Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CT Angiography Head w/ Contrast

Facility

$4,133.00

Service Code	CPT 70496
Hospital Charge Code	1477517
Hospital Revenue Code	351
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$3,719.70
Rate for Payer: Aetna of AZ Commercial	$3,719.70
Rate for Payer: Arizona Complete Health Allwell	$661.28
Rate for Payer: Banner UC Health Medicare	$661.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,810.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$661.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$661.28
Rate for Payer: Cash Price	$3,306.40
Rate for Payer: Cash Price	$3,306.40
Rate for Payer: Cigna of AZ Commercial	$2,686.45
Rate for Payer: Devoted Health Medicare	$743.94
Rate for Payer: Humana of AZ Medicare	$661.28
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$2,810.44
Rate for Payer: TriWest Medicare	$661.28
Rate for Payer: United Healthcare Commercial	$2,364.08
Rate for Payer: United Healthcare Medicare	$661.28
Rate for Payer: Veterans Affairs TRICARE	$654.67

CT Angiography Neck w/ Contrast

Facility

$4,126.00

Service Code	CPT 70498
Hospital Charge Code	1021517
Hospital Revenue Code	351
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$3,713.40
Rate for Payer: Aetna of AZ Commercial	$3,713.40
Rate for Payer: Arizona Complete Health Allwell	$660.16
Rate for Payer: Banner UC Health Medicare	$660.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,805.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$660.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$660.16
Rate for Payer: Cash Price	$3,300.80
Rate for Payer: Cash Price	$3,300.80
Rate for Payer: Cigna of AZ Commercial	$2,681.90
Rate for Payer: Devoted Health Medicare	$742.68
Rate for Payer: Humana of AZ Medicare	$660.16
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$2,805.68
Rate for Payer: TriWest Medicare	$660.16
Rate for Payer: United Healthcare Commercial	$2,360.07
Rate for Payer: United Healthcare Medicare	$660.16
Rate for Payer: Veterans Affairs TRICARE	$653.56

CT Angiography Neck w/ Contrast

Facility

$4,126.00

Service Code	CPT 70498
Hospital Charge Code	1021517
Hospital Revenue Code	351
Min. Negotiated Rate	$3,713.40
Max. Negotiated Rate	$3,713.40
Rate for Payer: Aetna of AZ Commercial	$3,713.40
Rate for Payer: Cash Price	$3,300.80

CT Chest W/Contrast

Facility

$2,385.00

Service Code	CPT 71260
Hospital Charge Code	1005140
Hospital Revenue Code	352
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Arizona Complete Health Allwell	$381.60
Rate for Payer: Banner UC Health Medicare	$381.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,621.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$381.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$381.60
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Cigna of AZ Commercial	$1,550.25
Rate for Payer: Devoted Health Medicare	$429.30
Rate for Payer: Humana of AZ Medicare	$381.60
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$1,621.80
Rate for Payer: TriWest Medicare	$381.60
Rate for Payer: United Healthcare Commercial	$1,364.22
Rate for Payer: United Healthcare Medicare	$381.60
Rate for Payer: Veterans Affairs TRICARE	$377.78

CT Chest W/Contrast

Facility

$2,385.00

Service Code	CPT 71260
Hospital Charge Code	1005140
Hospital Revenue Code	352
Min. Negotiated Rate	$2,146.50
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Cash Price	$1,908.00

CT Chest W/O Contrast

Facility

$1,950.00

Service Code	CPT 71250
Hospital Charge Code	1005143
Hospital Revenue Code	352
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna of AZ Commercial	$1,755.00
Rate for Payer: Arizona Complete Health Allwell	$312.00
Rate for Payer: Banner UC Health Medicare	$312.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,326.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$312.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$312.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Cigna of AZ Commercial	$1,267.50
Rate for Payer: Devoted Health Medicare	$351.00
Rate for Payer: Humana of AZ Medicare	$312.00
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$1,326.00
Rate for Payer: TriWest Medicare	$312.00
Rate for Payer: United Healthcare Commercial	$1,115.40
Rate for Payer: United Healthcare Medicare	$312.00
Rate for Payer: Veterans Affairs TRICARE	$308.88

CT Chest W/O Contrast

Facility

$1,950.00

Service Code	CPT 71250
Hospital Charge Code	1005143
Hospital Revenue Code	352
Min. Negotiated Rate	$1,755.00
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna of AZ Commercial	$1,755.00
Rate for Payer: Cash Price	$1,560.00

CT Chest W/WO Contrast

Facility

$2,920.00

Service Code	CPT 71270
Hospital Charge Code	1005146
Hospital Revenue Code	352
Min. Negotiated Rate	$2,628.00
Max. Negotiated Rate	$2,628.00
Rate for Payer: Aetna of AZ Commercial	$2,628.00
Rate for Payer: Cash Price	$2,336.00

CT Chest W/WO Contrast

Facility

$2,920.00

Service Code	CPT 71270
Hospital Charge Code	1005146
Hospital Revenue Code	352
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$2,628.00
Rate for Payer: Aetna of AZ Commercial	$2,628.00
Rate for Payer: Arizona Complete Health Allwell	$467.20
Rate for Payer: Banner UC Health Medicare	$467.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,985.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$467.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$467.20
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Cigna of AZ Commercial	$1,898.00
Rate for Payer: Devoted Health Medicare	$525.60
Rate for Payer: Humana of AZ Medicare	$467.20
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$1,985.60
Rate for Payer: TriWest Medicare	$467.20
Rate for Payer: United Healthcare Commercial	$1,670.24
Rate for Payer: United Healthcare Medicare	$467.20
Rate for Payer: Veterans Affairs TRICARE	$462.53

CT Head or Brain w/ Contrast

Facility

$383.00

Service Code	CPT 70460
Hospital Charge Code	22862164
Hospital Revenue Code	972
Min. Negotiated Rate	$344.70
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Cash Price	$306.40

CT Head or Brain w/ Contrast

Facility

$383.00

Service Code	CPT 70460
Hospital Charge Code	22862164
Hospital Revenue Code	972
Min. Negotiated Rate	$60.67
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Arizona Complete Health Allwell	$61.28
Rate for Payer: Banner UC Health Medicare	$61.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$260.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$61.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$61.28
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cigna of AZ Commercial	$268.10
Rate for Payer: Devoted Health Medicare	$68.94
Rate for Payer: Humana of AZ Medicare	$61.28
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$260.44
Rate for Payer: TriWest Medicare	$61.28
Rate for Payer: United Healthcare Commercial	$219.08
Rate for Payer: United Healthcare Medicare	$61.28
Rate for Payer: United Healthcare New Mexico Commercial	$72.77
Rate for Payer: Veterans Affairs TRICARE	$60.67

CT Head or Brain w/ Contrast

Facility

$2,097.00

Service Code	CPT 70460
Hospital Charge Code	821334
Hospital Revenue Code	351
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$1,887.30
Rate for Payer: Aetna of AZ Commercial	$1,887.30
Rate for Payer: Arizona Complete Health Allwell	$335.52
Rate for Payer: Banner UC Health Medicare	$335.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,425.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$335.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$335.52
Rate for Payer: Cash Price	$1,677.60
Rate for Payer: Cash Price	$1,677.60
Rate for Payer: Cigna of AZ Commercial	$1,363.05
Rate for Payer: Devoted Health Medicare	$377.46
Rate for Payer: Humana of AZ Medicare	$335.52
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$1,425.96
Rate for Payer: TriWest Medicare	$335.52
Rate for Payer: United Healthcare Commercial	$1,199.48
Rate for Payer: United Healthcare Medicare	$335.52
Rate for Payer: Veterans Affairs TRICARE	$332.16

CT Head or Brain w/ Contrast

Facility

$2,097.00

Service Code	CPT 70460
Hospital Charge Code	821334
Hospital Revenue Code	351
Min. Negotiated Rate	$1,887.30
Max. Negotiated Rate	$1,887.30
Rate for Payer: Aetna of AZ Commercial	$1,887.30
Rate for Payer: Cash Price	$1,677.60

CT Head or Brain w/o Contrast

Facility

$1,788.15

Service Code	CPT 70450
Hospital Charge Code	821336
Hospital Revenue Code	351
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,609.34
Rate for Payer: Aetna of AZ Commercial	$1,609.34
Rate for Payer: Arizona Complete Health Allwell	$286.10
Rate for Payer: Banner UC Health Medicare	$286.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,215.94
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$286.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$286.10
Rate for Payer: Cash Price	$1,430.52
Rate for Payer: Cash Price	$1,430.52
Rate for Payer: Cigna of AZ Commercial	$1,162.30
Rate for Payer: Devoted Health Medicare	$321.87
Rate for Payer: Humana of AZ Medicare	$286.10
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$1,215.94
Rate for Payer: TriWest Medicare	$286.10
Rate for Payer: United Healthcare Commercial	$1,022.82
Rate for Payer: United Healthcare Medicare	$286.10
Rate for Payer: Veterans Affairs TRICARE	$283.24

CT Head or Brain w/o Contrast

Facility

$1,788.15

Service Code	CPT 70450
Hospital Charge Code	821336
Hospital Revenue Code	351
Min. Negotiated Rate	$1,609.34
Max. Negotiated Rate	$1,609.34
Rate for Payer: Aetna of AZ Commercial	$1,609.34
Rate for Payer: Cash Price	$1,430.52

CT Head or Brain w/ + w/o Contrast

Facility

$2,574.00

Service Code	CPT 70470
Hospital Charge Code	821332
Hospital Revenue Code	351
Min. Negotiated Rate	$271.40
Max. Negotiated Rate	$2,316.60
Rate for Payer: Aetna of AZ Commercial	$2,316.60
Rate for Payer: Arizona Complete Health Allwell	$411.84
Rate for Payer: Banner UC Health Medicare	$411.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,750.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$411.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$411.84
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Cigna of AZ Commercial	$1,673.10
Rate for Payer: Devoted Health Medicare	$463.32
Rate for Payer: Humana of AZ Medicare	$411.84
Rate for Payer: Seven Corners Travel Insurance	$271.40
Rate for Payer: Southwest Service Administrators UFCW	$1,750.32
Rate for Payer: TriWest Medicare	$411.84
Rate for Payer: United Healthcare Commercial	$1,472.33
Rate for Payer: United Healthcare Medicare	$411.84
Rate for Payer: Veterans Affairs TRICARE	$407.72

CT Head or Brain w/ + w/o Contrast

Facility

$2,574.00

Service Code	CPT 70470
Hospital Charge Code	821332
Hospital Revenue Code	351
Min. Negotiated Rate	$2,316.60
Max. Negotiated Rate	$2,316.60
Rate for Payer: Aetna of AZ Commercial	$2,316.60
Rate for Payer: Cash Price	$2,059.20

CT Lower Extremity w/ Contrast Left

Facility

$2,385.00

Service Code	CPT 73701 LT
Hospital Charge Code	821338
Hospital Revenue Code	352
Min. Negotiated Rate	$377.78
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Arizona Complete Health Allwell	$381.60
Rate for Payer: Banner UC Health Medicare	$381.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,621.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$381.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$381.60
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Cigna of AZ Commercial	$1,550.25
Rate for Payer: Devoted Health Medicare	$429.30
Rate for Payer: Humana of AZ Medicare	$381.60
Rate for Payer: Southwest Service Administrators UFCW	$1,621.80
Rate for Payer: TriWest Medicare	$381.60
Rate for Payer: United Healthcare Commercial	$1,364.22
Rate for Payer: United Healthcare Medicare	$381.60
Rate for Payer: Veterans Affairs TRICARE	$377.78

CT Lower Extremity w/ Contrast Left

Facility

$2,385.00

Service Code	CPT 73701 LT
Hospital Charge Code	821338
Hospital Revenue Code	352
Min. Negotiated Rate	$2,146.50
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Cash Price	$1,908.00

CT Lower Extremity w/ Contrast Right

Facility

$2,389.00

Service Code	CPT 73701 RT
Hospital Charge Code	821340
Hospital Revenue Code	352
Min. Negotiated Rate	$378.42
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Arizona Complete Health Allwell	$382.24
Rate for Payer: Banner UC Health Medicare	$382.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,624.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$382.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$382.24
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Cigna of AZ Commercial	$1,552.85
Rate for Payer: Devoted Health Medicare	$430.02
Rate for Payer: Humana of AZ Medicare	$382.24
Rate for Payer: Southwest Service Administrators UFCW	$1,624.52
Rate for Payer: TriWest Medicare	$382.24
Rate for Payer: United Healthcare Commercial	$1,366.51
Rate for Payer: United Healthcare Medicare	$382.24
Rate for Payer: Veterans Affairs TRICARE	$378.42

CT Lower Extremity w/ Contrast Right

Facility

$2,389.00

Service Code	CPT 73701 RT
Hospital Charge Code	821340
Hospital Revenue Code	352
Min. Negotiated Rate	$2,150.10
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Cash Price	$1,911.20

CT Lower Extremity w/o Contrast Left

Facility

$1,918.00

Service Code	CPT 73700 LT
Hospital Charge Code	821342
Hospital Revenue Code	352
Min. Negotiated Rate	$1,726.20
Max. Negotiated Rate	$1,726.20
Rate for Payer: Aetna of AZ Commercial	$1,726.20
Rate for Payer: Cash Price	$1,534.40

CT Lower Extremity w/o Contrast Left

Facility

$1,918.00

Service Code	CPT 73700 LT
Hospital Charge Code	821342
Hospital Revenue Code	352
Min. Negotiated Rate	$303.81
Max. Negotiated Rate	$1,726.20
Rate for Payer: Aetna of AZ Commercial	$1,726.20
Rate for Payer: Arizona Complete Health Allwell	$306.88
Rate for Payer: Banner UC Health Medicare	$306.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,304.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$306.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$306.88
Rate for Payer: Cash Price	$1,534.40
Rate for Payer: Cigna of AZ Commercial	$1,246.70
Rate for Payer: Devoted Health Medicare	$345.24
Rate for Payer: Humana of AZ Medicare	$306.88
Rate for Payer: Southwest Service Administrators UFCW	$1,304.24
Rate for Payer: TriWest Medicare	$306.88
Rate for Payer: United Healthcare Commercial	$1,097.10
Rate for Payer: United Healthcare Medicare	$306.88
Rate for Payer: Veterans Affairs TRICARE	$303.81

CT Lower Extremity w/o Contrast Right

Facility

$2,019.00

Service Code	CPT 73700 RT
Hospital Charge Code	821344
Hospital Revenue Code	352
Min. Negotiated Rate	$319.81
Max. Negotiated Rate	$1,817.10
Rate for Payer: Aetna of AZ Commercial	$1,817.10
Rate for Payer: Arizona Complete Health Allwell	$323.04
Rate for Payer: Banner UC Health Medicare	$323.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,372.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$323.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$323.04
Rate for Payer: Cash Price	$1,615.20
Rate for Payer: Cigna of AZ Commercial	$1,312.35
Rate for Payer: Devoted Health Medicare	$363.42
Rate for Payer: Humana of AZ Medicare	$323.04
Rate for Payer: Southwest Service Administrators UFCW	$1,372.92
Rate for Payer: TriWest Medicare	$323.04
Rate for Payer: United Healthcare Commercial	$1,154.87
Rate for Payer: United Healthcare Medicare	$323.04
Rate for Payer: Veterans Affairs TRICARE	$319.81

CT Lower Extremity w/o Contrast Right

Facility

$2,019.00

Service Code	CPT 73700 RT
Hospital Charge Code	821344
Hospital Revenue Code	352
Min. Negotiated Rate	$1,817.10
Max. Negotiated Rate	$1,817.10
Rate for Payer: Aetna of AZ Commercial	$1,817.10
Rate for Payer: Cash Price	$1,615.20

Know your out-of-pocket cost for care.

All Charges