Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

27560 CLSD TX PATELLA DIS WOAN

Facility

$1,326.00

Service Code	CPT 27560
Hospital Charge Code	22282862
Hospital Revenue Code	450
Min. Negotiated Rate	$35.22
Max. Negotiated Rate	$1,193.40
Rate for Payer: Aetna of AZ Commercial	$1,193.40
Rate for Payer: Arizona Complete Health Allwell	$212.16
Rate for Payer: Banner UC Health Medicare	$212.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$901.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$35.22
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$212.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$212.16
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cigna of AZ Commercial	$928.20
Rate for Payer: Devoted Health Medicare	$238.68
Rate for Payer: Humana of AZ Medicare	$212.16
Rate for Payer: Mercy Care Medicaid	$35.22
Rate for Payer: NaphCare Correctional Healthcare	$35.22
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$901.68
Rate for Payer: TriWest Medicare	$212.16
Rate for Payer: United Healthcare Commercial	$758.47
Rate for Payer: United Healthcare Medicare	$212.16
Rate for Payer: United Healthcare New Mexico Commercial	$251.94
Rate for Payer: Veterans Affairs TRICARE	$210.04

27560 CLSD TX PATELLA DIS WOAN

Facility

$1,326.00

Service Code	CPT 27560
Hospital Charge Code	22282862
Hospital Revenue Code	450
Min. Negotiated Rate	$1,193.40
Max. Negotiated Rate	$1,193.40
Rate for Payer: Aetna of AZ Commercial	$1,193.40
Rate for Payer: Cash Price	$1,060.80

27750 CLSD TX FX TIB W/O MANIP

Facility

$1,394.00

Service Code	CPT 27750
Hospital Charge Code	22282863
Hospital Revenue Code	450
Min. Negotiated Rate	$1,254.60
Max. Negotiated Rate	$1,254.60
Rate for Payer: Aetna of AZ Commercial	$1,254.60
Rate for Payer: Cash Price	$1,115.20

27750 CLSD TX FX TIB W/O MANIP

Facility

$1,394.00

Service Code	CPT 27750
Hospital Charge Code	22282863
Hospital Revenue Code	450
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$1,254.60
Rate for Payer: Aetna of AZ Commercial	$1,254.60
Rate for Payer: Arizona Complete Health Allwell	$223.04
Rate for Payer: Banner UC Health Medicare	$223.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$947.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$223.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$223.04
Rate for Payer: Cash Price	$1,115.20
Rate for Payer: Cash Price	$1,115.20
Rate for Payer: Cigna of AZ Commercial	$975.80
Rate for Payer: Devoted Health Medicare	$250.92
Rate for Payer: Humana of AZ Medicare	$223.04
Rate for Payer: Mercy Care Medicaid	$27.20
Rate for Payer: NaphCare Correctional Healthcare	$27.20
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$947.92
Rate for Payer: TriWest Medicare	$223.04
Rate for Payer: United Healthcare Commercial	$797.37
Rate for Payer: United Healthcare Medicare	$223.04
Rate for Payer: United Healthcare New Mexico Commercial	$264.86
Rate for Payer: Veterans Affairs TRICARE	$220.81

27760 CLSD TX FX MMALL WO MANI

Facility

$1,125.00

Service Code	CPT 27760
Hospital Charge Code	22282864
Hospital Revenue Code	450
Min. Negotiated Rate	$27.89
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna of AZ Commercial	$1,012.50
Rate for Payer: Arizona Complete Health Allwell	$180.00
Rate for Payer: Banner UC Health Medicare	$180.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$765.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.89
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$180.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$180.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cigna of AZ Commercial	$787.50
Rate for Payer: Devoted Health Medicare	$202.50
Rate for Payer: Humana of AZ Medicare	$180.00
Rate for Payer: Mercy Care Medicaid	$27.89
Rate for Payer: NaphCare Correctional Healthcare	$27.89
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$765.00
Rate for Payer: TriWest Medicare	$180.00
Rate for Payer: United Healthcare Commercial	$643.50
Rate for Payer: United Healthcare Medicare	$180.00
Rate for Payer: United Healthcare New Mexico Commercial	$213.75
Rate for Payer: Veterans Affairs TRICARE	$178.20

27760 CLSD TX FX MMALL WO MANI

Facility

$1,125.00

Service Code	CPT 27760
Hospital Charge Code	22282864
Hospital Revenue Code	450
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna of AZ Commercial	$1,012.50
Rate for Payer: Cash Price	$900.00

27780 CLSD TX FX PRX FIBWO/MAN

Facility

$991.00

Service Code	CPT 27780
Hospital Charge Code	22282865
Hospital Revenue Code	450
Min. Negotiated Rate	$891.90
Max. Negotiated Rate	$891.90
Rate for Payer: Aetna of AZ Commercial	$891.90
Rate for Payer: Cash Price	$792.80

27780 CLSD TX FX PRX FIBWO/MAN

Facility

$991.00

Service Code	CPT 27780
Hospital Charge Code	22282865
Hospital Revenue Code	450
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$891.90
Rate for Payer: Aetna of AZ Commercial	$891.90
Rate for Payer: Arizona Complete Health Allwell	$158.56
Rate for Payer: Banner UC Health Medicare	$158.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$673.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26.50
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$158.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$158.56
Rate for Payer: Cash Price	$792.80
Rate for Payer: Cash Price	$792.80
Rate for Payer: Cigna of AZ Commercial	$693.70
Rate for Payer: Devoted Health Medicare	$178.38
Rate for Payer: Humana of AZ Medicare	$158.56
Rate for Payer: Mercy Care Medicaid	$26.50
Rate for Payer: NaphCare Correctional Healthcare	$26.50
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$673.88
Rate for Payer: TriWest Medicare	$158.56
Rate for Payer: United Healthcare Commercial	$566.85
Rate for Payer: United Healthcare Medicare	$158.56
Rate for Payer: United Healthcare New Mexico Commercial	$188.29
Rate for Payer: Veterans Affairs TRICARE	$156.97

27781 CLSD TX FX PROX FIB W/MA

Facility

$1,705.00

Service Code	CPT 27781
Hospital Charge Code	22282866
Hospital Revenue Code	450
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$2,488.00
Rate for Payer: Aetna of AZ Commercial	$1,534.50
Rate for Payer: Arizona Complete Health Allwell	$272.80
Rate for Payer: Banner UC Health Medicare	$272.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,159.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$36.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$272.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$272.80
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Cigna of AZ Commercial	$1,193.50
Rate for Payer: Devoted Health Medicare	$306.90
Rate for Payer: Humana of AZ Medicare	$272.80
Rate for Payer: Mercy Care Medicaid	$36.96
Rate for Payer: NaphCare Correctional Healthcare	$36.96
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$1,159.40
Rate for Payer: TriWest Medicare	$272.80
Rate for Payer: United Healthcare Commercial	$975.26
Rate for Payer: United Healthcare Medicare	$272.80
Rate for Payer: United Healthcare New Mexico Commercial	$323.95
Rate for Payer: Veterans Affairs TRICARE	$270.07

27781 CLSD TX FX PROX FIB W/MA

Facility

$1,705.00

Service Code	CPT 27781
Hospital Charge Code	22282866
Hospital Revenue Code	450
Min. Negotiated Rate	$1,534.50
Max. Negotiated Rate	$1,534.50
Rate for Payer: Aetna of AZ Commercial	$1,534.50
Rate for Payer: Cash Price	$1,364.00

27786 CLSD TX FX DIS FIB WO/MA

Facility

$1,076.00

Service Code	CPT 27786
Hospital Charge Code	22282867
Hospital Revenue Code	450
Min. Negotiated Rate	$28.24
Max. Negotiated Rate	$968.40
Rate for Payer: Aetna of AZ Commercial	$968.40
Rate for Payer: Arizona Complete Health Allwell	$172.16
Rate for Payer: Banner UC Health Medicare	$172.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$731.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$172.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$172.16
Rate for Payer: Cash Price	$860.80
Rate for Payer: Cash Price	$860.80
Rate for Payer: Cigna of AZ Commercial	$753.20
Rate for Payer: Devoted Health Medicare	$193.68
Rate for Payer: Humana of AZ Medicare	$172.16
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	$731.68
Rate for Payer: TriWest Medicare	$172.16
Rate for Payer: United Healthcare Commercial	$615.47
Rate for Payer: United Healthcare Medicare	$172.16
Rate for Payer: United Healthcare New Mexico Commercial	$204.44
Rate for Payer: Veterans Affairs TRICARE	$170.44

27786 CLSD TX FX DIS FIB WO/MA

Facility

$1,076.00

Service Code	CPT 27786
Hospital Charge Code	22282867
Hospital Revenue Code	450
Min. Negotiated Rate	$968.40
Max. Negotiated Rate	$968.40
Rate for Payer: Aetna of AZ Commercial	$968.40
Rate for Payer: Cash Price	$860.80

27788 CLSD TX FX DISTFIB W/M

Facility

$1,467.00

Service Code	CPT 27788
Hospital Charge Code	22282868
Hospital Revenue Code	450
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$1,320.30
Rate for Payer: Aetna of AZ Commercial	$1,320.30
Rate for Payer: Arizona Complete Health Allwell	$234.72
Rate for Payer: Banner UC Health Medicare	$234.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$997.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43.93
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$234.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$234.72
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Cigna of AZ Commercial	$1,026.90
Rate for Payer: Devoted Health Medicare	$264.06
Rate for Payer: Humana of AZ Medicare	$234.72
Rate for Payer: Mercy Care Medicaid	$43.93
Rate for Payer: NaphCare Correctional Healthcare	$43.93
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$997.56
Rate for Payer: TriWest Medicare	$234.72
Rate for Payer: United Healthcare Commercial	$839.12
Rate for Payer: United Healthcare Medicare	$234.72
Rate for Payer: United Healthcare New Mexico Commercial	$278.73
Rate for Payer: Veterans Affairs TRICARE	$232.37

27788 CLSD TX FX DISTFIB W/M

Facility

$1,467.00

Service Code	CPT 27788
Hospital Charge Code	22282868
Hospital Revenue Code	450
Min. Negotiated Rate	$1,320.30
Max. Negotiated Rate	$1,320.30
Rate for Payer: Aetna of AZ Commercial	$1,320.30
Rate for Payer: Cash Price	$1,173.60

27808 CLD TX FX BIMALL AKL WOM

Facility

$1,288.00

Service Code	CPT 27808
Hospital Charge Code	22282869
Hospital Revenue Code	450
Min. Negotiated Rate	$1,159.20
Max. Negotiated Rate	$1,159.20
Rate for Payer: Aetna of AZ Commercial	$1,159.20
Rate for Payer: Cash Price	$1,030.40

27808 CLD TX FX BIMALL AKL WOM

Facility

$1,288.00

Service Code	CPT 27808
Hospital Charge Code	22282869
Hospital Revenue Code	450
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$1,159.20
Rate for Payer: Aetna of AZ Commercial	$1,159.20
Rate for Payer: Arizona Complete Health Allwell	$206.08
Rate for Payer: Banner UC Health Medicare	$206.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$875.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32.77
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$206.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$206.08
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Cigna of AZ Commercial	$901.60
Rate for Payer: Devoted Health Medicare	$231.84
Rate for Payer: Humana of AZ Medicare	$206.08
Rate for Payer: Mercy Care Medicaid	$32.77
Rate for Payer: NaphCare Correctional Healthcare	$32.77
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$875.84
Rate for Payer: TriWest Medicare	$206.08
Rate for Payer: United Healthcare Commercial	$736.74
Rate for Payer: United Healthcare Medicare	$206.08
Rate for Payer: United Healthcare New Mexico Commercial	$244.72
Rate for Payer: Veterans Affairs TRICARE	$204.02

27810 CLSD TXFXBIMALL ANKLN/MN

Facility

$2,881.00

Service Code	CPT 27810
Hospital Charge Code	22282870
Hospital Revenue Code	450
Min. Negotiated Rate	$2,592.90
Max. Negotiated Rate	$2,592.90
Rate for Payer: Aetna of AZ Commercial	$2,592.90
Rate for Payer: Cash Price	$2,304.80

27810 CLSD TXFXBIMALL ANKLN/MN

Facility

$2,881.00

Service Code	CPT 27810
Hospital Charge Code	22282870
Hospital Revenue Code	450
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$2,592.90
Rate for Payer: Aetna of AZ Commercial	$2,592.90
Rate for Payer: Arizona Complete Health Allwell	$460.96
Rate for Payer: Banner UC Health Medicare	$460.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,959.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$50.90
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$460.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$460.96
Rate for Payer: Cash Price	$2,304.80
Rate for Payer: Cash Price	$2,304.80
Rate for Payer: Cigna of AZ Commercial	$2,016.70
Rate for Payer: Devoted Health Medicare	$518.58
Rate for Payer: Humana of AZ Medicare	$460.96
Rate for Payer: Mercy Care Medicaid	$50.90
Rate for Payer: NaphCare Correctional Healthcare	$50.90
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: Southwest Service Administrators UFCW	$1,959.08
Rate for Payer: TriWest Medicare	$460.96
Rate for Payer: United Healthcare Commercial	$1,647.93
Rate for Payer: United Healthcare Medicare	$460.96
Rate for Payer: United Healthcare New Mexico Commercial	$547.39
Rate for Payer: Veterans Affairs TRICARE	$456.35

27840 CLSD TX AKLE DIS W/O ANE

Facility

$1,675.00

Service Code	CPT 27840
Hospital Charge Code	22282871
Hospital Revenue Code	450
Min. Negotiated Rate	$265.32
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna of AZ Commercial	$1,507.50
Rate for Payer: Arizona Complete Health Allwell	$268.00
Rate for Payer: Banner UC Health Medicare	$268.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,139.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$268.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$268.00
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cigna of AZ Commercial	$1,172.50
Rate for Payer: Devoted Health Medicare	$301.50
Rate for Payer: Humana of AZ Medicare	$268.00
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$1,139.00
Rate for Payer: TriWest Medicare	$268.00
Rate for Payer: United Healthcare Commercial	$958.10
Rate for Payer: United Healthcare Medicare	$268.00
Rate for Payer: United Healthcare New Mexico Commercial	$318.25
Rate for Payer: Veterans Affairs TRICARE	$265.32

27840 CLSD TX AKLE DIS W/O ANE

Facility

$1,675.00

Service Code	CPT 27840
Hospital Charge Code	22282871
Hospital Revenue Code	450
Min. Negotiated Rate	$1,507.50
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna of AZ Commercial	$1,507.50
Rate for Payer: Cash Price	$1,340.00

28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH

Facility

$1,549.00

Service Code	CPT 28108
Hospital Charge Code	27410736
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

28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH

Facility

$1,549.00

Service Code	CPT 28108
Hospital Charge Code	27410736
Hospital Revenue Code	360
Min. Negotiated Rate	$141.22
Max. Negotiated Rate	$4,169.00
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	$504.49
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,053.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$141.22
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	$141.22
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	$1,053.32
Rate for Payer: TriWest Medicare	$247.84
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$247.84
Rate for Payer: Veterans Affairs TRICARE	$245.36

28475 Closed tx of metatarsal fx, with manipulation each

Facility

$518.00

Service Code	CPT 28470
Hospital Charge Code	22009906
Hospital Revenue Code	521
Min. Negotiated Rate	$466.20
Max. Negotiated Rate	$466.20
Rate for Payer: Aetna of AZ Commercial	$466.20
Rate for Payer: Cash Price	$414.40

28475 Closed tx of metatarsal fx, with manipulation each

Facility

$518.00

Service Code	CPT 28470
Hospital Charge Code	22009906
Hospital Revenue Code	521
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$466.20
Rate for Payer: Aetna of AZ Commercial	$466.20
Rate for Payer: Arizona Complete Health Allwell	$82.88
Rate for Payer: Banner UC Health Medicare	$82.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$352.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12.90
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$82.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$82.88
Rate for Payer: Cash Price	$414.40
Rate for Payer: Cash Price	$414.40
Rate for Payer: Cigna of AZ Commercial	$362.60
Rate for Payer: Devoted Health Medicare	$93.24
Rate for Payer: Humana of AZ Medicare	$82.88
Rate for Payer: Mercy Care Medicaid	$12.90
Rate for Payer: NaphCare Correctional Healthcare	$12.90
Rate for Payer: Seven Corners Travel Insurance	$381.65
Rate for Payer: Southwest Service Administrators UFCW	$352.24
Rate for Payer: TriWest Medicare	$82.88
Rate for Payer: United Healthcare Commercial	$296.30
Rate for Payer: United Healthcare Medicare	$82.88
Rate for Payer: Veterans Affairs TRICARE	$82.05

28490 CLSD TX FX GR TOE W/O MA

Facility

$457.00

Service Code	CPT 28490
Hospital Charge Code	22282872
Hospital Revenue Code	450
Min. Negotiated Rate	$411.30
Max. Negotiated Rate	$411.30
Rate for Payer: Aetna of AZ Commercial	$411.30
Rate for Payer: Cash Price	$365.60

Know your out-of-pocket cost for care.

All Charges