Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

17-OH Progesterone LC

Facility

$441.00

Service Code	CPT 83498
Hospital Charge Code	6738679
Hospital Revenue Code	301
Min. Negotiated Rate	$396.90
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of AZ Commercial	$396.90
Rate for Payer: Cash Price	$352.80

18 GA Percutaneous Acce+B2:B102ss Needle

Facility

$292.00

Hospital Charge Code	22926475
Hospital Revenue Code	272
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Cash Price	$233.60

18 GA Percutaneous Acce+B2:B102ss Needle

Facility

$292.00

Hospital Charge Code	22926475
Hospital Revenue Code	272
Min. Negotiated Rate	$46.25
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Arizona Complete Health Allwell	$46.72
Rate for Payer: Banner UC Health Medicare	$46.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$198.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$46.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$46.72
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cigna of AZ Commercial	$204.40
Rate for Payer: Devoted Health Medicare	$52.56
Rate for Payer: Humana of AZ Medicare	$46.72
Rate for Payer: Southwest Service Administrators UFCW	$198.56
Rate for Payer: TriWest Medicare	$46.72
Rate for Payer: United Healthcare Commercial	$167.02
Rate for Payer: United Healthcare Medicare	$46.72
Rate for Payer: Veterans Affairs TRICARE	$46.25

1 Ethibond Excel CCS

Facility

$109.00

Hospital Charge Code	22926435
Hospital Revenue Code	272
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Arizona Complete Health Allwell	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$74.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.44
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Devoted Health Medicare	$19.62
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Southwest Service Administrators UFCW	$74.12
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: United Healthcare Commercial	$62.35
Rate for Payer: United Healthcare Medicare	$17.44
Rate for Payer: Veterans Affairs TRICARE	$17.27

1 Ethibond Excel CCS

Facility

$109.00

Hospital Charge Code	22926435
Hospital Revenue Code	272
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Cash Price	$87.20

1 Ethibond Excel OS-8

Facility

$19.00

Hospital Charge Code	22926437
Hospital Revenue Code	272
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Cash Price	$15.20

1 Ethibond Excel OS-8

Facility

$19.00

Hospital Charge Code	22926437
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Arizona Complete Health Allwell	$3.04
Rate for Payer: Banner UC Health Medicare	$3.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.04
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of AZ Commercial	$13.30
Rate for Payer: Devoted Health Medicare	$3.42
Rate for Payer: Humana of AZ Medicare	$3.04
Rate for Payer: Southwest Service Administrators UFCW	$12.92
Rate for Payer: TriWest Medicare	$3.04
Rate for Payer: United Healthcare Commercial	$10.87
Rate for Payer: United Healthcare Medicare	$3.04
Rate for Payer: Veterans Affairs TRICARE	$3.01

1 Silk Ties

Facility

$9.00

Hospital Charge Code	22926441
Hospital Revenue Code	272
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

1 Silk Ties

Facility

$9.00

Hospital Charge Code	22926441
Hospital Revenue Code	272
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

2019 Novel Coronavirus (CoVID-19), NAA LC

Facility

$200.00

Service Code	CPT 87635
Hospital Charge Code	23925248
Hospital Revenue Code	300
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Cash Price	$160.00

2019 Novel Coronavirus (CoVID-19), NAA LC

Facility

$200.00

Service Code	CPT 87635
Hospital Charge Code	23925248
Hospital Revenue Code	300
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Arizona Complete Health Allwell	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$136.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$130.00
Rate for Payer: Devoted Health Medicare	$36.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Seven Corners Travel Insurance	$74.40
Rate for Payer: Southwest Service Administrators UFCW	$136.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: United Healthcare Commercial	$114.40
Rate for Payer: United Healthcare Medicare	$32.00
Rate for Payer: Veterans Affairs TRICARE	$31.68

20520 RMV FB MSCL/TDN SMPL

Facility

$710.00

Service Code	CPT 20520
Hospital Charge Code	22282820
Hospital Revenue Code	450
Min. Negotiated Rate	$639.00
Max. Negotiated Rate	$639.00
Rate for Payer: Aetna of AZ Commercial	$639.00
Rate for Payer: Cash Price	$568.00

20520 RMV FB MSCL/TDN SMPL

Facility

$710.00

Service Code	CPT 20520
Hospital Charge Code	22282820
Hospital Revenue Code	450
Min. Negotiated Rate	$69.74
Max. Negotiated Rate	$2,555.47
Rate for Payer: Aetna of AZ Commercial	$639.00
Rate for Payer: Arizona Complete Health Allwell	$113.60
Rate for Payer: Banner UC Health Medicare	$113.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$482.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$69.74
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$113.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$113.60
Rate for Payer: Cash Price	$568.00
Rate for Payer: Cash Price	$568.00
Rate for Payer: Cigna of AZ Commercial	$497.00
Rate for Payer: Devoted Health Medicare	$127.80
Rate for Payer: Humana of AZ Medicare	$113.60
Rate for Payer: Mercy Care Medicaid	$69.74
Rate for Payer: NaphCare Correctional Healthcare	$69.74
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$482.80
Rate for Payer: TriWest Medicare	$113.60
Rate for Payer: United Healthcare Commercial	$406.12
Rate for Payer: United Healthcare Medicare	$113.60
Rate for Payer: United Healthcare New Mexico Commercial	$134.90
Rate for Payer: Veterans Affairs TRICARE	$112.46

20550 INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBR

Facility

$266.00

Service Code	CPT 20550
Hospital Charge Code	24063185
Hospital Revenue Code	521
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$474.93
Rate for Payer: Aetna of AZ Commercial	$239.40
Rate for Payer: Arizona Complete Health Allwell	$42.56
Rate for Payer: Banner UC Health Medicare	$42.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$180.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.56
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cigna of AZ Commercial	$186.20
Rate for Payer: Devoted Health Medicare	$47.88
Rate for Payer: Humana of AZ Medicare	$42.56
Rate for Payer: Mercy Care Medicaid	$19.52
Rate for Payer: NaphCare Correctional Healthcare	$19.52
Rate for Payer: Seven Corners Travel Insurance	$474.93
Rate for Payer: Southwest Service Administrators UFCW	$180.88
Rate for Payer: TriWest Medicare	$42.56
Rate for Payer: United Healthcare Commercial	$152.15
Rate for Payer: United Healthcare Medicare	$42.56
Rate for Payer: Veterans Affairs TRICARE	$42.13

20550 INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBR

Facility

$266.00

Service Code	CPT 20550
Hospital Charge Code	24063185
Hospital Revenue Code	521
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$239.40
Rate for Payer: Aetna of AZ Commercial	$239.40
Rate for Payer: Cash Price	$212.80

20550 INJ TENDON ETC

Facility

$226.00

Service Code	CPT 20550
Hospital Charge Code	22282821
Hospital Revenue Code	450
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Cash Price	$180.80

20550 INJ TENDON ETC

Facility

$226.00

Service Code	CPT 20550
Hospital Charge Code	22282821
Hospital Revenue Code	450
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$474.93
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Arizona Complete Health Allwell	$36.16
Rate for Payer: Banner UC Health Medicare	$36.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$153.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.16
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cigna of AZ Commercial	$158.20
Rate for Payer: Devoted Health Medicare	$40.68
Rate for Payer: Humana of AZ Medicare	$36.16
Rate for Payer: Mercy Care Medicaid	$19.52
Rate for Payer: NaphCare Correctional Healthcare	$19.52
Rate for Payer: Seven Corners Travel Insurance	$474.93
Rate for Payer: Southwest Service Administrators UFCW	$153.68
Rate for Payer: TriWest Medicare	$36.16
Rate for Payer: United Healthcare Commercial	$129.27
Rate for Payer: United Healthcare Medicare	$36.16
Rate for Payer: United Healthcare New Mexico Commercial	$42.94
Rate for Payer: Veterans Affairs TRICARE	$35.80

20560 Dry Needle without PT

Facility

$72.00

Service Code	CPT 20560
Hospital Charge Code	24197499
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Cash Price	$57.60

20560 Dry Needle without PT

Facility

$72.00

Service Code	CPT 20560
Hospital Charge Code	24197499
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Arizona Complete Health Allwell	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.52
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Devoted Health Medicare	$12.96
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$48.96
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: United Healthcare Commercial	$41.18
Rate for Payer: United Healthcare Medicare	$11.52
Rate for Payer: Veterans Affairs TRICARE	$11.40

20560 Dry Needle without PT Package of 3 sessions

Facility

$180.00

Service Code	CPT 20560
Hospital Charge Code	24197500
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Cash Price	$144.00

20560 Dry Needle without PT Package of 3 sessions

Facility

$180.00

Service Code	CPT 20560
Hospital Charge Code	24197500
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Arizona Complete Health Allwell	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$122.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Devoted Health Medicare	$32.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$122.40
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: United Healthcare Commercial	$102.96
Rate for Payer: United Healthcare Medicare	$28.80
Rate for Payer: Veterans Affairs TRICARE	$28.51

20560 Dry Needle without PT Package of 6 sessions

Facility

$359.00

Service Code	CPT 20560
Hospital Charge Code	24197501
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$323.10
Rate for Payer: Aetna of AZ Commercial	$323.10
Rate for Payer: Arizona Complete Health Allwell	$57.44
Rate for Payer: Banner UC Health Medicare	$57.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$244.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$57.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$57.44
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cigna of AZ Commercial	$251.30
Rate for Payer: Devoted Health Medicare	$64.62
Rate for Payer: Humana of AZ Medicare	$57.44
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$244.12
Rate for Payer: TriWest Medicare	$57.44
Rate for Payer: United Healthcare Commercial	$205.35
Rate for Payer: United Healthcare Medicare	$57.44
Rate for Payer: Veterans Affairs TRICARE	$56.87

20560 Dry Needle without PT Package of 6 sessions

Facility

$359.00

Service Code	CPT 20560
Hospital Charge Code	24197501
Min. Negotiated Rate	$323.10
Max. Negotiated Rate	$323.10
Rate for Payer: Aetna of AZ Commercial	$323.10
Rate for Payer: Cash Price	$287.20

20560 Dry Needle with PT Package of 6 sessions

Facility

$287.00

Service Code	CPT 20560
Hospital Charge Code	24197498
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna of AZ Commercial	$258.30
Rate for Payer: Arizona Complete Health Allwell	$45.92
Rate for Payer: Banner UC Health Medicare	$45.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$195.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.92
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cigna of AZ Commercial	$200.90
Rate for Payer: Devoted Health Medicare	$51.66
Rate for Payer: Humana of AZ Medicare	$45.92
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$195.16
Rate for Payer: TriWest Medicare	$45.92
Rate for Payer: United Healthcare Commercial	$164.16
Rate for Payer: United Healthcare Medicare	$45.92
Rate for Payer: Veterans Affairs TRICARE	$45.46

20560 Dry Needle with PT Package of 6 sessions

Facility

$287.00

Service Code	CPT 20560
Hospital Charge Code	24197498
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna of AZ Commercial	$258.30
Rate for Payer: Cash Price	$229.60

Know your out-of-pocket cost for care.

All Charges