Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$24,024.70

Service Code	MSDRG 479
Min. Negotiated Rate	$24,024.70
Max. Negotiated Rate	$24,024.70
Rate for Payer: Seven Corners Travel Insurance	$24,024.70

Biopsy Endometrial Charge

Facility

$506.00

Service Code	CPT 58100
Hospital Charge Code	667646
Hospital Revenue Code	521
Min. Negotiated Rate	$455.40
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Cash Price	$404.80

Biopsy Endometrial Charge

Facility

$506.00

Service Code	CPT 58100
Hospital Charge Code	667646
Hospital Revenue Code	521
Min. Negotiated Rate	$38.01
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Arizona Complete Health Allwell	$80.96
Rate for Payer: Banner UC Health Medicare	$80.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$344.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$80.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$80.96
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cigna of AZ Commercial	$354.20
Rate for Payer: Devoted Health Medicare	$91.08
Rate for Payer: Humana of AZ Medicare	$80.96
Rate for Payer: Mercy Care Medicaid	$38.01
Rate for Payer: NaphCare Correctional Healthcare	$38.01
Rate for Payer: Seven Corners Travel Insurance	$312.81
Rate for Payer: Southwest Service Administrators UFCW	$344.08
Rate for Payer: TriWest Medicare	$80.96
Rate for Payer: United Healthcare Commercial	$289.43
Rate for Payer: United Healthcare Medicare	$80.96
Rate for Payer: Veterans Affairs TRICARE	$80.15

Biopsy mucosa

Facility

$357.00

Service Code	CPT 57100
Hospital Charge Code	27267837
Hospital Revenue Code	360
Min. Negotiated Rate	$32.33
Max. Negotiated Rate	$3,098.00
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Arizona Complete Health Allwell	$57.12
Rate for Payer: Banner UC Health Medicare	$32.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$242.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$57.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$57.12
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cigna of AZ Commercial	$178.50
Rate for Payer: Devoted Health Medicare	$64.26
Rate for Payer: Humana of AZ Medicare	$57.12
Rate for Payer: Mercy Care Medicaid	$38.36
Rate for Payer: NaphCare Correctional Healthcare	$32.33
Rate for Payer: Seven Corners Travel Insurance	$1,425.12
Rate for Payer: Southwest Service Administrators UFCW	$242.76
Rate for Payer: TriWest Medicare	$57.12
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$57.12
Rate for Payer: Veterans Affairs TRICARE	$56.55

Biopsy mucosa

Facility

$357.00

Service Code	CPT 57100
Hospital Charge Code	27267837
Hospital Revenue Code	360
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Cash Price	$285.60

Biopsy mucosa with suturing

Facility

$772.00

Service Code	CPT 57105
Hospital Charge Code	27291809
Hospital Revenue Code	360
Min. Negotiated Rate	$29.63
Max. Negotiated Rate	$5,008.71
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Arizona Complete Health Allwell	$123.52
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$524.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29.63
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$123.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$123.52
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cigna of AZ Commercial	$386.00
Rate for Payer: Devoted Health Medicare	$138.96
Rate for Payer: Humana of AZ Medicare	$123.52
Rate for Payer: Mercy Care Medicaid	$29.63
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: Southwest Service Administrators UFCW	$524.96
Rate for Payer: TriWest Medicare	$123.52
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$123.52
Rate for Payer: Veterans Affairs TRICARE	$122.28

Biopsy mucosa with suturing

Facility

$772.00

Service Code	CPT 57105
Hospital Charge Code	27291809
Hospital Revenue Code	360
Min. Negotiated Rate	$694.80
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Cash Price	$617.60

Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)

Facility

$3,098.00

Service Code	CPT 57500
Hospital Revenue Code	360
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$58.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$76.36
Rate for Payer: Mercy Care Medicaid	$76.36
Rate for Payer: NaphCare Correctional Healthcare	$58.04
Rate for Payer: Seven Corners Travel Insurance	$1,425.12
Rate for Payer: United Healthcare Commercial	$3,098.00

BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT

Facility

$600.00

Service Code	CPT 47001
Hospital Charge Code	28286992
Hospital Revenue Code	314
Min. Negotiated Rate	$66.67
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Arizona Complete Health Allwell	$96.00
Rate for Payer: Banner UC Health Medicare	$96.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$408.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.67
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cigna of AZ Commercial	$390.00
Rate for Payer: Devoted Health Medicare	$108.00
Rate for Payer: Humana of AZ Medicare	$96.00
Rate for Payer: Southwest Service Administrators UFCW	$408.00
Rate for Payer: TriWest Medicare	$96.00
Rate for Payer: United Healthcare Commercial	$343.20
Rate for Payer: United Healthcare Medicare	$96.00
Rate for Payer: Veterans Affairs TRICARE	$95.04

BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT

Facility

$600.00

Service Code	CPT 47001
Hospital Charge Code	28286992
Hospital Revenue Code	314
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Cash Price	$480.00

BIOPSY OF LOWER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE

Facility

$370.00

Service Code	CPT 45331
Hospital Charge Code	28133136
Hospital Revenue Code	360
Min. Negotiated Rate	$58.61
Max. Negotiated Rate	$3,098.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Arizona Complete Health Allwell	$59.20
Rate for Payer: Banner UC Health Medicare	$297.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$251.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$212.34
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$59.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$59.20
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cigna of AZ Commercial	$185.00
Rate for Payer: Devoted Health Medicare	$66.60
Rate for Payer: Humana of AZ Medicare	$59.20
Rate for Payer: Mercy Care Medicaid	$212.34
Rate for Payer: NaphCare Correctional Healthcare	$297.60
Rate for Payer: Seven Corners Travel Insurance	$1,438.89
Rate for Payer: Southwest Service Administrators UFCW	$251.60
Rate for Payer: TriWest Medicare	$59.20
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$59.20
Rate for Payer: Veterans Affairs TRICARE	$58.61

BIOPSY OF LOWER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE

Facility

$370.00

Service Code	CPT 45331
Hospital Charge Code	28133136
Hospital Revenue Code	360
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Cash Price	$296.00

BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PR

Facility

$307.00

Service Code	CPT 11755
Hospital Charge Code	24049514
Hospital Revenue Code	360
Min. Negotiated Rate	$41.33
Max. Negotiated Rate	$3,098.00
Rate for Payer: Aetna of AZ Commercial	$276.30
Rate for Payer: Arizona Complete Health Allwell	$49.12
Rate for Payer: Banner UC Health Medicare	$41.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$208.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$65.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.12
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cigna of AZ Commercial	$153.50
Rate for Payer: Devoted Health Medicare	$55.26
Rate for Payer: Humana of AZ Medicare	$49.12
Rate for Payer: Mercy Care Medicaid	$65.44
Rate for Payer: NaphCare Correctional Healthcare	$41.33
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$208.76
Rate for Payer: TriWest Medicare	$49.12
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$49.12
Rate for Payer: Veterans Affairs TRICARE	$48.63

BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PR

Facility

$307.00

Service Code	CPT 11755
Hospital Charge Code	24049514
Hospital Revenue Code	360
Min. Negotiated Rate	$276.30
Max. Negotiated Rate	$276.30
Rate for Payer: Aetna of AZ Commercial	$276.30
Rate for Payer: Cash Price	$245.60

Biopsy of skin, subcutaneous tissue; single lesion

Facility

$274.00

Service Code	CPT 11100
Hospital Charge Code	7693341
Hospital Revenue Code	521
Min. Negotiated Rate	$246.60
Max. Negotiated Rate	$246.60
Rate for Payer: Aetna of AZ Commercial	$246.60
Rate for Payer: Cash Price	$219.20

Biopsy of skin, subcutaneous tissue; single lesion

Facility

$274.00

Service Code	CPT 11100
Hospital Charge Code	7693341
Hospital Revenue Code	521
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$246.60
Rate for Payer: Aetna of AZ Commercial	$246.60
Rate for Payer: Arizona Complete Health Allwell	$43.84
Rate for Payer: Banner UC Health Medicare	$43.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$186.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$43.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$43.84
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cigna of AZ Commercial	$191.80
Rate for Payer: Devoted Health Medicare	$49.32
Rate for Payer: Humana of AZ Medicare	$43.84
Rate for Payer: Southwest Service Administrators UFCW	$186.32
Rate for Payer: TriWest Medicare	$43.84
Rate for Payer: United Healthcare Commercial	$156.73
Rate for Payer: United Healthcare Medicare	$43.84
Rate for Payer: Veterans Affairs TRICARE	$43.40

BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL U

Facility

$3,325.00

Service Code	CPT 43239
Hospital Charge Code	23598978
Hospital Revenue Code	750
Min. Negotiated Rate	$2,992.50
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna of AZ Commercial	$2,992.50
Rate for Payer: Cash Price	$2,660.00

BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL U

Facility

$3,325.00

Service Code	CPT 43239
Hospital Charge Code	23598978
Hospital Revenue Code	750
Min. Negotiated Rate	$236.04
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$2,992.50
Rate for Payer: Arizona Complete Health Allwell	$532.00
Rate for Payer: Banner UC Health Medicare	$343.75
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,261.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$236.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$532.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$532.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cigna of AZ Commercial	$2,327.50
Rate for Payer: Devoted Health Medicare	$598.50
Rate for Payer: Humana of AZ Medicare	$532.00
Rate for Payer: Mercy Care Medicaid	$236.04
Rate for Payer: NaphCare Correctional Healthcare	$343.75
Rate for Payer: Seven Corners Travel Insurance	$1,403.35
Rate for Payer: Southwest Service Administrators UFCW	$2,261.00
Rate for Payer: TriWest Medicare	$532.00
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$532.00
Rate for Payer: United Healthcare New Mexico Commercial	$631.75
Rate for Payer: Veterans Affairs TRICARE	$526.68

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION

Facility

$3,098.00

Service Code	CPT 56605
Hospital Revenue Code	360
Min. Negotiated Rate	$28.47
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$28.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$37.66
Rate for Payer: Mercy Care Medicaid	$37.66
Rate for Payer: NaphCare Correctional Healthcare	$28.47
Rate for Payer: Seven Corners Travel Insurance	$1,425.12
Rate for Payer: United Healthcare Commercial	$3,098.00

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION

Facility

$3,098.00

Service Code	CPT 56605
Hospital Revenue Code	750
Min. Negotiated Rate	$28.47
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$28.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$37.66
Rate for Payer: Mercy Care Medicaid	$37.66
Rate for Payer: NaphCare Correctional Healthcare	$28.47
Rate for Payer: Seven Corners Travel Insurance	$1,425.12
Rate for Payer: United Healthcare Commercial	$3,098.00

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,671.00

Service Code	CPT 56606
Hospital Revenue Code	360
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$2,671.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9.41
Rate for Payer: Mercy Care Medicaid	$9.41
Rate for Payer: NaphCare Correctional Healthcare	$9.41
Rate for Payer: United Healthcare Commercial	$2,671.00

Biopsy or excision of lymph node(s); open, deep axillary node(s)

Facility

$6,058.23

Service Code	CPT 38525
Hospital Revenue Code	360
Min. Negotiated Rate	$995.48
Max. Negotiated Rate	$6,058.23
Rate for Payer: Banner UC Health Medicare	$995.48
Rate for Payer: NaphCare Correctional Healthcare	$995.48
Rate for Payer: Seven Corners Travel Insurance	$6,058.23
Rate for Payer: United Healthcare Commercial	$4,169.00

Biopsy or excision of lymph node(s); open, superficial

Facility

$6,058.23

Service Code	CPT 38500
Hospital Revenue Code	360
Min. Negotiated Rate	$81.24
Max. Negotiated Rate	$6,058.23
Rate for Payer: Banner UC Health Medicare	$995.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$81.24
Rate for Payer: Mercy Care Medicaid	$81.24
Rate for Payer: NaphCare Correctional Healthcare	$995.48
Rate for Payer: Seven Corners Travel Insurance	$6,058.23
Rate for Payer: United Healthcare Commercial	$4,169.00

BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY A

Facility

$676.00

Service Code	CPT 55707
Hospital Charge Code	27883521
Hospital Revenue Code	360
Min. Negotiated Rate	$608.40
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Cash Price	$540.80

BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY A

Facility

$676.00

Service Code	CPT 55707
Hospital Charge Code	27883521
Hospital Revenue Code	360
Min. Negotiated Rate	$107.08
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Arizona Complete Health Allwell	$108.16
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$459.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$209.55
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$108.16
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cigna of AZ Commercial	$338.00
Rate for Payer: Devoted Health Medicare	$121.68
Rate for Payer: Humana of AZ Medicare	$108.16
Rate for Payer: Mercy Care Medicaid	$209.55
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$459.68
Rate for Payer: TriWest Medicare	$108.16
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$108.16
Rate for Payer: Veterans Affairs TRICARE	$107.08

Know your out-of-pocket cost for care.

All Charges