Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

sotalol 80 mg Tab [CQCH]

Facility

$0.31

Service Code	NDC 68084065401
Hospital Charge Code	105942235
Hospital Revenue Code	251
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of AZ Commercial	$0.28
Rate for Payer: Cash Price	$0.25

sotalol 80 mg Tab [CQCH]

Facility

$0.31

Service Code	NDC 68084065401
Hospital Charge Code	105942235
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of AZ Commercial	$0.28
Rate for Payer: Arizona Complete Health Allwell	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.21
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.05
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.05
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of AZ Commercial	$0.20
Rate for Payer: Devoted Health Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Southwest Service Administrators UFCW	$0.21
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: United Healthcare Commercial	$0.18
Rate for Payer: United Healthcare Medicare	$0.05
Rate for Payer: Veterans Affairs TRICARE	$0.05

SPACER OR CHAMBER FOR MDI

Facility

$97.00

Hospital Charge Code	22354981
Hospital Revenue Code	270
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Cash Price	$77.60

SPACER OR CHAMBER FOR MDI

Facility

$97.00

Hospital Charge Code	22354981
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

SPACER RIGID RECLOSABLE BAG

Facility

$25.00

Hospital Charge Code	23589698
Hospital Revenue Code	272
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

SPACER RIGID RECLOSABLE BAG

Facility

$25.00

Hospital Charge Code	23589698
Hospital Revenue Code	272
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

SPACER RIGID RECLOSABLE BAG W/ PED MASK

Facility

$70.00

Hospital Charge Code	23589699
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Cash Price	$56.00

SPACER RIGID RECLOSABLE BAG W/ PED MASK

Facility

$70.00

Hospital Charge Code	23589699
Hospital Revenue Code	272
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Arizona Complete Health Allwell	$11.20
Rate for Payer: Banner UC Health Medicare	$11.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$47.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.20
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cigna of AZ Commercial	$49.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$11.20
Rate for Payer: Southwest Service Administrators UFCW	$47.60
Rate for Payer: TriWest Medicare	$11.20
Rate for Payer: United Healthcare Commercial	$40.04
Rate for Payer: United Healthcare Medicare	$11.20
Rate for Payer: Veterans Affairs TRICARE	$11.09

SPECIAL STAINS GROUP 1

Facility

$1,699.00

Service Code	CPT 88312
Hospital Charge Code	22545719
Hospital Revenue Code	310
Min. Negotiated Rate	$79.06
Max. Negotiated Rate	$1,529.10
Rate for Payer: Aetna of AZ Commercial	$1,529.10
Rate for Payer: Arizona Complete Health Allwell	$271.84
Rate for Payer: Banner UC Health Medicare	$271.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,155.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$271.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$79.06
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cigna of AZ Commercial	$1,104.35
Rate for Payer: Devoted Health Medicare	$305.82
Rate for Payer: Humana of AZ Medicare	$271.84
Rate for Payer: Seven Corners Travel Insurance	$80.63
Rate for Payer: Southwest Service Administrators UFCW	$1,155.32
Rate for Payer: TriWest Medicare	$271.84
Rate for Payer: United Healthcare Commercial	$971.83
Rate for Payer: United Healthcare Medicare	$271.84
Rate for Payer: Veterans Affairs TRICARE	$269.12

SPECIAL STAINS GROUP 1

Facility

$1,699.00

Service Code	CPT 88312
Hospital Charge Code	22545719
Hospital Revenue Code	310
Min. Negotiated Rate	$1,529.10
Max. Negotiated Rate	$1,529.10
Rate for Payer: Aetna of AZ Commercial	$1,529.10
Rate for Payer: Cash Price	$1,359.20

SPECIAL STAINS GROUP 2

Facility

$1,368.00

Service Code	CPT 88313
Hospital Charge Code	22545721
Hospital Revenue Code	310
Min. Negotiated Rate	$58.25
Max. Negotiated Rate	$1,231.20
Rate for Payer: Aetna of AZ Commercial	$1,231.20
Rate for Payer: Arizona Complete Health Allwell	$218.88
Rate for Payer: Banner UC Health Medicare	$218.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$930.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$218.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.25
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cigna of AZ Commercial	$889.20
Rate for Payer: Devoted Health Medicare	$246.24
Rate for Payer: Humana of AZ Medicare	$218.88
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$930.24
Rate for Payer: TriWest Medicare	$218.88
Rate for Payer: United Healthcare Commercial	$782.50
Rate for Payer: United Healthcare Medicare	$218.88
Rate for Payer: Veterans Affairs TRICARE	$216.69

SPECIAL STAINS GROUP 2

Facility

$1,368.00

Service Code	CPT 88313
Hospital Charge Code	22545721
Hospital Revenue Code	310
Min. Negotiated Rate	$1,231.20
Max. Negotiated Rate	$1,231.20
Rate for Payer: Aetna of AZ Commercial	$1,231.20
Rate for Payer: Cash Price	$1,094.40

SPECIMEN TRAPS 70CC

Facility

$13.00

Hospital Charge Code	22355566
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Cash Price	$10.40

SPECIMEN TRAPS 70CC

Facility

$13.00

Hospital Charge Code	22355566
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Arizona Complete Health Allwell	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.08
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Devoted Health Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Southwest Service Administrators UFCW	$8.84
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: United Healthcare Commercial	$7.44
Rate for Payer: United Healthcare Medicare	$2.08
Rate for Payer: Veterans Affairs TRICARE	$2.06

SPECULUM VAGINAL MEDIUM

Facility

$9.00

Hospital Charge Code	22355372
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

SPECULUM VAGINAL MEDIUM

Facility

$9.00

Hospital Charge Code	22355372
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

SPECULUM VAGINAL SMALL

Facility

$9.00

Hospital Charge Code	22354946
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

SPECULUM VAGINAL SMALL

Facility

$9.00

Hospital Charge Code	22354946
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

Speed Band Superview Super 7

Facility

$1,222.00

Hospital Charge Code	22926474
Hospital Revenue Code	272
Min. Negotiated Rate	$193.56
Max. Negotiated Rate	$1,099.80
Rate for Payer: Aetna of AZ Commercial	$1,099.80
Rate for Payer: Arizona Complete Health Allwell	$195.52
Rate for Payer: Banner UC Health Medicare	$195.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$830.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$195.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$195.52
Rate for Payer: Cash Price	$977.60
Rate for Payer: Cigna of AZ Commercial	$855.40
Rate for Payer: Devoted Health Medicare	$219.96
Rate for Payer: Humana of AZ Medicare	$195.52
Rate for Payer: Southwest Service Administrators UFCW	$830.96
Rate for Payer: TriWest Medicare	$195.52
Rate for Payer: United Healthcare Commercial	$698.98
Rate for Payer: United Healthcare Medicare	$195.52
Rate for Payer: Veterans Affairs TRICARE	$193.56

Speed Band Superview Super 7

Facility

$1,222.00

Hospital Charge Code	22926474
Hospital Revenue Code	272
Min. Negotiated Rate	$1,099.80
Max. Negotiated Rate	$1,099.80
Rate for Payer: Aetna of AZ Commercial	$1,099.80
Rate for Payer: Cash Price	$977.60

SPEEDRELEASE GUIDED RELEASE INSTRUMENT

Facility

$4,975.00

Hospital Charge Code	27820409
Hospital Revenue Code	270
Min. Negotiated Rate	$788.04
Max. Negotiated Rate	$4,477.50
Rate for Payer: Aetna of AZ Commercial	$4,477.50
Rate for Payer: Arizona Complete Health Allwell	$796.00
Rate for Payer: Banner UC Health Medicare	$796.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,383.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$796.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$796.00
Rate for Payer: Cash Price	$3,980.00
Rate for Payer: Cigna of AZ Commercial	$3,482.50
Rate for Payer: Devoted Health Medicare	$895.50
Rate for Payer: Humana of AZ Medicare	$796.00
Rate for Payer: Southwest Service Administrators UFCW	$3,383.00
Rate for Payer: TriWest Medicare	$796.00
Rate for Payer: United Healthcare Commercial	$2,845.70
Rate for Payer: United Healthcare Medicare	$796.00
Rate for Payer: Veterans Affairs TRICARE	$788.04

SPEEDRELEASE GUIDED RELEASE INSTRUMENT

Facility

$4,975.00

Hospital Charge Code	27820409
Hospital Revenue Code	270
Min. Negotiated Rate	$4,477.50
Max. Negotiated Rate	$4,477.50
Rate for Payer: Aetna of AZ Commercial	$4,477.50
Rate for Payer: Cash Price	$3,980.00

Spinal Disorders And Injuries

Facility

$13,968.38

Service Code	APR-DRG 0403
Hospital Charge Code	APRDRG0404
Min. Negotiated Rate	$13,968.38
Max. Negotiated Rate	$13,968.38
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,968.38
Rate for Payer: Mercy Care Medicaid	$13,968.38
Rate for Payer: NaphCare Correctional Healthcare	$13,968.38

Spinal Disorders And Injuries

Facility

$9,300.56

Service Code	APR-DRG 0402
Hospital Charge Code	APRDRG0403
Min. Negotiated Rate	$9,300.56
Max. Negotiated Rate	$9,300.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,300.56
Rate for Payer: Mercy Care Medicaid	$9,300.56
Rate for Payer: NaphCare Correctional Healthcare	$9,300.56

Spinal Disorders And Injuries

Facility

$6,868.11

Service Code	APR-DRG 0401
Hospital Charge Code	APRDRG0403
Min. Negotiated Rate	$6,868.11
Max. Negotiated Rate	$6,868.11
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,868.11
Rate for Payer: Mercy Care Medicaid	$6,868.11
Rate for Payer: NaphCare Correctional Healthcare	$6,868.11

Know your out-of-pocket cost for care.

All Charges