Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

COLLECTING CONTAINER

Facility

$127.19

Hospital Charge Code	27839760
Hospital Revenue Code	270
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$114.47
Rate for Payer: Aetna of AZ Commercial	$114.47
Rate for Payer: Arizona Complete Health Allwell	$20.35
Rate for Payer: Banner UC Health Medicare	$20.35
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$86.49
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.35
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.35
Rate for Payer: Cash Price	$101.75
Rate for Payer: Cigna of AZ Commercial	$89.03
Rate for Payer: Devoted Health Medicare	$22.89
Rate for Payer: Humana of AZ Medicare	$20.35
Rate for Payer: Southwest Service Administrators UFCW	$86.49
Rate for Payer: TriWest Medicare	$20.35
Rate for Payer: United Healthcare Commercial	$72.75
Rate for Payer: United Healthcare Medicare	$20.35
Rate for Payer: Veterans Affairs TRICARE	$20.15

COLLECTING CONTAINER

Facility

$127.19

Hospital Charge Code	27839760
Hospital Revenue Code	270
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$114.47
Rate for Payer: Aetna of AZ Commercial	$114.47
Rate for Payer: Cash Price	$101.75

COLLECTION AND INTERPRETATION OF PHYSICAL PARAMETERS ST

Facility

$155.00

Service Code	CPT 99091
Hospital Charge Code	23889555
Hospital Revenue Code	521
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

COLLECTION AND INTERPRETATION OF PHYSICAL PARAMETERS ST

Facility

$155.00

Service Code	CPT 99091
Hospital Charge Code	23889555
Hospital Revenue Code	521
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.80
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: Veterans Affairs TRICARE	$24.55

COLLECTION AND INTERPRETATION OF PHYSICAL PARAMETERS ST

Facility

$147.00

Service Code	CPT 99091
Hospital Charge Code	23889599
Hospital Revenue Code	521
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Cash Price	$117.60

COLLECTION AND INTERPRETATION OF PHYSICAL PARAMETERS ST

Facility

$147.00

Service Code	CPT 99091
Hospital Charge Code	23889599
Hospital Revenue Code	521
Min. Negotiated Rate	$23.28
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Arizona Complete Health Allwell	$23.52
Rate for Payer: Banner UC Health Medicare	$23.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$99.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.52
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cigna of AZ Commercial	$102.90
Rate for Payer: Devoted Health Medicare	$26.46
Rate for Payer: Humana of AZ Medicare	$23.52
Rate for Payer: Southwest Service Administrators UFCW	$99.96
Rate for Payer: TriWest Medicare	$23.52
Rate for Payer: United Healthcare Commercial	$84.08
Rate for Payer: United Healthcare Medicare	$23.52
Rate for Payer: Veterans Affairs TRICARE	$23.28

COLLECTION: Capillary

Facility

$38.00

Service Code	CPT 36416
Hospital Charge Code	796177
Hospital Revenue Code	300
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Cash Price	$30.40

COLLECTION: Capillary

Facility

$38.00

Service Code	CPT 36416
Hospital Charge Code	796177
Hospital Revenue Code	300
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Arizona Complete Health Allwell	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.79
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$24.70
Rate for Payer: Devoted Health Medicare	$6.84
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Southwest Service Administrators UFCW	$25.84
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: United Healthcare Commercial	$21.74
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: Veterans Affairs TRICARE	$6.02

COLLECTION: Fingerstick

Facility

$41.00

Service Code	CPT 36416
Hospital Charge Code	796183
Hospital Revenue Code	300
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

COLLECTION: Fingerstick

Facility

$41.00

Service Code	CPT 36416
Hospital Charge Code	796183
Hospital Revenue Code	300
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.79
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

Collection of Venous Blood by venipuncture

Facility

$39.00

Service Code	CPT 36415
Hospital Charge Code	23597541
Hospital Revenue Code	301
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Arizona Complete Health Allwell	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.24
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$25.35
Rate for Payer: Devoted Health Medicare	$7.02
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$26.52
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: United Healthcare Commercial	$22.31
Rate for Payer: United Healthcare Medicare	$6.24
Rate for Payer: Veterans Affairs TRICARE	$6.18

Collection of Venous Blood by venipuncture

Facility

$39.00

Service Code	CPT 36415
Hospital Charge Code	23597541
Hospital Revenue Code	301
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Cash Price	$31.20

COLLECTION: Venous Draw

Facility

$39.00

Service Code	CPT 36415
Hospital Charge Code	796180
Hospital Revenue Code	300
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Arizona Complete Health Allwell	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.24
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$25.35
Rate for Payer: Devoted Health Medicare	$7.02
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$26.52
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: United Healthcare Commercial	$22.31
Rate for Payer: United Healthcare Medicare	$6.24
Rate for Payer: Veterans Affairs TRICARE	$6.18

COLLECTION: Venous Draw

Facility

$39.00

Service Code	CPT 36415
Hospital Charge Code	796180
Hospital Revenue Code	300
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Cash Price	$31.20

Colonoscopy

Facility

$3,684.00

Service Code	CPT 45378
Hospital Charge Code	22499690
Hospital Revenue Code	750
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$3,315.60
Rate for Payer: Arizona Complete Health Allwell	$589.44
Rate for Payer: Banner UC Health Medicare	$297.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,505.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$158.29
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$589.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$589.44
Rate for Payer: Cash Price	$2,947.20
Rate for Payer: Cash Price	$2,947.20
Rate for Payer: Cash Price	$2,947.20
Rate for Payer: Cigna of AZ Commercial	$2,578.80
Rate for Payer: Devoted Health Medicare	$663.12
Rate for Payer: Humana of AZ Medicare	$589.44
Rate for Payer: Mercy Care Medicaid	$158.29
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	$2,505.12
Rate for Payer: TriWest Medicare	$589.44
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$589.44
Rate for Payer: United Healthcare New Mexico Commercial	$699.96
Rate for Payer: Veterans Affairs TRICARE	$583.55

Colonoscopy

Facility

$3,684.00

Service Code	CPT 45378
Hospital Charge Code	22499690
Hospital Revenue Code	750
Min. Negotiated Rate	$3,315.60
Max. Negotiated Rate	$3,315.60
Rate for Payer: Aetna of AZ Commercial	$3,315.60
Rate for Payer: Cash Price	$2,947.20

COLONOSCOPY

Facility

$2,114.00

Service Code	CPT 45378
Hospital Charge Code	885907
Hospital Revenue Code	750
Min. Negotiated Rate	$1,902.60
Max. Negotiated Rate	$1,902.60
Rate for Payer: Aetna of AZ Commercial	$1,902.60
Rate for Payer: Cash Price	$1,691.20

COLONOSCOPY

Facility

$2,114.00

Service Code	CPT 45378
Hospital Charge Code	885907
Hospital Revenue Code	750
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$1,902.60
Rate for Payer: Arizona Complete Health Allwell	$338.24
Rate for Payer: Banner UC Health Medicare	$297.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,437.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$158.29
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$338.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$338.24
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Cigna of AZ Commercial	$1,479.80
Rate for Payer: Devoted Health Medicare	$380.52
Rate for Payer: Humana of AZ Medicare	$338.24
Rate for Payer: Mercy Care Medicaid	$158.29
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	$1,437.52
Rate for Payer: TriWest Medicare	$338.24
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$338.24
Rate for Payer: United Healthcare New Mexico Commercial	$401.66
Rate for Payer: Veterans Affairs TRICARE	$334.86

COLONOSCOPY BX

Facility

$4,896.09

Service Code	CPT 45380
Hospital Charge Code	1251755
Hospital Revenue Code	750
Min. Negotiated Rate	$233.26
Max. Negotiated Rate	$4,406.48
Rate for Payer: Aetna of AZ Commercial	$4,406.48
Rate for Payer: Arizona Complete Health Allwell	$783.37
Rate for Payer: Banner UC Health Medicare	$383.41
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,329.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$233.26
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$783.37
Rate for Payer: Care1st Health Plan Arizona Medicare	$783.37
Rate for Payer: Cash Price	$3,916.87
Rate for Payer: Cash Price	$3,916.87
Rate for Payer: Cash Price	$3,916.87
Rate for Payer: Cigna of AZ Commercial	$3,427.26
Rate for Payer: Devoted Health Medicare	$881.30
Rate for Payer: Humana of AZ Medicare	$783.37
Rate for Payer: Mercy Care Medicaid	$233.26
Rate for Payer: NaphCare Correctional Healthcare	$383.41
Rate for Payer: Seven Corners Travel Insurance	$1,851.53
Rate for Payer: Southwest Service Administrators UFCW	$3,329.34
Rate for Payer: TriWest Medicare	$783.37
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$783.37
Rate for Payer: United Healthcare New Mexico Commercial	$930.26
Rate for Payer: Veterans Affairs TRICARE	$775.54

COLONOSCOPY BX

Facility

$4,896.09

Service Code	CPT 45380
Hospital Charge Code	1251755
Hospital Revenue Code	750
Min. Negotiated Rate	$4,406.48
Max. Negotiated Rate	$4,406.48
Rate for Payer: Aetna of AZ Commercial	$4,406.48
Rate for Payer: Cash Price	$3,916.87

COLONOSCOPY BX ADD ON CHARGE

Facility

$103.00

Hospital Charge Code	22331686
Hospital Revenue Code	750
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$92.70
Rate for Payer: Arizona Complete Health Allwell	$16.48
Rate for Payer: Banner UC Health Medicare	$16.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$70.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.48
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cigna of AZ Commercial	$72.10
Rate for Payer: Devoted Health Medicare	$18.54
Rate for Payer: Humana of AZ Medicare	$16.48
Rate for Payer: Southwest Service Administrators UFCW	$70.04
Rate for Payer: TriWest Medicare	$16.48
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$16.48
Rate for Payer: United Healthcare New Mexico Commercial	$19.57
Rate for Payer: Veterans Affairs TRICARE	$16.32

COLONOSCOPY BX ADD ON CHARGE

Facility

$103.00

Hospital Charge Code	22331686
Hospital Revenue Code	750
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of AZ Commercial	$92.70
Rate for Payer: Cash Price	$82.40

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Facility

$3,596.00

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$297.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$158.29
Rate for Payer: Mercy Care Medicaid	$158.29
Rate for Payer: NaphCare Correctional Healthcare	$297.60
Rate for Payer: Seven Corners Travel Insurance	$1,438.89
Rate for Payer: United Healthcare Commercial	$3,596.00

Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Facility

$3,596.00

Service Code	CPT 45388
Hospital Revenue Code	750
Min. Negotiated Rate	$383.41
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$383.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,075.63
Rate for Payer: Mercy Care Medicaid	$2,075.63
Rate for Payer: NaphCare Correctional Healthcare	$383.41
Rate for Payer: Seven Corners Travel Insurance	$1,851.53
Rate for Payer: United Healthcare Commercial	$3,596.00

Colonoscopy, flexible; with biopsy, single or multiple

Facility

$3,596.00

Service Code	CPT 45380
Hospital Revenue Code	360
Min. Negotiated Rate	$233.26
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$383.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$233.26
Rate for Payer: Mercy Care Medicaid	$233.26
Rate for Payer: NaphCare Correctional Healthcare	$383.41
Rate for Payer: Seven Corners Travel Insurance	$1,851.53
Rate for Payer: United Healthcare Commercial	$3,596.00

Know your out-of-pocket cost for care.

All Charges