Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

STENT SOFT URETERAL 28F UNIVERSA COOK

Facility

$478.00

Hospital Charge Code	22354232
Hospital Revenue Code	270
Min. Negotiated Rate	$75.72
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Arizona Complete Health Allwell	$76.48
Rate for Payer: Banner UC Health Medicare	$76.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$325.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.48
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cigna of AZ Commercial	$334.60
Rate for Payer: Devoted Health Medicare	$86.04
Rate for Payer: Humana of AZ Medicare	$76.48
Rate for Payer: Southwest Service Administrators UFCW	$325.04
Rate for Payer: TriWest Medicare	$76.48
Rate for Payer: United Healthcare Commercial	$273.42
Rate for Payer: United Healthcare Medicare	$76.48
Rate for Payer: Veterans Affairs TRICARE	$75.72

STENT SOFT URETERAL 28F UNIVERSA COOK

Facility

$478.00

Hospital Charge Code	22354232
Hospital Revenue Code	270
Min. Negotiated Rate	$430.20
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Cash Price	$382.40

STENT SOFT URETERAL 7X26 UNIVERSA COOK

Facility

$327.00

Hospital Charge Code	22354234
Hospital Revenue Code	270
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Arizona Complete Health Allwell	$52.32
Rate for Payer: Banner UC Health Medicare	$52.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$222.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.32
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cigna of AZ Commercial	$228.90
Rate for Payer: Devoted Health Medicare	$58.86
Rate for Payer: Humana of AZ Medicare	$52.32
Rate for Payer: Southwest Service Administrators UFCW	$222.36
Rate for Payer: TriWest Medicare	$52.32
Rate for Payer: United Healthcare Commercial	$187.04
Rate for Payer: United Healthcare Medicare	$52.32
Rate for Payer: Veterans Affairs TRICARE	$51.80

STENT SOFT URETERAL 7X26 UNIVERSA COOK

Facility

$327.00

Hospital Charge Code	22354234
Hospital Revenue Code	270
Min. Negotiated Rate	$294.30
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Cash Price	$261.60

STENT SOFT URETERAL UNIVERSA 28F COOK

Facility

$478.00

Hospital Charge Code	22354233
Hospital Revenue Code	270
Min. Negotiated Rate	$430.20
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Cash Price	$382.40

STENT SOFT URETERAL UNIVERSA 28F COOK

Facility

$478.00

Hospital Charge Code	22354233
Hospital Revenue Code	270
Min. Negotiated Rate	$75.72
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Arizona Complete Health Allwell	$76.48
Rate for Payer: Banner UC Health Medicare	$76.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$325.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.48
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cigna of AZ Commercial	$334.60
Rate for Payer: Devoted Health Medicare	$86.04
Rate for Payer: Humana of AZ Medicare	$76.48
Rate for Payer: Southwest Service Administrators UFCW	$325.04
Rate for Payer: TriWest Medicare	$76.48
Rate for Payer: United Healthcare Commercial	$273.42
Rate for Payer: United Healthcare Medicare	$76.48
Rate for Payer: Veterans Affairs TRICARE	$75.72

STENT URETERAL SOFT 22F UNIVERSA COOK

Facility

$478.00

Hospital Charge Code	22354229
Hospital Revenue Code	270
Min. Negotiated Rate	$430.20
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Cash Price	$382.40

STENT URETERAL SOFT 22F UNIVERSA COOK

Facility

$478.00

Hospital Charge Code	22354229
Hospital Revenue Code	270
Min. Negotiated Rate	$75.72
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Arizona Complete Health Allwell	$76.48
Rate for Payer: Banner UC Health Medicare	$76.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$325.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.48
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cigna of AZ Commercial	$334.60
Rate for Payer: Devoted Health Medicare	$86.04
Rate for Payer: Humana of AZ Medicare	$76.48
Rate for Payer: Southwest Service Administrators UFCW	$325.04
Rate for Payer: TriWest Medicare	$76.48
Rate for Payer: United Healthcare Commercial	$273.42
Rate for Payer: United Healthcare Medicare	$76.48
Rate for Payer: Veterans Affairs TRICARE	$75.72

Sterile Water 100 mL [CQCH]

Facility

$0.03

Service Code	HCPCS A4217
Hospital Charge Code	108476148
Hospital Revenue Code	252
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

Sterile Water 100 mL [CQCH]

Facility

$0.03

Service Code	HCPCS A4217
Hospital Charge Code	108476148
Hospital Revenue Code	252
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Cash Price	$0.03

sterile water 10 ml Sol[CQCH]

Facility

$0.07

Service Code	HCPCS A4217
Hospital Charge Code	233117851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.04
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

sterile water 10 ml Sol[CQCH]

Facility

$0.07

Service Code	HCPCS A4217
Hospital Charge Code	233117851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Cash Price	$0.06

STERIS PAPER ROLL

Facility

$16.00

Hospital Charge Code	27456000
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Cash Price	$12.80

STERIS PAPER ROLL

Facility

$16.00

Hospital Charge Code	27456000
Hospital Revenue Code	270
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Arizona Complete Health Allwell	$2.56
Rate for Payer: Banner UC Health Medicare	$2.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$10.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.56
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Devoted Health Medicare	$2.88
Rate for Payer: Humana of AZ Medicare	$2.56
Rate for Payer: Southwest Service Administrators UFCW	$10.88
Rate for Payer: TriWest Medicare	$2.56
Rate for Payer: United Healthcare Commercial	$9.15
Rate for Payer: United Healthcare Medicare	$2.56
Rate for Payer: Veterans Affairs TRICARE	$2.53

STOAII 19

Facility

$12,087.05

Hospital Charge Code	28080114
Hospital Revenue Code	270
Min. Negotiated Rate	$1,914.59
Max. Negotiated Rate	$10,878.34
Rate for Payer: Aetna of AZ Commercial	$10,878.34
Rate for Payer: Arizona Complete Health Allwell	$1,933.93
Rate for Payer: Banner UC Health Medicare	$1,933.93
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8,219.19
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,933.93
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,933.93
Rate for Payer: Cash Price	$9,669.64
Rate for Payer: Cigna of AZ Commercial	$8,460.93
Rate for Payer: Devoted Health Medicare	$2,175.67
Rate for Payer: Humana of AZ Medicare	$1,933.93
Rate for Payer: Southwest Service Administrators UFCW	$8,219.19
Rate for Payer: TriWest Medicare	$1,933.93
Rate for Payer: United Healthcare Commercial	$6,913.79
Rate for Payer: United Healthcare Medicare	$1,933.93
Rate for Payer: Veterans Affairs TRICARE	$1,914.59

STOAII 19

Facility

$12,087.05

Hospital Charge Code	28080114
Hospital Revenue Code	270
Min. Negotiated Rate	$10,878.34
Max. Negotiated Rate	$10,878.34
Rate for Payer: Aetna of AZ Commercial	$10,878.34
Rate for Payer: Cash Price	$9,669.64

STOCKINETTE 9''''

Facility

$19.00

Hospital Charge Code	22926424
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Arizona Complete Health Allwell	$3.04
Rate for Payer: Banner UC Health Medicare	$3.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.04
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of AZ Commercial	$13.30
Rate for Payer: Devoted Health Medicare	$3.42
Rate for Payer: Humana of AZ Medicare	$3.04
Rate for Payer: Southwest Service Administrators UFCW	$12.92
Rate for Payer: TriWest Medicare	$3.04
Rate for Payer: United Healthcare Commercial	$10.87
Rate for Payer: United Healthcare Medicare	$3.04
Rate for Payer: Veterans Affairs TRICARE	$3.01

STOCKINETTE 9''''

Facility

$19.00

Hospital Charge Code	22926424
Hospital Revenue Code	272
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Cash Price	$15.20

STOCKING KNEE HI LARGE REG

Facility

$22.00

Hospital Charge Code	22355113
Hospital Revenue Code	270
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Arizona Complete Health Allwell	$3.52
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.52
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$15.40
Rate for Payer: Devoted Health Medicare	$3.96
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Southwest Service Administrators UFCW	$14.96
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: United Healthcare Commercial	$12.58
Rate for Payer: United Healthcare Medicare	$3.52
Rate for Payer: Veterans Affairs TRICARE	$3.48

STOCKING KNEE HI LARGE REG

Facility

$22.00

Hospital Charge Code	22355113
Hospital Revenue Code	270
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Cash Price	$17.60

STOCKING KNEE HI MED REG

Facility

$22.00

Hospital Charge Code	22355112
Hospital Revenue Code	270
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Cash Price	$17.60

STOCKING KNEE HI MED REG

Facility

$22.00

Hospital Charge Code	22355112
Hospital Revenue Code	270
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Arizona Complete Health Allwell	$3.52
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.52
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$15.40
Rate for Payer: Devoted Health Medicare	$3.96
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Southwest Service Administrators UFCW	$14.96
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: United Healthcare Commercial	$12.58
Rate for Payer: United Healthcare Medicare	$3.52
Rate for Payer: Veterans Affairs TRICARE	$3.48

STOCKING KNEE HI SMALL REG

Facility

$22.00

Hospital Charge Code	22355111
Hospital Revenue Code	270
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Arizona Complete Health Allwell	$3.52
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.52
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$15.40
Rate for Payer: Devoted Health Medicare	$3.96
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Southwest Service Administrators UFCW	$14.96
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: United Healthcare Commercial	$12.58
Rate for Payer: United Healthcare Medicare	$3.52
Rate for Payer: Veterans Affairs TRICARE	$3.48

STOCKING KNEE HI SMALL REG

Facility

$22.00

Hospital Charge Code	22355111
Hospital Revenue Code	270
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Cash Price	$17.60

STOCKING THIGH LARGE LONG

Facility

$34.00

Hospital Charge Code	22355117
Hospital Revenue Code	270
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.44
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$23.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39

Know your out-of-pocket cost for care.

All Charges