Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$26,710.32

Service Code	MSDRG 415
Min. Negotiated Rate	$26,710.32
Max. Negotiated Rate	$26,710.32
Rate for Payer: Seven Corners Travel Insurance	$26,710.32

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$46,043.53

Service Code	MSDRG 414
Min. Negotiated Rate	$46,043.53
Max. Negotiated Rate	$46,043.53
Rate for Payer: Seven Corners Travel Insurance	$46,043.53

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$17,630.06

Service Code	MSDRG 416
Min. Negotiated Rate	$17,630.06
Max. Negotiated Rate	$17,630.06
Rate for Payer: Seven Corners Travel Insurance	$17,630.06

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$27,173.01

Service Code	MSDRG 412
Min. Negotiated Rate	$27,173.01
Max. Negotiated Rate	$27,173.01
Rate for Payer: Seven Corners Travel Insurance	$27,173.01

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$42,692.31

Service Code	MSDRG 411
Min. Negotiated Rate	$42,692.31
Max. Negotiated Rate	$42,692.31
Rate for Payer: Seven Corners Travel Insurance	$42,692.31

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$21,460.54

Service Code	MSDRG 413
Min. Negotiated Rate	$21,460.54
Max. Negotiated Rate	$21,460.54
Rate for Payer: Seven Corners Travel Insurance	$21,460.54

Cholesterol High Density Lipid

Facility

$99.00

Service Code	CPT 83718
Hospital Charge Code	633703
Hospital Revenue Code	301
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Arizona Complete Health Allwell	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$67.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.84
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Devoted Health Medicare	$17.82
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Seven Corners Travel Insurance	$11.88
Rate for Payer: Southwest Service Administrators UFCW	$67.32
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: United Healthcare Commercial	$56.63
Rate for Payer: United Healthcare Medicare	$15.84
Rate for Payer: Veterans Affairs TRICARE	$15.68

Cholesterol High Density Lipid

Facility

$99.00

Service Code	CPT 83718
Hospital Charge Code	633703
Hospital Revenue Code	301
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Cash Price	$79.20

Cholesterol Total

Facility

$76.00

Service Code	CPT 82465
Hospital Charge Code	633705
Hospital Revenue Code	301
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Cash Price	$60.80

Cholesterol Total

Facility

$76.00

Service Code	CPT 82465
Hospital Charge Code	633705
Hospital Revenue Code	301
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Arizona Complete Health Allwell	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.16
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Devoted Health Medicare	$13.68
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Seven Corners Travel Insurance	$6.31
Rate for Payer: Southwest Service Administrators UFCW	$51.68
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: United Healthcare Commercial	$43.47
Rate for Payer: United Healthcare Medicare	$12.16
Rate for Payer: Veterans Affairs TRICARE	$12.04

cholestyramine 4 g/ PKT UD [CQCH]

Facility

$0.77

Service Code	NDC 245003642
Hospital Charge Code	105916320
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Arizona Complete Health Allwell	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.12
Rate for Payer: Cash Price	$0.62
Rate for Payer: Cigna of AZ Commercial	$0.50
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Southwest Service Administrators UFCW	$0.52
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: United Healthcare Commercial	$0.44
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: Veterans Affairs TRICARE	$0.12

cholestyramine 4 g/ PKT UD [CQCH]

Facility

$0.77

Service Code	NDC 245003642
Hospital Charge Code	105916320
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Cash Price	$0.62

CHORIOFIX 2X3

Facility

$17,500.00

Service Code	HCPCS Q4412
Hospital Charge Code	28300712
Hospital Revenue Code	636
Min. Negotiated Rate	$15,750.00
Max. Negotiated Rate	$15,750.00
Rate for Payer: Aetna of AZ Commercial	$15,750.00
Rate for Payer: Cash Price	$14,000.00

CHORIOFIX 2X3

Facility

$17,500.00

Service Code	HCPCS Q4412
Hospital Charge Code	28300712
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$15,750.00
Rate for Payer: Aetna of AZ Commercial	$15,750.00
Rate for Payer: Arizona Complete Health Allwell	$2,800.00
Rate for Payer: Banner UC Health Medicare	$2,800.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$11,900.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2,800.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$2,800.00
Rate for Payer: Cash Price	$14,000.00
Rate for Payer: Cash Price	$14,000.00
Rate for Payer: Cigna of AZ Commercial	$12,250.00
Rate for Payer: Devoted Health Medicare	$3,150.00
Rate for Payer: Humana of AZ Medicare	$2,800.00
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$11,900.00
Rate for Payer: TriWest Medicare	$2,800.00
Rate for Payer: United Healthcare Commercial	$10,010.00
Rate for Payer: United Healthcare Medicare	$2,800.00
Rate for Payer: United Healthcare New Mexico Commercial	$3,325.00
Rate for Payer: Veterans Affairs TRICARE	$2,772.00

CHORIOFIX 3CM X 5CM SHEET

Facility

$17,500.00

Service Code	HCPCS Q4412
Hospital Charge Code	28285493
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$15,750.00
Rate for Payer: Aetna of AZ Commercial	$15,750.00
Rate for Payer: Arizona Complete Health Allwell	$2,800.00
Rate for Payer: Banner UC Health Medicare	$2,800.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$11,900.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2,800.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$2,800.00
Rate for Payer: Cash Price	$14,000.00
Rate for Payer: Cash Price	$14,000.00
Rate for Payer: Cigna of AZ Commercial	$12,250.00
Rate for Payer: Devoted Health Medicare	$3,150.00
Rate for Payer: Humana of AZ Medicare	$2,800.00
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$11,900.00
Rate for Payer: TriWest Medicare	$2,800.00
Rate for Payer: United Healthcare Commercial	$10,010.00
Rate for Payer: United Healthcare Medicare	$2,800.00
Rate for Payer: United Healthcare New Mexico Commercial	$3,325.00
Rate for Payer: Veterans Affairs TRICARE	$2,772.00

CHORIOFIX 3CM X 5CM SHEET

Facility

$17,500.00

Service Code	HCPCS Q4412
Hospital Charge Code	28285493
Hospital Revenue Code	636
Min. Negotiated Rate	$15,750.00
Max. Negotiated Rate	$15,750.00
Rate for Payer: Aetna of AZ Commercial	$15,750.00
Rate for Payer: Cash Price	$14,000.00

Chromium LC

Facility

$284.00

Service Code	CPT 82495
Hospital Charge Code	6738684
Hospital Revenue Code	301
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Cash Price	$227.20

Chromium LC

Facility

$284.00

Service Code	CPT 82495
Hospital Charge Code	6738684
Hospital Revenue Code	301
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Arizona Complete Health Allwell	$45.44
Rate for Payer: Banner UC Health Medicare	$45.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$193.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.44
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cigna of AZ Commercial	$184.60
Rate for Payer: Devoted Health Medicare	$51.12
Rate for Payer: Humana of AZ Medicare	$45.44
Rate for Payer: Seven Corners Travel Insurance	$29.41
Rate for Payer: Southwest Service Administrators UFCW	$193.12
Rate for Payer: TriWest Medicare	$45.44
Rate for Payer: United Healthcare Commercial	$162.45
Rate for Payer: United Healthcare Medicare	$45.44
Rate for Payer: Veterans Affairs TRICARE	$44.99

Chromogranin A LC

Facility

$392.00

Service Code	CPT 86316
Hospital Charge Code	2029214
Hospital Revenue Code	302
Min. Negotiated Rate	$30.17
Max. Negotiated Rate	$352.80
Rate for Payer: Aetna of AZ Commercial	$352.80
Rate for Payer: Arizona Complete Health Allwell	$62.72
Rate for Payer: Banner UC Health Medicare	$62.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$266.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$62.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$62.72
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cigna of AZ Commercial	$254.80
Rate for Payer: Devoted Health Medicare	$70.56
Rate for Payer: Humana of AZ Medicare	$62.72
Rate for Payer: Seven Corners Travel Insurance	$30.17
Rate for Payer: Southwest Service Administrators UFCW	$266.56
Rate for Payer: TriWest Medicare	$62.72
Rate for Payer: United Healthcare Commercial	$224.22
Rate for Payer: United Healthcare Medicare	$62.72
Rate for Payer: Veterans Affairs TRICARE	$62.09

Chromogranin A LC

Facility

$392.00

Service Code	CPT 86316
Hospital Charge Code	2029214
Hospital Revenue Code	302
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$352.80
Rate for Payer: Aetna of AZ Commercial	$352.80
Rate for Payer: Cash Price	$313.60

.CHROMOSOM IN SITU HYB <300 CELLS

Facility

$169.00

Service Code	CPT 88275
Hospital Charge Code	22481444
Hospital Revenue Code	310
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna of AZ Commercial	$152.10
Rate for Payer: Cash Price	$135.20

.CHROMOSOM IN SITU HYB <300 CELLS

Facility

$169.00

Service Code	CPT 88275
Hospital Charge Code	22481444
Hospital Revenue Code	310
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna of AZ Commercial	$152.10
Rate for Payer: Arizona Complete Health Allwell	$27.04
Rate for Payer: Banner UC Health Medicare	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.04
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cigna of AZ Commercial	$109.85
Rate for Payer: Devoted Health Medicare	$30.42
Rate for Payer: Humana of AZ Medicare	$27.04
Rate for Payer: Seven Corners Travel Insurance	$74.23
Rate for Payer: Southwest Service Administrators UFCW	$114.92
Rate for Payer: TriWest Medicare	$27.04
Rate for Payer: United Healthcare Commercial	$96.67
Rate for Payer: United Healthcare Medicare	$27.04
Rate for Payer: Veterans Affairs TRICARE	$26.77

Chromotubation

Facility

$265.00

Service Code	CPT 58350
Hospital Charge Code	23390089
Hospital Revenue Code	982
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$238.50
Rate for Payer: Arizona Complete Health Allwell	$42.40
Rate for Payer: Banner UC Health Medicare	$42.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$180.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.40
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cigna of AZ Commercial	$185.50
Rate for Payer: Devoted Health Medicare	$47.70
Rate for Payer: Humana of AZ Medicare	$42.40
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: Southwest Service Administrators UFCW	$180.20
Rate for Payer: TriWest Medicare	$42.40
Rate for Payer: United Healthcare Commercial	$151.58
Rate for Payer: United Healthcare Medicare	$42.40
Rate for Payer: United Healthcare New Mexico Commercial	$50.35
Rate for Payer: Veterans Affairs TRICARE	$41.98

Chromotubation

Facility

$265.00

Service Code	CPT 58350
Hospital Charge Code	23390089
Hospital Revenue Code	982
Min. Negotiated Rate	$238.50
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna of AZ Commercial	$238.50
Rate for Payer: Cash Price	$212.00

Chronic Kidney Disease

Facility

$4,275.73

Service Code	APR-DRG 4702
Hospital Charge Code	APRDRG4704
Min. Negotiated Rate	$4,275.73
Max. Negotiated Rate	$4,275.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,275.73
Rate for Payer: Mercy Care Medicaid	$4,275.73
Rate for Payer: NaphCare Correctional Healthcare	$4,275.73

Know your out-of-pocket cost for care.

All Charges