Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	$864.00
Max. Negotiated Rate	$864.00
Rate for Payer: Aetna of AZ Commercial	$864.00
Rate for Payer: Cash Price	$768.00

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

Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Le

Facility

$456.00

Service Code	CPT 11600
Hospital Charge Code	729109
Hospital Revenue Code	521
Min. Negotiated Rate	$410.40
Max. Negotiated Rate	$410.40
Rate for Payer: Aetna of AZ Commercial	$410.40
Rate for Payer: Cash Price	$364.80

Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.5 cm or Le

Facility

$456.00

Service Code	CPT 11600
Hospital Charge Code	729109
Hospital Revenue Code	521
Min. Negotiated Rate	$72.23
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$410.40
Rate for Payer: Arizona Complete Health Allwell	$72.96
Rate for Payer: Banner UC Health Medicare	$72.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$310.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$79.39
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$72.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$72.96
Rate for Payer: Cash Price	$364.80
Rate for Payer: Cash Price	$364.80
Rate for Payer: Cigna of AZ Commercial	$319.20
Rate for Payer: Devoted Health Medicare	$82.08
Rate for Payer: Humana of AZ Medicare	$72.96
Rate for Payer: Mercy Care Medicaid	$79.39
Rate for Payer: NaphCare Correctional Healthcare	$79.39
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$310.08
Rate for Payer: TriWest Medicare	$72.96
Rate for Payer: United Healthcare Commercial	$260.83
Rate for Payer: United Healthcare Medicare	$72.96
Rate for Payer: Veterans Affairs TRICARE	$72.23

Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.6 to 1.0 c

Facility

$738.00

Service Code	CPT 11601
Hospital Charge Code	729111
Hospital Revenue Code	521
Min. Negotiated Rate	$85.11
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$664.20
Rate for Payer: Arizona Complete Health Allwell	$118.08
Rate for Payer: Banner UC Health Medicare	$118.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$501.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$85.11
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$118.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$118.08
Rate for Payer: Cash Price	$590.40
Rate for Payer: Cash Price	$590.40
Rate for Payer: Cigna of AZ Commercial	$516.60
Rate for Payer: Devoted Health Medicare	$132.84
Rate for Payer: Humana of AZ Medicare	$118.08
Rate for Payer: Mercy Care Medicaid	$85.11
Rate for Payer: NaphCare Correctional Healthcare	$85.11
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$501.84
Rate for Payer: TriWest Medicare	$118.08
Rate for Payer: United Healthcare Commercial	$422.14
Rate for Payer: United Healthcare Medicare	$118.08
Rate for Payer: Veterans Affairs TRICARE	$116.90

Excise, Malign Lesion w/Margins, Trunk, Arms, or Legs; Excised diam 0.6 to 1.0 c

Facility

$738.00

Service Code	CPT 11601
Hospital Charge Code	729111
Hospital Revenue Code	521
Min. Negotiated Rate	$664.20
Max. Negotiated Rate	$664.20
Rate for Payer: Aetna of AZ Commercial	$664.20
Rate for Payer: Cash Price	$590.40

Excise of Nail matrix, Part. or Complete, for Permanent Removal Charge

Facility

$600.00

Service Code	CPT 11750
Hospital Charge Code	749077
Hospital Revenue Code	521
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Cash Price	$480.00

Excise of Nail matrix, Part. or Complete, for Permanent Removal Charge

Facility

$600.00

Service Code	CPT 11750
Hospital Charge Code	749077
Hospital Revenue Code	521
Min. Negotiated Rate	$61.87
Max. Negotiated Rate	$629.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Arizona Complete Health Allwell	$96.00
Rate for Payer: Banner UC Health Medicare	$96.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$408.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$61.87
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$96.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cigna of AZ Commercial	$420.00
Rate for Payer: Devoted Health Medicare	$108.00
Rate for Payer: Humana of AZ Medicare	$96.00
Rate for Payer: Mercy Care Medicaid	$61.87
Rate for Payer: NaphCare Correctional Healthcare	$61.87
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: Southwest Service Administrators UFCW	$408.00
Rate for Payer: TriWest Medicare	$96.00
Rate for Payer: United Healthcare Commercial	$343.20
Rate for Payer: United Healthcare Medicare	$96.00
Rate for Payer: Veterans Affairs TRICARE	$95.04

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

Facility

$3,098.00

Service Code	CPT 11420
Hospital Revenue Code	360
Min. Negotiated Rate	$46.85
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$48.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46.85
Rate for Payer: Mercy Care Medicaid	$46.85
Rate for Payer: NaphCare Correctional Healthcare	$48.30
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: United Healthcare Commercial	$3,098.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm

Facility

$3,596.00

Service Code	CPT 11424
Hospital Revenue Code	360
Min. Negotiated Rate	$60.08
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$60.08
Rate for Payer: Mercy Care Medicaid	$60.08
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: United Healthcare Commercial	$3,596.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less

Facility

$3,098.00

Service Code	CPT 11400
Hospital Revenue Code	360
Min. Negotiated Rate	$46.13
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$52.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46.13
Rate for Payer: Mercy Care Medicaid	$46.13
Rate for Payer: NaphCare Correctional Healthcare	$52.16
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: United Healthcare Commercial	$3,098.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm

Facility

$2,671.00

Service Code	CPT 11401
Hospital Revenue Code	360
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$59.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52.92
Rate for Payer: Mercy Care Medicaid	$52.92
Rate for Payer: NaphCare Correctional Healthcare	$59.32
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: United Healthcare Commercial	$2,671.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm

Facility

$3,098.00

Service Code	CPT 11402
Hospital Revenue Code	360
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$64.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$59.00
Rate for Payer: Mercy Care Medicaid	$59.00
Rate for Payer: NaphCare Correctional Healthcare	$64.83
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: United Healthcare Commercial	$3,098.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm

Facility

$3,098.00

Service Code	CPT 11402
Hospital Revenue Code	490
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$64.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$59.00
Rate for Payer: Mercy Care Medicaid	$59.00
Rate for Payer: NaphCare Correctional Healthcare	$64.83
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: United Healthcare Commercial	$3,098.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm

Facility

$3,098.00

Service Code	CPT 11403
Hospital Revenue Code	490
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$72.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$50.78
Rate for Payer: Mercy Care Medicaid	$50.78
Rate for Payer: NaphCare Correctional Healthcare	$72.37
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: United Healthcare Commercial	$3,098.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm

Facility

$3,098.00

Service Code	CPT 11403
Hospital Revenue Code	360
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$72.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$50.78
Rate for Payer: Mercy Care Medicaid	$50.78
Rate for Payer: NaphCare Correctional Healthcare	$72.37
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: United Healthcare Commercial	$3,098.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm

Facility

$3,596.00

Service Code	CPT 11404
Hospital Revenue Code	360
Min. Negotiated Rate	$62.58
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$62.58
Rate for Payer: Mercy Care Medicaid	$62.58
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: United Healthcare Commercial	$3,596.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm

Facility

$3,596.00

Service Code	CPT 11406
Hospital Revenue Code	360
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$74.74
Rate for Payer: Mercy Care Medicaid	$74.74
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: United Healthcare Commercial	$3,596.00

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm

Facility

$3,596.00

Service Code	CPT 11406
Hospital Revenue Code	490
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$74.74
Rate for Payer: Mercy Care Medicaid	$74.74
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: United Healthcare Commercial	$3,596.00

EXCISION INTERDIGITAL (MORTON) NEUROMA SINGLE EACH

Facility

$1,791.00

Service Code	CPT 28080
Hospital Charge Code	24043265
Hospital Revenue Code	360
Min. Negotiated Rate	$1,611.90
Max. Negotiated Rate	$1,611.90
Rate for Payer: Aetna of AZ Commercial	$1,611.90
Rate for Payer: Cash Price	$1,432.80

EXCISION INTERDIGITAL (MORTON) NEUROMA SINGLE EACH

Facility

$1,791.00

Service Code	CPT 28080
Hospital Charge Code	24043265
Hospital Revenue Code	360
Min. Negotiated Rate	$151.32
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,611.90
Rate for Payer: Arizona Complete Health Allwell	$286.56
Rate for Payer: Banner UC Health Medicare	$504.49
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,217.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$151.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$286.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$286.56
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Cigna of AZ Commercial	$895.50
Rate for Payer: Devoted Health Medicare	$322.38
Rate for Payer: Humana of AZ Medicare	$286.56
Rate for Payer: Mercy Care Medicaid	$151.32
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	$1,217.88
Rate for Payer: TriWest Medicare	$286.56
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$286.56
Rate for Payer: Veterans Affairs TRICARE	$283.69

Excision, malignant lesion face, ears, eyelids, nose, lips; 1.1-2.0 cm Technical

Facility

$1,195.00

Service Code	CPT 11642
Hospital Charge Code	1323595
Hospital Revenue Code	521
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,075.50
Rate for Payer: Aetna of AZ Commercial	$1,075.50
Rate for Payer: Cash Price	$956.00

Excision, malignant lesion face, ears, eyelids, nose, lips; 1.1-2.0 cm Technical

Facility

$1,195.00

Service Code	CPT 11642
Hospital Charge Code	1323595
Hospital Revenue Code	521
Min. Negotiated Rate	$91.55
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$1,075.50
Rate for Payer: Arizona Complete Health Allwell	$191.20
Rate for Payer: Banner UC Health Medicare	$191.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$812.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$91.55
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$191.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$191.20
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cash Price	$956.00
Rate for Payer: Cigna of AZ Commercial	$836.50
Rate for Payer: Devoted Health Medicare	$215.10
Rate for Payer: Humana of AZ Medicare	$191.20
Rate for Payer: Mercy Care Medicaid	$91.55
Rate for Payer: NaphCare Correctional Healthcare	$91.55
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$812.60
Rate for Payer: TriWest Medicare	$191.20
Rate for Payer: United Healthcare Commercial	$683.54
Rate for Payer: United Healthcare Medicare	$191.20
Rate for Payer: Veterans Affairs TRICARE	$189.29

Excision of Cervical Stump

Facility

$4,321.00

Service Code	CPT 57540
Hospital Charge Code	27291793
Hospital Revenue Code	360
Min. Negotiated Rate	$684.45
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$3,888.90
Rate for Payer: Arizona Complete Health Allwell	$691.36
Rate for Payer: Banner UC Health Medicare	$691.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,938.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$691.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$691.36
Rate for Payer: Cash Price	$3,456.80
Rate for Payer: Cash Price	$3,456.80
Rate for Payer: Cigna of AZ Commercial	$2,160.50
Rate for Payer: Devoted Health Medicare	$777.78
Rate for Payer: Humana of AZ Medicare	$691.36
Rate for Payer: Southwest Service Administrators UFCW	$2,938.28
Rate for Payer: TriWest Medicare	$691.36
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$691.36
Rate for Payer: Veterans Affairs TRICARE	$684.45

Excision of Cervical Stump

Facility

$4,321.00

Service Code	CPT 57540
Hospital Charge Code	27291793
Hospital Revenue Code	360
Min. Negotiated Rate	$3,888.90
Max. Negotiated Rate	$3,888.90
Rate for Payer: Aetna of AZ Commercial	$3,888.90
Rate for Payer: Cash Price	$3,456.80

Know your out-of-pocket cost for care.

All Charges