Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SKIN ULCERS WITH MCC

Facility

$25,012.11

Service Code	MSDRG 592
Min. Negotiated Rate	$25,012.11
Max. Negotiated Rate	$25,012.11
Rate for Payer: Seven Corners Travel Insurance	$25,012.11

SKIN ULCERS WITHOUT CC/MCC

Facility

$11,338.81

Service Code	MSDRG 594
Min. Negotiated Rate	$11,338.81
Max. Negotiated Rate	$11,338.81
Rate for Payer: Seven Corners Travel Insurance	$11,338.81

SKYLA IUD CQCH_AZ

Facility

$1,218.00

Service Code	HCPCS J7307
Hospital Charge Code	28228887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,096.20
Max. Negotiated Rate	$1,096.20
Rate for Payer: Aetna of AZ Commercial	$1,096.20
Rate for Payer: Cash Price	$974.40

SKYLA IUD CQCH_AZ

Facility

$1,218.00

Service Code	HCPCS J7307
Hospital Charge Code	28228887
Hospital Revenue Code	272
Min. Negotiated Rate	$192.93
Max. Negotiated Rate	$1,096.20
Rate for Payer: Aetna of AZ Commercial	$1,096.20
Rate for Payer: Arizona Complete Health Allwell	$194.88
Rate for Payer: Banner UC Health Medicare	$194.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$828.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$194.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$194.88
Rate for Payer: Cash Price	$974.40
Rate for Payer: Cigna of AZ Commercial	$852.60
Rate for Payer: Devoted Health Medicare	$219.24
Rate for Payer: Humana of AZ Medicare	$194.88
Rate for Payer: Southwest Service Administrators UFCW	$828.24
Rate for Payer: TriWest Medicare	$194.88
Rate for Payer: United Healthcare Commercial	$696.70
Rate for Payer: United Healthcare Medicare	$194.88
Rate for Payer: Veterans Affairs TRICARE	$192.93

SLEEVE ALP CALF

Facility

$98.00

Hospital Charge Code	22354965
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Arizona Complete Health Allwell	$15.68
Rate for Payer: Banner UC Health Medicare	$15.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$66.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.68
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Humana of AZ Medicare	$15.68
Rate for Payer: Southwest Service Administrators UFCW	$66.64
Rate for Payer: TriWest Medicare	$15.68
Rate for Payer: United Healthcare Commercial	$56.06
Rate for Payer: United Healthcare Medicare	$15.68
Rate for Payer: Veterans Affairs TRICARE	$15.52

SLEEVE ALP CALF

Facility

$98.00

Hospital Charge Code	22354965
Hospital Revenue Code	270
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Cash Price	$78.40

SLEEVE TROCARE 5CM STR REFLEX

Facility

$106.00

Hospital Charge Code	22706520
Hospital Revenue Code	272
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Cash Price	$84.80

SLEEVE TROCARE 5CM STR REFLEX

Facility

$106.00

Hospital Charge Code	22706520
Hospital Revenue Code	272
Min. Negotiated Rate	$16.79
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Arizona Complete Health Allwell	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.96
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$74.20
Rate for Payer: Devoted Health Medicare	$19.08
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Southwest Service Administrators UFCW	$72.08
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: United Healthcare Commercial	$60.63
Rate for Payer: United Healthcare Medicare	$16.96
Rate for Payer: Veterans Affairs TRICARE	$16.79

Slide Coagulase

Facility

$35.00

Service Code	CPT 87147
Hospital Charge Code	634041
Hospital Revenue Code	301
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Arizona Complete Health Allwell	$5.60
Rate for Payer: Banner UC Health Medicare	$5.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.60
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$22.75
Rate for Payer: Devoted Health Medicare	$6.30
Rate for Payer: Humana of AZ Medicare	$5.60
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$23.80
Rate for Payer: TriWest Medicare	$5.60
Rate for Payer: United Healthcare Commercial	$20.02
Rate for Payer: United Healthcare Medicare	$5.60
Rate for Payer: Veterans Affairs TRICARE	$5.54

Slide Coagulase

Facility

$35.00

Service Code	CPT 87147
Hospital Charge Code	634041
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Cash Price	$28.00

SLING ARM LARGE

Facility

$30.00

Service Code	HCPCS A4565
Hospital Charge Code	22354278
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Cash Price	$24.00

SLING ARM LARGE

Facility

$30.00

Service Code	HCPCS A4565
Hospital Charge Code	22354278
Hospital Revenue Code	270
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Arizona Complete Health Allwell	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$20.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Devoted Health Medicare	$5.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Southwest Service Administrators UFCW	$20.40
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: United Healthcare Commercial	$17.16
Rate for Payer: United Healthcare Medicare	$4.80
Rate for Payer: Veterans Affairs TRICARE	$4.75

SLING ARM LG

Facility

$25.00

Hospital Charge Code	22354133
Hospital Revenue Code	270
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Cash Price	$20.00

SLING ARM LG

Facility

$25.00

Hospital Charge Code	22354133
Hospital Revenue Code	270
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Arizona Complete Health Allwell	$4.00
Rate for Payer: Banner UC Health Medicare	$4.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cigna of AZ Commercial	$17.50
Rate for Payer: Devoted Health Medicare	$4.50
Rate for Payer: Humana of AZ Medicare	$4.00
Rate for Payer: Southwest Service Administrators UFCW	$17.00
Rate for Payer: TriWest Medicare	$4.00
Rate for Payer: United Healthcare Commercial	$14.30
Rate for Payer: United Healthcare Medicare	$4.00
Rate for Payer: Veterans Affairs TRICARE	$3.96

SLING ARM LG ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354164
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Arizona Complete Health Allwell	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.72
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Southwest Service Administrators UFCW	$28.56
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: United Healthcare Commercial	$24.02
Rate for Payer: United Healthcare Medicare	$6.72
Rate for Payer: Veterans Affairs TRICARE	$6.65

SLING ARM LG ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354164
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Cash Price	$33.60

SLING ARM MD ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354163
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Arizona Complete Health Allwell	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.72
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Southwest Service Administrators UFCW	$28.56
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: United Healthcare Commercial	$24.02
Rate for Payer: United Healthcare Medicare	$6.72
Rate for Payer: Veterans Affairs TRICARE	$6.65

SLING ARM MD ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354163
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Cash Price	$33.60

SLING ARM MEDIUM

Facility

$23.00

Service Code	HCPCS A4565
Hospital Charge Code	22354277
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Arizona Complete Health Allwell	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$15.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.68
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Devoted Health Medicare	$4.14
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Southwest Service Administrators UFCW	$15.64
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: United Healthcare Commercial	$13.16
Rate for Payer: United Healthcare Medicare	$3.68
Rate for Payer: Veterans Affairs TRICARE	$3.64

SLING ARM MEDIUM

Facility

$23.00

Service Code	HCPCS A4565
Hospital Charge Code	22354277
Hospital Revenue Code	270
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Cash Price	$18.40

SLING ARM SM ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354162
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Cash Price	$33.60

SLING ARM SM ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354162
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Arizona Complete Health Allwell	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.72
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Southwest Service Administrators UFCW	$28.56
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: United Healthcare Commercial	$24.02
Rate for Payer: United Healthcare Medicare	$6.72
Rate for Payer: Veterans Affairs TRICARE	$6.65

SLING ARM XL ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354165
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Arizona Complete Health Allwell	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.72
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Southwest Service Administrators UFCW	$28.56
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: United Healthcare Commercial	$24.02
Rate for Payer: United Healthcare Medicare	$6.72
Rate for Payer: Veterans Affairs TRICARE	$6.65

SLING ARM XL ZIMMER

Facility

$42.00

Service Code	HCPCS A4565
Hospital Charge Code	22354165
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Cash Price	$33.60

SLING ARM XS-CHILD ZIMMER

Facility

$80.00

Service Code	HCPCS A4565
Hospital Charge Code	22354166
Hospital Revenue Code	270
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Cash Price	$64.00

Know your out-of-pocket cost for care.

All Charges