Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CATH SET SUPRAPUBIC INTRUDER

Facility

$455.00

Hospital Charge Code	22354288
Hospital Revenue Code	270
Min. Negotiated Rate	$72.07
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna of AZ Commercial	$409.50
Rate for Payer: Arizona Complete Health Allwell	$72.80
Rate for Payer: Banner UC Health Medicare	$72.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$309.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$72.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$72.80
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cigna of AZ Commercial	$318.50
Rate for Payer: Devoted Health Medicare	$81.90
Rate for Payer: Humana of AZ Medicare	$72.80
Rate for Payer: Southwest Service Administrators UFCW	$309.40
Rate for Payer: TriWest Medicare	$72.80
Rate for Payer: United Healthcare Commercial	$260.26
Rate for Payer: United Healthcare Medicare	$72.80
Rate for Payer: Veterans Affairs TRICARE	$72.07

CATH SUCT 10FR

Facility

$11.00

Hospital Charge Code	22355570
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

CATH SUCT 10FR

Facility

$11.00

Hospital Charge Code	22355570
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

CATH SUCT 6FR

Facility

$8.00

Hospital Charge Code	22355573
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

CATH SUCT 6FR

Facility

$8.00

Hospital Charge Code	22355573
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

CATH SUCT 8FR

Facility

$8.00

Hospital Charge Code	22355569
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

CATH SUCT 8FR

Facility

$8.00

Hospital Charge Code	22355569
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

CATH TEXAS 2-IN

Facility

$9.00

Hospital Charge Code	22355432
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

CATH TEXAS 2-IN

Facility

$9.00

Hospital Charge Code	22355432
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

CATH THORACIC 24F STRAIGHT STERILE

Facility

$62.00

Hospital Charge Code	22354944
Hospital Revenue Code	270
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

CATH THORACIC 24F STRAIGHT STERILE

Facility

$62.00

Hospital Charge Code	22354944
Hospital Revenue Code	270
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

CATH THORACIC 32F STRAIGHT STERILE

Facility

$62.00

Hospital Charge Code	22354945
Hospital Revenue Code	270
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

CATH THORACIC 32F STRAIGHT STERILE

Facility

$62.00

Hospital Charge Code	22354945
Hospital Revenue Code	270
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

CATH URETERAL 8F CONE TIP

Facility

$995.00

Hospital Charge Code	22354212
Hospital Revenue Code	270
Min. Negotiated Rate	$895.50
Max. Negotiated Rate	$895.50
Rate for Payer: Aetna of AZ Commercial	$895.50
Rate for Payer: Cash Price	$796.00

CATH URETERAL 8F CONE TIP

Facility

$995.00

Hospital Charge Code	22354212
Hospital Revenue Code	270
Min. Negotiated Rate	$157.61
Max. Negotiated Rate	$895.50
Rate for Payer: Aetna of AZ Commercial	$895.50
Rate for Payer: Arizona Complete Health Allwell	$159.20
Rate for Payer: Banner UC Health Medicare	$159.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$676.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$159.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$159.20
Rate for Payer: Cash Price	$796.00
Rate for Payer: Cigna of AZ Commercial	$696.50
Rate for Payer: Devoted Health Medicare	$179.10
Rate for Payer: Humana of AZ Medicare	$159.20
Rate for Payer: Southwest Service Administrators UFCW	$676.60
Rate for Payer: TriWest Medicare	$159.20
Rate for Payer: United Healthcare Commercial	$569.14
Rate for Payer: United Healthcare Medicare	$159.20
Rate for Payer: Veterans Affairs TRICARE	$157.61

CAUTERY PEN DISPOSABLE

Facility

$58.00

Hospital Charge Code	22575511
Hospital Revenue Code	279
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Arizona Complete Health Allwell	$9.28
Rate for Payer: Banner UC Health Medicare	$9.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$39.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.28
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Devoted Health Medicare	$10.44
Rate for Payer: Humana of AZ Medicare	$9.28
Rate for Payer: Southwest Service Administrators UFCW	$39.44
Rate for Payer: TriWest Medicare	$9.28
Rate for Payer: United Healthcare Commercial	$33.18
Rate for Payer: United Healthcare Medicare	$9.28
Rate for Payer: Veterans Affairs TRICARE	$9.19

CAUTERY PEN DISPOSABLE

Facility

$58.00

Hospital Charge Code	22575511
Hospital Revenue Code	279
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Cash Price	$46.40

CBG With Free Cortisol LC

Facility

$271.00

Service Code	CPT 82533
Hospital Charge Code	22956825
Hospital Revenue Code	306
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$243.90
Rate for Payer: Aetna of AZ Commercial	$243.90
Rate for Payer: Arizona Complete Health Allwell	$43.36
Rate for Payer: Banner UC Health Medicare	$43.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$184.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$43.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$43.36
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cigna of AZ Commercial	$176.15
Rate for Payer: Devoted Health Medicare	$48.78
Rate for Payer: Humana of AZ Medicare	$43.36
Rate for Payer: Seven Corners Travel Insurance	$23.64
Rate for Payer: Southwest Service Administrators UFCW	$184.28
Rate for Payer: TriWest Medicare	$43.36
Rate for Payer: United Healthcare Commercial	$155.01
Rate for Payer: United Healthcare Medicare	$43.36
Rate for Payer: Veterans Affairs TRICARE	$42.93

CBG With Free Cortisol LC

Facility

$271.00

Service Code	CPT 82533
Hospital Charge Code	22956825
Hospital Revenue Code	306
Min. Negotiated Rate	$243.90
Max. Negotiated Rate	$243.90
Rate for Payer: Aetna of AZ Commercial	$243.90
Rate for Payer: Cash Price	$216.80

CCM Services 20 min per month

Facility

$132.00

Service Code	CPT 99490
Hospital Charge Code	22521501
Hospital Revenue Code	521
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Cash Price	$105.60

CCM Services 20 min per month

Facility

$125.00

Service Code	CPT 99490
Hospital Charge Code	23790901
Hospital Revenue Code	521
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$157.18
Rate for Payer: Aetna of AZ Commercial	$112.50
Rate for Payer: Arizona Complete Health Allwell	$20.00
Rate for Payer: Banner UC Health Medicare	$20.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$85.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cigna of AZ Commercial	$87.50
Rate for Payer: Devoted Health Medicare	$22.50
Rate for Payer: Humana of AZ Medicare	$20.00
Rate for Payer: Seven Corners Travel Insurance	$157.18
Rate for Payer: Southwest Service Administrators UFCW	$85.00
Rate for Payer: TriWest Medicare	$20.00
Rate for Payer: United Healthcare Commercial	$71.50
Rate for Payer: United Healthcare Medicare	$20.00
Rate for Payer: Veterans Affairs TRICARE	$19.80

CCM Services 20 min per month

Facility

$125.00

Service Code	CPT 99490
Hospital Charge Code	23790901
Hospital Revenue Code	521
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of AZ Commercial	$112.50
Rate for Payer: Cash Price	$100.00

CCM Services 20 min per month

Facility

$132.00

Service Code	CPT 99490
Hospital Charge Code	22521501
Hospital Revenue Code	521
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$157.18
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Arizona Complete Health Allwell	$21.12
Rate for Payer: Banner UC Health Medicare	$21.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$89.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$21.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$21.12
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cigna of AZ Commercial	$92.40
Rate for Payer: Devoted Health Medicare	$23.76
Rate for Payer: Humana of AZ Medicare	$21.12
Rate for Payer: Seven Corners Travel Insurance	$157.18
Rate for Payer: Southwest Service Administrators UFCW	$89.76
Rate for Payer: TriWest Medicare	$21.12
Rate for Payer: United Healthcare Commercial	$75.50
Rate for Payer: United Healthcare Medicare	$21.12
Rate for Payer: Veterans Affairs TRICARE	$20.91

CCP Antibodies IgG/IgA LC

Facility

$372.00

Service Code	CPT 86200
Hospital Charge Code	1285795
Hospital Revenue Code	301
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Aetna of AZ Commercial	$463.50
Rate for Payer: Arizona Complete Health Allwell	$82.40
Rate for Payer: Arizona Complete Health Allwell	$59.52
Rate for Payer: Banner UC Health Medicare	$82.40
Rate for Payer: Banner UC Health Medicare	$59.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$252.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$350.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$59.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$82.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$59.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$82.40
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cigna of AZ Commercial	$334.75
Rate for Payer: Cigna of AZ Commercial	$241.80
Rate for Payer: Devoted Health Medicare	$92.70
Rate for Payer: Devoted Health Medicare	$66.96
Rate for Payer: Humana of AZ Medicare	$59.52
Rate for Payer: Humana of AZ Medicare	$82.40
Rate for Payer: Seven Corners Travel Insurance	$18.78
Rate for Payer: Seven Corners Travel Insurance	$18.78
Rate for Payer: Southwest Service Administrators UFCW	$350.20
Rate for Payer: Southwest Service Administrators UFCW	$252.96
Rate for Payer: TriWest Medicare	$59.52
Rate for Payer: TriWest Medicare	$82.40
Rate for Payer: United Healthcare Commercial	$212.78
Rate for Payer: United Healthcare Commercial	$294.58
Rate for Payer: United Healthcare Medicare	$59.52
Rate for Payer: United Healthcare Medicare	$82.40
Rate for Payer: Veterans Affairs TRICARE	$81.58
Rate for Payer: Veterans Affairs TRICARE	$58.92

CCP Antibodies IgG/IgA LC

Facility

$515.00

Service Code	CPT 86200
Hospital Charge Code	1285795
Hospital Revenue Code	301
Min. Negotiated Rate	$463.50
Max. Negotiated Rate	$463.50
Rate for Payer: Aetna of AZ Commercial	$463.50
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$297.60

Know your out-of-pocket cost for care.

All Charges