Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SPLINT WRIST/FA SM RIGHT HAND

Facility

$93.00

Hospital Charge Code	22354268
Hospital Revenue Code	270
Min. Negotiated Rate	$83.70
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Cash Price	$74.40

SPLINT WRIST/FA SM RIGHT HAND

Facility

$93.00

Hospital Charge Code	22354268
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Arizona Complete Health Allwell	$14.88
Rate for Payer: Banner UC Health Medicare	$14.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$63.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.88
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cigna of AZ Commercial	$65.10
Rate for Payer: Devoted Health Medicare	$16.74
Rate for Payer: Humana of AZ Medicare	$14.88
Rate for Payer: Southwest Service Administrators UFCW	$63.24
Rate for Payer: TriWest Medicare	$14.88
Rate for Payer: United Healthcare Commercial	$53.20
Rate for Payer: United Healthcare Medicare	$14.88
Rate for Payer: Veterans Affairs TRICARE	$14.73

SPLINT WRIST LARGE LEFT

Facility

$46.00

Hospital Charge Code	22354254
Hospital Revenue Code	270
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Arizona Complete Health Allwell	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.36
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Devoted Health Medicare	$8.28
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Southwest Service Administrators UFCW	$31.28
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: United Healthcare Commercial	$26.31
Rate for Payer: United Healthcare Medicare	$7.36
Rate for Payer: Veterans Affairs TRICARE	$7.29

SPLINT WRIST LARGE LEFT

Facility

$46.00

Hospital Charge Code	22354254
Hospital Revenue Code	270
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Cash Price	$36.80

SPLINT WRIST LARGE RIGHT

Facility

$38.00

Hospital Charge Code	22354255
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Cash Price	$30.40

SPLINT WRIST LARGE RIGHT

Facility

$38.00

Hospital Charge Code	22354255
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Arizona Complete Health Allwell	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.08
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Devoted Health Medicare	$6.84
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Southwest Service Administrators UFCW	$25.84
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: United Healthcare Commercial	$21.74
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: Veterans Affairs TRICARE	$6.02

SPLINT WRIST MEDIUM LEFT

Facility

$47.00

Hospital Charge Code	22354252
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

SPLINT WRIST MEDIUM LEFT

Facility

$47.00

Hospital Charge Code	22354252
Hospital Revenue Code	270
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

SPLINT WRIST MEDIUM RIGHT

Facility

$47.00

Hospital Charge Code	22354253
Hospital Revenue Code	270
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

SPLINT WRIST MEDIUM RIGHT

Facility

$47.00

Hospital Charge Code	22354253
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

SPLINT WRIST SMALL LEFT

Facility

$47.00

Hospital Charge Code	22354250
Hospital Revenue Code	270
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

SPLINT WRIST SMALL LEFT

Facility

$47.00

Hospital Charge Code	22354250
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

SPLINT WRIST SMALL RIGHT

Facility

$47.00

Hospital Charge Code	22354251
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

SPLINT WRIST SMALL RIGHT

Facility

$47.00

Hospital Charge Code	22354251
Hospital Revenue Code	270
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

SPLINT WRIST XS PED LEFT

Facility

$98.00

Hospital Charge Code	22354187
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

SPLINT WRIST XS PED LEFT

Facility

$98.00

Hospital Charge Code	22354187
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

Spotted Fever Group Antibodies, IgG and IgM LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	27666165
Hospital Revenue Code	302
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Arizona Complete Health Allwell	$38.08
Rate for Payer: Banner UC Health Medicare	$38.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.08
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$154.70
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Humana of AZ Medicare	$38.08
Rate for Payer: Seven Corners Travel Insurance	$28.06
Rate for Payer: Southwest Service Administrators UFCW	$161.84
Rate for Payer: TriWest Medicare	$38.08
Rate for Payer: United Healthcare Commercial	$136.14
Rate for Payer: United Healthcare Medicare	$38.08
Rate for Payer: Veterans Affairs TRICARE	$37.70

Spotted Fever Group Antibodies, IgG and IgM LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	27666165
Hospital Revenue Code	302
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Cash Price	$190.40

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$12,447.55

Service Code	MSDRG 537
Min. Negotiated Rate	$12,447.55
Max. Negotiated Rate	$12,447.55
Rate for Payer: Seven Corners Travel Insurance	$12,447.55

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$9,482.51

Service Code	MSDRG 538
Min. Negotiated Rate	$9,482.51
Max. Negotiated Rate	$9,482.51
Rate for Payer: Seven Corners Travel Insurance	$9,482.51

Sputum Culture

Facility

$173.00

Service Code	CPT 87070
Hospital Charge Code	858006
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Arizona Complete Health Allwell	$27.68
Rate for Payer: Banner UC Health Medicare	$27.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$117.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.68
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$112.45
Rate for Payer: Devoted Health Medicare	$31.14
Rate for Payer: Humana of AZ Medicare	$27.68
Rate for Payer: Seven Corners Travel Insurance	$12.50
Rate for Payer: Southwest Service Administrators UFCW	$117.64
Rate for Payer: TriWest Medicare	$27.68
Rate for Payer: United Healthcare Commercial	$98.96
Rate for Payer: United Healthcare Medicare	$27.68
Rate for Payer: Veterans Affairs TRICARE	$27.40

Sputum Culture

Facility

$173.00

Service Code	CPT 87070
Hospital Charge Code	858006
Hospital Revenue Code	306
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Cash Price	$138.40

SPUTUM INDUCT

Facility

$92.00

Service Code	CPT 94664
Hospital Charge Code	1886886
Hospital Revenue Code	412
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Cash Price	$73.60

SPUTUM INDUCT

Facility

$92.00

Service Code	CPT 94664
Hospital Charge Code	1886886
Hospital Revenue Code	412
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$338.82
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Arizona Complete Health Allwell	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$62.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.72
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$64.40
Rate for Payer: Devoted Health Medicare	$16.56
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Seven Corners Travel Insurance	$338.82
Rate for Payer: Southwest Service Administrators UFCW	$62.56
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: United Healthcare Commercial	$52.62
Rate for Payer: United Healthcare Medicare	$14.72
Rate for Payer: United Healthcare New Mexico Commercial	$17.48
Rate for Payer: Veterans Affairs TRICARE	$14.57

SSA Urine

Facility

$55.00

Service Code	CPT 81099
Hospital Charge Code	1657596
Hospital Revenue Code	300
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

Know your out-of-pocket cost for care.

All Charges