Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ENDOCLOT SIS

Facility

$525.00

Hospital Charge Code	27537158
Hospital Revenue Code	270
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

ENDOCLOT SIS

Facility

$525.00

Hospital Charge Code	27537158
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

ENDOCRINE DISORDERS WITH CC

Facility

$13,343.39

Service Code	MSDRG 644
Min. Negotiated Rate	$13,343.39
Max. Negotiated Rate	$13,343.39
Rate for Payer: Seven Corners Travel Insurance	$13,343.39

ENDOCRINE DISORDERS WITH MCC

Facility

$21,274.43

Service Code	MSDRG 643
Min. Negotiated Rate	$21,274.43
Max. Negotiated Rate	$21,274.43
Rate for Payer: Seven Corners Travel Insurance	$21,274.43

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$10,090.71

Service Code	MSDRG 645
Min. Negotiated Rate	$10,090.71
Max. Negotiated Rate	$10,090.71
Rate for Payer: Seven Corners Travel Insurance	$10,090.71

ENDO KITS (INFECTION PREVENTION)

Facility

$55.85

Hospital Charge Code	23531708
Hospital Revenue Code	272
Min. Negotiated Rate	$50.27
Max. Negotiated Rate	$50.27
Rate for Payer: Aetna of AZ Commercial	$50.27
Rate for Payer: Cash Price	$44.68

ENDO KITS (INFECTION PREVENTION)

Facility

$55.85

Hospital Charge Code	23531708
Hospital Revenue Code	272
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$50.27
Rate for Payer: Aetna of AZ Commercial	$50.27
Rate for Payer: Arizona Complete Health Allwell	$8.94
Rate for Payer: Banner UC Health Medicare	$8.94
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.98
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.94
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.94
Rate for Payer: Cash Price	$44.68
Rate for Payer: Cigna of AZ Commercial	$39.09
Rate for Payer: Devoted Health Medicare	$10.05
Rate for Payer: Humana of AZ Medicare	$8.94
Rate for Payer: Southwest Service Administrators UFCW	$37.98
Rate for Payer: TriWest Medicare	$8.94
Rate for Payer: United Healthcare Commercial	$31.95
Rate for Payer: United Healthcare Medicare	$8.94
Rate for Payer: Veterans Affairs TRICARE	$8.85

Endometrial Ablation hysteroscopic

Facility

$1,275.00

Service Code	CPT 58563
Hospital Charge Code	27291806
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$1,147.50
Rate for Payer: Aetna of AZ Commercial	$1,147.50
Rate for Payer: Cash Price	$1,020.00

Endometrial Ablation hysteroscopic

Facility

$1,275.00

Service Code	CPT 58563
Hospital Charge Code	27291806
Hospital Revenue Code	360
Min. Negotiated Rate	$201.96
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$1,147.50
Rate for Payer: Arizona Complete Health Allwell	$204.00
Rate for Payer: Banner UC Health Medicare	$1,698.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$867.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$1,756.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$204.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$204.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cigna of AZ Commercial	$637.50
Rate for Payer: Devoted Health Medicare	$229.50
Rate for Payer: Humana of AZ Medicare	$204.00
Rate for Payer: Mercy Care Medicaid	$1,756.60
Rate for Payer: NaphCare Correctional Healthcare	$1,698.98
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: Southwest Service Administrators UFCW	$867.00
Rate for Payer: TriWest Medicare	$204.00
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$204.00
Rate for Payer: Veterans Affairs TRICARE	$201.96

Endometrial Ablation Thermal

Facility

$1,255.00

Service Code	CPT 58353
Hospital Charge Code	27291807
Hospital Revenue Code	360
Min. Negotiated Rate	$198.79
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$1,129.50
Rate for Payer: Arizona Complete Health Allwell	$200.80
Rate for Payer: Banner UC Health Medicare	$1,698.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$853.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$661.77
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$200.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$200.80
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cigna of AZ Commercial	$627.50
Rate for Payer: Devoted Health Medicare	$225.90
Rate for Payer: Humana of AZ Medicare	$200.80
Rate for Payer: Mercy Care Medicaid	$661.77
Rate for Payer: NaphCare Correctional Healthcare	$1,698.98
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: Southwest Service Administrators UFCW	$853.40
Rate for Payer: TriWest Medicare	$200.80
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$200.80
Rate for Payer: Veterans Affairs TRICARE	$198.79

Endometrial Ablation Thermal

Facility

$1,255.00

Service Code	CPT 58353
Hospital Charge Code	27291807
Hospital Revenue Code	360
Min. Negotiated Rate	$1,129.50
Max. Negotiated Rate	$1,129.50
Rate for Payer: Aetna of AZ Commercial	$1,129.50
Rate for Payer: Cash Price	$1,004.00

ENDOMYSIAL AB

Facility

$772.00

Service Code	CPT 86255
Hospital Charge Code	22481473
Hospital Revenue Code	302
Min. Negotiated Rate	$694.80
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Cash Price	$617.60

ENDOMYSIAL AB

Facility

$772.00

Service Code	CPT 86255
Hospital Charge Code	22481473
Hospital Revenue Code	302
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Arizona Complete Health Allwell	$123.52
Rate for Payer: Banner UC Health Medicare	$123.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$524.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$123.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$123.52
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cigna of AZ Commercial	$501.80
Rate for Payer: Devoted Health Medicare	$138.96
Rate for Payer: Humana of AZ Medicare	$123.52
Rate for Payer: Seven Corners Travel Insurance	$17.47
Rate for Payer: Southwest Service Administrators UFCW	$524.96
Rate for Payer: TriWest Medicare	$123.52
Rate for Payer: United Healthcare Commercial	$441.58
Rate for Payer: United Healthcare Medicare	$123.52
Rate for Payer: Veterans Affairs TRICARE	$122.28

Endomysial Ab IgA w/Reflex LC

Facility

$60.00

Service Code	CPT 86231
Hospital Charge Code	28059750
Hospital Revenue Code	302
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$39.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Seven Corners Travel Insurance	$17.53
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: Veterans Affairs TRICARE	$9.50

Endomysial Ab IgA w/Reflex LC

Facility

$60.00

Service Code	CPT 86231
Hospital Charge Code	28059750
Hospital Revenue Code	302
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

Endomysial Antibody IgA LC

Facility

$227.00

Service Code	CPT 86255
Hospital Charge Code	2087582
Hospital Revenue Code	302
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Aetna of AZ Commercial	$641.70
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cash Price	$570.40

Endomysial Antibody IgA LC

Facility

$713.00

Service Code	CPT 86255
Hospital Charge Code	2087582
Hospital Revenue Code	302
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$641.70
Rate for Payer: Aetna of AZ Commercial	$641.70
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Arizona Complete Health Allwell	$36.32
Rate for Payer: Arizona Complete Health Allwell	$114.08
Rate for Payer: Banner UC Health Medicare	$36.32
Rate for Payer: Banner UC Health Medicare	$114.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$484.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$154.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$114.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$114.08
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cigna of AZ Commercial	$463.45
Rate for Payer: Cigna of AZ Commercial	$147.55
Rate for Payer: Devoted Health Medicare	$128.34
Rate for Payer: Devoted Health Medicare	$40.86
Rate for Payer: Humana of AZ Medicare	$36.32
Rate for Payer: Humana of AZ Medicare	$114.08
Rate for Payer: Seven Corners Travel Insurance	$17.47
Rate for Payer: Seven Corners Travel Insurance	$17.47
Rate for Payer: Southwest Service Administrators UFCW	$154.36
Rate for Payer: Southwest Service Administrators UFCW	$484.84
Rate for Payer: TriWest Medicare	$36.32
Rate for Payer: TriWest Medicare	$114.08
Rate for Payer: United Healthcare Commercial	$407.84
Rate for Payer: United Healthcare Commercial	$129.84
Rate for Payer: United Healthcare Medicare	$36.32
Rate for Payer: United Healthcare Medicare	$114.08
Rate for Payer: Veterans Affairs TRICARE	$112.94
Rate for Payer: Veterans Affairs TRICARE	$35.96

ENDO PADDLE RETRACT 12MM

Facility

$2,456.00

Hospital Charge Code	27977761
Hospital Revenue Code	270
Min. Negotiated Rate	$389.03
Max. Negotiated Rate	$2,210.40
Rate for Payer: Aetna of AZ Commercial	$2,210.40
Rate for Payer: Arizona Complete Health Allwell	$392.96
Rate for Payer: Banner UC Health Medicare	$392.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,670.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$392.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$392.96
Rate for Payer: Cash Price	$1,964.80
Rate for Payer: Cigna of AZ Commercial	$1,719.20
Rate for Payer: Devoted Health Medicare	$442.08
Rate for Payer: Humana of AZ Medicare	$392.96
Rate for Payer: Southwest Service Administrators UFCW	$1,670.08
Rate for Payer: TriWest Medicare	$392.96
Rate for Payer: United Healthcare Commercial	$1,404.83
Rate for Payer: United Healthcare Medicare	$392.96
Rate for Payer: Veterans Affairs TRICARE	$389.03

ENDO PADDLE RETRACT 12MM

Facility

$2,456.00

Hospital Charge Code	27977761
Hospital Revenue Code	270
Min. Negotiated Rate	$2,210.40
Max. Negotiated Rate	$2,210.40
Rate for Payer: Aetna of AZ Commercial	$2,210.40
Rate for Payer: Cash Price	$1,964.80

ENDOPATH SCISSORS CURVED 5MM W/ MON CAUT

Facility

$1,403.00

Hospital Charge Code	22354144
Hospital Revenue Code	270
Min. Negotiated Rate	$222.24
Max. Negotiated Rate	$1,262.70
Rate for Payer: Aetna of AZ Commercial	$1,262.70
Rate for Payer: Arizona Complete Health Allwell	$224.48
Rate for Payer: Banner UC Health Medicare	$224.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$954.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$224.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$224.48
Rate for Payer: Cash Price	$1,122.40
Rate for Payer: Cigna of AZ Commercial	$982.10
Rate for Payer: Devoted Health Medicare	$252.54
Rate for Payer: Humana of AZ Medicare	$224.48
Rate for Payer: Southwest Service Administrators UFCW	$954.04
Rate for Payer: TriWest Medicare	$224.48
Rate for Payer: United Healthcare Commercial	$802.52
Rate for Payer: United Healthcare Medicare	$224.48
Rate for Payer: Veterans Affairs TRICARE	$222.24

ENDOPATH SCISSORS CURVED 5MM W/ MON CAUT

Facility

$1,403.00

Hospital Charge Code	22354144
Hospital Revenue Code	270
Min. Negotiated Rate	$1,262.70
Max. Negotiated Rate	$1,262.70
Rate for Payer: Aetna of AZ Commercial	$1,262.70
Rate for Payer: Cash Price	$1,122.40

ENDOPATH STAPLER RELOAD 45MM BLUE

Facility

$12,794.90

Hospital Charge Code	29870427
Hospital Revenue Code	270
Min. Negotiated Rate	$2,026.71
Max. Negotiated Rate	$11,515.41
Rate for Payer: Aetna of AZ Commercial	$11,515.41
Rate for Payer: Arizona Complete Health Allwell	$2,047.18
Rate for Payer: Banner UC Health Medicare	$2,047.18
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8,700.53
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2,047.18
Rate for Payer: Care1st Health Plan Arizona Medicare	$2,047.18
Rate for Payer: Cash Price	$10,235.92
Rate for Payer: Cigna of AZ Commercial	$8,956.43
Rate for Payer: Devoted Health Medicare	$2,303.08
Rate for Payer: Humana of AZ Medicare	$2,047.18
Rate for Payer: Southwest Service Administrators UFCW	$8,700.53
Rate for Payer: TriWest Medicare	$2,047.18
Rate for Payer: United Healthcare Commercial	$7,318.68
Rate for Payer: United Healthcare Medicare	$2,047.18
Rate for Payer: Veterans Affairs TRICARE	$2,026.71

ENDOPATH STAPLER RELOAD 45MM BLUE

Facility

$12,794.90

Hospital Charge Code	29870427
Hospital Revenue Code	270
Min. Negotiated Rate	$11,515.41
Max. Negotiated Rate	$11,515.41
Rate for Payer: Aetna of AZ Commercial	$11,515.41
Rate for Payer: Cash Price	$10,235.92

ENDOPATH STAPLER RELOAD 45MM WHITE

Facility

$12,794.90

Hospital Charge Code	29870426
Hospital Revenue Code	270
Min. Negotiated Rate	$2,026.71
Max. Negotiated Rate	$11,515.41
Rate for Payer: Aetna of AZ Commercial	$11,515.41
Rate for Payer: Arizona Complete Health Allwell	$2,047.18
Rate for Payer: Banner UC Health Medicare	$2,047.18
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8,700.53
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2,047.18
Rate for Payer: Care1st Health Plan Arizona Medicare	$2,047.18
Rate for Payer: Cash Price	$10,235.92
Rate for Payer: Cigna of AZ Commercial	$8,956.43
Rate for Payer: Devoted Health Medicare	$2,303.08
Rate for Payer: Humana of AZ Medicare	$2,047.18
Rate for Payer: Southwest Service Administrators UFCW	$8,700.53
Rate for Payer: TriWest Medicare	$2,047.18
Rate for Payer: United Healthcare Commercial	$7,318.68
Rate for Payer: United Healthcare Medicare	$2,047.18
Rate for Payer: Veterans Affairs TRICARE	$2,026.71

ENDOPATH STAPLER RELOAD 45MM WHITE

Facility

$12,794.90

Hospital Charge Code	29870426
Hospital Revenue Code	270
Min. Negotiated Rate	$11,515.41
Max. Negotiated Rate	$11,515.41
Rate for Payer: Aetna of AZ Commercial	$11,515.41
Rate for Payer: Cash Price	$10,235.92

Know your out-of-pocket cost for care.

All Charges