Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Creatinine

Facility

$76.00

Service Code	CPT 82565
Hospital Charge Code	633606
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

Creatinine

Facility

$76.00

Service Code	CPT 82565
Hospital Charge Code	633606
Hospital Revenue Code	301
Min. Negotiated Rate	$7.42
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	$7.42
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

Creatinine Clearance Standard

Facility

$159.00

Service Code	CPT 82575
Hospital Charge Code	22141049
Hospital Revenue Code	301
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Cash Price	$127.20

Creatinine Clearance Standard

Facility

$159.00

Service Code	CPT 82575
Hospital Charge Code	22141049
Hospital Revenue Code	301
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Arizona Complete Health Allwell	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$108.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.44
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$103.35
Rate for Payer: Devoted Health Medicare	$28.62
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Seven Corners Travel Insurance	$13.72
Rate for Payer: Southwest Service Administrators UFCW	$108.12
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: United Healthcare Commercial	$90.95
Rate for Payer: United Healthcare Medicare	$25.44
Rate for Payer: Veterans Affairs TRICARE	$25.19

Creatinine Kinase

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	22525239
Hospital Revenue Code	301
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Arizona Complete Health Allwell	$51.36
Rate for Payer: Banner UC Health Medicare	$51.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$218.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$51.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$51.36
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$208.65
Rate for Payer: Devoted Health Medicare	$57.78
Rate for Payer: Humana of AZ Medicare	$51.36
Rate for Payer: Seven Corners Travel Insurance	$16.75
Rate for Payer: Southwest Service Administrators UFCW	$218.28
Rate for Payer: TriWest Medicare	$51.36
Rate for Payer: United Healthcare Commercial	$183.61
Rate for Payer: United Healthcare Medicare	$51.36
Rate for Payer: Veterans Affairs TRICARE	$50.85

Creatinine Kinase

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	22525239
Hospital Revenue Code	301
Min. Negotiated Rate	$288.90
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Cash Price	$256.80

Creatinine Level Urine

Facility

$76.00

Service Code	CPT 82570
Hospital Charge Code	633607
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
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	$7.51
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

Creatinine Level Urine

Facility

$76.00

Service Code	CPT 82570
Hospital Charge Code	633607
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

CREATININE S

Facility

$80.00

Service Code	CPT 82565
Hospital Charge Code	22481470
Hospital Revenue Code	301
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Arizona Complete Health Allwell	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$54.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Devoted Health Medicare	$14.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Seven Corners Travel Insurance	$7.42
Rate for Payer: Southwest Service Administrators UFCW	$54.40
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: United Healthcare Commercial	$45.76
Rate for Payer: United Healthcare Medicare	$12.80
Rate for Payer: Veterans Affairs TRICARE	$12.67

CREATININE S

Facility

$80.00

Service Code	CPT 82565
Hospital Charge Code	22481470
Hospital Revenue Code	301
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Cash Price	$64.00

CREATININE URINE 24

Facility

$94.00

Service Code	CPT 82570
Hospital Charge Code	22481471
Hospital Revenue Code	301
Min. Negotiated Rate	$84.60
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of AZ Commercial	$84.60
Rate for Payer: Cash Price	$75.20

CREATININE URINE 24

Facility

$94.00

Service Code	CPT 82570
Hospital Charge Code	22481471
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of AZ Commercial	$84.60
Rate for Payer: Arizona Complete Health Allwell	$15.04
Rate for Payer: Banner UC Health Medicare	$15.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$63.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.04
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cigna of AZ Commercial	$61.10
Rate for Payer: Devoted Health Medicare	$16.92
Rate for Payer: Humana of AZ Medicare	$15.04
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$63.92
Rate for Payer: TriWest Medicare	$15.04
Rate for Payer: United Healthcare Commercial	$53.77
Rate for Payer: United Healthcare Medicare	$15.04
Rate for Payer: Veterans Affairs TRICARE	$14.89

Creatinine, Urine LC

Facility

$84.00

Service Code	CPT 82570
Hospital Charge Code	1285619
Hospital Revenue Code	301
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Cash Price	$67.20

Creatinine, Urine LC

Facility

$84.00

Service Code	CPT 82570
Hospital Charge Code	1285619
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Arizona Complete Health Allwell	$13.44
Rate for Payer: Banner UC Health Medicare	$13.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.44
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Humana of AZ Medicare	$13.44
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$57.12
Rate for Payer: TriWest Medicare	$13.44
Rate for Payer: United Healthcare Commercial	$48.05
Rate for Payer: United Healthcare Medicare	$13.44
Rate for Payer: Veterans Affairs TRICARE	$13.31

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	4662835
Hospital Revenue Code	302
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$263.61
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$263.61
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	1681878
Hospital Revenue Code	302
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$263.61
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$263.61
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	1681878
Hospital Revenue Code	302
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

Crossmatch AHG Tube

Facility

$177.00

Service Code	CPT 86922
Hospital Charge Code	4662835
Hospital Revenue Code	302
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

Crossmatch Immediate Spin

Facility

$177.00

Service Code	CPT 86920
Hospital Charge Code	22107850
Hospital Revenue Code	302
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

Crossmatch Immediate Spin

Facility

$177.00

Service Code	CPT 86920
Hospital Charge Code	22107850
Hospital Revenue Code	302
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$263.61
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$263.61
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, LESS T

Facility

$1,790.00

Service Code	CPT 52317
Hospital Charge Code	27881569
Hospital Revenue Code	360
Min. Negotiated Rate	$283.54
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,611.00
Rate for Payer: Arizona Complete Health Allwell	$286.40
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,217.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$513.59
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$286.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$286.40
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cigna of AZ Commercial	$895.00
Rate for Payer: Devoted Health Medicare	$322.20
Rate for Payer: Humana of AZ Medicare	$286.40
Rate for Payer: Mercy Care Medicaid	$513.59
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$1,217.20
Rate for Payer: TriWest Medicare	$286.40
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$286.40
Rate for Payer: Veterans Affairs TRICARE	$283.54

CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, LESS T

Facility

$1,790.00

Service Code	CPT 52317
Hospital Charge Code	27881569
Hospital Revenue Code	360
Min. Negotiated Rate	$1,611.00
Max. Negotiated Rate	$1,611.00
Rate for Payer: Aetna of AZ Commercial	$1,611.00
Rate for Payer: Cash Price	$1,432.00

CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, MORE T

Facility

$2,399.00

Service Code	CPT 52318
Hospital Charge Code	28172284
Hospital Revenue Code	360
Min. Negotiated Rate	$2,159.10
Max. Negotiated Rate	$2,159.10
Rate for Payer: Aetna of AZ Commercial	$2,159.10
Rate for Payer: Cash Price	$1,919.20

CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, MORE T

Facility

$2,399.00

Service Code	CPT 52318
Hospital Charge Code	28172284
Hospital Revenue Code	360
Min. Negotiated Rate	$380.00
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$2,159.10
Rate for Payer: Arizona Complete Health Allwell	$383.84
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,631.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$383.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$383.84
Rate for Payer: Cash Price	$1,919.20
Rate for Payer: Cash Price	$1,919.20
Rate for Payer: Cash Price	$1,919.20
Rate for Payer: Cigna of AZ Commercial	$1,199.50
Rate for Payer: Devoted Health Medicare	$431.82
Rate for Payer: Humana of AZ Medicare	$383.84
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$1,631.32
Rate for Payer: TriWest Medicare	$383.84
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$383.84
Rate for Payer: Veterans Affairs TRICARE	$380.00

CRUSHING OF STONE OF URETER USING AN ENDOSCOPE Tech

Facility

$2,026.00

Service Code	CPT 52353
Hospital Charge Code	27880780
Hospital Revenue Code	360
Min. Negotiated Rate	$1,823.40
Max. Negotiated Rate	$1,823.40
Rate for Payer: Aetna of AZ Commercial	$1,823.40
Rate for Payer: Cash Price	$1,620.80

Know your out-of-pocket cost for care.

All Charges