Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$20,708.36

Service Code	MSDRG 328
Min. Negotiated Rate	$20,708.36
Max. Negotiated Rate	$20,708.36
Rate for Payer: Seven Corners Travel Insurance	$20,708.36

STONE EXTR NITINOL

Facility

$544.00

Hospital Charge Code	22354218
Hospital Revenue Code	270
Min. Negotiated Rate	$86.17
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Arizona Complete Health Allwell	$87.04
Rate for Payer: Banner UC Health Medicare	$87.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$369.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$87.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$87.04
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cigna of AZ Commercial	$380.80
Rate for Payer: Devoted Health Medicare	$97.92
Rate for Payer: Humana of AZ Medicare	$87.04
Rate for Payer: Southwest Service Administrators UFCW	$369.92
Rate for Payer: TriWest Medicare	$87.04
Rate for Payer: United Healthcare Commercial	$311.17
Rate for Payer: United Healthcare Medicare	$87.04
Rate for Payer: Veterans Affairs TRICARE	$86.17

STONE EXTR NITINOL

Facility

$544.00

Hospital Charge Code	22354218
Hospital Revenue Code	270
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Cash Price	$435.20

STORZ D- BLADE

Facility

$90.00

Hospital Charge Code	22834566
Hospital Revenue Code	272
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

STORZ D- BLADE

Facility

$90.00

Hospital Charge Code	22834566
Hospital Revenue Code	272
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

STORZ MAC #3

Facility

$90.00

Hospital Charge Code	22832863
Hospital Revenue Code	272
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

STORZ MAC #3

Facility

$90.00

Hospital Charge Code	22832863
Hospital Revenue Code	272
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

STORZ MAC #4

Facility

$90.00

Hospital Charge Code	22834564
Hospital Revenue Code	272
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

STORZ MAC #4

Facility

$90.00

Hospital Charge Code	22834564
Hospital Revenue Code	272
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

STORZ MILLER 0

Facility

$776.00

Hospital Charge Code	22834570
Hospital Revenue Code	272
Min. Negotiated Rate	$122.92
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Arizona Complete Health Allwell	$124.16
Rate for Payer: Banner UC Health Medicare	$124.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$527.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$124.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$124.16
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cigna of AZ Commercial	$543.20
Rate for Payer: Devoted Health Medicare	$139.68
Rate for Payer: Humana of AZ Medicare	$124.16
Rate for Payer: Southwest Service Administrators UFCW	$527.68
Rate for Payer: TriWest Medicare	$124.16
Rate for Payer: United Healthcare Commercial	$443.87
Rate for Payer: United Healthcare Medicare	$124.16
Rate for Payer: Veterans Affairs TRICARE	$122.92

STORZ MILLER 0

Facility

$776.00

Hospital Charge Code	22834570
Hospital Revenue Code	272
Min. Negotiated Rate	$698.40
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Cash Price	$620.80

STORZ MILLER 1

Facility

$104.00

Hospital Charge Code	22834572
Hospital Revenue Code	272
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Arizona Complete Health Allwell	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$70.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.64
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Southwest Service Administrators UFCW	$70.72
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: United Healthcare Commercial	$59.49
Rate for Payer: United Healthcare Medicare	$16.64
Rate for Payer: Veterans Affairs TRICARE	$16.47

STORZ MILLER 1

Facility

$104.00

Hospital Charge Code	22834572
Hospital Revenue Code	272
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Cash Price	$83.20

STRAP CLAVICLE ADULT

Facility

$66.00

Hospital Charge Code	22354243
Hospital Revenue Code	270
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Cash Price	$52.80

STRAP CLAVICLE ADULT

Facility

$66.00

Hospital Charge Code	22354243
Hospital Revenue Code	270
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Arizona Complete Health Allwell	$10.56
Rate for Payer: Banner UC Health Medicare	$10.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.56
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$46.20
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Humana of AZ Medicare	$10.56
Rate for Payer: Southwest Service Administrators UFCW	$44.88
Rate for Payer: TriWest Medicare	$10.56
Rate for Payer: United Healthcare Commercial	$37.75
Rate for Payer: United Healthcare Medicare	$10.56
Rate for Payer: Veterans Affairs TRICARE	$10.45

STRAP CLAVICLE CHILD

Facility

$104.00

Hospital Charge Code	22354245
Hospital Revenue Code	270
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Cash Price	$83.20

STRAP CLAVICLE CHILD

Facility

$104.00

Hospital Charge Code	22354245
Hospital Revenue Code	270
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Arizona Complete Health Allwell	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$70.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.64
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Southwest Service Administrators UFCW	$70.72
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: United Healthcare Commercial	$59.49
Rate for Payer: United Healthcare Medicare	$16.64
Rate for Payer: Veterans Affairs TRICARE	$16.47

STRAP CLAVICLE YOUTH

Facility

$45.00

Hospital Charge Code	22354260
Hospital Revenue Code	270
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Arizona Complete Health Allwell	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$30.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Devoted Health Medicare	$8.10
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Southwest Service Administrators UFCW	$30.60
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: United Healthcare Commercial	$25.74
Rate for Payer: United Healthcare Medicare	$7.20
Rate for Payer: Veterans Affairs TRICARE	$7.13

STRAP CLAVICLE YOUTH

Facility

$45.00

Hospital Charge Code	22354260
Hospital Revenue Code	270
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Cash Price	$36.00

Strep A Rapid Screen

Facility

$175.00

Service Code	CPT 87880
Hospital Charge Code	5850971
Hospital Revenue Code	306
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$140.00

Strep A Rapid Screen

Facility

$195.00

Service Code	CPT 87880
Hospital Charge Code	5850971
Hospital Revenue Code	306
Min. Negotiated Rate	$23.97
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Arizona Complete Health Allwell	$31.20
Rate for Payer: Arizona Complete Health Allwell	$28.00
Rate for Payer: Banner UC Health Medicare	$28.00
Rate for Payer: Banner UC Health Medicare	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$132.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$119.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.20
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cigna of AZ Commercial	$113.75
Rate for Payer: Cigna of AZ Commercial	$126.75
Rate for Payer: Devoted Health Medicare	$35.10
Rate for Payer: Devoted Health Medicare	$31.50
Rate for Payer: Humana of AZ Medicare	$28.00
Rate for Payer: Humana of AZ Medicare	$31.20
Rate for Payer: Seven Corners Travel Insurance	$23.97
Rate for Payer: Seven Corners Travel Insurance	$23.97
Rate for Payer: Southwest Service Administrators UFCW	$119.00
Rate for Payer: Southwest Service Administrators UFCW	$132.60
Rate for Payer: TriWest Medicare	$31.20
Rate for Payer: TriWest Medicare	$28.00
Rate for Payer: United Healthcare Commercial	$111.54
Rate for Payer: United Healthcare Commercial	$100.10
Rate for Payer: United Healthcare Medicare	$28.00
Rate for Payer: United Healthcare Medicare	$31.20
Rate for Payer: Veterans Affairs TRICARE	$30.89
Rate for Payer: Veterans Affairs TRICARE	$27.72

Strep Confirmation

Facility

$173.00

Service Code	CPT 87081
Hospital Charge Code	853207
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

Strep Confirmation

Facility

$173.00

Service Code	CPT 87081
Hospital Charge Code	853207
Hospital Revenue Code	306
Min. Negotiated Rate	$9.61
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	$9.61
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

Strep Test POC

Facility

$25.00

Service Code	CPT 87880 QW
Hospital Charge Code	23799747
Hospital Revenue Code	521
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

Strep Test POC

Facility

$25.00

Service Code	CPT 87880 QW
Hospital Charge Code	23799747
Hospital Revenue Code	521
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$23.97
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: 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: Seven Corners Travel Insurance	$23.97
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

Know your out-of-pocket cost for care.

All Charges