Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MRI UE Non Joint w/ + w/o Contrast Bilat

Facility

$2,481.00

Service Code	CPT 73220 50
Hospital Charge Code	1007522
Hospital Revenue Code	610
Min. Negotiated Rate	$392.99
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Arizona Complete Health Allwell	$396.96
Rate for Payer: Banner UC Health Medicare	$396.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,687.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$396.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$396.96
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Devoted Health Medicare	$446.58
Rate for Payer: Humana of AZ Medicare	$396.96
Rate for Payer: Southwest Service Administrators UFCW	$1,687.08
Rate for Payer: TriWest Medicare	$396.96
Rate for Payer: United Healthcare Commercial	$1,419.13
Rate for Payer: United Healthcare Medicare	$396.96
Rate for Payer: United Healthcare New Mexico Commercial	$471.39
Rate for Payer: Veterans Affairs TRICARE	$392.99

MRI UE Non Joint w/ + w/o Contrast Left

Facility

$2,481.00

Service Code	CPT 73220 LT
Hospital Charge Code	1007524
Hospital Revenue Code	610
Min. Negotiated Rate	$392.99
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Arizona Complete Health Allwell	$396.96
Rate for Payer: Banner UC Health Medicare	$396.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,687.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$396.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$396.96
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Devoted Health Medicare	$446.58
Rate for Payer: Humana of AZ Medicare	$396.96
Rate for Payer: Southwest Service Administrators UFCW	$1,687.08
Rate for Payer: TriWest Medicare	$396.96
Rate for Payer: United Healthcare Commercial	$1,419.13
Rate for Payer: United Healthcare Medicare	$396.96
Rate for Payer: United Healthcare New Mexico Commercial	$471.39
Rate for Payer: Veterans Affairs TRICARE	$392.99

MRI UE Non Joint w/ + w/o Contrast Left

Facility

$2,481.00

Service Code	CPT 73220 LT
Hospital Charge Code	1007524
Hospital Revenue Code	610
Min. Negotiated Rate	$2,232.90
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Cash Price	$1,984.80

MRI UE Non Joint w/ + w/o Contrast Right

Facility

$2,481.00

Service Code	CPT 73220 RT
Hospital Charge Code	1007526
Hospital Revenue Code	610
Min. Negotiated Rate	$392.99
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Arizona Complete Health Allwell	$396.96
Rate for Payer: Banner UC Health Medicare	$396.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,687.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$396.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$396.96
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Devoted Health Medicare	$446.58
Rate for Payer: Humana of AZ Medicare	$396.96
Rate for Payer: Southwest Service Administrators UFCW	$1,687.08
Rate for Payer: TriWest Medicare	$396.96
Rate for Payer: United Healthcare Commercial	$1,419.13
Rate for Payer: United Healthcare Medicare	$396.96
Rate for Payer: United Healthcare New Mexico Commercial	$471.39
Rate for Payer: Veterans Affairs TRICARE	$392.99

MRI UE Non Joint w/ + w/o Contrast Right

Facility

$2,481.00

Service Code	CPT 73220 RT
Hospital Charge Code	1007526
Hospital Revenue Code	610
Min. Negotiated Rate	$2,232.90
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Cash Price	$1,984.80

MRSA Screen Culture

Facility

$127.00

Service Code	CPT 87081
Hospital Charge Code	1164500
Hospital Revenue Code	306
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of AZ Commercial	$114.30
Rate for Payer: Arizona Complete Health Allwell	$20.32
Rate for Payer: Banner UC Health Medicare	$20.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$86.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.32
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cigna of AZ Commercial	$82.55
Rate for Payer: Devoted Health Medicare	$22.86
Rate for Payer: Humana of AZ Medicare	$20.32
Rate for Payer: Seven Corners Travel Insurance	$9.61
Rate for Payer: Southwest Service Administrators UFCW	$86.36
Rate for Payer: TriWest Medicare	$20.32
Rate for Payer: United Healthcare Commercial	$72.64
Rate for Payer: United Healthcare Medicare	$20.32
Rate for Payer: Veterans Affairs TRICARE	$20.12

MRSA Screen Culture

Facility

$127.00

Service Code	CPT 87081
Hospital Charge Code	1164500
Hospital Revenue Code	306
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of AZ Commercial	$114.30
Rate for Payer: Cash Price	$101.60

MRV Head w/o Contrast

Facility

$3,247.00

Service Code	CPT 70544
Hospital Charge Code	1005367
Hospital Revenue Code	610
Min. Negotiated Rate	$369.18
Max. Negotiated Rate	$2,922.30
Rate for Payer: Aetna of AZ Commercial	$2,922.30
Rate for Payer: Arizona Complete Health Allwell	$519.52
Rate for Payer: Banner UC Health Medicare	$519.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,207.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$519.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$519.52
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Cigna of AZ Commercial	$2,272.90
Rate for Payer: Devoted Health Medicare	$584.46
Rate for Payer: Humana of AZ Medicare	$519.52
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$2,207.96
Rate for Payer: TriWest Medicare	$519.52
Rate for Payer: United Healthcare Commercial	$1,857.28
Rate for Payer: United Healthcare Medicare	$519.52
Rate for Payer: United Healthcare New Mexico Commercial	$616.93
Rate for Payer: Veterans Affairs TRICARE	$514.32

MRV Head w/o Contrast

Facility

$3,085.00

Service Code	CPT 70544
Hospital Charge Code	1003592
Hospital Revenue Code	610
Min. Negotiated Rate	$369.18
Max. Negotiated Rate	$2,776.50
Rate for Payer: Aetna of AZ Commercial	$2,776.50
Rate for Payer: Arizona Complete Health Allwell	$493.60
Rate for Payer: Banner UC Health Medicare	$493.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,097.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$493.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$493.60
Rate for Payer: Cash Price	$2,468.00
Rate for Payer: Cash Price	$2,468.00
Rate for Payer: Cigna of AZ Commercial	$2,159.50
Rate for Payer: Devoted Health Medicare	$555.30
Rate for Payer: Humana of AZ Medicare	$493.60
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$2,097.80
Rate for Payer: TriWest Medicare	$493.60
Rate for Payer: United Healthcare Commercial	$1,764.62
Rate for Payer: United Healthcare Medicare	$493.60
Rate for Payer: United Healthcare New Mexico Commercial	$586.15
Rate for Payer: Veterans Affairs TRICARE	$488.66

MRV Head w/o Contrast

Facility

$1,985.00

Service Code	CPT 70544
Hospital Charge Code	1007574
Hospital Revenue Code	610
Min. Negotiated Rate	$1,786.50
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Cash Price	$1,588.00

MRV Head w/o Contrast

Facility

$1,985.00

Service Code	CPT 70544
Hospital Charge Code	1007574
Hospital Revenue Code	610
Min. Negotiated Rate	$314.42
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Arizona Complete Health Allwell	$317.60
Rate for Payer: Banner UC Health Medicare	$317.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,349.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$317.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$317.60
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cigna of AZ Commercial	$1,389.50
Rate for Payer: Devoted Health Medicare	$357.30
Rate for Payer: Humana of AZ Medicare	$317.60
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,349.80
Rate for Payer: TriWest Medicare	$317.60
Rate for Payer: United Healthcare Commercial	$1,135.42
Rate for Payer: United Healthcare Medicare	$317.60
Rate for Payer: United Healthcare New Mexico Commercial	$377.15
Rate for Payer: Veterans Affairs TRICARE	$314.42

MRV Head w/o Contrast

Facility

$3,085.00

Service Code	CPT 70544
Hospital Charge Code	1003592
Hospital Revenue Code	610
Min. Negotiated Rate	$2,776.50
Max. Negotiated Rate	$2,776.50
Rate for Payer: Aetna of AZ Commercial	$2,776.50
Rate for Payer: Cash Price	$2,468.00

MRV Head w/o Contrast

Facility

$3,247.00

Service Code	CPT 70544
Hospital Charge Code	1005367
Hospital Revenue Code	610
Min. Negotiated Rate	$2,922.30
Max. Negotiated Rate	$2,922.30
Rate for Payer: Aetna of AZ Commercial	$2,922.30
Rate for Payer: Cash Price	$2,597.60

MTP 0 DEGREE PLATE RIGHT

Facility

$19,609.00

Hospital Charge Code	27663808
Hospital Revenue Code	270
Min. Negotiated Rate	$17,648.10
Max. Negotiated Rate	$17,648.10
Rate for Payer: Aetna of AZ Commercial	$17,648.10
Rate for Payer: Cash Price	$15,687.20

MTP 0 DEGREE PLATE RIGHT

Facility

$19,609.00

Hospital Charge Code	27663808
Hospital Revenue Code	270
Min. Negotiated Rate	$3,106.07
Max. Negotiated Rate	$17,648.10
Rate for Payer: Aetna of AZ Commercial	$17,648.10
Rate for Payer: Arizona Complete Health Allwell	$3,137.44
Rate for Payer: Banner UC Health Medicare	$3,137.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$13,334.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3,137.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$3,137.44
Rate for Payer: Cash Price	$15,687.20
Rate for Payer: Cigna of AZ Commercial	$13,726.30
Rate for Payer: Devoted Health Medicare	$3,529.62
Rate for Payer: Humana of AZ Medicare	$3,137.44
Rate for Payer: Southwest Service Administrators UFCW	$13,334.12
Rate for Payer: TriWest Medicare	$3,137.44
Rate for Payer: United Healthcare Commercial	$11,216.35
Rate for Payer: United Healthcare Medicare	$3,137.44
Rate for Payer: Veterans Affairs TRICARE	$3,106.07

MUCOUS TRAP ADULT

Facility

$9.00

Hospital Charge Code	22355581
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

MUCOUS TRAP ADULT

Facility

$9.00

Hospital Charge Code	22355581
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

MULTI-LUMEN CVC KIT 7FRX20CM

Facility

$203.00

Hospital Charge Code	23641815
Hospital Revenue Code	270
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Cash Price	$162.40

MULTI-LUMEN CVC KIT 7FRX20CM

Facility

$203.00

Hospital Charge Code	23641815
Hospital Revenue Code	270
Min. Negotiated Rate	$32.16
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Arizona Complete Health Allwell	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.48
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Devoted Health Medicare	$36.54
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Southwest Service Administrators UFCW	$138.04
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: United Healthcare Commercial	$116.12
Rate for Payer: United Healthcare Medicare	$32.48
Rate for Payer: Veterans Affairs TRICARE	$32.16

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$93,294.19

Service Code	MSDRG 427
Min. Negotiated Rate	$93,294.19
Max. Negotiated Rate	$93,294.19
Rate for Payer: Seven Corners Travel Insurance	$93,294.19

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$142,439.55

Service Code	MSDRG 426
Min. Negotiated Rate	$142,439.55
Max. Negotiated Rate	$142,439.55
Rate for Payer: Seven Corners Travel Insurance	$142,439.55

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$72,659.53

Service Code	MSDRG 428
Min. Negotiated Rate	$72,659.53
Max. Negotiated Rate	$72,659.53
Rate for Payer: Seven Corners Travel Insurance	$72,659.53

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$86,353.92

Service Code	MSDRG 447
Min. Negotiated Rate	$86,353.92
Max. Negotiated Rate	$86,353.92
Rate for Payer: Seven Corners Travel Insurance	$86,353.92

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$54,808.68

Service Code	MSDRG 448
Min. Negotiated Rate	$54,808.68
Max. Negotiated Rate	$54,808.68
Rate for Payer: Seven Corners Travel Insurance	$54,808.68

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$16,079.12

Service Code	MSDRG 059
Min. Negotiated Rate	$16,079.12
Max. Negotiated Rate	$16,079.12
Rate for Payer: Seven Corners Travel Insurance	$16,079.12

Know your out-of-pocket cost for care.

All Charges