Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MASK LARYNGEAL #2 DISPOSABLE

Facility

$44.00

Hospital Charge Code	22570783
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Arizona Complete Health Allwell	$7.04
Rate for Payer: Banner UC Health Medicare	$7.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$29.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.04
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Devoted Health Medicare	$7.92
Rate for Payer: Humana of AZ Medicare	$7.04
Rate for Payer: Southwest Service Administrators UFCW	$29.92
Rate for Payer: TriWest Medicare	$7.04
Rate for Payer: United Healthcare Commercial	$25.17
Rate for Payer: United Healthcare Medicare	$7.04
Rate for Payer: Veterans Affairs TRICARE	$6.97

MASK LARYNGEAL NO. 1 DISPOSABLE

Facility

$41.00

Hospital Charge Code	22570781
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

MASK LARYNGEAL NO. 1 DISPOSABLE

Facility

$41.00

Hospital Charge Code	22570781
Hospital Revenue Code	270
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

MASK LARYNGEAL NO.3 DISPOSABLE

Facility

$65.00

Hospital Charge Code	22354933
Hospital Revenue Code	270
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Cash Price	$52.00

MASK LARYNGEAL NO.3 DISPOSABLE

Facility

$65.00

Hospital Charge Code	22354933
Hospital Revenue Code	270
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Arizona Complete Health Allwell	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.40
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Devoted Health Medicare	$11.70
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Southwest Service Administrators UFCW	$44.20
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: United Healthcare Commercial	$37.18
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: Veterans Affairs TRICARE	$10.30

MASK LARYNGEAL NO.4 DISPOSABLE

Facility

$76.00

Hospital Charge Code	22354934
Hospital Revenue Code	270
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Arizona Complete Health Allwell	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.16
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$53.20
Rate for Payer: Devoted Health Medicare	$13.68
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Southwest Service Administrators UFCW	$51.68
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: United Healthcare Commercial	$43.47
Rate for Payer: United Healthcare Medicare	$12.16
Rate for Payer: Veterans Affairs TRICARE	$12.04

MASK LARYNGEAL NO.4 DISPOSABLE

Facility

$76.00

Hospital Charge Code	22354934
Hospital Revenue Code	270
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Cash Price	$60.80

MASK LARYNGEAL NO.5 DISPOSABLE

Facility

$67.00

Hospital Charge Code	22354935
Hospital Revenue Code	270
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Cash Price	$53.60

MASK LARYNGEAL NO.5 DISPOSABLE

Facility

$67.00

Hospital Charge Code	22354935
Hospital Revenue Code	270
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Arizona Complete Health Allwell	$10.72
Rate for Payer: Banner UC Health Medicare	$10.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$45.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.72
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Devoted Health Medicare	$12.06
Rate for Payer: Humana of AZ Medicare	$10.72
Rate for Payer: Southwest Service Administrators UFCW	$45.56
Rate for Payer: TriWest Medicare	$10.72
Rate for Payer: United Healthcare Commercial	$38.32
Rate for Payer: United Healthcare Medicare	$10.72
Rate for Payer: Veterans Affairs TRICARE	$10.61

MASK NRB ADULT

Facility

$13.00

Hospital Charge Code	22354318
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Cash Price	$10.40

MASK NRB ADULT

Facility

$13.00

Hospital Charge Code	22354318
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Arizona Complete Health Allwell	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.08
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Devoted Health Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Southwest Service Administrators UFCW	$8.84
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: United Healthcare Commercial	$7.44
Rate for Payer: United Healthcare Medicare	$2.08
Rate for Payer: Veterans Affairs TRICARE	$2.06

MASK NRB PEDIATRIC NON-REBREATHER

Facility

$12.00

Hospital Charge Code	22562175
Hospital Revenue Code	272
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

MASK NRB PEDIATRIC NON-REBREATHER

Facility

$12.00

Hospital Charge Code	22562175
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

MASK O2 PED

Facility

$9.00

Hospital Charge Code	22354263
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

MASK O2 PED

Facility

$9.00

Hospital Charge Code	22354263
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

MASK VENTI ADULT

Facility

$47.00

Hospital Charge Code	22355297
Hospital Revenue Code	270
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

MASK VENTI ADULT

Facility

$47.00

Hospital Charge Code	22355297
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

Massage Charges (97124)

Facility

$172.00

Service Code	CPT 97124 GP
Hospital Charge Code	1675794
Hospital Revenue Code	420
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

Massage Charges (97124)

Facility

$172.00

Service Code	CPT 97124 GP
Hospital Charge Code	1675794
Hospital Revenue Code	420
Min. Negotiated Rate	$27.24
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.81
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: United Healthcare New Mexico Commercial	$32.68
Rate for Payer: Veterans Affairs TRICARE	$27.24

MASTECTOMY FOR GYNECOMASTIA

Facility

$6,058.23

Service Code	CPT 19300
Hospital Revenue Code	360
Min. Negotiated Rate	$143.65
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	$143.65
Rate for Payer: Mercy Care Medicaid	$143.65
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

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$24,899.66

Service Code	MSDRG 582
Min. Negotiated Rate	$24,899.66
Max. Negotiated Rate	$24,899.66
Rate for Payer: Seven Corners Travel Insurance	$24,899.66

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$22,286.38

Service Code	MSDRG 583
Min. Negotiated Rate	$22,286.38
Max. Negotiated Rate	$22,286.38
Rate for Payer: Seven Corners Travel Insurance	$22,286.38

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTO

Facility

$1,877.00

Service Code	CPT 19302
Hospital Charge Code	23390088
Hospital Revenue Code	982
Min. Negotiated Rate	$1,689.30
Max. Negotiated Rate	$1,689.30
Rate for Payer: Aetna of AZ Commercial	$1,689.30
Rate for Payer: Cash Price	$1,501.60

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTO

Facility

$1,877.00

Service Code	CPT 19302
Hospital Charge Code	23390088
Hospital Revenue Code	982
Min. Negotiated Rate	$297.32
Max. Negotiated Rate	$10,274.13
Rate for Payer: Aetna of AZ Commercial	$1,689.30
Rate for Payer: Arizona Complete Health Allwell	$300.32
Rate for Payer: Banner UC Health Medicare	$300.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,276.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$300.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$300.32
Rate for Payer: Cash Price	$1,501.60
Rate for Payer: Cash Price	$1,501.60
Rate for Payer: Cigna of AZ Commercial	$1,313.90
Rate for Payer: Devoted Health Medicare	$337.86
Rate for Payer: Humana of AZ Medicare	$300.32
Rate for Payer: Seven Corners Travel Insurance	$10,274.13
Rate for Payer: Southwest Service Administrators UFCW	$1,276.36
Rate for Payer: TriWest Medicare	$300.32
Rate for Payer: United Healthcare Commercial	$1,073.64
Rate for Payer: United Healthcare Medicare	$300.32
Rate for Payer: United Healthcare New Mexico Commercial	$356.63
Rate for Payer: Veterans Affairs TRICARE	$297.32

Mastectomy Procedures

Facility

$17,489.41

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG3622
Min. Negotiated Rate	$17,489.41
Max. Negotiated Rate	$17,489.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,489.41
Rate for Payer: Mercy Care Medicaid	$17,489.41
Rate for Payer: NaphCare Correctional Healthcare	$17,489.41

Know your out-of-pocket cost for care.

All Charges