Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CYSTINE 24HR

Facility

$283.00

Service Code	CPT 82131
Hospital Charge Code	22481472
Hospital Revenue Code	301
Min. Negotiated Rate	$33.32
Max. Negotiated Rate	$254.70
Rate for Payer: Aetna of AZ Commercial	$254.70
Rate for Payer: Arizona Complete Health Allwell	$45.28
Rate for Payer: Banner UC Health Medicare	$45.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$192.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.28
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cigna of AZ Commercial	$183.95
Rate for Payer: Devoted Health Medicare	$50.94
Rate for Payer: Humana of AZ Medicare	$45.28
Rate for Payer: Seven Corners Travel Insurance	$33.32
Rate for Payer: Southwest Service Administrators UFCW	$192.44
Rate for Payer: TriWest Medicare	$45.28
Rate for Payer: United Healthcare Commercial	$161.88
Rate for Payer: United Healthcare Medicare	$45.28
Rate for Payer: Veterans Affairs TRICARE	$44.83

Cystometrogram- Complex

Facility

$1,649.00

Service Code	CPT 51726
Hospital Charge Code	27267786
Hospital Revenue Code	360
Min. Negotiated Rate	$1,484.10
Max. Negotiated Rate	$1,484.10
Rate for Payer: Aetna of AZ Commercial	$1,484.10
Rate for Payer: Cash Price	$1,319.20

Cystometrogram- Complex

Facility

$1,649.00

Service Code	CPT 51726
Hospital Charge Code	27267786
Hospital Revenue Code	360
Min. Negotiated Rate	$95.24
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$1,484.10
Rate for Payer: Arizona Complete Health Allwell	$263.84
Rate for Payer: Banner UC Health Medicare	$95.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,121.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$263.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$263.84
Rate for Payer: Cash Price	$1,319.20
Rate for Payer: Cash Price	$1,319.20
Rate for Payer: Cash Price	$1,319.20
Rate for Payer: Cigna of AZ Commercial	$824.50
Rate for Payer: Devoted Health Medicare	$296.82
Rate for Payer: Humana of AZ Medicare	$263.84
Rate for Payer: NaphCare Correctional Healthcare	$95.24
Rate for Payer: Seven Corners Travel Insurance	$386.58
Rate for Payer: Southwest Service Administrators UFCW	$1,121.32
Rate for Payer: TriWest Medicare	$263.84
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$263.84
Rate for Payer: Veterans Affairs TRICARE	$261.20

Cystometrogram-Simple

Facility

$1,234.00

Service Code	CPT 51725
Hospital Charge Code	27267785
Hospital Revenue Code	360
Min. Negotiated Rate	$1,110.60
Max. Negotiated Rate	$1,110.60
Rate for Payer: Aetna of AZ Commercial	$1,110.60
Rate for Payer: Cash Price	$987.20

Cystometrogram-Simple

Facility

$1,234.00

Service Code	CPT 51725
Hospital Charge Code	27267785
Hospital Revenue Code	360
Min. Negotiated Rate	$66.86
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$1,110.60
Rate for Payer: Arizona Complete Health Allwell	$197.44
Rate for Payer: Banner UC Health Medicare	$66.86
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$839.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$197.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$197.44
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cigna of AZ Commercial	$617.00
Rate for Payer: Devoted Health Medicare	$222.12
Rate for Payer: Humana of AZ Medicare	$197.44
Rate for Payer: NaphCare Correctional Healthcare	$66.86
Rate for Payer: Seven Corners Travel Insurance	$386.58
Rate for Payer: Southwest Service Administrators UFCW	$839.12
Rate for Payer: TriWest Medicare	$197.44
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$197.44
Rate for Payer: Veterans Affairs TRICARE	$195.47

Cystorrhaphy suture baldder inury simple

Facility

$4,037.00

Service Code	CPT 51860
Hospital Charge Code	27267818
Hospital Revenue Code	360
Min. Negotiated Rate	$3,633.30
Max. Negotiated Rate	$3,633.30
Rate for Payer: Aetna of AZ Commercial	$3,633.30
Rate for Payer: Cash Price	$3,229.60

Cystorrhaphy suture baldder inury simple

Facility

$4,037.00

Service Code	CPT 51860
Hospital Charge Code	27267818
Hospital Revenue Code	360
Min. Negotiated Rate	$639.46
Max. Negotiated Rate	$14,647.16
Rate for Payer: Aetna of AZ Commercial	$3,633.30
Rate for Payer: Arizona Complete Health Allwell	$645.92
Rate for Payer: Banner UC Health Medicare	$4,907.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,745.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$645.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$645.92
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cigna of AZ Commercial	$2,018.50
Rate for Payer: Devoted Health Medicare	$726.66
Rate for Payer: Humana of AZ Medicare	$645.92
Rate for Payer: NaphCare Correctional Healthcare	$4,907.31
Rate for Payer: Seven Corners Travel Insurance	$14,647.16
Rate for Payer: Southwest Service Administrators UFCW	$2,745.16
Rate for Payer: TriWest Medicare	$645.92
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$645.92
Rate for Payer: Veterans Affairs TRICARE	$639.46

Cystorrhaphy suture ballder injury complicated

Facility

$4,862.00

Service Code	CPT 51865
Hospital Charge Code	27291795
Hospital Revenue Code	360
Min. Negotiated Rate	$4,375.80
Max. Negotiated Rate	$4,375.80
Rate for Payer: Aetna of AZ Commercial	$4,375.80
Rate for Payer: Cash Price	$3,889.60

Cystorrhaphy suture ballder injury complicated

Facility

$4,862.00

Service Code	CPT 51865
Hospital Charge Code	27291795
Hospital Revenue Code	360
Min. Negotiated Rate	$770.14
Max. Negotiated Rate	$4,838.00
Rate for Payer: Aetna of AZ Commercial	$4,375.80
Rate for Payer: Arizona Complete Health Allwell	$777.92
Rate for Payer: Banner UC Health Medicare	$777.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,306.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$777.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$777.92
Rate for Payer: Cash Price	$3,889.60
Rate for Payer: Cash Price	$3,889.60
Rate for Payer: Cigna of AZ Commercial	$2,431.00
Rate for Payer: Devoted Health Medicare	$875.16
Rate for Payer: Humana of AZ Medicare	$777.92
Rate for Payer: Southwest Service Administrators UFCW	$3,306.16
Rate for Payer: TriWest Medicare	$777.92
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$777.92
Rate for Payer: Veterans Affairs TRICARE	$770.14

CYSTOSCOPY

Facility

$1,924.76

Service Code	CPT 52000
Hospital Charge Code	885909
Hospital Revenue Code	750
Min. Negotiated Rate	$142.60
Max. Negotiated Rate	$3,098.00
Rate for Payer: Aetna of AZ Commercial	$1,732.28
Rate for Payer: Arizona Complete Health Allwell	$307.96
Rate for Payer: Banner UC Health Medicare	$211.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,308.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$142.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$307.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$307.96
Rate for Payer: Cash Price	$1,539.81
Rate for Payer: Cash Price	$1,539.81
Rate for Payer: Cash Price	$1,539.81
Rate for Payer: Cigna of AZ Commercial	$1,347.33
Rate for Payer: Devoted Health Medicare	$346.46
Rate for Payer: Humana of AZ Medicare	$307.96
Rate for Payer: Mercy Care Medicaid	$142.60
Rate for Payer: NaphCare Correctional Healthcare	$211.61
Rate for Payer: Seven Corners Travel Insurance	$1,078.90
Rate for Payer: Southwest Service Administrators UFCW	$1,308.84
Rate for Payer: TriWest Medicare	$307.96
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$307.96
Rate for Payer: United Healthcare New Mexico Commercial	$365.70
Rate for Payer: Veterans Affairs TRICARE	$304.88

CYSTOSCOPY

Facility

$1,924.76

Service Code	CPT 52000
Hospital Charge Code	885909
Hospital Revenue Code	750
Min. Negotiated Rate	$1,732.28
Max. Negotiated Rate	$1,732.28
Rate for Payer: Aetna of AZ Commercial	$1,732.28
Rate for Payer: Cash Price	$1,539.81

Cystoscopy and Biopsy

Facility

$761.00

Service Code	CPT 52204
Hospital Charge Code	27281885
Hospital Revenue Code	360
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Arizona Complete Health Allwell	$121.76
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$517.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$217.57
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$121.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$121.76
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cigna of AZ Commercial	$380.50
Rate for Payer: Devoted Health Medicare	$136.98
Rate for Payer: Humana of AZ Medicare	$121.76
Rate for Payer: Mercy Care Medicaid	$217.57
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$517.48
Rate for Payer: TriWest Medicare	$121.76
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$121.76
Rate for Payer: Veterans Affairs TRICARE	$120.54

Cystoscopy and Biopsy

Facility

$761.00

Service Code	CPT 52204
Hospital Charge Code	27281885
Hospital Revenue Code	360
Min. Negotiated Rate	$684.90
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Cash Price	$608.80

CYSTOSCOPY INJ NEEDLE WILIAMS -COOK

Facility

$148.00

Hospital Charge Code	22354216
Hospital Revenue Code	270
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Arizona Complete Health Allwell	$23.68
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$100.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.68
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$103.60
Rate for Payer: Devoted Health Medicare	$26.64
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Southwest Service Administrators UFCW	$100.64
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: United Healthcare Commercial	$84.66
Rate for Payer: United Healthcare Medicare	$23.68
Rate for Payer: Veterans Affairs TRICARE	$23.44

CYSTOSCOPY INJ NEEDLE WILIAMS -COOK

Facility

$148.00

Hospital Charge Code	22354216
Hospital Revenue Code	270
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Cash Price	$118.40

Cystoscopy w/hydrodistension for IC

Facility

$1,134.00

Service Code	CPT 52260
Hospital Charge Code	27281909
Hospital Revenue Code	360
Min. Negotiated Rate	$1,020.60
Max. Negotiated Rate	$1,020.60
Rate for Payer: Aetna of AZ Commercial	$1,020.60
Rate for Payer: Cash Price	$907.20

Cystoscopy w/hydrodistension for IC

Facility

$1,134.00

Service Code	CPT 52260
Hospital Charge Code	27281909
Hospital Revenue Code	360
Min. Negotiated Rate	$179.63
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$1,020.60
Rate for Payer: Arizona Complete Health Allwell	$181.44
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$771.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$181.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$181.44
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cigna of AZ Commercial	$567.00
Rate for Payer: Devoted Health Medicare	$204.12
Rate for Payer: Humana of AZ Medicare	$181.44
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$771.12
Rate for Payer: TriWest Medicare	$181.44
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$181.44
Rate for Payer: Veterans Affairs TRICARE	$179.63

Cystoscopy w/irrigation clots

Facility

$1,549.00

Service Code	CPT 52001
Hospital Charge Code	27291811
Hospital Revenue Code	360
Min. Negotiated Rate	$138.77
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Arizona Complete Health Allwell	$247.84
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,053.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$138.77
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$247.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$247.84
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cigna of AZ Commercial	$774.50
Rate for Payer: Devoted Health Medicare	$278.82
Rate for Payer: Humana of AZ Medicare	$247.84
Rate for Payer: Mercy Care Medicaid	$138.77
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	$1,053.32
Rate for Payer: TriWest Medicare	$247.84
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$247.84
Rate for Payer: Veterans Affairs TRICARE	$245.36

Cystoscopy w/irrigation clots

Facility

$1,549.00

Service Code	CPT 52001
Hospital Charge Code	27291811
Hospital Revenue Code	360
Min. Negotiated Rate	$1,394.10
Max. Negotiated Rate	$1,394.10
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Cash Price	$1,239.20

CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE CQCH

Facility

$1,513.25

Service Code	CPT 51040
Hospital Charge Code	28134684
Hospital Revenue Code	360
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,361.92
Rate for Payer: Arizona Complete Health Allwell	$242.12
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,029.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$242.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$242.12
Rate for Payer: Cash Price	$1,210.60
Rate for Payer: Cash Price	$1,210.60
Rate for Payer: Cash Price	$1,210.60
Rate for Payer: Cigna of AZ Commercial	$756.62
Rate for Payer: Devoted Health Medicare	$272.38
Rate for Payer: Humana of AZ Medicare	$242.12
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$1,029.01
Rate for Payer: TriWest Medicare	$242.12
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$242.12
Rate for Payer: Veterans Affairs TRICARE	$239.70

CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE CQCH

Facility

$1,513.25

Service Code	CPT 51040
Hospital Charge Code	28134684
Hospital Revenue Code	360
Min. Negotiated Rate	$1,361.92
Max. Negotiated Rate	$1,361.92
Rate for Payer: Aetna of AZ Commercial	$1,361.92
Rate for Payer: Cash Price	$1,210.60

Cystotomy closure

Facility

$2,405.00

Service Code	CPT 51880
Hospital Charge Code	27291794
Hospital Revenue Code	360
Min. Negotiated Rate	$2,164.50
Max. Negotiated Rate	$2,164.50
Rate for Payer: Aetna of AZ Commercial	$2,164.50
Rate for Payer: Cash Price	$1,924.00

Cystotomy closure

Facility

$2,405.00

Service Code	CPT 51880
Hospital Charge Code	27291794
Hospital Revenue Code	360
Min. Negotiated Rate	$380.95
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$2,164.50
Rate for Payer: Arizona Complete Health Allwell	$384.80
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,635.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$384.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$384.80
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cigna of AZ Commercial	$1,202.50
Rate for Payer: Devoted Health Medicare	$432.90
Rate for Payer: Humana of AZ Medicare	$384.80
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	$1,635.40
Rate for Payer: TriWest Medicare	$384.80
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$384.80
Rate for Payer: Veterans Affairs TRICARE	$380.95

Cystotomy with insertion of ureteral stent

Facility

$2,720.00

Service Code	CPT 51045
Hospital Charge Code	27267817
Hospital Revenue Code	360
Min. Negotiated Rate	$430.85
Max. Negotiated Rate	$3,234.38
Rate for Payer: Aetna of AZ Commercial	$2,448.00
Rate for Payer: Arizona Complete Health Allwell	$435.20
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,849.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$435.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$435.20
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cigna of AZ Commercial	$1,360.00
Rate for Payer: Devoted Health Medicare	$489.60
Rate for Payer: Humana of AZ Medicare	$435.20
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$1,849.60
Rate for Payer: TriWest Medicare	$435.20
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$435.20
Rate for Payer: Veterans Affairs TRICARE	$430.85

Cystotomy with insertion of ureteral stent

Facility

$2,720.00

Service Code	CPT 51045
Hospital Charge Code	27267817
Hospital Revenue Code	360
Min. Negotiated Rate	$2,448.00
Max. Negotiated Rate	$2,448.00
Rate for Payer: Aetna of AZ Commercial	$2,448.00
Rate for Payer: Cash Price	$2,176.00

Know your out-of-pocket cost for care.

All Charges