Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SLING ARM XS-CHILD ZIMMER

Facility

$80.00

Service Code	HCPCS A4565
Hospital Charge Code	22354166
Hospital Revenue Code	270
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Arizona Complete Health Allwell	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$54.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$56.00
Rate for Payer: Devoted Health Medicare	$14.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Southwest Service Administrators UFCW	$54.40
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: United Healthcare Commercial	$45.76
Rate for Payer: United Healthcare Medicare	$12.80
Rate for Payer: Veterans Affairs TRICARE	$12.67

SLING BLADDER SPARC

Facility

$3,470.00

Service Code	HCPCS C1771
Hospital Charge Code	22354146
Hospital Revenue Code	270
Min. Negotiated Rate	$549.65
Max. Negotiated Rate	$3,123.00
Rate for Payer: Aetna of AZ Commercial	$3,123.00
Rate for Payer: Arizona Complete Health Allwell	$555.20
Rate for Payer: Banner UC Health Medicare	$555.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,359.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$555.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$555.20
Rate for Payer: Cash Price	$2,776.00
Rate for Payer: Cigna of AZ Commercial	$2,429.00
Rate for Payer: Devoted Health Medicare	$624.60
Rate for Payer: Humana of AZ Medicare	$555.20
Rate for Payer: Southwest Service Administrators UFCW	$2,359.60
Rate for Payer: TriWest Medicare	$555.20
Rate for Payer: United Healthcare Commercial	$1,984.84
Rate for Payer: United Healthcare Medicare	$555.20
Rate for Payer: Veterans Affairs TRICARE	$549.65

SLING BLADDER SPARC

Facility

$3,470.00

Service Code	HCPCS C1771
Hospital Charge Code	22354146
Hospital Revenue Code	270
Min. Negotiated Rate	$3,123.00
Max. Negotiated Rate	$3,123.00
Rate for Payer: Aetna of AZ Commercial	$3,123.00
Rate for Payer: Cash Price	$2,776.00

SLING MINIARC PRECISE SINGLE INCISION

Facility

$4,415.00

Service Code	HCPCS C1771
Hospital Charge Code	22354153
Hospital Revenue Code	270
Min. Negotiated Rate	$3,973.50
Max. Negotiated Rate	$3,973.50
Rate for Payer: Aetna of AZ Commercial	$3,973.50
Rate for Payer: Cash Price	$3,532.00

SLING MINIARC PRECISE SINGLE INCISION

Facility

$4,415.00

Service Code	HCPCS C1771
Hospital Charge Code	22354153
Hospital Revenue Code	270
Min. Negotiated Rate	$699.34
Max. Negotiated Rate	$3,973.50
Rate for Payer: Aetna of AZ Commercial	$3,973.50
Rate for Payer: Arizona Complete Health Allwell	$706.40
Rate for Payer: Banner UC Health Medicare	$706.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,002.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$706.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$706.40
Rate for Payer: Cash Price	$3,532.00
Rate for Payer: Cigna of AZ Commercial	$3,090.50
Rate for Payer: Devoted Health Medicare	$794.70
Rate for Payer: Humana of AZ Medicare	$706.40
Rate for Payer: Southwest Service Administrators UFCW	$3,002.20
Rate for Payer: TriWest Medicare	$706.40
Rate for Payer: United Healthcare Commercial	$2,525.38
Rate for Payer: United Healthcare Medicare	$706.40
Rate for Payer: Veterans Affairs TRICARE	$699.34

SLING MINIARC SINGLE INCISION

Facility

$3,999.00

Service Code	HCPCS C1771
Hospital Charge Code	22354151
Hospital Revenue Code	270
Min. Negotiated Rate	$633.44
Max. Negotiated Rate	$3,599.10
Rate for Payer: Aetna of AZ Commercial	$3,599.10
Rate for Payer: Arizona Complete Health Allwell	$639.84
Rate for Payer: Banner UC Health Medicare	$639.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,719.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$639.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$639.84
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Cigna of AZ Commercial	$2,799.30
Rate for Payer: Devoted Health Medicare	$719.82
Rate for Payer: Humana of AZ Medicare	$639.84
Rate for Payer: Southwest Service Administrators UFCW	$2,719.32
Rate for Payer: TriWest Medicare	$639.84
Rate for Payer: United Healthcare Commercial	$2,287.43
Rate for Payer: United Healthcare Medicare	$639.84
Rate for Payer: Veterans Affairs TRICARE	$633.44

SLING MINIARC SINGLE INCISION

Facility

$3,999.00

Service Code	HCPCS C1771
Hospital Charge Code	22354151
Hospital Revenue Code	270
Min. Negotiated Rate	$3,599.10
Max. Negotiated Rate	$3,599.10
Rate for Payer: Aetna of AZ Commercial	$3,599.10
Rate for Payer: Cash Price	$3,199.20

SLING MONARC

Facility

$3,999.00

Service Code	HCPCS C1771
Hospital Charge Code	22354147
Hospital Revenue Code	270
Min. Negotiated Rate	$633.44
Max. Negotiated Rate	$3,599.10
Rate for Payer: Aetna of AZ Commercial	$3,599.10
Rate for Payer: Arizona Complete Health Allwell	$639.84
Rate for Payer: Banner UC Health Medicare	$639.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,719.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$639.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$639.84
Rate for Payer: Cash Price	$3,199.20
Rate for Payer: Cigna of AZ Commercial	$2,799.30
Rate for Payer: Devoted Health Medicare	$719.82
Rate for Payer: Humana of AZ Medicare	$639.84
Rate for Payer: Southwest Service Administrators UFCW	$2,719.32
Rate for Payer: TriWest Medicare	$639.84
Rate for Payer: United Healthcare Commercial	$2,287.43
Rate for Payer: United Healthcare Medicare	$639.84
Rate for Payer: Veterans Affairs TRICARE	$633.44

SLING MONARC

Facility

$3,999.00

Service Code	HCPCS C1771
Hospital Charge Code	22354147
Hospital Revenue Code	270
Min. Negotiated Rate	$3,599.10
Max. Negotiated Rate	$3,599.10
Rate for Payer: Aetna of AZ Commercial	$3,599.10
Rate for Payer: Cash Price	$3,199.20

Sling operation for stress incontinence (e.g., fascia or synthetic)

Facility

$7,740.14

Service Code	CPT 57288
Hospital Revenue Code	490
Min. Negotiated Rate	$2,069.94
Max. Negotiated Rate	$7,740.14
Rate for Payer: Banner UC Health Medicare	$2,069.94
Rate for Payer: NaphCare Correctional Healthcare	$2,069.94
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: United Healthcare Commercial	$5,611.00

Sling operation for stress incontinence (e.g., fascia or synthetic)

Facility

$7,740.14

Service Code	CPT 57288
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.94
Max. Negotiated Rate	$7,740.14
Rate for Payer: Banner UC Health Medicare	$2,069.94
Rate for Payer: NaphCare Correctional Healthcare	$2,069.94
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: United Healthcare Commercial	$5,611.00

SLING PROLAPSE ELEVATE POSTERIOR

Facility

$5,103.00

Hospital Charge Code	22354152
Hospital Revenue Code	270
Min. Negotiated Rate	$808.32
Max. Negotiated Rate	$4,592.70
Rate for Payer: Aetna of AZ Commercial	$4,592.70
Rate for Payer: Arizona Complete Health Allwell	$816.48
Rate for Payer: Banner UC Health Medicare	$816.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,470.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$816.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$816.48
Rate for Payer: Cash Price	$4,082.40
Rate for Payer: Cigna of AZ Commercial	$3,572.10
Rate for Payer: Devoted Health Medicare	$918.54
Rate for Payer: Humana of AZ Medicare	$816.48
Rate for Payer: Southwest Service Administrators UFCW	$3,470.04
Rate for Payer: TriWest Medicare	$816.48
Rate for Payer: United Healthcare Commercial	$2,918.92
Rate for Payer: United Healthcare Medicare	$816.48
Rate for Payer: Veterans Affairs TRICARE	$808.32

SLING PROLAPSE ELEVATE POSTERIOR

Facility

$5,103.00

Hospital Charge Code	22354152
Hospital Revenue Code	270
Min. Negotiated Rate	$4,592.70
Max. Negotiated Rate	$4,592.70
Rate for Payer: Aetna of AZ Commercial	$4,592.70
Rate for Payer: Cash Price	$4,082.40

Sling (Removal or Revision)

Facility

$3,805.00

Service Code	CPT 57287
Hospital Charge Code	27267790
Hospital Revenue Code	360
Min. Negotiated Rate	$602.71
Max. Negotiated Rate	$5,008.71
Rate for Payer: Aetna of AZ Commercial	$3,424.50
Rate for Payer: Arizona Complete Health Allwell	$608.80
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,587.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$608.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$608.80
Rate for Payer: Cash Price	$3,044.00
Rate for Payer: Cash Price	$3,044.00
Rate for Payer: Cash Price	$3,044.00
Rate for Payer: Cigna of AZ Commercial	$1,902.50
Rate for Payer: Devoted Health Medicare	$684.90
Rate for Payer: Humana of AZ Medicare	$608.80
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: Southwest Service Administrators UFCW	$2,587.40
Rate for Payer: TriWest Medicare	$608.80
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$608.80
Rate for Payer: Veterans Affairs TRICARE	$602.71

Sling (Removal or Revision)

Facility

$3,805.00

Service Code	CPT 57287
Hospital Charge Code	27267790
Hospital Revenue Code	360
Min. Negotiated Rate	$3,424.50
Max. Negotiated Rate	$3,424.50
Rate for Payer: Aetna of AZ Commercial	$3,424.50
Rate for Payer: Cash Price	$3,044.00

Slings

Facility

$54.00

Service Code	HCPCS A4565
Hospital Charge Code	1287755
Hospital Revenue Code	521
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Arizona Complete Health Allwell	$8.64
Rate for Payer: Banner UC Health Medicare	$8.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.64
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of AZ Commercial	$37.80
Rate for Payer: Devoted Health Medicare	$9.72
Rate for Payer: Humana of AZ Medicare	$8.64
Rate for Payer: Southwest Service Administrators UFCW	$36.72
Rate for Payer: TriWest Medicare	$8.64
Rate for Payer: United Healthcare Commercial	$30.89
Rate for Payer: United Healthcare Medicare	$8.64
Rate for Payer: Veterans Affairs TRICARE	$8.55

Slings

Facility

$54.00

Service Code	HCPCS A4565
Hospital Charge Code	1287755
Hospital Revenue Code	521
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Cash Price	$43.20

SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT

Facility

$2,619.00

Hospital Charge Code	22354161
Hospital Revenue Code	270
Min. Negotiated Rate	$414.85
Max. Negotiated Rate	$2,357.10
Rate for Payer: Aetna of AZ Commercial	$2,357.10
Rate for Payer: Arizona Complete Health Allwell	$419.04
Rate for Payer: Banner UC Health Medicare	$419.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,780.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$419.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$419.04
Rate for Payer: Cash Price	$2,095.20
Rate for Payer: Cigna of AZ Commercial	$1,833.30
Rate for Payer: Devoted Health Medicare	$471.42
Rate for Payer: Humana of AZ Medicare	$419.04
Rate for Payer: Southwest Service Administrators UFCW	$1,780.92
Rate for Payer: TriWest Medicare	$419.04
Rate for Payer: United Healthcare Commercial	$1,498.07
Rate for Payer: United Healthcare Medicare	$419.04
Rate for Payer: Veterans Affairs TRICARE	$414.85

SLING SUPRAPUBIC ALIGN URETHRAL SUPPORT

Facility

$2,619.00

Hospital Charge Code	22354161
Hospital Revenue Code	270
Min. Negotiated Rate	$2,357.10
Max. Negotiated Rate	$2,357.10
Rate for Payer: Aetna of AZ Commercial	$2,357.10
Rate for Payer: Cash Price	$2,095.20

SLING SWATH ADULT

Facility

$63.00

Hospital Charge Code	22354186
Hospital Revenue Code	270
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Cash Price	$50.40

SLING SWATH ADULT

Facility

$63.00

Hospital Charge Code	22354186
Hospital Revenue Code	270
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Arizona Complete Health Allwell	$10.08
Rate for Payer: Banner UC Health Medicare	$10.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.08
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna of AZ Commercial	$44.10
Rate for Payer: Devoted Health Medicare	$11.34
Rate for Payer: Humana of AZ Medicare	$10.08
Rate for Payer: Southwest Service Administrators UFCW	$42.84
Rate for Payer: TriWest Medicare	$10.08
Rate for Payer: United Healthcare Commercial	$36.04
Rate for Payer: United Healthcare Medicare	$10.08
Rate for Payer: Veterans Affairs TRICARE	$9.98

SLING SWATH PED

Facility

$105.00

Hospital Charge Code	22354242
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of AZ Commercial	$94.50
Rate for Payer: Cash Price	$84.00

SLING SWATH PED

Facility

$105.00

Hospital Charge Code	22354242
Hospital Revenue Code	270
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of AZ Commercial	$94.50
Rate for Payer: Arizona Complete Health Allwell	$16.80
Rate for Payer: Banner UC Health Medicare	$16.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$71.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cigna of AZ Commercial	$73.50
Rate for Payer: Devoted Health Medicare	$18.90
Rate for Payer: Humana of AZ Medicare	$16.80
Rate for Payer: Southwest Service Administrators UFCW	$71.40
Rate for Payer: TriWest Medicare	$16.80
Rate for Payer: United Healthcare Commercial	$60.06
Rate for Payer: United Healthcare Medicare	$16.80
Rate for Payer: Veterans Affairs TRICARE	$16.63

SLIPPER SOCKS EXTRA LARGE

Facility

$6.00

Hospital Charge Code	22355542
Hospital Revenue Code	270
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna of AZ Commercial	$5.40
Rate for Payer: Cash Price	$4.80

SLIPPER SOCKS EXTRA LARGE

Facility

$6.00

Hospital Charge Code	22355542
Hospital Revenue Code	270
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna of AZ Commercial	$5.40
Rate for Payer: Arizona Complete Health Allwell	$0.96
Rate for Payer: Banner UC Health Medicare	$0.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.96
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cigna of AZ Commercial	$4.20
Rate for Payer: Devoted Health Medicare	$1.08
Rate for Payer: Humana of AZ Medicare	$0.96
Rate for Payer: Southwest Service Administrators UFCW	$4.08
Rate for Payer: TriWest Medicare	$0.96
Rate for Payer: United Healthcare Commercial	$3.43
Rate for Payer: United Healthcare Medicare	$0.96
Rate for Payer: Veterans Affairs TRICARE	$0.95

Know your out-of-pocket cost for care.

All Charges