Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

BLADE LARYNGOSCOPE MACINTOSH 3

Facility

$114.00

Hospital Charge Code	24173665
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

BLADE LARYNGOSCOPE MACINTOSH 3

Facility

$114.00

Hospital Charge Code	24173665
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$79.80
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

BLADE SM62 PODIATRY

Facility

$18.00

Hospital Charge Code	22926423
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Cash Price	$14.40

BLADE SM62 PODIATRY

Facility

$18.00

Hospital Charge Code	22926423
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Arizona Complete Health Allwell	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.88
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Devoted Health Medicare	$3.24
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Southwest Service Administrators UFCW	$12.24
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: United Healthcare Commercial	$10.30
Rate for Payer: United Healthcare Medicare	$2.88
Rate for Payer: Veterans Affairs TRICARE	$2.85

Blood Admininstration

Facility

$958.00

Service Code	CPT 36430
Hospital Charge Code	22349429
Hospital Revenue Code	391
Min. Negotiated Rate	$862.20
Max. Negotiated Rate	$862.20
Rate for Payer: Aetna of AZ Commercial	$862.20
Rate for Payer: Cash Price	$766.40

Blood Admininstration

Facility

$958.00

Service Code	CPT 36430
Hospital Charge Code	22349429
Hospital Revenue Code	391
Min. Negotiated Rate	$151.75
Max. Negotiated Rate	$862.20
Rate for Payer: Aetna of AZ Commercial	$862.20
Rate for Payer: Arizona Complete Health Allwell	$153.28
Rate for Payer: Banner UC Health Medicare	$153.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$651.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$153.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$153.28
Rate for Payer: Cash Price	$766.40
Rate for Payer: Cash Price	$766.40
Rate for Payer: Cigna of AZ Commercial	$670.60
Rate for Payer: Devoted Health Medicare	$172.44
Rate for Payer: Humana of AZ Medicare	$153.28
Rate for Payer: Seven Corners Travel Insurance	$682.62
Rate for Payer: Southwest Service Administrators UFCW	$651.44
Rate for Payer: TriWest Medicare	$153.28
Rate for Payer: United Healthcare Commercial	$547.98
Rate for Payer: United Healthcare Medicare	$153.28
Rate for Payer: Veterans Affairs TRICARE	$151.75

Blood Administration

Facility

$866.00

Service Code	CPT 36430
Hospital Charge Code	609598
Hospital Revenue Code	391
Min. Negotiated Rate	$779.40
Max. Negotiated Rate	$779.40
Rate for Payer: Aetna of AZ Commercial	$779.40
Rate for Payer: Cash Price	$692.80

Blood Administration

Facility

$866.00

Service Code	CPT 36430
Hospital Charge Code	609598
Hospital Revenue Code	391
Min. Negotiated Rate	$137.17
Max. Negotiated Rate	$779.40
Rate for Payer: Aetna of AZ Commercial	$779.40
Rate for Payer: Arizona Complete Health Allwell	$138.56
Rate for Payer: Banner UC Health Medicare	$138.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$588.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$138.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$138.56
Rate for Payer: Cash Price	$692.80
Rate for Payer: Cash Price	$692.80
Rate for Payer: Cigna of AZ Commercial	$606.20
Rate for Payer: Devoted Health Medicare	$155.88
Rate for Payer: Humana of AZ Medicare	$138.56
Rate for Payer: Seven Corners Travel Insurance	$682.62
Rate for Payer: Southwest Service Administrators UFCW	$588.88
Rate for Payer: TriWest Medicare	$138.56
Rate for Payer: United Healthcare Commercial	$495.35
Rate for Payer: United Healthcare Medicare	$138.56
Rate for Payer: Veterans Affairs TRICARE	$137.17

Blood Culture

Facility

$158.00

Service Code	CPT 87040
Hospital Charge Code	850752
Hospital Revenue Code	306
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Arizona Complete Health Allwell	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$107.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.28
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$102.70
Rate for Payer: Devoted Health Medicare	$28.44
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Seven Corners Travel Insurance	$14.96
Rate for Payer: Southwest Service Administrators UFCW	$107.44
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: United Healthcare Commercial	$90.38
Rate for Payer: United Healthcare Medicare	$25.28
Rate for Payer: Veterans Affairs TRICARE	$25.03

Blood Culture

Facility

$158.00

Service Code	CPT 87040
Hospital Charge Code	850752
Hospital Revenue Code	306
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Cash Price	$126.40

Blood Culture Identification 2 Panel (Biofire)

Facility

$1,090.30

Service Code	CPT 87154
Hospital Charge Code	27355883
Hospital Revenue Code	301
Min. Negotiated Rate	$172.70
Max. Negotiated Rate	$981.27
Rate for Payer: Aetna of AZ Commercial	$981.27
Rate for Payer: Arizona Complete Health Allwell	$174.45
Rate for Payer: Banner UC Health Medicare	$174.45
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$741.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$174.45
Rate for Payer: Care1st Health Plan Arizona Medicare	$174.45
Rate for Payer: Cash Price	$872.24
Rate for Payer: Cash Price	$872.24
Rate for Payer: Cigna of AZ Commercial	$708.70
Rate for Payer: Devoted Health Medicare	$196.25
Rate for Payer: Humana of AZ Medicare	$174.45
Rate for Payer: Seven Corners Travel Insurance	$316.19
Rate for Payer: Southwest Service Administrators UFCW	$741.40
Rate for Payer: TriWest Medicare	$174.45
Rate for Payer: United Healthcare Commercial	$623.65
Rate for Payer: United Healthcare Medicare	$174.45
Rate for Payer: Veterans Affairs TRICARE	$172.70

Blood Culture Identification 2 Panel (Biofire)

Facility

$1,090.30

Service Code	CPT 87154
Hospital Charge Code	27355883
Hospital Revenue Code	301
Min. Negotiated Rate	$981.27
Max. Negotiated Rate	$981.27
Rate for Payer: Aetna of AZ Commercial	$981.27
Rate for Payer: Cash Price	$872.24

Blood Drugs of Abuse, 7,WB LC

Facility

$80.00

Service Code	CPT 80101
Hospital Charge Code	22311178
Hospital Revenue Code	301
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Cash Price	$64.00

Blood Drugs of Abuse, 7,WB LC

Facility

$80.00

Service Code	CPT 80101
Hospital Charge Code	22311178
Hospital Revenue Code	301
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Arizona Complete Health Allwell	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$54.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Devoted Health Medicare	$14.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Southwest Service Administrators UFCW	$54.40
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: United Healthcare Commercial	$45.76
Rate for Payer: United Healthcare Medicare	$12.80
Rate for Payer: Veterans Affairs TRICARE	$12.67

Blood Urea Nitrogen

Facility

$61.00

Service Code	CPT 84520
Hospital Charge Code	633605
Hospital Revenue Code	301
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Arizona Complete Health Allwell	$9.76
Rate for Payer: Banner UC Health Medicare	$9.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$41.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.76
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$39.65
Rate for Payer: Devoted Health Medicare	$10.98
Rate for Payer: Humana of AZ Medicare	$9.76
Rate for Payer: Seven Corners Travel Insurance	$5.73
Rate for Payer: Southwest Service Administrators UFCW	$41.48
Rate for Payer: TriWest Medicare	$9.76
Rate for Payer: United Healthcare Commercial	$34.89
Rate for Payer: United Healthcare Medicare	$9.76
Rate for Payer: Veterans Affairs TRICARE	$9.66

Blood Urea Nitrogen

Facility

$61.00

Service Code	CPT 84520
Hospital Charge Code	633605
Hospital Revenue Code	301
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Cash Price	$48.80

Body Fluid Culture

Facility

$327.00

Service Code	CPT 87070
Hospital Charge Code	858005
Hospital Revenue Code	306
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

Body Fluid Culture

Facility

$327.00

Service Code	CPT 87070
Hospital Charge Code	858005
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
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: Cash Price	$261.60
Rate for Payer: Cigna of AZ Commercial	$212.55
Rate for Payer: Devoted Health Medicare	$58.86
Rate for Payer: Humana of AZ Medicare	$52.32
Rate for Payer: Seven Corners Travel Insurance	$12.50
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

Body Fluid Culture

Facility

$311.00

Service Code	CPT 87070
Hospital Charge Code	633883
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Arizona Complete Health Allwell	$49.76
Rate for Payer: Banner UC Health Medicare	$49.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$211.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.76
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Devoted Health Medicare	$55.98
Rate for Payer: Humana of AZ Medicare	$49.76
Rate for Payer: Seven Corners Travel Insurance	$12.50
Rate for Payer: Southwest Service Administrators UFCW	$211.48
Rate for Payer: TriWest Medicare	$49.76
Rate for Payer: United Healthcare Commercial	$177.89
Rate for Payer: United Healthcare Medicare	$49.76
Rate for Payer: Veterans Affairs TRICARE	$49.26

Body Fluid Culture

Facility

$311.00

Service Code	CPT 87070
Hospital Charge Code	633883
Hospital Revenue Code	306
Min. Negotiated Rate	$279.90
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Cash Price	$248.80

BONE CERAMENT BONE VOID FILLER 10ML

Facility

$2,695.00

Hospital Charge Code	28236697
Hospital Revenue Code	270
Min. Negotiated Rate	$2,425.50
Max. Negotiated Rate	$2,425.50
Rate for Payer: Aetna of AZ Commercial	$2,425.50
Rate for Payer: Cash Price	$2,156.00

BONE CERAMENT BONE VOID FILLER 10ML

Facility

$2,695.00

Hospital Charge Code	28236697
Hospital Revenue Code	270
Min. Negotiated Rate	$426.89
Max. Negotiated Rate	$2,425.50
Rate for Payer: Aetna of AZ Commercial	$2,425.50
Rate for Payer: Arizona Complete Health Allwell	$431.20
Rate for Payer: Banner UC Health Medicare	$431.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,832.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$431.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$431.20
Rate for Payer: Cash Price	$2,156.00
Rate for Payer: Cigna of AZ Commercial	$1,886.50
Rate for Payer: Devoted Health Medicare	$485.10
Rate for Payer: Humana of AZ Medicare	$431.20
Rate for Payer: Southwest Service Administrators UFCW	$1,832.60
Rate for Payer: TriWest Medicare	$431.20
Rate for Payer: United Healthcare Commercial	$1,541.54
Rate for Payer: United Healthcare Medicare	$431.20
Rate for Payer: Veterans Affairs TRICARE	$426.89

BONE CERAMENT BONE VOID FILLER 5ML

Facility

$1,395.00

Hospital Charge Code	28234520
Hospital Revenue Code	270
Min. Negotiated Rate	$1,255.50
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna of AZ Commercial	$1,255.50
Rate for Payer: Cash Price	$1,116.00

BONE CERAMENT BONE VOID FILLER 5ML

Facility

$1,395.00

Hospital Charge Code	28234520
Hospital Revenue Code	270
Min. Negotiated Rate	$220.97
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna of AZ Commercial	$1,255.50
Rate for Payer: Arizona Complete Health Allwell	$223.20
Rate for Payer: Banner UC Health Medicare	$223.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$948.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$223.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$223.20
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Cigna of AZ Commercial	$976.50
Rate for Payer: Devoted Health Medicare	$251.10
Rate for Payer: Humana of AZ Medicare	$223.20
Rate for Payer: Southwest Service Administrators UFCW	$948.60
Rate for Payer: TriWest Medicare	$223.20
Rate for Payer: United Healthcare Commercial	$797.94
Rate for Payer: United Healthcare Medicare	$223.20
Rate for Payer: Veterans Affairs TRICARE	$220.97

BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$16,781.08

Service Code	MSDRG 553
Min. Negotiated Rate	$16,781.08
Max. Negotiated Rate	$16,781.08
Rate for Payer: Seven Corners Travel Insurance	$16,781.08

Know your out-of-pocket cost for care.

All Charges