Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Excision of Cervical Stump (vaginal)

Facility

$2,336.00

Service Code	CPT 57550
Hospital Charge Code	27281897
Hospital Revenue Code	360
Min. Negotiated Rate	$370.02
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$2,102.40
Rate for Payer: Arizona Complete Health Allwell	$373.76
Rate for Payer: Banner UC Health Medicare	$1,698.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,588.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$373.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$373.76
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Cigna of AZ Commercial	$1,168.00
Rate for Payer: Devoted Health Medicare	$420.48
Rate for Payer: Humana of AZ Medicare	$373.76
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	$1,588.48
Rate for Payer: TriWest Medicare	$373.76
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$373.76
Rate for Payer: Veterans Affairs TRICARE	$370.02

Excision of Cervical Stump (vaginal)

Facility

$2,336.00

Service Code	CPT 57550
Hospital Charge Code	27281897
Hospital Revenue Code	360
Min. Negotiated Rate	$2,102.40
Max. Negotiated Rate	$2,102.40
Rate for Payer: Aetna of AZ Commercial	$2,102.40
Rate for Payer: Cash Price	$1,868.80

Excision of Cervical Stump with AP repair

Facility

$3,371.00

Service Code	CPT 57555
Hospital Charge Code	27281898
Hospital Revenue Code	360
Min. Negotiated Rate	$533.97
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$3,033.90
Rate for Payer: Arizona Complete Health Allwell	$539.36
Rate for Payer: Banner UC Health Medicare	$1,698.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,292.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$539.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$539.36
Rate for Payer: Cash Price	$2,696.80
Rate for Payer: Cash Price	$2,696.80
Rate for Payer: Cash Price	$2,696.80
Rate for Payer: Cigna of AZ Commercial	$1,685.50
Rate for Payer: Devoted Health Medicare	$606.78
Rate for Payer: Humana of AZ Medicare	$539.36
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	$2,292.28
Rate for Payer: TriWest Medicare	$539.36
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$539.36
Rate for Payer: Veterans Affairs TRICARE	$533.97

Excision of Cervical Stump with AP repair

Facility

$3,371.00

Service Code	CPT 57555
Hospital Charge Code	27281898
Hospital Revenue Code	360
Min. Negotiated Rate	$3,033.90
Max. Negotiated Rate	$3,033.90
Rate for Payer: Aetna of AZ Commercial	$3,033.90
Rate for Payer: Cash Price	$2,696.80

Excision of Cervical Stump with enterocele repair

Facility

$3,192.00

Service Code	CPT 57556
Hospital Charge Code	27291802
Hospital Revenue Code	360
Min. Negotiated Rate	$2,872.80
Max. Negotiated Rate	$2,872.80
Rate for Payer: Aetna of AZ Commercial	$2,872.80
Rate for Payer: Cash Price	$2,553.60

Excision of Cervical Stump with enterocele repair

Facility

$3,192.00

Service Code	CPT 57556
Hospital Charge Code	27291802
Hospital Revenue Code	360
Min. Negotiated Rate	$505.61
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$2,872.80
Rate for Payer: Arizona Complete Health Allwell	$510.72
Rate for Payer: Banner UC Health Medicare	$1,698.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,170.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$510.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$510.72
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cigna of AZ Commercial	$1,596.00
Rate for Payer: Devoted Health Medicare	$574.56
Rate for Payer: Humana of AZ Medicare	$510.72
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	$2,170.56
Rate for Payer: TriWest Medicare	$510.72
Rate for Payer: United Healthcare Commercial	$5,611.00
Rate for Payer: United Healthcare Medicare	$510.72
Rate for Payer: Veterans Affairs TRICARE	$505.61

Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions

Facility

$6,058.23

Service Code	CPT 19120
Hospital Revenue Code	360
Min. Negotiated Rate	$102.86
Max. Negotiated Rate	$6,058.23
Rate for Payer: Banner UC Health Medicare	$995.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$102.86
Rate for Payer: Mercy Care Medicaid	$102.86
Rate for Payer: NaphCare Correctional Healthcare	$995.48
Rate for Payer: Seven Corners Travel Insurance	$6,058.23
Rate for Payer: United Healthcare Commercial	$4,169.00

Excision of ganglion, wrist (dorsal or volar); primary

Facility

$4,169.00

Service Code	CPT 25111
Hospital Revenue Code	360
Min. Negotiated Rate	$504.49
Max. Negotiated Rate	$4,169.00
Rate for Payer: Banner UC Health Medicare	$504.49
Rate for Payer: NaphCare Correctional Healthcare	$504.49
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: United Healthcare Commercial	$4,169.00

Excision of lesion of tendon sheath or joint capsule (e.g., cyst, mucous cyst, or ganglion), hand or finger

Facility

$3,596.00

Service Code	CPT 26160
Hospital Revenue Code	360
Min. Negotiated Rate	$291.14
Max. Negotiated Rate	$3,596.00
Rate for Payer: Banner UC Health Medicare	$504.49
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$291.14
Rate for Payer: Mercy Care Medicaid	$291.14
Rate for Payer: NaphCare Correctional Healthcare	$504.49
Rate for Payer: Seven Corners Travel Insurance	$2,488.00
Rate for Payer: United Healthcare Commercial	$3,596.00

EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY)

Facility

$1,502.00

Service Code	CPT 28090
Hospital Charge Code	24043267
Hospital Revenue Code	360
Min. Negotiated Rate	$1,351.80
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Cash Price	$1,201.60

EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY)

Facility

$1,502.00

Service Code	CPT 28090
Hospital Charge Code	24043267
Hospital Revenue Code	360
Min. Negotiated Rate	$152.37
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Arizona Complete Health Allwell	$240.32
Rate for Payer: Banner UC Health Medicare	$504.49
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,021.36
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$152.37
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$240.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$240.32
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cigna of AZ Commercial	$751.00
Rate for Payer: Devoted Health Medicare	$270.36
Rate for Payer: Humana of AZ Medicare	$240.32
Rate for Payer: Mercy Care Medicaid	$152.37
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	$1,021.36
Rate for Payer: TriWest Medicare	$240.32
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$240.32
Rate for Payer: Veterans Affairs TRICARE	$237.92

EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) - 28092

Facility

$1,322.00

Service Code	CPT 28092
Hospital Charge Code	24043310
Hospital Revenue Code	360
Min. Negotiated Rate	$1,189.80
Max. Negotiated Rate	$1,189.80
Rate for Payer: Aetna of AZ Commercial	$1,189.80
Rate for Payer: Cash Price	$1,057.60

EXCISION OF LESION TENDON TENDON SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) - 28092

Facility

$1,322.00

Service Code	CPT 28092
Hospital Charge Code	24043310
Hospital Revenue Code	360
Min. Negotiated Rate	$145.05
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,189.80
Rate for Payer: Arizona Complete Health Allwell	$211.52
Rate for Payer: Banner UC Health Medicare	$504.49
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$898.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$145.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$211.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$211.52
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cigna of AZ Commercial	$661.00
Rate for Payer: Devoted Health Medicare	$237.96
Rate for Payer: Humana of AZ Medicare	$211.52
Rate for Payer: Mercy Care Medicaid	$145.05
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	$898.96
Rate for Payer: TriWest Medicare	$211.52
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$211.52
Rate for Payer: Veterans Affairs TRICARE	$209.40

EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), FOR PERMANENT REMOVAL

Facility

$2,671.00

Service Code	CPT 11750
Hospital Revenue Code	490
Min. Negotiated Rate	$55.84
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$55.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$61.87
Rate for Payer: Mercy Care Medicaid	$61.87
Rate for Payer: NaphCare Correctional Healthcare	$55.84
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: United Healthcare Commercial	$2,671.00

EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), FOR PERMANENT REMOVAL

Facility

$2,671.00

Service Code	CPT 11750
Hospital Revenue Code	360
Min. Negotiated Rate	$55.84
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$55.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$61.87
Rate for Payer: Mercy Care Medicaid	$61.87
Rate for Payer: NaphCare Correctional Healthcare	$55.84
Rate for Payer: Seven Corners Travel Insurance	$629.00
Rate for Payer: United Healthcare Commercial	$2,671.00

Excision of pilonidal cyst or sinus; simple

Facility

$4,494.38

Service Code	CPT 11770
Hospital Revenue Code	360
Min. Negotiated Rate	$177.02
Max. Negotiated Rate	$4,494.38
Rate for Payer: Banner UC Health Medicare	$751.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$177.02
Rate for Payer: Mercy Care Medicaid	$177.02
Rate for Payer: NaphCare Correctional Healthcare	$751.83
Rate for Payer: Seven Corners Travel Insurance	$4,494.38
Rate for Payer: United Healthcare Commercial	$4,169.00

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH COMPLEX REPAIR

Facility

$4,494.38

Service Code	CPT 11471
Hospital Revenue Code	360
Min. Negotiated Rate	$203.13
Max. Negotiated Rate	$4,494.38
Rate for Payer: Banner UC Health Medicare	$751.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$203.13
Rate for Payer: Mercy Care Medicaid	$203.13
Rate for Payer: NaphCare Correctional Healthcare	$751.83
Rate for Payer: Seven Corners Travel Insurance	$4,494.38
Rate for Payer: United Healthcare Commercial	$4,169.00

EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY

Facility

$1,669.00

Service Code	CPT 54840
Hospital Charge Code	28262756
Hospital Revenue Code	360
Min. Negotiated Rate	$264.37
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,502.10
Rate for Payer: Arizona Complete Health Allwell	$267.04
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,134.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$267.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$267.04
Rate for Payer: Cash Price	$1,335.20
Rate for Payer: Cash Price	$1,335.20
Rate for Payer: Cash Price	$1,335.20
Rate for Payer: Cigna of AZ Commercial	$834.50
Rate for Payer: Devoted Health Medicare	$300.42
Rate for Payer: Humana of AZ Medicare	$267.04
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$1,134.92
Rate for Payer: TriWest Medicare	$267.04
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$267.04
Rate for Payer: Veterans Affairs TRICARE	$264.37

EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY

Facility

$1,669.00

Service Code	CPT 54840
Hospital Charge Code	28262756
Hospital Revenue Code	360
Min. Negotiated Rate	$1,502.10
Max. Negotiated Rate	$1,502.10
Rate for Payer: Aetna of AZ Commercial	$1,502.10
Rate for Payer: Cash Price	$1,335.20

Excision of vaginal septum

Facility

$885.00

Service Code	CPT 57130
Hospital Charge Code	19665350
Hospital Revenue Code	360
Min. Negotiated Rate	$56.14
Max. Negotiated Rate	$5,008.71
Rate for Payer: Aetna of AZ Commercial	$796.50
Rate for Payer: Arizona Complete Health Allwell	$141.60
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$601.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$56.14
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$141.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$141.60
Rate for Payer: Cash Price	$708.00
Rate for Payer: Cash Price	$708.00
Rate for Payer: Cash Price	$708.00
Rate for Payer: Cigna of AZ Commercial	$442.50
Rate for Payer: Devoted Health Medicare	$159.30
Rate for Payer: Humana of AZ Medicare	$141.60
Rate for Payer: Mercy Care Medicaid	$56.14
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: Southwest Service Administrators UFCW	$601.80
Rate for Payer: TriWest Medicare	$141.60
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$141.60
Rate for Payer: Veterans Affairs TRICARE	$140.18

Excision of vaginal septum

Facility

$885.00

Service Code	CPT 57130
Hospital Charge Code	19665350
Hospital Revenue Code	360
Min. Negotiated Rate	$796.50
Max. Negotiated Rate	$796.50
Rate for Payer: Aetna of AZ Commercial	$796.50
Rate for Payer: Cash Price	$708.00

EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM

Facility

$3,596.00

Service Code	CPT 28043
Hospital Revenue Code	360
Min. Negotiated Rate	$117.50
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	$117.50
Rate for Payer: Mercy Care Medicaid	$117.50
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

Exploration with removal of deep foreign body, forearm or wrist-pro

Facility

$183.00

Service Code	CPT 29055
Hospital Charge Code	11306751
Hospital Revenue Code	521
Min. Negotiated Rate	$164.70
Max. Negotiated Rate	$164.70
Rate for Payer: Aetna of AZ Commercial	$164.70
Rate for Payer: Cash Price	$146.40

Exploration with removal of deep foreign body, forearm or wrist-pro

Facility

$183.00

Service Code	CPT 29055
Hospital Charge Code	11306751
Hospital Revenue Code	521
Min. Negotiated Rate	$28.99
Max. Negotiated Rate	$432.75
Rate for Payer: Aetna of AZ Commercial	$164.70
Rate for Payer: Arizona Complete Health Allwell	$29.28
Rate for Payer: Banner UC Health Medicare	$29.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$124.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$96.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.28
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cigna of AZ Commercial	$128.10
Rate for Payer: Devoted Health Medicare	$32.94
Rate for Payer: Humana of AZ Medicare	$29.28
Rate for Payer: Mercy Care Medicaid	$96.92
Rate for Payer: NaphCare Correctional Healthcare	$96.92
Rate for Payer: Seven Corners Travel Insurance	$432.75
Rate for Payer: Southwest Service Administrators UFCW	$124.44
Rate for Payer: TriWest Medicare	$29.28
Rate for Payer: United Healthcare Commercial	$104.68
Rate for Payer: United Healthcare Medicare	$29.28
Rate for Payer: Veterans Affairs TRICARE	$28.99

Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma

Facility

$49,192.69

Service Code	APR-DRG 9114
Hospital Charge Code	APRDRG9111
Min. Negotiated Rate	$49,192.69
Max. Negotiated Rate	$49,192.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$49,192.69
Rate for Payer: Mercy Care Medicaid	$49,192.69
Rate for Payer: NaphCare Correctional Healthcare	$49,192.69

Know your out-of-pocket cost for care.

All Charges