Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Estradiol LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	1285575
Hospital Revenue Code	301
Min. Negotiated Rate	$297.90
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Cash Price	$264.80

Estradiol, Sensitive, LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	19106382
Hospital Revenue Code	301
Min. Negotiated Rate	$297.90
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Cash Price	$264.80

Estradiol, Sensitive, LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	19106382
Hospital Revenue Code	301
Min. Negotiated Rate	$40.51
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Arizona Complete Health Allwell	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$225.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.96
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Devoted Health Medicare	$59.58
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Seven Corners Travel Insurance	$40.51
Rate for Payer: Southwest Service Administrators UFCW	$225.08
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: United Healthcare Commercial	$189.33
Rate for Payer: United Healthcare Medicare	$52.96
Rate for Payer: Veterans Affairs TRICARE	$52.43

Estriol, Serum LC

Facility

$327.00

Service Code	CPT 82677
Hospital Charge Code	22200848
Hospital Revenue Code	301
Min. Negotiated Rate	$294.30
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Cash Price	$261.60

Estriol, Serum LC

Facility

$327.00

Service Code	CPT 82677
Hospital Charge Code	22200848
Hospital Revenue Code	301
Min. Negotiated Rate	$35.06
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Arizona Complete Health Allwell	$52.32
Rate for Payer: Banner UC Health Medicare	$52.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$222.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.32
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cigna of AZ Commercial	$212.55
Rate for Payer: Devoted Health Medicare	$58.86
Rate for Payer: Humana of AZ Medicare	$52.32
Rate for Payer: Seven Corners Travel Insurance	$35.06
Rate for Payer: Southwest Service Administrators UFCW	$222.36
Rate for Payer: TriWest Medicare	$52.32
Rate for Payer: United Healthcare Commercial	$187.04
Rate for Payer: United Healthcare Medicare	$52.32
Rate for Payer: Veterans Affairs TRICARE	$51.80

Estrogens, Total LC

Facility

$257.00

Service Code	CPT 82672
Hospital Charge Code	1906843
Hospital Revenue Code	301
Min. Negotiated Rate	$231.30
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Cash Price	$205.60

Estrogens, Total LC

Facility

$257.00

Service Code	CPT 82672
Hospital Charge Code	1906843
Hospital Revenue Code	301
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Arizona Complete Health Allwell	$41.12
Rate for Payer: Banner UC Health Medicare	$41.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$174.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.12
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Devoted Health Medicare	$46.26
Rate for Payer: Humana of AZ Medicare	$41.12
Rate for Payer: Seven Corners Travel Insurance	$31.46
Rate for Payer: Southwest Service Administrators UFCW	$174.76
Rate for Payer: TriWest Medicare	$41.12
Rate for Payer: United Healthcare Commercial	$147.00
Rate for Payer: United Healthcare Medicare	$41.12
Rate for Payer: Veterans Affairs TRICARE	$40.71

Estrone LC

Facility

$295.00

Service Code	CPT 82679
Hospital Charge Code	6738646
Hospital Revenue Code	301
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Arizona Complete Health Allwell	$47.20
Rate for Payer: Banner UC Health Medicare	$47.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$200.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.20
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Devoted Health Medicare	$53.10
Rate for Payer: Humana of AZ Medicare	$47.20
Rate for Payer: Seven Corners Travel Insurance	$36.18
Rate for Payer: Southwest Service Administrators UFCW	$200.60
Rate for Payer: TriWest Medicare	$47.20
Rate for Payer: United Healthcare Commercial	$168.74
Rate for Payer: United Healthcare Medicare	$47.20
Rate for Payer: Veterans Affairs TRICARE	$46.73

Estrone LC

Facility

$295.00

Service Code	CPT 82679
Hospital Charge Code	6738646
Hospital Revenue Code	301
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Cash Price	$236.00

Ethanol, Urine LC

Facility

$132.00

Service Code	HCPCS G6040
Hospital Charge Code	22201906
Hospital Revenue Code	306
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Cash Price	$105.60

Ethanol, Urine LC

Facility

$132.00

Service Code	HCPCS G6040
Hospital Charge Code	22201906
Hospital Revenue Code	306
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna of AZ Commercial	$118.80
Rate for Payer: Arizona Complete Health Allwell	$21.12
Rate for Payer: Banner UC Health Medicare	$21.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$89.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$21.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$21.12
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cigna of AZ Commercial	$85.80
Rate for Payer: Devoted Health Medicare	$23.76
Rate for Payer: Humana of AZ Medicare	$21.12
Rate for Payer: Southwest Service Administrators UFCW	$89.76
Rate for Payer: TriWest Medicare	$21.12
Rate for Payer: United Healthcare Commercial	$75.50
Rate for Payer: United Healthcare Medicare	$21.12
Rate for Payer: Veterans Affairs TRICARE	$20.91

ETHILON SUTURE 2 0 FS

Facility

$71.00

Hospital Charge Code	23770610
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

ETHILON SUTURE 2 0 FS

Facility

$71.00

Hospital Charge Code	23770610
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

ethyl chloride Topical spray-medium stream [CQCH]

Facility

$0.26

Service Code	NDC 386000111
Hospital Charge Code	105921705
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Cash Price	$0.21

ethyl chloride Topical spray-medium stream [CQCH]

Facility

$0.26

Service Code	NDC 386000111
Hospital Charge Code	105921705
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of AZ Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.15
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

etomidate 20 mg Inj Sol [CQCH]

Facility

$4.80

Service Code	NDC 72266014610
Hospital Charge Code	105921770
Hospital Revenue Code	251
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna of AZ Commercial	$4.32
Rate for Payer: Cash Price	$3.84

etomidate 20 mg Inj Sol [CQCH]

Facility

$4.80

Service Code	NDC 72266014610
Hospital Charge Code	105921770
Hospital Revenue Code	251
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna of AZ Commercial	$4.32
Rate for Payer: Arizona Complete Health Allwell	$0.77
Rate for Payer: Banner UC Health Medicare	$0.77
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.26
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.77
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.77
Rate for Payer: Cash Price	$3.84
Rate for Payer: Cigna of AZ Commercial	$3.12
Rate for Payer: Devoted Health Medicare	$0.86
Rate for Payer: Humana of AZ Medicare	$0.77
Rate for Payer: Southwest Service Administrators UFCW	$3.26
Rate for Payer: TriWest Medicare	$0.77
Rate for Payer: United Healthcare Commercial	$2.75
Rate for Payer: United Healthcare Medicare	$0.77
Rate for Payer: Veterans Affairs TRICARE	$0.76

ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLA

Facility

$1,182.00

Service Code	HCPCS J7307
Hospital Charge Code	22758888
Hospital Revenue Code	278
Min. Negotiated Rate	$187.23
Max. Negotiated Rate	$1,063.80
Rate for Payer: Aetna of AZ Commercial	$1,063.80
Rate for Payer: Arizona Complete Health Allwell	$189.12
Rate for Payer: Banner UC Health Medicare	$189.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$803.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$189.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$189.12
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cigna of AZ Commercial	$591.00
Rate for Payer: Devoted Health Medicare	$212.76
Rate for Payer: Humana of AZ Medicare	$189.12
Rate for Payer: Southwest Service Administrators UFCW	$803.76
Rate for Payer: TriWest Medicare	$189.12
Rate for Payer: United Healthcare Commercial	$676.10
Rate for Payer: United Healthcare Medicare	$189.12
Rate for Payer: Veterans Affairs TRICARE	$187.23

ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLA

Facility

$1,182.00

Service Code	HCPCS J7307
Hospital Charge Code	22758888
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,063.80
Rate for Payer: Aetna of AZ Commercial	$1,063.80
Rate for Payer: Cash Price	$945.60

Evacuation of Subungual Hematoma

Facility

$166.00

Service Code	CPT 11740
Hospital Charge Code	7804610
Hospital Revenue Code	521
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Aetna of AZ Commercial	$149.40
Rate for Payer: Cash Price	$132.80

Evacuation of Subungual Hematoma

Facility

$166.00

Service Code	CPT 11740
Hospital Charge Code	7804610
Hospital Revenue Code	521
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$205.86
Rate for Payer: Aetna of AZ Commercial	$149.40
Rate for Payer: Arizona Complete Health Allwell	$26.56
Rate for Payer: Banner UC Health Medicare	$26.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$112.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26.82
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.56
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cigna of AZ Commercial	$116.20
Rate for Payer: Devoted Health Medicare	$29.88
Rate for Payer: Humana of AZ Medicare	$26.56
Rate for Payer: Mercy Care Medicaid	$26.82
Rate for Payer: NaphCare Correctional Healthcare	$26.82
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$112.88
Rate for Payer: TriWest Medicare	$26.56
Rate for Payer: United Healthcare Commercial	$94.95
Rate for Payer: United Healthcare Medicare	$26.56
Rate for Payer: Veterans Affairs TRICARE	$26.29

EXAM OF VAGINA AND CERVIX USING AN ENDOSCOPE

Facility

$470.00

Service Code	CPT 57420
Hospital Charge Code	28068480
Hospital Revenue Code	360
Min. Negotiated Rate	$423.00
Max. Negotiated Rate	$423.00
Rate for Payer: Aetna of AZ Commercial	$423.00
Rate for Payer: Cash Price	$376.00

EXAM OF VAGINA AND CERVIX USING AN ENDOSCOPE

Facility

$470.00

Service Code	CPT 57420
Hospital Charge Code	28068480
Hospital Revenue Code	360
Min. Negotiated Rate	$41.51
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$423.00
Rate for Payer: Arizona Complete Health Allwell	$75.20
Rate for Payer: Banner UC Health Medicare	$41.51
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$319.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$44.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$75.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$75.20
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cigna of AZ Commercial	$235.00
Rate for Payer: Devoted Health Medicare	$84.60
Rate for Payer: Humana of AZ Medicare	$75.20
Rate for Payer: Mercy Care Medicaid	$44.28
Rate for Payer: NaphCare Correctional Healthcare	$41.51
Rate for Payer: Seven Corners Travel Insurance	$471.50
Rate for Payer: Southwest Service Administrators UFCW	$319.60
Rate for Payer: TriWest Medicare	$75.20
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$75.20
Rate for Payer: Veterans Affairs TRICARE	$74.45

Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0

Facility

$960.00

Service Code	CPT 11641
Hospital Charge Code	729121
Hospital Revenue Code	521
Min. Negotiated Rate	$86.19
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$864.00
Rate for Payer: Arizona Complete Health Allwell	$153.60
Rate for Payer: Banner UC Health Medicare	$153.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$652.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$86.19
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$153.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$153.60
Rate for Payer: Cash Price	$768.00
Rate for Payer: Cash Price	$768.00
Rate for Payer: Cigna of AZ Commercial	$672.00
Rate for Payer: Devoted Health Medicare	$172.80
Rate for Payer: Humana of AZ Medicare	$153.60
Rate for Payer: Mercy Care Medicaid	$86.19
Rate for Payer: NaphCare Correctional Healthcare	$86.19
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$652.80
Rate for Payer: TriWest Medicare	$153.60
Rate for Payer: United Healthcare Commercial	$549.12
Rate for Payer: United Healthcare Medicare	$153.60
Rate for Payer: Veterans Affairs TRICARE	$152.06

Excise, Malign Lesion w/Margins, Face, Ears, Eyelids, Nose, Lips; Excised diam 0

Facility

$721.00

Service Code	CPT 11640
Hospital Charge Code	729119
Hospital Revenue Code	521
Min. Negotiated Rate	$648.90
Max. Negotiated Rate	$648.90
Rate for Payer: Aetna of AZ Commercial	$648.90
Rate for Payer: Cash Price	$576.80

Know your out-of-pocket cost for care.

All Charges