Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

24505 CLSD TX FX HUM W/MANIP

Facility

$2,030.00

Service Code	CPT 24505
Hospital Charge Code	22282840
Hospital Revenue Code	450
Min. Negotiated Rate	$56.83
Max. Negotiated Rate	$2,488.00
Rate for Payer: Aetna of AZ Commercial	$1,827.00
Rate for Payer: Arizona Complete Health Allwell	$324.80
Rate for Payer: Banner UC Health Medicare	$324.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,380.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$56.83
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$324.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$324.80
Rate for Payer: Cash Price	$1,624.00
Rate for Payer: Cash Price	$1,624.00
Rate for Payer: Cigna of AZ Commercial	$1,421.00
Rate for Payer: Devoted Health Medicare	$365.40
Rate for Payer: Humana of AZ Medicare	$324.80
Rate for Payer: Mercy Care Medicaid	$56.83
Rate for Payer: NaphCare Correctional Healthcare	$56.83
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$1,380.40
Rate for Payer: TriWest Medicare	$324.80
Rate for Payer: United Healthcare Commercial	$1,161.16
Rate for Payer: United Healthcare Medicare	$324.80
Rate for Payer: United Healthcare New Mexico Commercial	$385.70
Rate for Payer: Veterans Affairs TRICARE	$321.55

24505 CLSD TX FX HUM W/MANIP

Facility

$2,030.00

Service Code	CPT 24505
Hospital Charge Code	22282840
Hospital Revenue Code	450
Min. Negotiated Rate	$1,827.00
Max. Negotiated Rate	$1,827.00
Rate for Payer: Aetna of AZ Commercial	$1,827.00
Rate for Payer: Cash Price	$1,624.00

24600 TX ELB DISL W/O ANES

Facility

$1,408.00

Service Code	CPT 24600
Hospital Charge Code	22282841
Hospital Revenue Code	450
Min. Negotiated Rate	$1,267.20
Max. Negotiated Rate	$1,267.20
Rate for Payer: Aetna of AZ Commercial	$1,267.20
Rate for Payer: Cash Price	$1,126.40

24600 TX ELB DISL W/O ANES

Facility

$1,408.00

Service Code	CPT 24600
Hospital Charge Code	22282841
Hospital Revenue Code	450
Min. Negotiated Rate	$38.01
Max. Negotiated Rate	$1,267.20
Rate for Payer: Aetna of AZ Commercial	$1,267.20
Rate for Payer: Arizona Complete Health Allwell	$225.28
Rate for Payer: Banner UC Health Medicare	$225.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$957.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$225.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$225.28
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cigna of AZ Commercial	$985.60
Rate for Payer: Devoted Health Medicare	$253.44
Rate for Payer: Humana of AZ Medicare	$225.28
Rate for Payer: Mercy Care Medicaid	$38.01
Rate for Payer: NaphCare Correctional Healthcare	$38.01
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$957.44
Rate for Payer: TriWest Medicare	$225.28
Rate for Payer: United Healthcare Commercial	$805.38
Rate for Payer: United Healthcare Medicare	$225.28
Rate for Payer: United Healthcare New Mexico Commercial	$267.52
Rate for Payer: Veterans Affairs TRICARE	$223.03

25028 I/D FOREARM ETC DEEP

Facility

$2,175.00

Service Code	CPT 25028
Hospital Charge Code	22282842
Hospital Revenue Code	450
Min. Negotiated Rate	$344.52
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,957.50
Rate for Payer: Arizona Complete Health Allwell	$348.00
Rate for Payer: Banner UC Health Medicare	$348.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,479.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$348.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$348.00
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Cigna of AZ Commercial	$1,522.50
Rate for Payer: Devoted Health Medicare	$391.50
Rate for Payer: Humana of AZ Medicare	$348.00
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$1,479.00
Rate for Payer: TriWest Medicare	$348.00
Rate for Payer: United Healthcare Commercial	$1,244.10
Rate for Payer: United Healthcare Medicare	$348.00
Rate for Payer: United Healthcare New Mexico Commercial	$413.25
Rate for Payer: Veterans Affairs TRICARE	$344.52

25028 I/D FOREARM ETC DEEP

Facility

$2,175.00

Service Code	CPT 25028
Hospital Charge Code	22282842
Hospital Revenue Code	450
Min. Negotiated Rate	$1,957.50
Max. Negotiated Rate	$1,957.50
Rate for Payer: Aetna of AZ Commercial	$1,957.50
Rate for Payer: Cash Price	$1,740.00

25500 CLD TX FX RADIUS W/O MAN

Facility

$901.00

Service Code	CPT 25500
Hospital Charge Code	22282843
Hospital Revenue Code	450
Min. Negotiated Rate	$28.94
Max. Negotiated Rate	$810.90
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Arizona Complete Health Allwell	$144.16
Rate for Payer: Banner UC Health Medicare	$144.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$612.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28.94
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$144.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$144.16
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cigna of AZ Commercial	$630.70
Rate for Payer: Devoted Health Medicare	$162.18
Rate for Payer: Humana of AZ Medicare	$144.16
Rate for Payer: Mercy Care Medicaid	$28.94
Rate for Payer: NaphCare Correctional Healthcare	$28.94
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$612.68
Rate for Payer: TriWest Medicare	$144.16
Rate for Payer: United Healthcare Commercial	$515.37
Rate for Payer: United Healthcare Medicare	$144.16
Rate for Payer: United Healthcare New Mexico Commercial	$171.19
Rate for Payer: Veterans Affairs TRICARE	$142.72

25500 CLD TX FX RADIUS W/O MAN

Facility

$901.00

Service Code	CPT 25500
Hospital Charge Code	22282843
Hospital Revenue Code	450
Min. Negotiated Rate	$810.90
Max. Negotiated Rate	$810.90
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Cash Price	$720.80

25505 CLSD TX FX RAD W/MANIP

Facility

$2,126.00

Service Code	CPT 25505
Hospital Charge Code	22282844
Hospital Revenue Code	450
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$2,488.00
Rate for Payer: Aetna of AZ Commercial	$1,913.40
Rate for Payer: Arizona Complete Health Allwell	$340.16
Rate for Payer: Banner UC Health Medicare	$340.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,445.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$51.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$340.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$340.16
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Cigna of AZ Commercial	$1,488.20
Rate for Payer: Devoted Health Medicare	$382.68
Rate for Payer: Humana of AZ Medicare	$340.16
Rate for Payer: Mercy Care Medicaid	$51.25
Rate for Payer: NaphCare Correctional Healthcare	$51.25
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$1,445.68
Rate for Payer: TriWest Medicare	$340.16
Rate for Payer: United Healthcare Commercial	$1,216.07
Rate for Payer: United Healthcare Medicare	$340.16
Rate for Payer: United Healthcare New Mexico Commercial	$403.94
Rate for Payer: Veterans Affairs TRICARE	$336.76

25505 CLSD TX FX RAD W/MANIP

Facility

$2,126.00

Service Code	CPT 25505
Hospital Charge Code	22282844
Hospital Revenue Code	450
Min. Negotiated Rate	$1,913.40
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of AZ Commercial	$1,913.40
Rate for Payer: Cash Price	$1,700.80

25530 CLD TX FX ULNA W/O MANIP

Facility

$818.00

Service Code	CPT 25530
Hospital Charge Code	22282845
Hospital Revenue Code	450
Min. Negotiated Rate	$23.01
Max. Negotiated Rate	$736.20
Rate for Payer: Aetna of AZ Commercial	$736.20
Rate for Payer: Arizona Complete Health Allwell	$130.88
Rate for Payer: Banner UC Health Medicare	$130.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$556.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$130.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$130.88
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cigna of AZ Commercial	$572.60
Rate for Payer: Devoted Health Medicare	$147.24
Rate for Payer: Humana of AZ Medicare	$130.88
Rate for Payer: Mercy Care Medicaid	$23.01
Rate for Payer: NaphCare Correctional Healthcare	$23.01
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$556.24
Rate for Payer: TriWest Medicare	$130.88
Rate for Payer: United Healthcare Commercial	$467.90
Rate for Payer: United Healthcare Medicare	$130.88
Rate for Payer: United Healthcare New Mexico Commercial	$155.42
Rate for Payer: Veterans Affairs TRICARE	$129.57

25530 CLD TX FX ULNA W/O MANIP

Facility

$818.00

Service Code	CPT 25530
Hospital Charge Code	22282845
Hospital Revenue Code	450
Min. Negotiated Rate	$736.20
Max. Negotiated Rate	$736.20
Rate for Payer: Aetna of AZ Commercial	$736.20
Rate for Payer: Cash Price	$654.40

25535 CLSD TX FX ULNA W/MANIP

Facility

$1,883.00

Service Code	CPT 25535
Hospital Charge Code	22282846
Hospital Revenue Code	450
Min. Negotiated Rate	$1,694.70
Max. Negotiated Rate	$1,694.70
Rate for Payer: Aetna of AZ Commercial	$1,694.70
Rate for Payer: Cash Price	$1,506.40

25535 CLSD TX FX ULNA W/MANIP

Facility

$1,883.00

Service Code	CPT 25535
Hospital Charge Code	22282846
Hospital Revenue Code	450
Min. Negotiated Rate	$40.79
Max. Negotiated Rate	$1,694.70
Rate for Payer: Aetna of AZ Commercial	$1,694.70
Rate for Payer: Arizona Complete Health Allwell	$301.28
Rate for Payer: Banner UC Health Medicare	$301.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,280.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40.79
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$301.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$301.28
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cigna of AZ Commercial	$1,318.10
Rate for Payer: Devoted Health Medicare	$338.94
Rate for Payer: Humana of AZ Medicare	$301.28
Rate for Payer: Mercy Care Medicaid	$40.79
Rate for Payer: NaphCare Correctional Healthcare	$40.79
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$1,280.44
Rate for Payer: TriWest Medicare	$301.28
Rate for Payer: United Healthcare Commercial	$1,077.08
Rate for Payer: United Healthcare Medicare	$301.28
Rate for Payer: United Healthcare New Mexico Commercial	$357.77
Rate for Payer: Veterans Affairs TRICARE	$298.27

25600 CLSD TX FX DIS RAD W/OMA

Facility

$986.00

Service Code	CPT 25600
Hospital Charge Code	22282847
Hospital Revenue Code	450
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$887.40
Rate for Payer: Aetna of AZ Commercial	$887.40
Rate for Payer: Arizona Complete Health Allwell	$157.76
Rate for Payer: Banner UC Health Medicare	$157.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$670.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$157.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$157.76
Rate for Payer: Cash Price	$788.80
Rate for Payer: Cash Price	$788.80
Rate for Payer: Cigna of AZ Commercial	$690.20
Rate for Payer: Devoted Health Medicare	$177.48
Rate for Payer: Humana of AZ Medicare	$157.76
Rate for Payer: Mercy Care Medicaid	$14.64
Rate for Payer: NaphCare Correctional Healthcare	$14.64
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$670.48
Rate for Payer: TriWest Medicare	$157.76
Rate for Payer: United Healthcare Commercial	$563.99
Rate for Payer: United Healthcare Medicare	$157.76
Rate for Payer: United Healthcare New Mexico Commercial	$187.34
Rate for Payer: Veterans Affairs TRICARE	$156.18

25600 CLSD TX FX DIS RAD W/OMA

Facility

$986.00

Service Code	CPT 25600
Hospital Charge Code	22282847
Hospital Revenue Code	450
Min. Negotiated Rate	$887.40
Max. Negotiated Rate	$887.40
Rate for Payer: Aetna of AZ Commercial	$887.40
Rate for Payer: Cash Price	$788.80

25605 CLSD TX FX DIST RAD W/M

Facility

$4,857.00

Service Code	CPT 25605
Hospital Charge Code	22282848
Hospital Revenue Code	450
Min. Negotiated Rate	$4,371.30
Max. Negotiated Rate	$4,371.30
Rate for Payer: Aetna of AZ Commercial	$4,371.30
Rate for Payer: Cash Price	$3,885.60

25605 CLSD TX FX DIST RAD W/M

Facility

$4,857.00

Service Code	CPT 25605
Hospital Charge Code	22282848
Hospital Revenue Code	450
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$4,371.30
Rate for Payer: Aetna of AZ Commercial	$4,371.30
Rate for Payer: Arizona Complete Health Allwell	$777.12
Rate for Payer: Banner UC Health Medicare	$777.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,302.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32.78
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$777.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$777.12
Rate for Payer: Cash Price	$3,885.60
Rate for Payer: Cash Price	$3,885.60
Rate for Payer: Cigna of AZ Commercial	$3,399.90
Rate for Payer: Devoted Health Medicare	$874.26
Rate for Payer: Humana of AZ Medicare	$777.12
Rate for Payer: Mercy Care Medicaid	$32.78
Rate for Payer: NaphCare Correctional Healthcare	$32.78
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$3,302.76
Rate for Payer: TriWest Medicare	$777.12
Rate for Payer: United Healthcare Commercial	$2,778.20
Rate for Payer: United Healthcare Medicare	$777.12
Rate for Payer: United Healthcare New Mexico Commercial	$922.83
Rate for Payer: Veterans Affairs TRICARE	$769.35

25-Hydroxyvitamin D LCMS D2+D3 LC

Facility

$515.00

Service Code	CPT 82306
Hospital Charge Code	22311171
Hospital Revenue Code	301
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$463.50
Rate for Payer: Aetna of AZ Commercial	$463.50
Rate for Payer: Arizona Complete Health Allwell	$82.40
Rate for Payer: Banner UC Health Medicare	$82.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$350.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$82.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$82.40
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cigna of AZ Commercial	$334.75
Rate for Payer: Devoted Health Medicare	$92.70
Rate for Payer: Humana of AZ Medicare	$82.40
Rate for Payer: Seven Corners Travel Insurance	$42.92
Rate for Payer: Southwest Service Administrators UFCW	$350.20
Rate for Payer: TriWest Medicare	$82.40
Rate for Payer: United Healthcare Commercial	$294.58
Rate for Payer: United Healthcare Medicare	$82.40
Rate for Payer: Veterans Affairs TRICARE	$81.58

25-Hydroxyvitamin D LCMS D2+D3 LC

Facility

$515.00

Service Code	CPT 82306
Hospital Charge Code	22311171
Hospital Revenue Code	301
Min. Negotiated Rate	$463.50
Max. Negotiated Rate	$463.50
Rate for Payer: Aetna of AZ Commercial	$463.50
Rate for Payer: Cash Price	$412.00

26010 DNG FING ABSJ SIMPLE

Facility

$1,103.00

Service Code	CPT 26010
Hospital Charge Code	22282849
Hospital Revenue Code	450
Min. Negotiated Rate	$992.70
Max. Negotiated Rate	$992.70
Rate for Payer: Aetna of AZ Commercial	$992.70
Rate for Payer: Cash Price	$882.40

26010 DNG FING ABSJ SIMPLE

Facility

$1,103.00

Service Code	CPT 26010
Hospital Charge Code	22282849
Hospital Revenue Code	450
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$992.70
Rate for Payer: Aetna of AZ Commercial	$992.70
Rate for Payer: Arizona Complete Health Allwell	$176.48
Rate for Payer: Banner UC Health Medicare	$176.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$750.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$194.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$176.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$176.48
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cigna of AZ Commercial	$772.10
Rate for Payer: Devoted Health Medicare	$198.54
Rate for Payer: Humana of AZ Medicare	$176.48
Rate for Payer: Mercy Care Medicaid	$194.56
Rate for Payer: NaphCare Correctional Healthcare	$194.56
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$750.04
Rate for Payer: TriWest Medicare	$176.48
Rate for Payer: United Healthcare Commercial	$630.92
Rate for Payer: United Healthcare Medicare	$176.48
Rate for Payer: United Healthcare New Mexico Commercial	$209.57
Rate for Payer: Veterans Affairs TRICARE	$174.72

26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER).

Facility

$1,580.00

Service Code	CPT 26055
Hospital Charge Code	27414134
Hospital Revenue Code	360
Min. Negotiated Rate	$1,422.00
Max. Negotiated Rate	$1,422.00
Rate for Payer: Aetna of AZ Commercial	$1,422.00
Rate for Payer: Cash Price	$1,264.00

26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER).

Facility

$1,580.00

Service Code	CPT 26055
Hospital Charge Code	27414134
Hospital Revenue Code	360
Min. Negotiated Rate	$250.27
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$1,422.00
Rate for Payer: Arizona Complete Health Allwell	$252.80
Rate for Payer: Banner UC Health Medicare	$504.49
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,074.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$289.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$252.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$252.80
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Cash Price	$1,264.00
Rate for Payer: Cigna of AZ Commercial	$790.00
Rate for Payer: Devoted Health Medicare	$284.40
Rate for Payer: Humana of AZ Medicare	$252.80
Rate for Payer: Mercy Care Medicaid	$289.05
Rate for Payer: NaphCare Correctional Healthcare	$504.49
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$1,074.40
Rate for Payer: TriWest Medicare	$252.80
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$252.80
Rate for Payer: Veterans Affairs TRICARE	$250.27

26123 REMOVAL OF TISSUE OF PALM AND RELEASE OF FINGER

Facility

$4,531.00

Service Code	CPT 26123
Hospital Charge Code	27407496
Hospital Revenue Code	360
Min. Negotiated Rate	$4,077.90
Max. Negotiated Rate	$4,077.90
Rate for Payer: Aetna of AZ Commercial	$4,077.90
Rate for Payer: Cash Price	$3,624.80

Know your out-of-pocket cost for care.

All Charges