Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN

Facility

$2,149.00

Service Code	CPT 52356
Hospital Charge Code	27999760
Hospital Revenue Code	750
Min. Negotiated Rate	$340.40
Max. Negotiated Rate	$8,296.15
Rate for Payer: Aetna of AZ Commercial	$1,934.10
Rate for Payer: Arizona Complete Health Allwell	$343.84
Rate for Payer: Banner UC Health Medicare	$1,977.90
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,461.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$343.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$343.84
Rate for Payer: Cash Price	$1,719.20
Rate for Payer: Cash Price	$1,719.20
Rate for Payer: Cash Price	$1,719.20
Rate for Payer: Cigna of AZ Commercial	$1,504.30
Rate for Payer: Devoted Health Medicare	$386.82
Rate for Payer: Humana of AZ Medicare	$343.84
Rate for Payer: NaphCare Correctional Healthcare	$1,977.90
Rate for Payer: Seven Corners Travel Insurance	$8,296.15
Rate for Payer: Southwest Service Administrators UFCW	$1,461.32
Rate for Payer: TriWest Medicare	$343.84
Rate for Payer: United Healthcare Commercial	$5,611.00
Rate for Payer: United Healthcare Medicare	$343.84
Rate for Payer: United Healthcare New Mexico Commercial	$408.31
Rate for Payer: Veterans Affairs TRICARE	$340.40

CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN

Facility

$2,149.00

Service Code	CPT 52356
Hospital Charge Code	27999760
Hospital Revenue Code	750
Min. Negotiated Rate	$1,934.10
Max. Negotiated Rate	$1,934.10
Rate for Payer: Aetna of AZ Commercial	$1,934.10
Rate for Payer: Cash Price	$1,719.20

CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN

Facility

$860.00

Service Code	CPT 52356
Hospital Charge Code	28003378
Hospital Revenue Code	982
Min. Negotiated Rate	$774.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna of AZ Commercial	$774.00
Rate for Payer: Cash Price	$688.00

CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN

Facility

$860.00

Service Code	CPT 52356
Hospital Charge Code	28003378
Hospital Revenue Code	982
Min. Negotiated Rate	$136.22
Max. Negotiated Rate	$8,296.15
Rate for Payer: Aetna of AZ Commercial	$774.00
Rate for Payer: Arizona Complete Health Allwell	$137.60
Rate for Payer: Banner UC Health Medicare	$137.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$584.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$137.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$137.60
Rate for Payer: Cash Price	$688.00
Rate for Payer: Cash Price	$688.00
Rate for Payer: Cigna of AZ Commercial	$602.00
Rate for Payer: Devoted Health Medicare	$154.80
Rate for Payer: Humana of AZ Medicare	$137.60
Rate for Payer: Seven Corners Travel Insurance	$8,296.15
Rate for Payer: Southwest Service Administrators UFCW	$584.80
Rate for Payer: TriWest Medicare	$137.60
Rate for Payer: United Healthcare Commercial	$491.92
Rate for Payer: United Healthcare Medicare	$137.60
Rate for Payer: United Healthcare New Mexico Commercial	$163.40
Rate for Payer: Veterans Affairs TRICARE	$136.22

CRUTCH ADULT

Facility

$60.00

Service Code	HCPCS E0113
Hospital Charge Code	22354909
Hospital Revenue Code	270
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

CRUTCH ADULT

Facility

$60.00

Service Code	HCPCS E0113
Hospital Charge Code	22354909
Hospital Revenue Code	270
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: Veterans Affairs TRICARE	$9.50

CRUTCH ADULT TALL

Facility

$60.00

Service Code	HCPCS E0113
Hospital Charge Code	22354907
Hospital Revenue Code	270
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: Veterans Affairs TRICARE	$9.50

CRUTCH ADULT TALL

Facility

$60.00

Service Code	HCPCS E0113
Hospital Charge Code	22354907
Hospital Revenue Code	270
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

CRUTCH YOUTH

Facility

$57.00

Service Code	HCPCS E0113
Hospital Charge Code	22354910
Hospital Revenue Code	270
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Arizona Complete Health Allwell	$9.12
Rate for Payer: Banner UC Health Medicare	$9.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$38.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.12
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Devoted Health Medicare	$10.26
Rate for Payer: Humana of AZ Medicare	$9.12
Rate for Payer: Southwest Service Administrators UFCW	$38.76
Rate for Payer: TriWest Medicare	$9.12
Rate for Payer: United Healthcare Commercial	$32.60
Rate for Payer: United Healthcare Medicare	$9.12
Rate for Payer: Veterans Affairs TRICARE	$9.03

CRUTCH YOUTH

Facility

$57.00

Service Code	HCPCS E0113
Hospital Charge Code	22354910
Hospital Revenue Code	270
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Cash Price	$45.60

Cryo AHF

Facility

$504.00

Service Code	HCPCS P9044
Hospital Charge Code	1011948
Hospital Revenue Code	390
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Cash Price	$403.20

Cryo AHF

Facility

$504.00

Service Code	HCPCS P9044
Hospital Charge Code	1011948
Hospital Revenue Code	390
Min. Negotiated Rate	$79.83
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Arizona Complete Health Allwell	$80.64
Rate for Payer: Banner UC Health Medicare	$80.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$342.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$80.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$80.64
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna of AZ Commercial	$327.60
Rate for Payer: Devoted Health Medicare	$90.72
Rate for Payer: Humana of AZ Medicare	$80.64
Rate for Payer: Seven Corners Travel Insurance	$199.98
Rate for Payer: Southwest Service Administrators UFCW	$342.72
Rate for Payer: TriWest Medicare	$80.64
Rate for Payer: United Healthcare Commercial	$288.29
Rate for Payer: United Healthcare Medicare	$80.64
Rate for Payer: Veterans Affairs TRICARE	$79.83

Cryoglobulin, Qualitative, Serum w/Quant Reflex LC

Facility

$78.00

Service Code	CPT 82595
Hospital Charge Code	12581373
Hospital Revenue Code	301
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Cash Price	$62.40

Cryoglobulin, Qualitative, Serum w/Quant Reflex LC

Facility

$78.00

Service Code	CPT 82595
Hospital Charge Code	12581373
Hospital Revenue Code	301
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Arizona Complete Health Allwell	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.48
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Seven Corners Travel Insurance	$9.38
Rate for Payer: Southwest Service Administrators UFCW	$53.04
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: United Healthcare Commercial	$44.62
Rate for Payer: United Healthcare Medicare	$12.48
Rate for Payer: Veterans Affairs TRICARE	$12.36

Cryo Pooled

Facility

$480.00

Service Code	HCPCS P9044
Hospital Charge Code	1221762
Hospital Revenue Code	390
Min. Negotiated Rate	$76.03
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of AZ Commercial	$432.00
Rate for Payer: Arizona Complete Health Allwell	$76.80
Rate for Payer: Banner UC Health Medicare	$76.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$326.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cigna of AZ Commercial	$312.00
Rate for Payer: Devoted Health Medicare	$86.40
Rate for Payer: Humana of AZ Medicare	$76.80
Rate for Payer: Seven Corners Travel Insurance	$199.98
Rate for Payer: Southwest Service Administrators UFCW	$326.40
Rate for Payer: TriWest Medicare	$76.80
Rate for Payer: United Healthcare Commercial	$274.56
Rate for Payer: United Healthcare Medicare	$76.80
Rate for Payer: Veterans Affairs TRICARE	$76.03

Cryo Pooled

Facility

$480.00

Service Code	HCPCS P9044
Hospital Charge Code	1221762
Hospital Revenue Code	390
Min. Negotiated Rate	$432.00
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of AZ Commercial	$432.00
Rate for Payer: Cash Price	$384.00

Crystal, Synovial/Fluid LC

Facility

$673.00

Service Code	CPT 89060
Hospital Charge Code	3976233
Hospital Revenue Code	301
Min. Negotiated Rate	$605.70
Max. Negotiated Rate	$605.70
Rate for Payer: Aetna of AZ Commercial	$605.70
Rate for Payer: Cash Price	$538.40

Crystal, Synovial/Fluid LC

Facility

$673.00

Service Code	CPT 89060
Hospital Charge Code	3976233
Hospital Revenue Code	301
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$605.70
Rate for Payer: Aetna of AZ Commercial	$605.70
Rate for Payer: Arizona Complete Health Allwell	$107.68
Rate for Payer: Banner UC Health Medicare	$107.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$457.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$107.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$107.68
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cigna of AZ Commercial	$437.45
Rate for Payer: Devoted Health Medicare	$121.14
Rate for Payer: Humana of AZ Medicare	$107.68
Rate for Payer: Seven Corners Travel Insurance	$10.63
Rate for Payer: Southwest Service Administrators UFCW	$457.64
Rate for Payer: TriWest Medicare	$107.68
Rate for Payer: United Healthcare Commercial	$384.96
Rate for Payer: United Healthcare Medicare	$107.68
Rate for Payer: Veterans Affairs TRICARE	$106.60

CSF Cell Count Standard

Facility

$154.00

Service Code	CPT 89051
Hospital Charge Code	22308749
Hospital Revenue Code	309
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$138.60
Rate for Payer: Aetna of AZ Commercial	$138.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Arizona Complete Health Allwell	$24.64
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$24.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$104.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.64
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$27.72
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Humana of AZ Medicare	$24.64
Rate for Payer: Seven Corners Travel Insurance	$8.12
Rate for Payer: Seven Corners Travel Insurance	$8.12
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: Southwest Service Administrators UFCW	$104.72
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: TriWest Medicare	$24.64
Rate for Payer: United Healthcare Commercial	$88.09
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: United Healthcare Medicare	$24.64
Rate for Payer: Veterans Affairs TRICARE	$24.39
Rate for Payer: Veterans Affairs TRICARE	$18.06

CSF Cell Count Standard

Facility

$114.00

Service Code	CPT 89051
Hospital Charge Code	22308749
Hospital Revenue Code	309
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Commercial	$138.60
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$123.20

CSF Culture

Facility

$116.00

Service Code	CPT 87070
Hospital Charge Code	858004
Hospital Revenue Code	306
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Cash Price	$92.80

CSF Culture

Facility

$116.00

Service Code	CPT 87070
Hospital Charge Code	858004
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Arizona Complete Health Allwell	$18.56
Rate for Payer: Banner UC Health Medicare	$18.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$78.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.56
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$75.40
Rate for Payer: Devoted Health Medicare	$20.88
Rate for Payer: Humana of AZ Medicare	$18.56
Rate for Payer: Seven Corners Travel Insurance	$12.50
Rate for Payer: Southwest Service Administrators UFCW	$78.88
Rate for Payer: TriWest Medicare	$18.56
Rate for Payer: United Healthcare Commercial	$66.35
Rate for Payer: United Healthcare Medicare	$18.56
Rate for Payer: Veterans Affairs TRICARE	$18.37

CT 3D Reconstruction

Facility

$1,166.00

Service Code	CPT 76377
Hospital Charge Code	1005104
Hospital Revenue Code	350
Min. Negotiated Rate	$184.69
Max. Negotiated Rate	$1,049.40
Rate for Payer: Aetna of AZ Commercial	$1,049.40
Rate for Payer: Arizona Complete Health Allwell	$186.56
Rate for Payer: Banner UC Health Medicare	$186.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$792.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$186.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$186.56
Rate for Payer: Cash Price	$932.80
Rate for Payer: Cigna of AZ Commercial	$757.90
Rate for Payer: Devoted Health Medicare	$209.88
Rate for Payer: Humana of AZ Medicare	$186.56
Rate for Payer: Southwest Service Administrators UFCW	$792.88
Rate for Payer: TriWest Medicare	$186.56
Rate for Payer: United Healthcare Commercial	$666.95
Rate for Payer: United Healthcare Medicare	$186.56
Rate for Payer: Veterans Affairs TRICARE	$184.69

CT 3D Reconstruction

Facility

$1,166.00

Service Code	CPT 76377
Hospital Charge Code	1005104
Hospital Revenue Code	350
Min. Negotiated Rate	$1,049.40
Max. Negotiated Rate	$1,049.40
Rate for Payer: Aetna of AZ Commercial	$1,049.40
Rate for Payer: Cash Price	$932.80

Know your out-of-pocket cost for care.

All Charges