Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method

Facility

$11,227.32

Service Code	CPT 28299
Hospital Revenue Code	360
Min. Negotiated Rate	$406.20
Max. Negotiated Rate	$11,227.32
Rate for Payer: Banner UC Health Medicare	$3,603.66
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$406.20
Rate for Payer: Mercy Care Medicaid	$406.20
Rate for Payer: NaphCare Correctional Healthcare	$3,603.66
Rate for Payer: Seven Corners Travel Insurance	$11,227.32
Rate for Payer: United Healthcare Commercial	$4,838.00

Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method

Facility

$19,864.90

Service Code	CPT 28297
Hospital Revenue Code	360
Min. Negotiated Rate	$406.20
Max. Negotiated Rate	$19,864.90
Rate for Payer: Banner UC Health Medicare	$8,331.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$406.20
Rate for Payer: Mercy Care Medicaid	$406.20
Rate for Payer: NaphCare Correctional Healthcare	$8,331.08
Rate for Payer: Seven Corners Travel Insurance	$19,864.90
Rate for Payer: United Healthcare Commercial	$4,838.00

Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method

Facility

$5,062.66

Service Code	CPT 28292
Hospital Revenue Code	360
Min. Negotiated Rate	$206.76
Max. Negotiated Rate	$5,062.66
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$206.76
Rate for Payer: Mercy Care Medicaid	$206.76
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: United Healthcare Commercial	$4,838.00

CORRECTION HAMMERTOE (EG INTERPHALANGEAL FUSION PARTIAL OR TOTAL

Facility

$1,851.00

Service Code	CPT 28285
Hospital Charge Code	24043260
Hospital Revenue Code	360
Min. Negotiated Rate	$148.19
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,665.90
Rate for Payer: Arizona Complete Health Allwell	$296.16
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,258.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$148.19
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$296.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$296.16
Rate for Payer: Cash Price	$1,480.80
Rate for Payer: Cash Price	$1,480.80
Rate for Payer: Cash Price	$1,480.80
Rate for Payer: Cigna of AZ Commercial	$925.50
Rate for Payer: Devoted Health Medicare	$333.18
Rate for Payer: Humana of AZ Medicare	$296.16
Rate for Payer: Mercy Care Medicaid	$148.19
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$1,258.68
Rate for Payer: TriWest Medicare	$296.16
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$296.16
Rate for Payer: Veterans Affairs TRICARE	$293.20

CORRECTION HAMMERTOE (EG INTERPHALANGEAL FUSION PARTIAL OR TOTAL

Facility

$1,851.00

Service Code	CPT 28285
Hospital Charge Code	24043260
Hospital Revenue Code	360
Min. Negotiated Rate	$1,665.90
Max. Negotiated Rate	$1,665.90
Rate for Payer: Aetna of AZ Commercial	$1,665.90
Rate for Payer: Cash Price	$1,480.80

CORRECTION HAMMERTOE (EG INTERPHALANGEAL FUSION PARTIAL OR TOTAL - Profee

Facility

$1,383.00

Service Code	CPT 28285
Hospital Charge Code	24043340
Min. Negotiated Rate	$1,244.70
Max. Negotiated Rate	$1,244.70
Rate for Payer: Aetna of AZ Commercial	$1,244.70
Rate for Payer: Cash Price	$1,106.40

CORRECTION HAMMERTOE (EG INTERPHALANGEAL FUSION PARTIAL OR TOTAL - Profee

Facility

$1,383.00

Service Code	CPT 28285
Hospital Charge Code	24043340
Min. Negotiated Rate	$148.19
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,244.70
Rate for Payer: Arizona Complete Health Allwell	$221.28
Rate for Payer: Banner UC Health Medicare	$221.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$940.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$148.19
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$221.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$221.28
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cigna of AZ Commercial	$968.10
Rate for Payer: Devoted Health Medicare	$248.94
Rate for Payer: Humana of AZ Medicare	$221.28
Rate for Payer: Mercy Care Medicaid	$148.19
Rate for Payer: NaphCare Correctional Healthcare	$148.19
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$940.44
Rate for Payer: TriWest Medicare	$221.28
Rate for Payer: United Healthcare Commercial	$791.08
Rate for Payer: United Healthcare Medicare	$221.28
Rate for Payer: Veterans Affairs TRICARE	$219.07

Cortisol LC

Facility

$192.00

Service Code	CPT 82533
Hospital Charge Code	1906812
Hospital Revenue Code	301
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$172.80
Rate for Payer: Aetna of AZ Commercial	$172.80
Rate for Payer: Arizona Complete Health Allwell	$30.72
Rate for Payer: Banner UC Health Medicare	$30.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$130.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$30.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.72
Rate for Payer: Cash Price	$153.60
Rate for Payer: Cash Price	$153.60
Rate for Payer: Cigna of AZ Commercial	$124.80
Rate for Payer: Devoted Health Medicare	$34.56
Rate for Payer: Humana of AZ Medicare	$30.72
Rate for Payer: Seven Corners Travel Insurance	$23.64
Rate for Payer: Southwest Service Administrators UFCW	$130.56
Rate for Payer: TriWest Medicare	$30.72
Rate for Payer: United Healthcare Commercial	$109.82
Rate for Payer: United Healthcare Medicare	$30.72
Rate for Payer: Veterans Affairs TRICARE	$30.41

Cortisol LC

Facility

$192.00

Service Code	CPT 82533
Hospital Charge Code	1906812
Hospital Revenue Code	301
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$172.80
Rate for Payer: Aetna of AZ Commercial	$172.80
Rate for Payer: Cash Price	$153.60

Cortisol, Urinary Free LC

Facility

$257.00

Service Code	CPT 82533
Hospital Charge Code	1906820
Hospital Revenue Code	306
Min. Negotiated Rate	$231.30
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Cash Price	$205.60

Cortisol, Urinary Free LC

Facility

$257.00

Service Code	CPT 82533
Hospital Charge Code	1906820
Hospital Revenue Code	306
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Arizona Complete Health Allwell	$41.12
Rate for Payer: Banner UC Health Medicare	$41.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$174.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.12
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Devoted Health Medicare	$46.26
Rate for Payer: Humana of AZ Medicare	$41.12
Rate for Payer: Seven Corners Travel Insurance	$23.64
Rate for Payer: Southwest Service Administrators UFCW	$174.76
Rate for Payer: TriWest Medicare	$41.12
Rate for Payer: United Healthcare Commercial	$147.00
Rate for Payer: United Healthcare Medicare	$41.12
Rate for Payer: Veterans Affairs TRICARE	$40.71

cortrosyn injection[CQCH]

Facility

$18.52

Service Code	NDC 3.05486E+11
Hospital Charge Code	124449918
Hospital Revenue Code	250
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$16.67
Rate for Payer: Aetna of AZ Commercial	$16.67
Rate for Payer: Cash Price	$14.82

cortrosyn injection[CQCH]

Facility

$18.52

Service Code	NDC 3.05486E+11
Hospital Charge Code	124449918
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$16.67
Rate for Payer: Aetna of AZ Commercial	$16.67
Rate for Payer: Arizona Complete Health Allwell	$2.96
Rate for Payer: Banner UC Health Medicare	$2.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.59
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.96
Rate for Payer: Cash Price	$14.82
Rate for Payer: Cigna of AZ Commercial	$12.04
Rate for Payer: Devoted Health Medicare	$3.33
Rate for Payer: Humana of AZ Medicare	$2.96
Rate for Payer: Southwest Service Administrators UFCW	$12.59
Rate for Payer: TriWest Medicare	$2.96
Rate for Payer: United Healthcare Commercial	$10.59
Rate for Payer: United Healthcare Medicare	$2.96
Rate for Payer: Veterans Affairs TRICARE	$2.93

COUNTERSINK 2MM

Facility

$1,775.00

Hospital Charge Code	29522629
Hospital Revenue Code	270
Min. Negotiated Rate	$1,597.50
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Cash Price	$1,420.00

COUNTERSINK 2MM

Facility

$1,775.00

Hospital Charge Code	29522629
Hospital Revenue Code	270
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Arizona Complete Health Allwell	$284.00
Rate for Payer: Banner UC Health Medicare	$284.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,207.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$284.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$284.00
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Cigna of AZ Commercial	$1,242.50
Rate for Payer: Devoted Health Medicare	$319.50
Rate for Payer: Humana of AZ Medicare	$284.00
Rate for Payer: Southwest Service Administrators UFCW	$1,207.00
Rate for Payer: TriWest Medicare	$284.00
Rate for Payer: United Healthcare Commercial	$1,015.30
Rate for Payer: United Healthcare Medicare	$284.00
Rate for Payer: Veterans Affairs TRICARE	$281.16

COVER LIGHT HANDLE

Facility

$47.00

Hospital Charge Code	22355305
Hospital Revenue Code	270
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

COVER LIGHT HANDLE

Facility

$47.00

Hospital Charge Code	22355305
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

Covidien Multifire Versa Tack Stapler reload

Facility

$203.00

Hospital Charge Code	22926412
Hospital Revenue Code	272
Min. Negotiated Rate	$32.16
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Arizona Complete Health Allwell	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.48
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Devoted Health Medicare	$36.54
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Southwest Service Administrators UFCW	$138.04
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: United Healthcare Commercial	$116.12
Rate for Payer: United Healthcare Medicare	$32.48
Rate for Payer: Veterans Affairs TRICARE	$32.16

Covidien Multifire Versa Tack Stapler reload

Facility

$203.00

Hospital Charge Code	22926412
Hospital Revenue Code	272
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Cash Price	$162.40

C-Peptide, Serum LC

Facility

$579.00

Service Code	CPT 84681
Hospital Charge Code	1285617
Hospital Revenue Code	301
Min. Negotiated Rate	$521.10
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Cash Price	$463.20

C-Peptide, Serum LC

Facility

$579.00

Service Code	CPT 84681
Hospital Charge Code	1285617
Hospital Revenue Code	301
Min. Negotiated Rate	$30.17
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Arizona Complete Health Allwell	$92.64
Rate for Payer: Banner UC Health Medicare	$92.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$393.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$92.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$92.64
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cigna of AZ Commercial	$376.35
Rate for Payer: Devoted Health Medicare	$104.22
Rate for Payer: Humana of AZ Medicare	$92.64
Rate for Payer: Seven Corners Travel Insurance	$30.17
Rate for Payer: Southwest Service Administrators UFCW	$393.72
Rate for Payer: TriWest Medicare	$92.64
Rate for Payer: United Healthcare Commercial	$331.19
Rate for Payer: United Healthcare Medicare	$92.64
Rate for Payer: Veterans Affairs TRICARE	$91.71

CPT ACAPELLA INITIAL

Facility

$310.00

Service Code	CPT 93016
Hospital Charge Code	1886933
Hospital Revenue Code	482
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Arizona Complete Health Allwell	$49.60
Rate for Payer: Banner UC Health Medicare	$49.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$210.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.60
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cigna of AZ Commercial	$217.00
Rate for Payer: Devoted Health Medicare	$55.80
Rate for Payer: Humana of AZ Medicare	$49.60
Rate for Payer: Southwest Service Administrators UFCW	$210.80
Rate for Payer: TriWest Medicare	$49.60
Rate for Payer: United Healthcare Commercial	$177.32
Rate for Payer: United Healthcare Medicare	$49.60
Rate for Payer: United Healthcare New Mexico Commercial	$58.90
Rate for Payer: Veterans Affairs TRICARE	$49.10

CPT ACAPELLA INITIAL

Facility

$310.00

Service Code	CPT 93016
Hospital Charge Code	1886933
Hospital Revenue Code	482
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Cash Price	$248.00

CQCH CT Angiography Neck w/ Contrast

Facility

$4,323.00

Service Code	CPT 70498
Hospital Charge Code	22543582
Hospital Revenue Code	351
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$3,890.70
Rate for Payer: Aetna of AZ Commercial	$3,890.70
Rate for Payer: Arizona Complete Health Allwell	$691.68
Rate for Payer: Banner UC Health Medicare	$691.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,939.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$691.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$691.68
Rate for Payer: Cash Price	$3,458.40
Rate for Payer: Cash Price	$3,458.40
Rate for Payer: Cigna of AZ Commercial	$2,809.95
Rate for Payer: Devoted Health Medicare	$778.14
Rate for Payer: Humana of AZ Medicare	$691.68
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$2,939.64
Rate for Payer: TriWest Medicare	$691.68
Rate for Payer: United Healthcare Commercial	$2,472.76
Rate for Payer: United Healthcare Medicare	$691.68
Rate for Payer: Veterans Affairs TRICARE	$684.76

CQCH CT Angiography Neck w/ Contrast

Facility

$4,323.00

Service Code	CPT 70498
Hospital Charge Code	22543582
Hospital Revenue Code	351
Min. Negotiated Rate	$3,890.70
Max. Negotiated Rate	$3,890.70
Rate for Payer: Aetna of AZ Commercial	$3,890.70
Rate for Payer: Cash Price	$3,458.40

Know your out-of-pocket cost for care.

All Charges