Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

51010 SUPRAPUBIC CATH INSERTIO

Facility

$473.00

Service Code	CPT 51010
Hospital Charge Code	22282920
Hospital Revenue Code	450
Min. Negotiated Rate	$74.92
Max. Negotiated Rate	$425.70
Rate for Payer: Aetna of AZ Commercial	$425.70
Rate for Payer: Arizona Complete Health Allwell	$75.68
Rate for Payer: Banner UC Health Medicare	$75.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$321.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$75.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$75.68
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cigna of AZ Commercial	$331.10
Rate for Payer: Devoted Health Medicare	$85.14
Rate for Payer: Humana of AZ Medicare	$75.68
Rate for Payer: Southwest Service Administrators UFCW	$321.64
Rate for Payer: TriWest Medicare	$75.68
Rate for Payer: United Healthcare Commercial	$270.56
Rate for Payer: United Healthcare Medicare	$75.68
Rate for Payer: United Healthcare New Mexico Commercial	$89.87
Rate for Payer: Veterans Affairs TRICARE	$74.92

51701 CATH URETHRA SIMPLE

Facility

$292.00

Service Code	CPT 51701
Hospital Charge Code	22282921
Hospital Revenue Code	450
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Cash Price	$233.60

51701 CATH URETHRA SIMPLE

Facility

$292.00

Service Code	CPT 51701
Hospital Charge Code	22282921
Hospital Revenue Code	450
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Arizona Complete Health Allwell	$46.72
Rate for Payer: Banner UC Health Medicare	$46.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$198.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19.18
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$46.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$46.72
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cigna of AZ Commercial	$204.40
Rate for Payer: Devoted Health Medicare	$52.56
Rate for Payer: Humana of AZ Medicare	$46.72
Rate for Payer: Mercy Care Medicaid	$19.18
Rate for Payer: NaphCare Correctional Healthcare	$19.18
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$198.56
Rate for Payer: TriWest Medicare	$46.72
Rate for Payer: United Healthcare Commercial	$167.02
Rate for Payer: United Healthcare Medicare	$46.72
Rate for Payer: United Healthcare New Mexico Commercial	$55.48
Rate for Payer: Veterans Affairs TRICARE	$46.25

51703 CATH URETHRA COMPLEX

Facility

$425.00

Service Code	CPT 51703
Hospital Charge Code	22282922
Hospital Revenue Code	450
Min. Negotiated Rate	$67.32
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna of AZ Commercial	$382.50
Rate for Payer: Arizona Complete Health Allwell	$68.00
Rate for Payer: Banner UC Health Medicare	$68.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$289.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$73.57
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$68.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$68.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cigna of AZ Commercial	$297.50
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Humana of AZ Medicare	$68.00
Rate for Payer: Mercy Care Medicaid	$73.57
Rate for Payer: NaphCare Correctional Healthcare	$73.57
Rate for Payer: Seven Corners Travel Insurance	$199.09
Rate for Payer: Southwest Service Administrators UFCW	$289.00
Rate for Payer: TriWest Medicare	$68.00
Rate for Payer: United Healthcare Commercial	$243.10
Rate for Payer: United Healthcare Medicare	$68.00
Rate for Payer: United Healthcare New Mexico Commercial	$80.75
Rate for Payer: Veterans Affairs TRICARE	$67.32

51703 CATH URETHRA COMPLEX

Facility

$425.00

Service Code	CPT 51703
Hospital Charge Code	22282922
Hospital Revenue Code	450
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna of AZ Commercial	$382.50
Rate for Payer: Cash Price	$340.00

54161-REMOVAL OF FORESKIN (OLDER THAN 28 DAYS)

Facility

$1,039.00

Service Code	CPT 54161
Hospital Charge Code	28004352
Hospital Revenue Code	360
Min. Negotiated Rate	$164.58
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$935.10
Rate for Payer: Arizona Complete Health Allwell	$166.24
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$706.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$166.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$166.24
Rate for Payer: Cash Price	$831.20
Rate for Payer: Cash Price	$831.20
Rate for Payer: Cash Price	$831.20
Rate for Payer: Cigna of AZ Commercial	$519.50
Rate for Payer: Devoted Health Medicare	$187.02
Rate for Payer: Humana of AZ Medicare	$166.24
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	$706.52
Rate for Payer: TriWest Medicare	$166.24
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$166.24
Rate for Payer: Veterans Affairs TRICARE	$164.58

54161-REMOVAL OF FORESKIN (OLDER THAN 28 DAYS)

Facility

$1,039.00

Service Code	CPT 54161
Hospital Charge Code	28004352
Hospital Revenue Code	360
Min. Negotiated Rate	$935.10
Max. Negotiated Rate	$935.10
Rate for Payer: Aetna of AZ Commercial	$935.10
Rate for Payer: Cash Price	$831.20

54300-REPAIR OF CURVED PENIS

Facility

$3,389.00

Service Code	CPT 54300
Hospital Charge Code	28004351
Hospital Revenue Code	360
Min. Negotiated Rate	$536.82
Max. Negotiated Rate	$5,611.00
Rate for Payer: Aetna of AZ Commercial	$3,050.10
Rate for Payer: Arizona Complete Health Allwell	$542.24
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,304.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$542.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$542.24
Rate for Payer: Cash Price	$2,711.20
Rate for Payer: Cash Price	$2,711.20
Rate for Payer: Cash Price	$2,711.20
Rate for Payer: Cigna of AZ Commercial	$1,694.50
Rate for Payer: Devoted Health Medicare	$610.02
Rate for Payer: Humana of AZ Medicare	$542.24
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$2,304.52
Rate for Payer: TriWest Medicare	$542.24
Rate for Payer: United Healthcare Commercial	$5,611.00
Rate for Payer: United Healthcare Medicare	$542.24
Rate for Payer: Veterans Affairs TRICARE	$536.82

54300-REPAIR OF CURVED PENIS

Facility

$3,389.00

Service Code	CPT 54300
Hospital Charge Code	28004351
Hospital Revenue Code	360
Min. Negotiated Rate	$3,050.10
Max. Negotiated Rate	$3,050.10
Rate for Payer: Aetna of AZ Commercial	$3,050.10
Rate for Payer: Cash Price	$2,711.20

55040-REMOVAL OF FLUID COLLECTION IN TESTICLE AND SPERM RESE

Facility

$1,790.00

Service Code	CPT 55040
Hospital Charge Code	28007318
Hospital Revenue Code	360
Min. Negotiated Rate	$1,611.00
Max. Negotiated Rate	$1,611.00
Rate for Payer: Aetna of AZ Commercial	$1,611.00
Rate for Payer: Cash Price	$1,432.00

55040-REMOVAL OF FLUID COLLECTION IN TESTICLE AND SPERM RESE

Facility

$1,790.00

Service Code	CPT 55040
Hospital Charge Code	28007318
Hospital Revenue Code	360
Min. Negotiated Rate	$283.54
Max. Negotiated Rate	$5,539.84
Rate for Payer: Aetna of AZ Commercial	$1,611.00
Rate for Payer: Arizona Complete Health Allwell	$286.40
Rate for Payer: Banner UC Health Medicare	$1,221.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,217.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$286.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$286.40
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cigna of AZ Commercial	$895.00
Rate for Payer: Devoted Health Medicare	$322.20
Rate for Payer: Humana of AZ Medicare	$286.40
Rate for Payer: NaphCare Correctional Healthcare	$1,221.04
Rate for Payer: Seven Corners Travel Insurance	$5,539.84
Rate for Payer: Southwest Service Administrators UFCW	$1,217.20
Rate for Payer: TriWest Medicare	$286.40
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$286.40
Rate for Payer: Veterans Affairs TRICARE	$283.54

551781 HIV-1 Genosure Archive

Facility

$1,244.00

Hospital Charge Code	23173814
Hospital Revenue Code	301
Min. Negotiated Rate	$197.05
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Arizona Complete Health Allwell	$199.04
Rate for Payer: Banner UC Health Medicare	$199.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$845.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$199.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$199.04
Rate for Payer: Cash Price	$995.20
Rate for Payer: Cigna of AZ Commercial	$808.60
Rate for Payer: Devoted Health Medicare	$223.92
Rate for Payer: Humana of AZ Medicare	$199.04
Rate for Payer: Southwest Service Administrators UFCW	$845.92
Rate for Payer: TriWest Medicare	$199.04
Rate for Payer: United Healthcare Commercial	$711.57
Rate for Payer: United Healthcare Medicare	$199.04
Rate for Payer: Veterans Affairs TRICARE	$197.05

551781 HIV-1 Genosure Archive

Facility

$1,244.00

Hospital Charge Code	23173814
Hospital Revenue Code	301
Min. Negotiated Rate	$1,119.60
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Cash Price	$995.20

55831 PARTIAL REMOVAL OF PROSTATE (RETROPUBIC)

Facility

$4,501.00

Service Code	CPT 55831
Hospital Charge Code	28038099
Hospital Revenue Code	360
Min. Negotiated Rate	$712.96
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$4,050.90
Rate for Payer: Arizona Complete Health Allwell	$720.16
Rate for Payer: Banner UC Health Medicare	$720.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,060.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$720.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$720.16
Rate for Payer: Cash Price	$3,600.80
Rate for Payer: Cash Price	$3,600.80
Rate for Payer: Cigna of AZ Commercial	$2,250.50
Rate for Payer: Devoted Health Medicare	$810.18
Rate for Payer: Humana of AZ Medicare	$720.16
Rate for Payer: Southwest Service Administrators UFCW	$3,060.68
Rate for Payer: TriWest Medicare	$720.16
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$720.16
Rate for Payer: Veterans Affairs TRICARE	$712.96

55831 PARTIAL REMOVAL OF PROSTATE (RETROPUBIC)

Facility

$4,501.00

Service Code	CPT 55831
Hospital Charge Code	28038099
Hospital Revenue Code	360
Min. Negotiated Rate	$4,050.90
Max. Negotiated Rate	$4,050.90
Rate for Payer: Aetna of AZ Commercial	$4,050.90
Rate for Payer: Cash Price	$3,600.80

55840 REMOVAL OF PROSTATE

Facility

$6,110.00

Service Code	CPT 55840
Hospital Charge Code	28035919
Hospital Revenue Code	360
Min. Negotiated Rate	$967.82
Max. Negotiated Rate	$5,499.00
Rate for Payer: Aetna of AZ Commercial	$5,499.00
Rate for Payer: Arizona Complete Health Allwell	$977.60
Rate for Payer: Banner UC Health Medicare	$977.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,154.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$977.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$977.60
Rate for Payer: Cash Price	$4,888.00
Rate for Payer: Cash Price	$4,888.00
Rate for Payer: Cigna of AZ Commercial	$3,055.00
Rate for Payer: Devoted Health Medicare	$1,099.80
Rate for Payer: Humana of AZ Medicare	$977.60
Rate for Payer: Southwest Service Administrators UFCW	$4,154.80
Rate for Payer: TriWest Medicare	$977.60
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$977.60
Rate for Payer: Veterans Affairs TRICARE	$967.82

55840 REMOVAL OF PROSTATE

Facility

$6,110.00

Service Code	CPT 55840
Hospital Charge Code	28035919
Hospital Revenue Code	360
Min. Negotiated Rate	$5,499.00
Max. Negotiated Rate	$5,499.00
Rate for Payer: Aetna of AZ Commercial	$5,499.00
Rate for Payer: Cash Price	$4,888.00

55866 LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICA

Facility

$6,235.00

Service Code	CPT 55866
Hospital Charge Code	28035922
Hospital Revenue Code	360
Min. Negotiated Rate	$5,611.50
Max. Negotiated Rate	$5,611.50
Rate for Payer: Aetna of AZ Commercial	$5,611.50
Rate for Payer: Cash Price	$4,988.00

55866 LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICA

Facility

$6,235.00

Service Code	CPT 55866
Hospital Charge Code	28035922
Hospital Revenue Code	360
Min. Negotiated Rate	$987.62
Max. Negotiated Rate	$16,447.22
Rate for Payer: Aetna of AZ Commercial	$5,611.50
Rate for Payer: Arizona Complete Health Allwell	$997.60
Rate for Payer: Banner UC Health Medicare	$3,457.91
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,239.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$997.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$997.60
Rate for Payer: Cash Price	$4,988.00
Rate for Payer: Cash Price	$4,988.00
Rate for Payer: Cash Price	$4,988.00
Rate for Payer: Cigna of AZ Commercial	$3,117.50
Rate for Payer: Devoted Health Medicare	$1,122.30
Rate for Payer: Humana of AZ Medicare	$997.60
Rate for Payer: NaphCare Correctional Healthcare	$3,457.91
Rate for Payer: Seven Corners Travel Insurance	$16,447.22
Rate for Payer: Southwest Service Administrators UFCW	$4,239.80
Rate for Payer: TriWest Medicare	$997.60
Rate for Payer: United Healthcare Commercial	$7,552.00
Rate for Payer: United Healthcare Medicare	$997.60
Rate for Payer: Veterans Affairs TRICARE	$987.62

56420 INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS

Facility

$694.00

Service Code	CPT 56420
Hospital Charge Code	23008151
Hospital Revenue Code	450
Min. Negotiated Rate	$624.60
Max. Negotiated Rate	$624.60
Rate for Payer: Aetna of AZ Commercial	$624.60
Rate for Payer: Cash Price	$555.20

56420 INCISION AND DRAINAGE OF FEMALE GENITAL GLAND ABSCESS

Facility

$694.00

Service Code	CPT 56420
Hospital Charge Code	23008151
Hospital Revenue Code	450
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$624.60
Rate for Payer: Aetna of AZ Commercial	$624.60
Rate for Payer: Arizona Complete Health Allwell	$111.04
Rate for Payer: Banner UC Health Medicare	$111.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$471.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$75.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$111.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$111.04
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cash Price	$555.20
Rate for Payer: Cigna of AZ Commercial	$485.80
Rate for Payer: Devoted Health Medicare	$124.92
Rate for Payer: Humana of AZ Medicare	$111.04
Rate for Payer: Mercy Care Medicaid	$75.31
Rate for Payer: NaphCare Correctional Healthcare	$75.31
Rate for Payer: Seven Corners Travel Insurance	$312.81
Rate for Payer: Southwest Service Administrators UFCW	$471.92
Rate for Payer: TriWest Medicare	$111.04
Rate for Payer: United Healthcare Commercial	$396.97
Rate for Payer: United Healthcare Medicare	$111.04
Rate for Payer: United Healthcare New Mexico Commercial	$131.86
Rate for Payer: Veterans Affairs TRICARE	$109.93

58301 Removal IUD Clinic Charge

Facility

$512.00

Service Code	CPT 58301
Hospital Charge Code	10197627
Hospital Revenue Code	521
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$471.50
Rate for Payer: Aetna of AZ Commercial	$460.80
Rate for Payer: Arizona Complete Health Allwell	$81.92
Rate for Payer: Banner UC Health Medicare	$81.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$348.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43.93
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$81.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$81.92
Rate for Payer: Cash Price	$409.60
Rate for Payer: Cash Price	$409.60
Rate for Payer: Cigna of AZ Commercial	$358.40
Rate for Payer: Devoted Health Medicare	$92.16
Rate for Payer: Humana of AZ Medicare	$81.92
Rate for Payer: Mercy Care Medicaid	$43.93
Rate for Payer: NaphCare Correctional Healthcare	$43.93
Rate for Payer: Seven Corners Travel Insurance	$471.50
Rate for Payer: Southwest Service Administrators UFCW	$348.16
Rate for Payer: TriWest Medicare	$81.92
Rate for Payer: United Healthcare Commercial	$292.86
Rate for Payer: United Healthcare Medicare	$81.92
Rate for Payer: Veterans Affairs TRICARE	$81.10

58301 Removal IUD Clinic Charge

Facility

$512.00

Service Code	CPT 58301
Hospital Charge Code	10197627
Hospital Revenue Code	521
Min. Negotiated Rate	$460.80
Max. Negotiated Rate	$460.80
Rate for Payer: Aetna of AZ Commercial	$460.80
Rate for Payer: Cash Price	$409.60

58662 LAPAROSCOPY PROCEDURE-OTHER-LOCAL

Facility

$1,424.00

Service Code	CPT 58662 26
Hospital Charge Code	22453039
Min. Negotiated Rate	$225.56
Max. Negotiated Rate	$1,281.60
Rate for Payer: Aetna of AZ Commercial	$1,281.60
Rate for Payer: Arizona Complete Health Allwell	$227.84
Rate for Payer: Banner UC Health Medicare	$227.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$968.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.84
Rate for Payer: Cash Price	$1,139.20
Rate for Payer: Cigna of AZ Commercial	$996.80
Rate for Payer: Devoted Health Medicare	$256.32
Rate for Payer: Humana of AZ Medicare	$227.84
Rate for Payer: Southwest Service Administrators UFCW	$968.32
Rate for Payer: TriWest Medicare	$227.84
Rate for Payer: United Healthcare Commercial	$814.53
Rate for Payer: United Healthcare Medicare	$227.84
Rate for Payer: Veterans Affairs TRICARE	$225.56

58662 LAPAROSCOPY PROCEDURE-OTHER-LOCAL

Facility

$1,424.00

Service Code	CPT 58662 26
Hospital Charge Code	22453039
Min. Negotiated Rate	$1,281.60
Max. Negotiated Rate	$1,281.60
Rate for Payer: Aetna of AZ Commercial	$1,281.60
Rate for Payer: Cash Price	$1,139.20

Know your out-of-pocket cost for care.

All Charges