate for Payer: United Healthcare Commercial	$2,002.00
Rate for Payer: United Healthcare Medicare	$560.00
Rate for Payer: United Healthcare New Mexico Commercial	$665.00
Rate for Payer: Veterans Affairs TRICARE	$554.40

EPIEFFECT 3CMX5CM

Facility

$3,500.00

Service Code	HCPCS Q4278
Hospital Charge Code	27651349
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna of AZ Commercial	$3,150.00
Rate for Payer: Arizona Complete Health Allwell	$560.00
Rate for Payer: Banner UC Health Medicare	$560.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,380.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$560.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$560.00
Rate for Payer: Cash Price	$2,800.00
Rate for Payer: Cash Price	$2,800.00
Rate for Payer: Cigna of AZ Commercial	$2,450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Humana of AZ Medicare	$560.00
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$2,380.00
Rate for Payer: TriWest Medicare	$560.00
Rate for Payer: United Healthcare Commercial	$2,002.00
Rate for Payer: United Healthcare Medicare	$560.00
Rate for Payer: United Healthcare New Mexico Commercial	$665.00
Rate for Payer: Veterans Affairs TRICARE	$554.40

EPIEFFECT 3CMX5CM

Facility

$3,500.00

Service Code	HCPCS Q4278
Hospital Charge Code	27651349
Hospital Revenue Code	636
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna of AZ Commercial	$3,150.00
Rate for Payer: Cash Price	$2,800.00

EPIEFFECT 7CMX7CM

Facility

$3,500.00

Service Code	HCPCS Q4278
Hospital Charge Code	27660335
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna of AZ Commercial	$3,150.00
Rate for Payer: Arizona Complete Health Allwell	$560.00
Rate for Payer: Banner UC Health Medicare	$560.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,380.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$560.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$560.00
Rate for Payer: Cash Price	$2,800.00
Rate for Payer: Cash Price	$2,800.00
Rate for Payer: Cigna of AZ Commercial	$2,450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Humana of AZ Medicare	$560.00
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$2,380.00
Rate for Payer: TriWest Medicare	$560.00
Rate for Payer: United Healthcare Commercial	$2,002.00
Rate for Payer: United Healthcare Medicare	$560.00
Rate for Payer: United Healthcare New Mexico Commercial	$665.00
Rate for Payer: Veterans Affairs TRICARE	$554.40

EPIEFFECT 7CMX7CM

Facility

$3,500.00

Service Code	HCPCS Q4278
Hospital Charge Code	27660335
Hospital Revenue Code	636
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna of AZ Commercial	$3,150.00
Rate for Payer: Cash Price	$2,800.00

EPIFIX 18MM DISK

Facility

$1,600.67

Service Code	HCPCS Q4186
Hospital Charge Code	27592022
Hospital Revenue Code	636
Min. Negotiated Rate	$1,440.60
Max. Negotiated Rate	$1,440.60
Rate for Payer: Aetna of AZ Commercial	$1,440.60
Rate for Payer: Cash Price	$1,280.54

EPIFIX 18MM DISK

Facility

$1,600.67

Service Code	HCPCS Q4186
Hospital Charge Code	27592022
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$1,440.60
Rate for Payer: Aetna of AZ Commercial	$1,440.60
Rate for Payer: Arizona Complete Health Allwell	$256.11
Rate for Payer: Banner UC Health Medicare	$256.11
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,088.46
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$256.11
Rate for Payer: Care1st Health Plan Arizona Medicare	$256.11
Rate for Payer: Cash Price	$1,280.54
Rate for Payer: Cash Price	$1,280.54
Rate for Payer: Cigna of AZ Commercial	$1,120.47
Rate for Payer: Devoted Health Medicare	$288.12
Rate for Payer: Humana of AZ Medicare	$256.11
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$1,088.46
Rate for Payer: TriWest Medicare	$256.11
Rate for Payer: United Healthcare Commercial	$915.58
Rate for Payer: United Healthcare Medicare	$256.11
Rate for Payer: United Healthcare New Mexico Commercial	$304.13
Rate for Payer: Veterans Affairs TRICARE	$253.55

EPIFIX 2X2

Facility

$1,725.50

Service Code	HCPCS Q4186
Hospital Charge Code	28244699
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$1,552.95
Rate for Payer: Aetna of AZ Commercial	$1,552.95
Rate for Payer: Arizona Complete Health Allwell	$276.08
Rate for Payer: Banner UC Health Medicare	$276.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,173.34
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$276.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$276.08
Rate for Payer: Cash Price	$1,380.40
Rate for Payer: Cash Price	$1,380.40
Rate for Payer: Cigna of AZ Commercial	$1,207.85
Rate for Payer: Devoted Health Medicare	$310.59
Rate for Payer: Humana of AZ Medicare	$276.08
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$1,173.34
Rate for Payer: TriWest Medicare	$276.08
Rate for Payer: United Healthcare Commercial	$986.99
Rate for Payer: United Healthcare Medicare	$276.08
Rate for Payer: United Healthcare New Mexico Commercial	$327.85
Rate for Payer: Veterans Affairs TRICARE	$273.32

Know your out-of-pocket cost for care.

All Charges