Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

FRACTURES OF FEMUR WITH MCC

Facility

$20,261.18

Service Code	MSDRG 533
Min. Negotiated Rate	$20,261.18
Max. Negotiated Rate	$20,261.18
Rate for Payer: Seven Corners Travel Insurance	$20,261.18

FRACTURES OF FEMUR WITHOUT MCC

Facility

$10,569.66

Service Code	MSDRG 534
Min. Negotiated Rate	$10,569.66
Max. Negotiated Rate	$10,569.66
Rate for Payer: Seven Corners Travel Insurance	$10,569.66

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$16,599.90

Service Code	MSDRG 535
Min. Negotiated Rate	$16,599.90
Max. Negotiated Rate	$16,599.90
Rate for Payer: Seven Corners Travel Insurance	$16,599.90

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$10,588.67

Service Code	MSDRG 536
Min. Negotiated Rate	$10,588.67
Max. Negotiated Rate	$10,588.67
Rate for Payer: Seven Corners Travel Insurance	$10,588.67

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$18,414.32

Service Code	MSDRG 562
Min. Negotiated Rate	$18,414.32
Max. Negotiated Rate	$18,414.32
Rate for Payer: Seven Corners Travel Insurance	$18,414.32

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$11,702.46

Service Code	MSDRG 563
Min. Negotiated Rate	$11,702.46
Max. Negotiated Rate	$11,702.46
Rate for Payer: Seven Corners Travel Insurance	$11,702.46

Free and Total Insulin LC

Facility

$185.00

Service Code	CPT 83527
Hospital Charge Code	22201725
Hospital Revenue Code	301
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Arizona Complete Health Allwell	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.60
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$120.25
Rate for Payer: Devoted Health Medicare	$33.30
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Seven Corners Travel Insurance	$18.78
Rate for Payer: Southwest Service Administrators UFCW	$125.80
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: United Healthcare Commercial	$105.82
Rate for Payer: United Healthcare Medicare	$29.60
Rate for Payer: Veterans Affairs TRICARE	$29.30

Free and Total Insulin LC

Facility

$185.00

Service Code	CPT 83527
Hospital Charge Code	22201725
Hospital Revenue Code	301
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Cash Price	$148.00

Free K+L Lt Chains,Qn,S LC

Facility

$260.00

Service Code	CPT 83883
Hospital Charge Code	2029245
Hospital Revenue Code	301
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of AZ Commercial	$234.00
Rate for Payer: Arizona Complete Health Allwell	$41.60
Rate for Payer: Banner UC Health Medicare	$41.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$176.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.60
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cigna of AZ Commercial	$169.00
Rate for Payer: Devoted Health Medicare	$46.80
Rate for Payer: Humana of AZ Medicare	$41.60
Rate for Payer: Seven Corners Travel Insurance	$19.72
Rate for Payer: Southwest Service Administrators UFCW	$176.80
Rate for Payer: TriWest Medicare	$41.60
Rate for Payer: United Healthcare Commercial	$148.72
Rate for Payer: United Healthcare Medicare	$41.60
Rate for Payer: Veterans Affairs TRICARE	$41.18

Free K+L Lt Chains,Qn,S LC

Facility

$260.00

Service Code	CPT 83883
Hospital Charge Code	2029245
Hospital Revenue Code	301
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna of AZ Commercial	$234.00
Rate for Payer: Cash Price	$208.00

Free K+L Lt Chains Ur Qn LC

Facility

$168.00

Service Code	CPT 83883
Hospital Charge Code	23756988
Hospital Revenue Code	300
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Arizona Complete Health Allwell	$26.88
Rate for Payer: Banner UC Health Medicare	$26.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.88
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$109.20
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$26.88
Rate for Payer: Seven Corners Travel Insurance	$19.72
Rate for Payer: Southwest Service Administrators UFCW	$114.24
Rate for Payer: TriWest Medicare	$26.88
Rate for Payer: United Healthcare Commercial	$96.10
Rate for Payer: United Healthcare Medicare	$26.88
Rate for Payer: Veterans Affairs TRICARE	$26.61

Free K+L Lt Chains Ur Qn LC

Facility

$168.00

Service Code	CPT 83883
Hospital Charge Code	6781685
Hospital Revenue Code	300
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Arizona Complete Health Allwell	$26.88
Rate for Payer: Banner UC Health Medicare	$26.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.88
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$109.20
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$26.88
Rate for Payer: Seven Corners Travel Insurance	$19.72
Rate for Payer: Southwest Service Administrators UFCW	$114.24
Rate for Payer: TriWest Medicare	$26.88
Rate for Payer: United Healthcare Commercial	$96.10
Rate for Payer: United Healthcare Medicare	$26.88
Rate for Payer: Veterans Affairs TRICARE	$26.61

Free K+L Lt Chains Ur Qn LC

Facility

$168.00

Service Code	CPT 83883
Hospital Charge Code	6781685
Hospital Revenue Code	300
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Cash Price	$134.40

Free K+L Lt Chains Ur Qn LC

Facility

$168.00

Service Code	CPT 83883
Hospital Charge Code	23756988
Hospital Revenue Code	300
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Cash Price	$134.40

Free T4

Facility

$355.00

Service Code	CPT 84439
Hospital Charge Code	857849
Hospital Revenue Code	301
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Arizona Complete Health Allwell	$56.80
Rate for Payer: Banner UC Health Medicare	$56.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$241.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$56.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$56.80
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cigna of AZ Commercial	$230.75
Rate for Payer: Devoted Health Medicare	$63.90
Rate for Payer: Humana of AZ Medicare	$56.80
Rate for Payer: Seven Corners Travel Insurance	$13.08
Rate for Payer: Southwest Service Administrators UFCW	$241.40
Rate for Payer: TriWest Medicare	$56.80
Rate for Payer: United Healthcare Commercial	$203.06
Rate for Payer: United Healthcare Medicare	$56.80
Rate for Payer: Veterans Affairs TRICARE	$56.23

Free T4

Facility

$355.00

Service Code	CPT 84439
Hospital Charge Code	857849
Hospital Revenue Code	301
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Cash Price	$284.00

FROZ SEC PREP

Facility

$34.00

Service Code	CPT 88331
Hospital Charge Code	22545752
Hospital Revenue Code	310
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$263.61
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$70.64
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$22.10
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Seven Corners Travel Insurance	$263.61
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39

FROZ SEC PREP

Facility

$34.00

Service Code	CPT 88331
Hospital Charge Code	22545752
Hospital Revenue Code	310
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Cash Price	$27.20

Frz Plasma CPD

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	15493410
Hospital Revenue Code	390
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$130.21
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Frz Plasma CPD

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	15493410
Hospital Revenue Code	390
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

FSH and LH LC

Facility

$419.00

Service Code	CPT 83001
Hospital Charge Code	1285571
Hospital Revenue Code	301
Min. Negotiated Rate	$26.94
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Arizona Complete Health Allwell	$67.04
Rate for Payer: Banner UC Health Medicare	$67.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$284.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$67.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$67.04
Rate for Payer: Cash Price	$335.20
Rate for Payer: Cash Price	$335.20
Rate for Payer: Cigna of AZ Commercial	$272.35
Rate for Payer: Devoted Health Medicare	$75.42
Rate for Payer: Humana of AZ Medicare	$67.04
Rate for Payer: Seven Corners Travel Insurance	$26.94
Rate for Payer: Southwest Service Administrators UFCW	$284.92
Rate for Payer: TriWest Medicare	$67.04
Rate for Payer: United Healthcare Commercial	$239.67
Rate for Payer: United Healthcare Medicare	$67.04
Rate for Payer: Veterans Affairs TRICARE	$66.37

FSH and LH LC

Facility

$419.00

Service Code	CPT 83001
Hospital Charge Code	1285571
Hospital Revenue Code	301
Min. Negotiated Rate	$377.10
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Cash Price	$335.20

FSH, Serum LC

Facility

$419.00

Service Code	CPT 83001
Hospital Charge Code	1285570
Hospital Revenue Code	301
Min. Negotiated Rate	$377.10
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Cash Price	$335.20

FSH, Serum LC

Facility

$419.00

Service Code	CPT 83001
Hospital Charge Code	1285570
Hospital Revenue Code	301
Min. Negotiated Rate	$26.94
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Arizona Complete Health Allwell	$67.04
Rate for Payer: Banner UC Health Medicare	$67.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$284.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$67.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$67.04
Rate for Payer: Cash Price	$335.20
Rate for Payer: Cash Price	$335.20
Rate for Payer: Cigna of AZ Commercial	$272.35
Rate for Payer: Devoted Health Medicare	$75.42
Rate for Payer: Humana of AZ Medicare	$67.04
Rate for Payer: Seven Corners Travel Insurance	$26.94
Rate for Payer: Southwest Service Administrators UFCW	$284.92
Rate for Payer: TriWest Medicare	$67.04
Rate for Payer: United Healthcare Commercial	$239.67
Rate for Payer: United Healthcare Medicare	$67.04
Rate for Payer: Veterans Affairs TRICARE	$66.37

FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$53,888.48

Service Code	MSDRG 793
Min. Negotiated Rate	$53,888.48
Max. Negotiated Rate	$53,888.48
Rate for Payer: Seven Corners Travel Insurance	$53,888.48

Know your out-of-pocket cost for care.

All Charges