Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Toes Great Left

Facility

$464.00

Service Code	CPT 73660 TA
Hospital Charge Code	823675
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Toes Great Left

Facility

$464.00

Service Code	CPT 73660 TA
Hospital Charge Code	823675
Hospital Revenue Code	320
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.68
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Toes Great Right

Facility

$464.00

Service Code	CPT 73660 T5
Hospital Charge Code	823677
Hospital Revenue Code	320
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.68
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Toes Great Right

Facility

$464.00

Service Code	CPT 73660 T5
Hospital Charge Code	823677
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Wrist 2 Views Left

Facility

$464.00

Service Code	CPT 73100 LT
Hospital Charge Code	823685
Hospital Revenue Code	320
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.18
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Wrist 2 Views Left

Facility

$464.00

Service Code	CPT 73100 LT
Hospital Charge Code	823685
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Wrist 2 Views Right

Facility

$464.00

Service Code	CPT 73100 RT
Hospital Charge Code	823683
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Wrist 2 Views Right

Facility

$464.00

Service Code	CPT 73100 RT
Hospital Charge Code	823683
Hospital Revenue Code	320
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.18
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Wrist Complete Left

Facility

$555.00

Service Code	CPT 73110 LT
Hospital Charge Code	823681
Hospital Revenue Code	320
Min. Negotiated Rate	$499.50
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Cash Price	$444.00

XR Wrist Complete Left

Facility

$555.00

Service Code	CPT 73110 LT
Hospital Charge Code	823681
Hospital Revenue Code	320
Min. Negotiated Rate	$38.94
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Arizona Complete Health Allwell	$88.80
Rate for Payer: Banner UC Health Medicare	$88.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$377.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.94
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cigna of AZ Commercial	$360.75
Rate for Payer: Devoted Health Medicare	$99.90
Rate for Payer: Humana of AZ Medicare	$88.80
Rate for Payer: Southwest Service Administrators UFCW	$377.40
Rate for Payer: TriWest Medicare	$88.80
Rate for Payer: United Healthcare Commercial	$317.46
Rate for Payer: United Healthcare Medicare	$88.80
Rate for Payer: Veterans Affairs TRICARE	$87.91

XR Wrist Complete Right

Facility

$555.00

Service Code	CPT 73110 RT
Hospital Charge Code	823679
Hospital Revenue Code	320
Min. Negotiated Rate	$499.50
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Cash Price	$444.00

XR Wrist Complete Right

Facility

$555.00

Service Code	CPT 73110 RT
Hospital Charge Code	823679
Hospital Revenue Code	320
Min. Negotiated Rate	$38.94
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Arizona Complete Health Allwell	$88.80
Rate for Payer: Banner UC Health Medicare	$88.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$377.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.94
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cigna of AZ Commercial	$360.75
Rate for Payer: Devoted Health Medicare	$99.90
Rate for Payer: Humana of AZ Medicare	$88.80
Rate for Payer: Southwest Service Administrators UFCW	$377.40
Rate for Payer: TriWest Medicare	$88.80
Rate for Payer: United Healthcare Commercial	$317.46
Rate for Payer: United Healthcare Medicare	$88.80
Rate for Payer: Veterans Affairs TRICARE	$87.91

XR Zygomatic Arches

Facility

$680.00

Service Code	CPT 70150
Hospital Charge Code	2620463
Hospital Revenue Code	320
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Cash Price	$544.00

XR Zygomatic Arches

Facility

$680.00

Service Code	CPT 70150
Hospital Charge Code	2620463
Hospital Revenue Code	320
Min. Negotiated Rate	$43.34
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Arizona Complete Health Allwell	$108.80
Rate for Payer: Banner UC Health Medicare	$108.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$462.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$43.34
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$442.00
Rate for Payer: Devoted Health Medicare	$122.40
Rate for Payer: Humana of AZ Medicare	$108.80
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$462.40
Rate for Payer: TriWest Medicare	$108.80
Rate for Payer: United Healthcare Commercial	$388.96
Rate for Payer: United Healthcare Medicare	$108.80
Rate for Payer: Veterans Affairs TRICARE	$107.71

YANKAUER 72

Facility

$11.00

Hospital Charge Code	22355322
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Arizona Complete Health Allwell	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.76
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Devoted Health Medicare	$1.98
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Southwest Service Administrators UFCW	$7.48
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: United Healthcare Commercial	$6.29
Rate for Payer: United Healthcare Medicare	$1.76
Rate for Payer: Veterans Affairs TRICARE	$1.74

YANKAUER 72

Facility

$11.00

Hospital Charge Code	22355322
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Cash Price	$8.80

YANKAUER HANDLE ONLY

Facility

$7.00

Hospital Charge Code	22355582
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Arizona Complete Health Allwell	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.12
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cigna of AZ Commercial	$4.90
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Southwest Service Administrators UFCW	$4.76
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: United Healthcare Commercial	$4.00
Rate for Payer: United Healthcare Medicare	$1.12
Rate for Payer: Veterans Affairs TRICARE	$1.11

YANKAUER HANDLE ONLY

Facility

$7.00

Hospital Charge Code	22355582
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Cash Price	$5.60

Yes

Facility

$340.00

Hospital Charge Code	1230419
Hospital Revenue Code	434
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna of AZ Commercial	$306.00
Rate for Payer: Cash Price	$272.00

Yes

Facility

$340.00

Hospital Charge Code	1230419
Hospital Revenue Code	434
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna of AZ Commercial	$306.00
Rate for Payer: Arizona Complete Health Allwell	$54.40
Rate for Payer: Banner UC Health Medicare	$54.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$231.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$54.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$54.40
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cigna of AZ Commercial	$238.00
Rate for Payer: Devoted Health Medicare	$61.20
Rate for Payer: Humana of AZ Medicare	$54.40
Rate for Payer: Southwest Service Administrators UFCW	$231.20
Rate for Payer: TriWest Medicare	$54.40
Rate for Payer: United Healthcare Commercial	$194.48
Rate for Payer: United Healthcare Medicare	$54.40
Rate for Payer: United Healthcare New Mexico Commercial	$64.60
Rate for Payer: Veterans Affairs TRICARE	$53.86

ZACURATE FINGER PULSE OX

Facility

$28.00

Hospital Charge Code	24335303
Hospital Revenue Code	270
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of AZ Commercial	$25.20
Rate for Payer: Arizona Complete Health Allwell	$4.48
Rate for Payer: Banner UC Health Medicare	$4.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$19.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.48
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cigna of AZ Commercial	$19.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$4.48
Rate for Payer: Southwest Service Administrators UFCW	$19.04
Rate for Payer: TriWest Medicare	$4.48
Rate for Payer: United Healthcare Commercial	$16.02
Rate for Payer: United Healthcare Medicare	$4.48
Rate for Payer: Veterans Affairs TRICARE	$4.44

ZACURATE FINGER PULSE OX

Facility

$28.00

Hospital Charge Code	24335303
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of AZ Commercial	$25.20
Rate for Payer: Cash Price	$22.40

ZEROWET SUPER SHIELD

Facility

$12.00

Hospital Charge Code	22355773
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

ZEROWET SUPER SHIELD

Facility

$12.00

Hospital Charge Code	22355773
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

Z GUIDE WIRE 1.5MMX80MM

Facility

$2,125.00

Hospital Charge Code	27887272
Hospital Revenue Code	270
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna of AZ Commercial	$1,912.50
Rate for Payer: Arizona Complete Health Allwell	$340.00
Rate for Payer: Banner UC Health Medicare	$340.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,445.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$340.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$340.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cigna of AZ Commercial	$1,487.50
Rate for Payer: Devoted Health Medicare	$382.50
Rate for Payer: Humana of AZ Medicare	$340.00
Rate for Payer: Southwest Service Administrators UFCW	$1,445.00
Rate for Payer: TriWest Medicare	$340.00
Rate for Payer: United Healthcare Commercial	$1,215.50
Rate for Payer: United Healthcare Medicare	$340.00
Rate for Payer: Veterans Affairs TRICARE	$336.60

Know your out-of-pocket cost for care.

All Charges