Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Elective Knee Joint Replacement

Facility

$19,383.19

Service Code	APR-DRG 3264
Hospital Charge Code	APRDRG3262
Min. Negotiated Rate	$19,383.19
Max. Negotiated Rate	$19,383.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,383.19
Rate for Payer: Mercy Care Medicaid	$19,383.19
Rate for Payer: NaphCare Correctional Healthcare	$19,383.19

Elective Knee Joint Replacement

Facility

$12,891.73

Service Code	APR-DRG 3263
Hospital Charge Code	APRDRG3263
Min. Negotiated Rate	$12,891.73
Max. Negotiated Rate	$12,891.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,891.73
Rate for Payer: Mercy Care Medicaid	$12,891.73
Rate for Payer: NaphCare Correctional Healthcare	$12,891.73

Elective Knee Joint Replacement

Facility

$19,383.19

Service Code	APR-DRG 3264
Hospital Charge Code	APRDRG3261
Min. Negotiated Rate	$19,383.19
Max. Negotiated Rate	$19,383.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,383.19
Rate for Payer: Mercy Care Medicaid	$19,383.19
Rate for Payer: NaphCare Correctional Healthcare	$19,383.19

ELECT PED QUIK-COMBO RTS PK/2

Facility

$144.08

Service Code	HCPCS A4556
Hospital Charge Code	22354172
Hospital Revenue Code	270
Min. Negotiated Rate	$129.67
Max. Negotiated Rate	$129.67
Rate for Payer: Aetna of AZ Commercial	$129.67
Rate for Payer: Cash Price	$115.26

ELECT PED QUIK-COMBO RTS PK/2

Facility

$144.08

Service Code	HCPCS A4556
Hospital Charge Code	22354172
Hospital Revenue Code	270
Min. Negotiated Rate	$22.82
Max. Negotiated Rate	$129.67
Rate for Payer: Aetna of AZ Commercial	$129.67
Rate for Payer: Arizona Complete Health Allwell	$23.05
Rate for Payer: Banner UC Health Medicare	$23.05
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.05
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.05
Rate for Payer: Cash Price	$115.26
Rate for Payer: Cigna of AZ Commercial	$100.86
Rate for Payer: Devoted Health Medicare	$25.93
Rate for Payer: Humana of AZ Medicare	$23.05
Rate for Payer: Southwest Service Administrators UFCW	$97.97
Rate for Payer: TriWest Medicare	$23.05
Rate for Payer: United Healthcare Commercial	$82.41
Rate for Payer: United Healthcare Medicare	$23.05
Rate for Payer: Veterans Affairs TRICARE	$22.82

ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FO

Facility

$42.00

Service Code	HCPCS G0283
Hospital Charge Code	24152191
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Arizona Complete Health Allwell	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.72
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Southwest Service Administrators UFCW	$28.56
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: United Healthcare Commercial	$24.02
Rate for Payer: United Healthcare Medicare	$6.72
Rate for Payer: Veterans Affairs TRICARE	$6.65

ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FO

Facility

$42.00

Service Code	HCPCS G0283
Hospital Charge Code	24152191
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Cash Price	$33.60

Electrocardiogram

Facility

$219.00

Service Code	CPT 93005
Hospital Charge Code	683593
Hospital Revenue Code	730
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Arizona Complete Health Allwell	$35.04
Rate for Payer: Banner UC Health Medicare	$35.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$148.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.04
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cigna of AZ Commercial	$153.30
Rate for Payer: Devoted Health Medicare	$39.42
Rate for Payer: Humana of AZ Medicare	$35.04
Rate for Payer: Seven Corners Travel Insurance	$91.28
Rate for Payer: Southwest Service Administrators UFCW	$148.92
Rate for Payer: TriWest Medicare	$35.04
Rate for Payer: United Healthcare Commercial	$125.27
Rate for Payer: United Healthcare Medicare	$35.04
Rate for Payer: United Healthcare New Mexico Commercial	$41.61
Rate for Payer: Veterans Affairs TRICARE	$34.69

Electrocardiogram

Facility

$219.00

Service Code	CPT 93005
Hospital Charge Code	683593
Hospital Revenue Code	730
Min. Negotiated Rate	$197.10
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Cash Price	$175.20

ELECTRODE BLADE 6-IN DISP BOVIE EXT TIP

Facility

$27.00

Hospital Charge Code	22355558
Hospital Revenue Code	270
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Cash Price	$21.60

ELECTRODE BLADE 6-IN DISP BOVIE EXT TIP

Facility

$27.00

Hospital Charge Code	22355558
Hospital Revenue Code	270
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Arizona Complete Health Allwell	$4.32
Rate for Payer: Banner UC Health Medicare	$4.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$18.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.32
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$18.90
Rate for Payer: Devoted Health Medicare	$4.86
Rate for Payer: Humana of AZ Medicare	$4.32
Rate for Payer: Southwest Service Administrators UFCW	$18.36
Rate for Payer: TriWest Medicare	$4.32
Rate for Payer: United Healthcare Commercial	$15.44
Rate for Payer: United Healthcare Medicare	$4.32
Rate for Payer: Veterans Affairs TRICARE	$4.28

ELECTRODE BLUE AMBU ECG

Facility

$14.00

Service Code	HCPCS A4556
Hospital Charge Code	22354143
Hospital Revenue Code	270
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Arizona Complete Health Allwell	$2.24
Rate for Payer: Banner UC Health Medicare	$2.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$9.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.24
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$2.24
Rate for Payer: Southwest Service Administrators UFCW	$9.52
Rate for Payer: TriWest Medicare	$2.24
Rate for Payer: United Healthcare Commercial	$8.01
Rate for Payer: United Healthcare Medicare	$2.24
Rate for Payer: Veterans Affairs TRICARE	$2.22

ELECTRODE BLUE AMBU ECG

Facility

$14.00

Service Code	HCPCS A4556
Hospital Charge Code	22354143
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Cash Price	$11.20

ELECTRODE CUTTING LOOP 24-28F OLYMPUS

Facility

$129.00

Hospital Charge Code	22354138
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$90.30
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: Veterans Affairs TRICARE	$20.43

ELECTRODE CUTTING LOOP 24-28F OLYMPUS

Facility

$129.00

Hospital Charge Code	22354138
Hospital Revenue Code	272
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Cash Price	$103.20

ELECTRODE CUTTING LOOP 24F

Facility

$116.00

Hospital Charge Code	22354140
Hospital Revenue Code	270
Min. Negotiated Rate	$18.37
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: Cigna of AZ Commercial	$81.20
Rate for Payer: Devoted Health Medicare	$20.88
Rate for Payer: Humana of AZ Medicare	$18.56
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

ELECTRODE CUTTING LOOP 24F

Facility

$116.00

Hospital Charge Code	22354140
Hospital Revenue Code	270
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

ELECTRODE CUTTING LOOP 24F 12 OLYMPUS

Facility

$3,246.00

Hospital Charge Code	22354280
Hospital Revenue Code	270
Min. Negotiated Rate	$2,921.40
Max. Negotiated Rate	$2,921.40
Rate for Payer: Aetna of AZ Commercial	$2,921.40
Rate for Payer: Cash Price	$2,596.80

ELECTRODE CUTTING LOOP 24F 12 OLYMPUS

Facility

$3,246.00

Hospital Charge Code	22354280
Hospital Revenue Code	270
Min. Negotiated Rate	$514.17
Max. Negotiated Rate	$2,921.40
Rate for Payer: Aetna of AZ Commercial	$2,921.40
Rate for Payer: Arizona Complete Health Allwell	$519.36
Rate for Payer: Banner UC Health Medicare	$519.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,207.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$519.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$519.36
Rate for Payer: Cash Price	$2,596.80
Rate for Payer: Cigna of AZ Commercial	$2,272.20
Rate for Payer: Devoted Health Medicare	$584.28
Rate for Payer: Humana of AZ Medicare	$519.36
Rate for Payer: Southwest Service Administrators UFCW	$2,207.28
Rate for Payer: TriWest Medicare	$519.36
Rate for Payer: United Healthcare Commercial	$1,856.71
Rate for Payer: United Healthcare Medicare	$519.36
Rate for Payer: Veterans Affairs TRICARE	$514.17

ELECTRODE NEEDLE TIP DISP 2-IN BOVIE

Facility

$11.00

Hospital Charge Code	22355518
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Cash Price	$8.80

ELECTRODE NEEDLE TIP DISP 2-IN BOVIE

Facility

$11.00

Hospital Charge Code	22355518
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Arizona Complete Health Allwell	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.76
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Devoted Health Medicare	$1.98
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Southwest Service Administrators UFCW	$7.48
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: United Healthcare Commercial	$6.29
Rate for Payer: United Healthcare Medicare	$1.76
Rate for Payer: Veterans Affairs TRICARE	$1.74

Electro lube

Facility

$214.00

Hospital Charge Code	22926413
Hospital Revenue Code	272
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$192.60
Rate for Payer: Aetna of AZ Commercial	$192.60
Rate for Payer: Arizona Complete Health Allwell	$34.24
Rate for Payer: Banner UC Health Medicare	$34.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$145.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.24
Rate for Payer: Cash Price	$171.20
Rate for Payer: Cigna of AZ Commercial	$149.80
Rate for Payer: Devoted Health Medicare	$38.52
Rate for Payer: Humana of AZ Medicare	$34.24
Rate for Payer: Southwest Service Administrators UFCW	$145.52
Rate for Payer: TriWest Medicare	$34.24
Rate for Payer: United Healthcare Commercial	$122.41
Rate for Payer: United Healthcare Medicare	$34.24
Rate for Payer: Veterans Affairs TRICARE	$33.90

Electro lube

Facility

$214.00

Hospital Charge Code	22926413
Hospital Revenue Code	272
Min. Negotiated Rate	$192.60
Max. Negotiated Rate	$192.60
Rate for Payer: Aetna of AZ Commercial	$192.60
Rate for Payer: Cash Price	$171.20

Electrolyte Panel Standard

Facility

$101.00

Service Code	CPT 80051
Hospital Charge Code	22141054
Hospital Revenue Code	301
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Cash Price	$80.80

Electrolyte Panel Standard

Facility

$101.00

Service Code	CPT 80051
Hospital Charge Code	22141054
Hospital Revenue Code	301
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Arizona Complete Health Allwell	$16.16
Rate for Payer: Banner UC Health Medicare	$16.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$68.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.16
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$65.65
Rate for Payer: Devoted Health Medicare	$18.18
Rate for Payer: Humana of AZ Medicare	$16.16
Rate for Payer: Seven Corners Travel Insurance	$10.16
Rate for Payer: Southwest Service Administrators UFCW	$68.68
Rate for Payer: TriWest Medicare	$16.16
Rate for Payer: United Healthcare Commercial	$57.77
Rate for Payer: United Healthcare Medicare	$16.16
Rate for Payer: Veterans Affairs TRICARE	$16.00

Know your out-of-pocket cost for care.

All Charges