Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

43760 GASTRO TUBE REPLACEMENT

Facility

$2,159.00

Service Code	CPT 43761
Hospital Charge Code	22282918
Hospital Revenue Code	750
Min. Negotiated Rate	$20.22
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$1,943.10
Rate for Payer: Arizona Complete Health Allwell	$345.44
Rate for Payer: Banner UC Health Medicare	$95.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,468.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$20.22
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$345.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$345.44
Rate for Payer: Cash Price	$1,727.20
Rate for Payer: Cash Price	$1,727.20
Rate for Payer: Cash Price	$1,727.20
Rate for Payer: Cigna of AZ Commercial	$1,511.30
Rate for Payer: Devoted Health Medicare	$388.62
Rate for Payer: Humana of AZ Medicare	$345.44
Rate for Payer: Mercy Care Medicaid	$20.22
Rate for Payer: NaphCare Correctional Healthcare	$95.24
Rate for Payer: Seven Corners Travel Insurance	$386.58
Rate for Payer: Southwest Service Administrators UFCW	$1,468.12
Rate for Payer: TriWest Medicare	$345.44
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$345.44
Rate for Payer: United Healthcare New Mexico Commercial	$410.21
Rate for Payer: Veterans Affairs TRICARE	$341.99

43760 GASTRO TUBE REPLACEMENT

Facility

$2,159.00

Service Code	CPT 43761
Hospital Charge Code	22282918
Hospital Revenue Code	750
Min. Negotiated Rate	$1,943.10
Max. Negotiated Rate	$1,943.10
Rate for Payer: Aetna of AZ Commercial	$1,943.10
Rate for Payer: Cash Price	$1,727.20

45378 PROF DIAGNOSTIC COLONSCOP

Facility

$3,684.00

Service Code	CPT 45378
Hospital Charge Code	22389269
Hospital Revenue Code	750
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$3,315.60
Rate for Payer: Arizona Complete Health Allwell	$589.44
Rate for Payer: Banner UC Health Medicare	$297.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,505.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$158.29
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$589.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$589.44
Rate for Payer: Cash Price	$2,947.20
Rate for Payer: Cash Price	$2,947.20
Rate for Payer: Cash Price	$2,947.20
Rate for Payer: Cigna of AZ Commercial	$2,578.80
Rate for Payer: Devoted Health Medicare	$663.12
Rate for Payer: Humana of AZ Medicare	$589.44
Rate for Payer: Mercy Care Medicaid	$158.29
Rate for Payer: NaphCare Correctional Healthcare	$297.60
Rate for Payer: Seven Corners Travel Insurance	$1,438.89
Rate for Payer: Southwest Service Administrators UFCW	$2,505.12
Rate for Payer: TriWest Medicare	$589.44
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$589.44
Rate for Payer: United Healthcare New Mexico Commercial	$699.96
Rate for Payer: Veterans Affairs TRICARE	$583.55

45378 PROF DIAGNOSTIC COLONSCOP

Facility

$3,684.00

Service Code	CPT 45378
Hospital Charge Code	22389269
Hospital Revenue Code	750
Min. Negotiated Rate	$3,315.60
Max. Negotiated Rate	$3,315.60
Rate for Payer: Aetna of AZ Commercial	$3,315.60
Rate for Payer: Cash Price	$2,947.20

45381 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WI

Facility

$872.00

Service Code	CPT 45381 26
Hospital Charge Code	23597821
Min. Negotiated Rate	$138.12
Max. Negotiated Rate	$784.80
Rate for Payer: Aetna of AZ Commercial	$784.80
Rate for Payer: Arizona Complete Health Allwell	$139.52
Rate for Payer: Banner UC Health Medicare	$139.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$592.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$241.98
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$139.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$139.52
Rate for Payer: Cash Price	$697.60
Rate for Payer: Cash Price	$697.60
Rate for Payer: Cigna of AZ Commercial	$610.40
Rate for Payer: Devoted Health Medicare	$156.96
Rate for Payer: Humana of AZ Medicare	$139.52
Rate for Payer: Mercy Care Medicaid	$241.98
Rate for Payer: NaphCare Correctional Healthcare	$241.98
Rate for Payer: Southwest Service Administrators UFCW	$592.96
Rate for Payer: TriWest Medicare	$139.52
Rate for Payer: United Healthcare Commercial	$498.78
Rate for Payer: United Healthcare Medicare	$139.52
Rate for Payer: Veterans Affairs TRICARE	$138.12

45381 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WI

Facility

$872.00

Service Code	CPT 45381 26
Hospital Charge Code	23597821
Min. Negotiated Rate	$784.80
Max. Negotiated Rate	$784.80
Rate for Payer: Aetna of AZ Commercial	$784.80
Rate for Payer: Cash Price	$697.60

45385 COLONSCOPY W/LESION REMOVAL BY SNARE

Facility

$1,137.00

Service Code	CPT 45385
Hospital Charge Code	22453001
Min. Negotiated Rate	$1,023.30
Max. Negotiated Rate	$1,023.30
Rate for Payer: Aetna of AZ Commercial	$1,023.30
Rate for Payer: Cash Price	$909.60

45385 COLONSCOPY W/LESION REMOVAL BY SNARE

Facility

$1,137.00

Service Code	CPT 45385
Hospital Charge Code	22453001
Min. Negotiated Rate	$180.10
Max. Negotiated Rate	$1,851.53
Rate for Payer: Aetna of AZ Commercial	$1,023.30
Rate for Payer: Arizona Complete Health Allwell	$181.92
Rate for Payer: Banner UC Health Medicare	$181.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$773.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$202.23
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$181.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$181.92
Rate for Payer: Cash Price	$909.60
Rate for Payer: Cash Price	$909.60
Rate for Payer: Cigna of AZ Commercial	$795.90
Rate for Payer: Devoted Health Medicare	$204.66
Rate for Payer: Humana of AZ Medicare	$181.92
Rate for Payer: Mercy Care Medicaid	$202.23
Rate for Payer: NaphCare Correctional Healthcare	$202.23
Rate for Payer: Seven Corners Travel Insurance	$1,851.53
Rate for Payer: Southwest Service Administrators UFCW	$773.16
Rate for Payer: TriWest Medicare	$181.92
Rate for Payer: United Healthcare Commercial	$650.36
Rate for Payer: United Healthcare Medicare	$181.92
Rate for Payer: Veterans Affairs TRICARE	$180.10

46221 BANDING OF INTERNAL HEMORRHOID

Facility

$1,116.00

Service Code	CPT 46221
Hospital Charge Code	22453052
Hospital Revenue Code	982
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$1,438.89
Rate for Payer: Aetna of AZ Commercial	$1,004.40
Rate for Payer: Arizona Complete Health Allwell	$178.56
Rate for Payer: Banner UC Health Medicare	$178.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$758.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$92.75
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$178.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$178.56
Rate for Payer: Cash Price	$892.80
Rate for Payer: Cash Price	$892.80
Rate for Payer: Cigna of AZ Commercial	$781.20
Rate for Payer: Devoted Health Medicare	$200.88
Rate for Payer: Humana of AZ Medicare	$178.56
Rate for Payer: Mercy Care Medicaid	$92.75
Rate for Payer: NaphCare Correctional Healthcare	$92.75
Rate for Payer: Seven Corners Travel Insurance	$1,438.89
Rate for Payer: Southwest Service Administrators UFCW	$758.88
Rate for Payer: TriWest Medicare	$178.56
Rate for Payer: United Healthcare Commercial	$638.35
Rate for Payer: United Healthcare Medicare	$178.56
Rate for Payer: United Healthcare New Mexico Commercial	$212.04
Rate for Payer: Veterans Affairs TRICARE	$176.77

46221 BANDING OF INTERNAL HEMORRHOID

Facility

$1,116.00

Service Code	CPT 46221
Hospital Charge Code	22453052
Hospital Revenue Code	982
Min. Negotiated Rate	$1,004.40
Max. Negotiated Rate	$1,004.40
Rate for Payer: Aetna of AZ Commercial	$1,004.40
Rate for Payer: Cash Price	$892.80

47562 LAPAROSCOPY CHOLECYSTECOM

Facility

$4,585.00

Service Code	CPT 47562 26
Hospital Charge Code	22389357
Min. Negotiated Rate	$726.26
Max. Negotiated Rate	$4,126.50
Rate for Payer: Aetna of AZ Commercial	$4,126.50
Rate for Payer: Arizona Complete Health Allwell	$733.60
Rate for Payer: Banner UC Health Medicare	$733.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,117.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$733.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$733.60
Rate for Payer: Cash Price	$3,668.00
Rate for Payer: Cigna of AZ Commercial	$3,209.50
Rate for Payer: Devoted Health Medicare	$825.30
Rate for Payer: Humana of AZ Medicare	$733.60
Rate for Payer: Southwest Service Administrators UFCW	$3,117.80
Rate for Payer: TriWest Medicare	$733.60
Rate for Payer: United Healthcare Commercial	$2,622.62
Rate for Payer: United Healthcare Medicare	$733.60
Rate for Payer: Veterans Affairs TRICARE	$726.26

47562 LAPAROSCOPY CHOLECYSTECOM

Facility

$4,585.00

Service Code	CPT 47562 26
Hospital Charge Code	22389357
Min. Negotiated Rate	$4,126.50
Max. Negotiated Rate	$4,126.50
Rate for Payer: Aetna of AZ Commercial	$4,126.50
Rate for Payer: Cash Price	$3,668.00

49082 ABDOMINAL PARACENTESIS

Facility

$885.00

Service Code	CPT 49082
Hospital Charge Code	22282919
Hospital Revenue Code	301
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$1,403.35
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	$141.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$601.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$136.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$141.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$51.55
Rate for Payer: Cash Price	$708.00
Rate for Payer: Cash Price	$708.00
Rate for Payer: Cigna of AZ Commercial	$575.25
Rate for Payer: Devoted Health Medicare	$159.30
Rate for Payer: Humana of AZ Medicare	$141.60
Rate for Payer: Mercy Care Medicaid	$136.33
Rate for Payer: NaphCare Correctional Healthcare	$136.33
Rate for Payer: Seven Corners Travel Insurance	$1,403.35
Rate for Payer: Southwest Service Administrators UFCW	$601.80
Rate for Payer: TriWest Medicare	$141.60
Rate for Payer: United Healthcare Commercial	$506.22
Rate for Payer: United Healthcare Medicare	$141.60
Rate for Payer: Veterans Affairs TRICARE	$140.18

49082 ABDOMINAL PARACENTESIS

Facility

$885.00

Service Code	CPT 49082
Hospital Charge Code	22282919
Hospital Revenue Code	301
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

49505 PROF REPAIR INTL INGUN HERNI

Facility

$3,679.00

Service Code	CPT 49505 26
Hospital Charge Code	22389351
Min. Negotiated Rate	$3,311.10
Max. Negotiated Rate	$3,311.10
Rate for Payer: Aetna of AZ Commercial	$3,311.10
Rate for Payer: Cash Price	$2,943.20

49505 PROF REPAIR INTL INGUN HERNI

Facility

$3,679.00

Service Code	CPT 49505 26
Hospital Charge Code	22389351
Min. Negotiated Rate	$582.75
Max. Negotiated Rate	$3,311.10
Rate for Payer: Aetna of AZ Commercial	$3,311.10
Rate for Payer: Arizona Complete Health Allwell	$588.64
Rate for Payer: Banner UC Health Medicare	$588.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,501.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$588.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$588.64
Rate for Payer: Cash Price	$2,943.20
Rate for Payer: Cigna of AZ Commercial	$2,575.30
Rate for Payer: Devoted Health Medicare	$662.22
Rate for Payer: Humana of AZ Medicare	$588.64
Rate for Payer: Southwest Service Administrators UFCW	$2,501.72
Rate for Payer: TriWest Medicare	$588.64
Rate for Payer: United Healthcare Commercial	$2,104.39
Rate for Payer: United Healthcare Medicare	$588.64
Rate for Payer: Veterans Affairs TRICARE	$582.75

4MM OVAL CARBIDE BUR

Facility

$166.00

Hospital Charge Code	27433626
Hospital Revenue Code	270
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$149.40
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 Medicare	$26.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.56
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: 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

4MM OVAL CARBIDE BUR

Facility

$166.00

Hospital Charge Code	27433626
Hospital Revenue Code	270
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

5-0 Polysorb P-13 Violet Braided

Facility

$78.00

Hospital Charge Code	22926431
Hospital Revenue Code	272
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Cash Price	$62.40

5-0 Polysorb P-13 Violet Braided

Facility

$78.00

Hospital Charge Code	22926431
Hospital Revenue Code	272
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Arizona Complete Health Allwell	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.48
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Southwest Service Administrators UFCW	$53.04
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: United Healthcare Commercial	$44.62
Rate for Payer: United Healthcare Medicare	$12.48
Rate for Payer: Veterans Affairs TRICARE	$12.36

5-0 Prolene FS-2

Facility

$56.00

Hospital Charge Code	22926433
Hospital Revenue Code	272
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of AZ Commercial	$50.40
Rate for Payer: Arizona Complete Health Allwell	$8.96
Rate for Payer: Banner UC Health Medicare	$8.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$38.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.96
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cigna of AZ Commercial	$39.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Humana of AZ Medicare	$8.96
Rate for Payer: Southwest Service Administrators UFCW	$38.08
Rate for Payer: TriWest Medicare	$8.96
Rate for Payer: United Healthcare Commercial	$32.03
Rate for Payer: United Healthcare Medicare	$8.96
Rate for Payer: Veterans Affairs TRICARE	$8.87

5-0 Prolene FS-2

Facility

$56.00

Hospital Charge Code	22926433
Hospital Revenue Code	272
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of AZ Commercial	$50.40
Rate for Payer: Cash Price	$44.80

5-0 Vicryl Plus P-3 Undyed Braided

Facility

$17.00

Hospital Charge Code	22926430
Hospital Revenue Code	272
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of AZ Commercial	$15.30
Rate for Payer: Cash Price	$13.60

5-0 Vicryl Plus P-3 Undyed Braided

Facility

$17.00

Hospital Charge Code	22926430
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of AZ Commercial	$15.30
Rate for Payer: Arizona Complete Health Allwell	$2.72
Rate for Payer: Banner UC Health Medicare	$2.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$11.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.72
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cigna of AZ Commercial	$11.90
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Humana of AZ Medicare	$2.72
Rate for Payer: Southwest Service Administrators UFCW	$11.56
Rate for Payer: TriWest Medicare	$2.72
Rate for Payer: United Healthcare Commercial	$9.72
Rate for Payer: United Healthcare Medicare	$2.72
Rate for Payer: Veterans Affairs TRICARE	$2.69

51010 SUPRAPUBIC CATH INSERTIO

Facility

$473.00

Service Code	CPT 51010
Hospital Charge Code	22282920
Hospital Revenue Code	450
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$425.70
Rate for Payer: Aetna of AZ Commercial	$425.70
Rate for Payer: Cash Price	$378.40

Know your out-of-pocket cost for care.

All Charges