Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

GYRUS CUTTING FORCEPS 10MM

Facility

$2,409.00

Hospital Charge Code	22354831
Hospital Revenue Code	270
Min. Negotiated Rate	$381.59
Max. Negotiated Rate	$2,168.10
Rate for Payer: Aetna of AZ Commercial	$2,168.10
Rate for Payer: Arizona Complete Health Allwell	$385.44
Rate for Payer: Banner UC Health Medicare	$385.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,638.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$385.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$385.44
Rate for Payer: Cash Price	$1,927.20
Rate for Payer: Cigna of AZ Commercial	$1,686.30
Rate for Payer: Devoted Health Medicare	$433.62
Rate for Payer: Humana of AZ Medicare	$385.44
Rate for Payer: Southwest Service Administrators UFCW	$1,638.12
Rate for Payer: TriWest Medicare	$385.44
Rate for Payer: United Healthcare Commercial	$1,377.95
Rate for Payer: United Healthcare Medicare	$385.44
Rate for Payer: Veterans Affairs TRICARE	$381.59

GYRUS CUTTING FORCEPS 10MM

Facility

$2,409.00

Hospital Charge Code	22354831
Hospital Revenue Code	270
Min. Negotiated Rate	$2,168.10
Max. Negotiated Rate	$2,168.10
Rate for Payer: Aetna of AZ Commercial	$2,168.10
Rate for Payer: Cash Price	$1,927.20

GYRUS CUTTING FORCEPS 5MM

Facility

$1,665.00

Hospital Charge Code	22354830
Hospital Revenue Code	270
Min. Negotiated Rate	$263.74
Max. Negotiated Rate	$1,498.50
Rate for Payer: Aetna of AZ Commercial	$1,498.50
Rate for Payer: Arizona Complete Health Allwell	$266.40
Rate for Payer: Banner UC Health Medicare	$266.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,132.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$266.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$266.40
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Cigna of AZ Commercial	$1,165.50
Rate for Payer: Devoted Health Medicare	$299.70
Rate for Payer: Humana of AZ Medicare	$266.40
Rate for Payer: Southwest Service Administrators UFCW	$1,132.20
Rate for Payer: TriWest Medicare	$266.40
Rate for Payer: United Healthcare Commercial	$952.38
Rate for Payer: United Healthcare Medicare	$266.40
Rate for Payer: Veterans Affairs TRICARE	$263.74

GYRUS CUTTING FORCEPS 5MM

Facility

$1,665.00

Hospital Charge Code	22354830
Hospital Revenue Code	270
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$1,498.50
Rate for Payer: Aetna of AZ Commercial	$1,498.50
Rate for Payer: Cash Price	$1,332.00

GYRUS LAP SPATULA

Facility

$981.00

Hospital Charge Code	22354817
Hospital Revenue Code	270
Min. Negotiated Rate	$882.90
Max. Negotiated Rate	$882.90
Rate for Payer: Aetna of AZ Commercial	$882.90
Rate for Payer: Cash Price	$784.80

GYRUS LAP SPATULA

Facility

$981.00

Hospital Charge Code	22354817
Hospital Revenue Code	270
Min. Negotiated Rate	$155.39
Max. Negotiated Rate	$882.90
Rate for Payer: Aetna of AZ Commercial	$882.90
Rate for Payer: Arizona Complete Health Allwell	$156.96
Rate for Payer: Banner UC Health Medicare	$156.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$667.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$156.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$156.96
Rate for Payer: Cash Price	$784.80
Rate for Payer: Cigna of AZ Commercial	$686.70
Rate for Payer: Devoted Health Medicare	$176.58
Rate for Payer: Humana of AZ Medicare	$156.96
Rate for Payer: Southwest Service Administrators UFCW	$667.08
Rate for Payer: TriWest Medicare	$156.96
Rate for Payer: United Healthcare Commercial	$561.13
Rate for Payer: United Healthcare Medicare	$156.96
Rate for Payer: Veterans Affairs TRICARE	$155.39

GYRUS SUPERLOOP

Facility

$1,686.00

Hospital Charge Code	22354814
Hospital Revenue Code	270
Min. Negotiated Rate	$267.06
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Arizona Complete Health Allwell	$269.76
Rate for Payer: Banner UC Health Medicare	$269.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,146.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$269.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$269.76
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Cigna of AZ Commercial	$1,180.20
Rate for Payer: Devoted Health Medicare	$303.48
Rate for Payer: Humana of AZ Medicare	$269.76
Rate for Payer: Southwest Service Administrators UFCW	$1,146.48
Rate for Payer: TriWest Medicare	$269.76
Rate for Payer: United Healthcare Commercial	$964.39
Rate for Payer: United Healthcare Medicare	$269.76
Rate for Payer: Veterans Affairs TRICARE	$267.06

GYRUS SUPERLOOP

Facility

$1,686.00

Hospital Charge Code	22354814
Hospital Revenue Code	270
Min. Negotiated Rate	$1,517.40
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Cash Price	$1,348.80

GYRUS SUPERSECT

Facility

$1,681.00

Hospital Charge Code	22354816
Hospital Revenue Code	270
Min. Negotiated Rate	$1,512.90
Max. Negotiated Rate	$1,512.90
Rate for Payer: Aetna of AZ Commercial	$1,512.90
Rate for Payer: Cash Price	$1,344.80

GYRUS SUPERSECT

Facility

$1,681.00

Hospital Charge Code	22354816
Hospital Revenue Code	270
Min. Negotiated Rate	$266.27
Max. Negotiated Rate	$1,512.90
Rate for Payer: Aetna of AZ Commercial	$1,512.90
Rate for Payer: Arizona Complete Health Allwell	$268.96
Rate for Payer: Banner UC Health Medicare	$268.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,143.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$268.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$268.96
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cigna of AZ Commercial	$1,176.70
Rate for Payer: Devoted Health Medicare	$302.58
Rate for Payer: Humana of AZ Medicare	$268.96
Rate for Payer: Southwest Service Administrators UFCW	$1,143.08
Rate for Payer: TriWest Medicare	$268.96
Rate for Payer: United Healthcare Commercial	$961.53
Rate for Payer: United Healthcare Medicare	$268.96
Rate for Payer: Veterans Affairs TRICARE	$266.27

HALLU LOCK C PLACE SIZE 2 RIGHT

Facility

$8,175.00

Hospital Charge Code	27595621
Hospital Revenue Code	270
Min. Negotiated Rate	$1,294.92
Max. Negotiated Rate	$7,357.50
Rate for Payer: Aetna of AZ Commercial	$7,357.50
Rate for Payer: Arizona Complete Health Allwell	$1,308.00
Rate for Payer: Banner UC Health Medicare	$1,308.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5,559.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,308.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,308.00
Rate for Payer: Cash Price	$6,540.00
Rate for Payer: Cigna of AZ Commercial	$5,722.50
Rate for Payer: Devoted Health Medicare	$1,471.50
Rate for Payer: Humana of AZ Medicare	$1,308.00
Rate for Payer: Southwest Service Administrators UFCW	$5,559.00
Rate for Payer: TriWest Medicare	$1,308.00
Rate for Payer: United Healthcare Commercial	$4,676.10
Rate for Payer: United Healthcare Medicare	$1,308.00
Rate for Payer: Veterans Affairs TRICARE	$1,294.92

HALLU LOCK C PLACE SIZE 2 RIGHT

Facility

$8,175.00

Hospital Charge Code	27595621
Hospital Revenue Code	270
Min. Negotiated Rate	$7,357.50
Max. Negotiated Rate	$7,357.50
Rate for Payer: Aetna of AZ Commercial	$7,357.50
Rate for Payer: Cash Price	$6,540.00

HALLULOCK R S PLATE 5 DEGREE

Facility

$8,997.00

Hospital Charge Code	27663803
Hospital Revenue Code	270
Min. Negotiated Rate	$8,097.30
Max. Negotiated Rate	$8,097.30
Rate for Payer: Aetna of AZ Commercial	$8,097.30
Rate for Payer: Cash Price	$7,197.60

HALLULOCK R S PLATE 5 DEGREE

Facility

$8,997.00

Hospital Charge Code	27663803
Hospital Revenue Code	270
Min. Negotiated Rate	$1,425.12
Max. Negotiated Rate	$8,097.30
Rate for Payer: Aetna of AZ Commercial	$8,097.30
Rate for Payer: Arizona Complete Health Allwell	$1,439.52
Rate for Payer: Banner UC Health Medicare	$1,439.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6,117.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,439.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,439.52
Rate for Payer: Cash Price	$7,197.60
Rate for Payer: Cigna of AZ Commercial	$6,297.90
Rate for Payer: Devoted Health Medicare	$1,619.46
Rate for Payer: Humana of AZ Medicare	$1,439.52
Rate for Payer: Southwest Service Administrators UFCW	$6,117.96
Rate for Payer: TriWest Medicare	$1,439.52
Rate for Payer: United Healthcare Commercial	$5,146.28
Rate for Payer: United Healthcare Medicare	$1,439.52
Rate for Payer: Veterans Affairs TRICARE	$1,425.12

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF

Facility

$2,242.00

Service Code	CPT 28291
Hospital Charge Code	24043295
Hospital Revenue Code	360
Min. Negotiated Rate	$199.79
Max. Negotiated Rate	$11,227.32
Rate for Payer: Aetna of AZ Commercial	$2,017.80
Rate for Payer: Arizona Complete Health Allwell	$358.72
Rate for Payer: Banner UC Health Medicare	$3,723.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,524.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$199.79
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$358.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$358.72
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cigna of AZ Commercial	$1,121.00
Rate for Payer: Devoted Health Medicare	$403.56
Rate for Payer: Humana of AZ Medicare	$358.72
Rate for Payer: Mercy Care Medicaid	$199.79
Rate for Payer: NaphCare Correctional Healthcare	$3,723.48
Rate for Payer: Seven Corners Travel Insurance	$11,227.32
Rate for Payer: Southwest Service Administrators UFCW	$1,524.56
Rate for Payer: TriWest Medicare	$358.72
Rate for Payer: United Healthcare Commercial	$6,508.00
Rate for Payer: United Healthcare Medicare	$358.72
Rate for Payer: Veterans Affairs TRICARE	$355.13

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF

Facility

$2,242.00

Service Code	CPT 28291
Hospital Charge Code	24043295
Hospital Revenue Code	360
Min. Negotiated Rate	$2,017.80
Max. Negotiated Rate	$2,017.80
Rate for Payer: Aetna of AZ Commercial	$2,017.80
Rate for Payer: Cash Price	$1,793.60

haloperidol 1 mg Tab [CQCH]

Facility

$0.46

Service Code	NDC 51079073420
Hospital Charge Code	105925162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Arizona Complete Health Allwell	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.07
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.30
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.31
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.26
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.07

haloperidol 1 mg Tab [CQCH]

Facility

$0.46

Service Code	NDC 51079073420
Hospital Charge Code	105925162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Cash Price	$0.36

haloperidol 5 mg/mL Inj Sol [CQCH]

Facility

$0.63

Service Code	HCPCS J1630
Hospital Charge Code	105925093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Arizona Complete Health Allwell	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.43
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.10
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.41
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Southwest Service Administrators UFCW	$0.43
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: United Healthcare Commercial	$0.36
Rate for Payer: United Healthcare Medicare	$0.10
Rate for Payer: Veterans Affairs TRICARE	$0.10

haloperidol 5 mg/mL Inj Sol [CQCH]

Facility

$0.63

Service Code	HCPCS J1630
Hospital Charge Code	105925093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Cash Price	$0.50

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35
Rate for Payer: NaphCare Correctional Healthcare	$7,741.35

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19
Rate for Payer: NaphCare Correctional Healthcare	$12,369.19

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20
Rate for Payer: NaphCare Correctional Healthcare	$5,813.20

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20
Rate for Payer: NaphCare Correctional Healthcare	$5,813.20

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35
Rate for Payer: NaphCare Correctional Healthcare	$7,741.35

Know your out-of-pocket cost for care.

All Charges