Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	$717.71
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$4,077.90
Rate for Payer: Arizona Complete Health Allwell	$724.96
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,081.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$724.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$724.96
Rate for Payer: Cash Price	$3,624.80
Rate for Payer: Cash Price	$3,624.80
Rate for Payer: Cash Price	$3,624.80
Rate for Payer: Cigna of AZ Commercial	$2,265.50
Rate for Payer: Devoted Health Medicare	$815.58
Rate for Payer: Humana of AZ Medicare	$724.96
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$3,081.08
Rate for Payer: TriWest Medicare	$724.96
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$724.96
Rate for Payer: Veterans Affairs TRICARE	$717.71

26600 CLD TX FX FING W/OMANIP@

Facility

$748.00

Service Code	CPT 26600
Hospital Charge Code	22282850
Hospital Revenue Code	450
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$673.20
Rate for Payer: Aetna of AZ Commercial	$673.20
Rate for Payer: Arizona Complete Health Allwell	$119.68
Rate for Payer: Banner UC Health Medicare	$119.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$508.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15.74
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$119.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$119.68
Rate for Payer: Cash Price	$598.40
Rate for Payer: Cash Price	$598.40
Rate for Payer: Cigna of AZ Commercial	$523.60
Rate for Payer: Devoted Health Medicare	$134.64
Rate for Payer: Humana of AZ Medicare	$119.68
Rate for Payer: Mercy Care Medicaid	$15.74
Rate for Payer: NaphCare Correctional Healthcare	$15.74
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$508.64
Rate for Payer: TriWest Medicare	$119.68
Rate for Payer: United Healthcare Commercial	$427.86
Rate for Payer: United Healthcare Medicare	$119.68
Rate for Payer: United Healthcare New Mexico Commercial	$142.12
Rate for Payer: Veterans Affairs TRICARE	$118.48

26600 CLD TX FX FING W/OMANIP@

Facility

$748.00

Service Code	CPT 26600
Hospital Charge Code	22282850
Hospital Revenue Code	450
Min. Negotiated Rate	$673.20
Max. Negotiated Rate	$673.20
Rate for Payer: Aetna of AZ Commercial	$673.20
Rate for Payer: Cash Price	$598.40

26605 CLSD TX FX FING W/MAN EA

Facility

$1,101.00

Service Code	CPT 26605
Hospital Charge Code	22282851
Hospital Revenue Code	450
Min. Negotiated Rate	$990.90
Max. Negotiated Rate	$990.90
Rate for Payer: Aetna of AZ Commercial	$990.90
Rate for Payer: Cash Price	$880.80

26605 CLSD TX FX FING W/MAN EA

Facility

$1,101.00

Service Code	CPT 26605
Hospital Charge Code	22282851
Hospital Revenue Code	450
Min. Negotiated Rate	$36.12
Max. Negotiated Rate	$990.90
Rate for Payer: Aetna of AZ Commercial	$990.90
Rate for Payer: Arizona Complete Health Allwell	$176.16
Rate for Payer: Banner UC Health Medicare	$176.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$748.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$36.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$176.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$176.16
Rate for Payer: Cash Price	$880.80
Rate for Payer: Cash Price	$880.80
Rate for Payer: Cigna of AZ Commercial	$770.70
Rate for Payer: Devoted Health Medicare	$198.18
Rate for Payer: Humana of AZ Medicare	$176.16
Rate for Payer: Mercy Care Medicaid	$36.12
Rate for Payer: NaphCare Correctional Healthcare	$36.12
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$748.68
Rate for Payer: TriWest Medicare	$176.16
Rate for Payer: United Healthcare Commercial	$629.77
Rate for Payer: United Healthcare Medicare	$176.16
Rate for Payer: United Healthcare New Mexico Commercial	$209.19
Rate for Payer: Veterans Affairs TRICARE	$174.40

26700 CLD TX DIS HAND BN WMANP

Facility

$1,138.00

Service Code	CPT 26700
Hospital Charge Code	22282852
Hospital Revenue Code	450
Min. Negotiated Rate	$1,024.20
Max. Negotiated Rate	$1,024.20
Rate for Payer: Aetna of AZ Commercial	$1,024.20
Rate for Payer: Cash Price	$910.40

26700 CLD TX DIS HAND BN WMANP

Facility

$1,138.00

Service Code	CPT 26700
Hospital Charge Code	22282852
Hospital Revenue Code	450
Min. Negotiated Rate	$29.33
Max. Negotiated Rate	$1,024.20
Rate for Payer: Aetna of AZ Commercial	$1,024.20
Rate for Payer: Arizona Complete Health Allwell	$182.08
Rate for Payer: Banner UC Health Medicare	$182.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$773.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$182.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$182.08
Rate for Payer: Cash Price	$910.40
Rate for Payer: Cash Price	$910.40
Rate for Payer: Cigna of AZ Commercial	$796.60
Rate for Payer: Devoted Health Medicare	$204.84
Rate for Payer: Humana of AZ Medicare	$182.08
Rate for Payer: Mercy Care Medicaid	$29.33
Rate for Payer: NaphCare Correctional Healthcare	$29.33
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$773.84
Rate for Payer: TriWest Medicare	$182.08
Rate for Payer: United Healthcare Commercial	$650.94
Rate for Payer: United Healthcare Medicare	$182.08
Rate for Payer: United Healthcare New Mexico Commercial	$216.22
Rate for Payer: Veterans Affairs TRICARE	$180.26

26720 CLSD TX FX PHAL W/O MANI

Facility

$532.00

Service Code	CPT 26720
Hospital Charge Code	22282853
Hospital Revenue Code	450
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of AZ Commercial	$478.80
Rate for Payer: Arizona Complete Health Allwell	$85.12
Rate for Payer: Banner UC Health Medicare	$85.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$361.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13.23
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$85.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$85.12
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cigna of AZ Commercial	$372.40
Rate for Payer: Devoted Health Medicare	$95.76
Rate for Payer: Humana of AZ Medicare	$85.12
Rate for Payer: Mercy Care Medicaid	$13.23
Rate for Payer: NaphCare Correctional Healthcare	$13.23
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$361.76
Rate for Payer: TriWest Medicare	$85.12
Rate for Payer: United Healthcare Commercial	$304.30
Rate for Payer: United Healthcare Medicare	$85.12
Rate for Payer: United Healthcare New Mexico Commercial	$101.08
Rate for Payer: Veterans Affairs TRICARE	$84.27

26720 CLSD TX FX PHAL W/O MANI

Facility

$532.00

Service Code	CPT 26720
Hospital Charge Code	22282853
Hospital Revenue Code	450
Min. Negotiated Rate	$478.80
Max. Negotiated Rate	$478.80
Rate for Payer: Aetna of AZ Commercial	$478.80
Rate for Payer: Cash Price	$425.60

26725 CLSD TX FX PHAL W/MANIP

Facility

$1,024.00

Service Code	CPT 26725
Hospital Charge Code	22282854
Hospital Revenue Code	450
Min. Negotiated Rate	$921.60
Max. Negotiated Rate	$921.60
Rate for Payer: Aetna of AZ Commercial	$921.60
Rate for Payer: Cash Price	$819.20

26725 CLSD TX FX PHAL W/MANIP

Facility

$1,024.00

Service Code	CPT 26725
Hospital Charge Code	22282854
Hospital Revenue Code	450
Min. Negotiated Rate	$41.13
Max. Negotiated Rate	$921.60
Rate for Payer: Aetna of AZ Commercial	$921.60
Rate for Payer: Arizona Complete Health Allwell	$163.84
Rate for Payer: Banner UC Health Medicare	$163.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$696.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$41.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$163.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$163.84
Rate for Payer: Cash Price	$819.20
Rate for Payer: Cash Price	$819.20
Rate for Payer: Cigna of AZ Commercial	$716.80
Rate for Payer: Devoted Health Medicare	$184.32
Rate for Payer: Humana of AZ Medicare	$163.84
Rate for Payer: Mercy Care Medicaid	$41.13
Rate for Payer: NaphCare Correctional Healthcare	$41.13
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$696.32
Rate for Payer: TriWest Medicare	$163.84
Rate for Payer: United Healthcare Commercial	$585.73
Rate for Payer: United Healthcare Medicare	$163.84
Rate for Payer: United Healthcare New Mexico Commercial	$194.56
Rate for Payer: Veterans Affairs TRICARE	$162.20

26740 CLSD TX ARTCLR FX W/OMAN

Facility

$693.00

Service Code	CPT 26740
Hospital Charge Code	22282855
Hospital Revenue Code	450
Min. Negotiated Rate	$623.70
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of AZ Commercial	$623.70
Rate for Payer: Cash Price	$554.40

26740 CLSD TX ARTCLR FX W/OMAN

Facility

$693.00

Service Code	CPT 26740
Hospital Charge Code	22282855
Hospital Revenue Code	450
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna of AZ Commercial	$623.70
Rate for Payer: Arizona Complete Health Allwell	$110.88
Rate for Payer: Banner UC Health Medicare	$110.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$471.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$110.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$110.88
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cigna of AZ Commercial	$485.10
Rate for Payer: Devoted Health Medicare	$124.74
Rate for Payer: Humana of AZ Medicare	$110.88
Rate for Payer: Mercy Care Medicaid	$13.60
Rate for Payer: NaphCare Correctional Healthcare	$13.60
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$471.24
Rate for Payer: TriWest Medicare	$110.88
Rate for Payer: United Healthcare Commercial	$396.40
Rate for Payer: United Healthcare Medicare	$110.88
Rate for Payer: United Healthcare New Mexico Commercial	$131.67
Rate for Payer: Veterans Affairs TRICARE	$109.77

26742 CLSD TX ART FX W/MAN ECH

Facility

$1,472.00

Service Code	CPT 26742
Hospital Charge Code	22282856
Hospital Revenue Code	450
Min. Negotiated Rate	$1,324.80
Max. Negotiated Rate	$1,324.80
Rate for Payer: Aetna of AZ Commercial	$1,324.80
Rate for Payer: Cash Price	$1,177.60

26742 CLSD TX ART FX W/MAN ECH

Facility

$1,472.00

Service Code	CPT 26742
Hospital Charge Code	22282856
Hospital Revenue Code	450
Min. Negotiated Rate	$41.14
Max. Negotiated Rate	$2,488.00
Rate for Payer: Aetna of AZ Commercial	$1,324.80
Rate for Payer: Arizona Complete Health Allwell	$235.52
Rate for Payer: Banner UC Health Medicare	$235.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,000.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$41.14
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$235.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$235.52
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cigna of AZ Commercial	$1,030.40
Rate for Payer: Devoted Health Medicare	$264.96
Rate for Payer: Humana of AZ Medicare	$235.52
Rate for Payer: Mercy Care Medicaid	$41.14
Rate for Payer: NaphCare Correctional Healthcare	$41.14
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$1,000.96
Rate for Payer: TriWest Medicare	$235.52
Rate for Payer: United Healthcare Commercial	$841.98
Rate for Payer: United Healthcare Medicare	$235.52
Rate for Payer: United Healthcare New Mexico Commercial	$279.68
Rate for Payer: Veterans Affairs TRICARE	$233.16

26750 CLD TX METATARSAL

Facility

$650.00

Service Code	CPT 26750
Hospital Charge Code	22282857
Hospital Revenue Code	450
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna of AZ Commercial	$585.00
Rate for Payer: Cash Price	$520.00

26750 CLD TX METATARSAL

Facility

$650.00

Service Code	CPT 26750
Hospital Charge Code	22282857
Hospital Revenue Code	450
Min. Negotiated Rate	$102.96
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna of AZ Commercial	$585.00
Rate for Payer: Arizona Complete Health Allwell	$104.00
Rate for Payer: Banner UC Health Medicare	$104.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$442.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$104.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$104.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Cigna of AZ Commercial	$455.00
Rate for Payer: Devoted Health Medicare	$117.00
Rate for Payer: Humana of AZ Medicare	$104.00
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$442.00
Rate for Payer: TriWest Medicare	$104.00
Rate for Payer: United Healthcare Commercial	$371.80
Rate for Payer: United Healthcare Medicare	$104.00
Rate for Payer: United Healthcare New Mexico Commercial	$123.50
Rate for Payer: Veterans Affairs TRICARE	$102.96

26770 CLD TX IPHAL JT DIS N/AN

Facility

$1,299.00

Service Code	CPT 26770
Hospital Charge Code	22282858
Hospital Revenue Code	450
Min. Negotiated Rate	$28.24
Max. Negotiated Rate	$1,169.10
Rate for Payer: Aetna of AZ Commercial	$1,169.10
Rate for Payer: Arizona Complete Health Allwell	$207.84
Rate for Payer: Banner UC Health Medicare	$207.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$883.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$207.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$207.84
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: Cigna of AZ Commercial	$909.30
Rate for Payer: Devoted Health Medicare	$233.82
Rate for Payer: Humana of AZ Medicare	$207.84
Rate for Payer: Mercy Care Medicaid	$28.24
Rate for Payer: NaphCare Correctional Healthcare	$28.24
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$883.32
Rate for Payer: TriWest Medicare	$207.84
Rate for Payer: United Healthcare Commercial	$743.03
Rate for Payer: United Healthcare Medicare	$207.84
Rate for Payer: United Healthcare New Mexico Commercial	$246.81
Rate for Payer: Veterans Affairs TRICARE	$205.76

26770 CLD TX IPHAL JT DIS N/AN

Facility

$1,299.00

Service Code	CPT 26770
Hospital Charge Code	22282858
Hospital Revenue Code	450
Min. Negotiated Rate	$1,169.10
Max. Negotiated Rate	$1,169.10
Rate for Payer: Aetna of AZ Commercial	$1,169.10
Rate for Payer: Cash Price	$1,039.20

27200 CLSD TX COCCYX FX

Facility

$702.00

Service Code	CPT 27200
Hospital Charge Code	22282859
Hospital Revenue Code	450
Min. Negotiated Rate	$111.20
Max. Negotiated Rate	$631.80
Rate for Payer: Aetna of AZ Commercial	$631.80
Rate for Payer: Arizona Complete Health Allwell	$112.32
Rate for Payer: Banner UC Health Medicare	$112.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$477.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$112.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$112.32
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cigna of AZ Commercial	$491.40
Rate for Payer: Devoted Health Medicare	$126.36
Rate for Payer: Humana of AZ Medicare	$112.32
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$477.36
Rate for Payer: TriWest Medicare	$112.32
Rate for Payer: United Healthcare Commercial	$401.54
Rate for Payer: United Healthcare Medicare	$112.32
Rate for Payer: United Healthcare New Mexico Commercial	$133.38
Rate for Payer: Veterans Affairs TRICARE	$111.20

27200 CLSD TX COCCYX FX

Facility

$702.00

Service Code	CPT 27200
Hospital Charge Code	22282859
Hospital Revenue Code	450
Min. Negotiated Rate	$631.80
Max. Negotiated Rate	$631.80
Rate for Payer: Aetna of AZ Commercial	$631.80
Rate for Payer: Cash Price	$561.60

27246 CLSD TX FX GR TROCH WO/M

Facility

$1,914.00

Service Code	CPT 27246
Hospital Charge Code	22282860
Hospital Revenue Code	450
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$1,722.60
Rate for Payer: Aetna of AZ Commercial	$1,722.60
Rate for Payer: Arizona Complete Health Allwell	$306.24
Rate for Payer: Banner UC Health Medicare	$306.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,301.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3.49
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$306.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$306.24
Rate for Payer: Cash Price	$1,531.20
Rate for Payer: Cash Price	$1,531.20
Rate for Payer: Cigna of AZ Commercial	$1,339.80
Rate for Payer: Devoted Health Medicare	$344.52
Rate for Payer: Humana of AZ Medicare	$306.24
Rate for Payer: Mercy Care Medicaid	$3.49
Rate for Payer: NaphCare Correctional Healthcare	$3.49
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$1,301.52
Rate for Payer: TriWest Medicare	$306.24
Rate for Payer: United Healthcare Commercial	$1,094.81
Rate for Payer: United Healthcare Medicare	$306.24
Rate for Payer: United Healthcare New Mexico Commercial	$363.66
Rate for Payer: Veterans Affairs TRICARE	$303.18

27246 CLSD TX FX GR TROCH WO/M

Facility

$1,914.00

Service Code	CPT 27246
Hospital Charge Code	22282860
Hospital Revenue Code	450
Min. Negotiated Rate	$1,722.60
Max. Negotiated Rate	$1,722.60
Rate for Payer: Aetna of AZ Commercial	$1,722.60
Rate for Payer: Cash Price	$1,531.20

27550 CLSD TX KNEE DIS W/OANES

Facility

$2,723.00

Service Code	CPT 27550
Hospital Charge Code	22282861
Hospital Revenue Code	450
Min. Negotiated Rate	$45.33
Max. Negotiated Rate	$2,450.70
Rate for Payer: Aetna of AZ Commercial	$2,450.70
Rate for Payer: Arizona Complete Health Allwell	$435.68
Rate for Payer: Banner UC Health Medicare	$435.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,851.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$45.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$435.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$435.68
Rate for Payer: Cash Price	$2,178.40
Rate for Payer: Cash Price	$2,178.40
Rate for Payer: Cigna of AZ Commercial	$1,906.10
Rate for Payer: Devoted Health Medicare	$490.14
Rate for Payer: Humana of AZ Medicare	$435.68
Rate for Payer: Mercy Care Medicaid	$45.33
Rate for Payer: NaphCare Correctional Healthcare	$45.33
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$1,851.64
Rate for Payer: TriWest Medicare	$435.68
Rate for Payer: United Healthcare Commercial	$1,557.56
Rate for Payer: United Healthcare Medicare	$435.68
Rate for Payer: United Healthcare New Mexico Commercial	$517.37
Rate for Payer: Veterans Affairs TRICARE	$431.32

27550 CLSD TX KNEE DIS W/OANES

Facility

$2,723.00

Service Code	CPT 27550
Hospital Charge Code	22282861
Hospital Revenue Code	450
Min. Negotiated Rate	$2,450.70
Max. Negotiated Rate	$2,450.70
Rate for Payer: Aetna of AZ Commercial	$2,450.70
Rate for Payer: Cash Price	$2,178.40

Know your out-of-pocket cost for care.

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