Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

00832 ANES VENTRAL INCISIONAL HERNIA ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406136
Hospital Revenue Code	370
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	$5.85
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

00832 ANES VENTRAL INCISIONAL HERNIAS BASE CHG AND 1ST MIN

Facility

$723.00

Hospital Charge Code	22406135
Hospital Revenue Code	964
Min. Negotiated Rate	$114.52
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Arizona Complete Health Allwell	$115.68
Rate for Payer: Banner UC Health Medicare	$115.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$491.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$115.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$115.68
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cigna of AZ Commercial	$506.10
Rate for Payer: Devoted Health Medicare	$130.14
Rate for Payer: Humana of AZ Medicare	$115.68
Rate for Payer: Southwest Service Administrators UFCW	$491.64
Rate for Payer: TriWest Medicare	$115.68
Rate for Payer: United Healthcare Commercial	$413.56
Rate for Payer: United Healthcare Medicare	$115.68
Rate for Payer: United Healthcare New Mexico Commercial	$137.37
Rate for Payer: Veterans Affairs TRICARE	$114.52

00832 ANES VENTRAL INCISIONAL HERNIAS BASE CHG AND 1ST MIN

Facility

$723.00

Hospital Charge Code	22406135
Hospital Revenue Code	964
Min. Negotiated Rate	$650.70
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Cash Price	$578.40

0083A Pfizer Pediatric 6mth-4yr Third Dose Admin Charge

Facility

$55.00

Service Code	CPT 0083A
Hospital Charge Code	27410757
Hospital Revenue Code	521
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

0083A Pfizer Pediatric 6mth-4yr Third Dose Admin Charge

Facility

$55.00

Service Code	CPT 0083A
Hospital Charge Code	27410757
Hospital Revenue Code	521
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

00840 ANES INTRAPERITONEAL LOWER ABDOMEN 0:30 CHARGE

Facility

$8.00

Hospital Charge Code	22406140
Hospital Revenue Code	370
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.20
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

00840 ANES INTRAPERITONEAL LOWER ABDOMEN 0:30 CHARGE

Facility

$8.00

Hospital Charge Code	22406140
Hospital Revenue Code	370
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

00840 ANES INTRAPERITONEAL LOWER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406139
Hospital Revenue Code	370
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

00840 ANES INTRAPERITONEAL LOWER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406139
Hospital Revenue Code	370
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	$5.85
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

00840 ANES INTRAPERITONEAL LOWER ABDOMEN BASE CHG AND 1ST MI

Facility

$723.00

Hospital Charge Code	22406138
Hospital Revenue Code	964
Min. Negotiated Rate	$650.70
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Cash Price	$578.40

00840 ANES INTRAPERITONEAL LOWER ABDOMEN BASE CHG AND 1ST MI

Facility

$723.00

Hospital Charge Code	22406138
Hospital Revenue Code	964
Min. Negotiated Rate	$114.52
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Arizona Complete Health Allwell	$115.68
Rate for Payer: Banner UC Health Medicare	$115.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$491.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$115.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$115.68
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cigna of AZ Commercial	$506.10
Rate for Payer: Devoted Health Medicare	$130.14
Rate for Payer: Humana of AZ Medicare	$115.68
Rate for Payer: Southwest Service Administrators UFCW	$491.64
Rate for Payer: TriWest Medicare	$115.68
Rate for Payer: United Healthcare Commercial	$413.56
Rate for Payer: United Healthcare Medicare	$115.68
Rate for Payer: United Healthcare New Mexico Commercial	$137.37
Rate for Payer: Veterans Affairs TRICARE	$114.52

00851 ANES TUBAL LIGATION TRASECTION ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406142
Hospital Revenue Code	964
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

00851 ANES TUBAL LIGATION TRASECTION ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406142
Hospital Revenue Code	964
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: United Healthcare New Mexico Commercial	$1.71
Rate for Payer: Veterans Affairs TRICARE	$1.43

00851 ANES TUBAL LIGATION TRASECTION BASE CHARGE AND 1ST MIN

Facility

$723.00

Hospital Charge Code	22406141
Hospital Revenue Code	964
Min. Negotiated Rate	$650.70
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Cash Price	$578.40

00851 ANES TUBAL LIGATION TRASECTION BASE CHARGE AND 1ST MIN

Facility

$723.00

Hospital Charge Code	22406141
Hospital Revenue Code	964
Min. Negotiated Rate	$114.52
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Arizona Complete Health Allwell	$115.68
Rate for Payer: Banner UC Health Medicare	$115.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$491.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$115.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$115.68
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cigna of AZ Commercial	$506.10
Rate for Payer: Devoted Health Medicare	$130.14
Rate for Payer: Humana of AZ Medicare	$115.68
Rate for Payer: Southwest Service Administrators UFCW	$491.64
Rate for Payer: TriWest Medicare	$115.68
Rate for Payer: United Healthcare Commercial	$413.56
Rate for Payer: United Healthcare Medicare	$115.68
Rate for Payer: United Healthcare New Mexico Commercial	$137.37
Rate for Payer: Veterans Affairs TRICARE	$114.52

00860 ANES LOWER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406210
Hospital Revenue Code	370
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	$5.85
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

00860 ANES LOWER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406210
Hospital Revenue Code	370
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

00860 ANES LOWER ABDOMEN ADDTNL 0:30 CHARGE

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406213
Hospital Revenue Code	370
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	$5.85
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

00860 ANES LOWER ABDOMEN ADDTNL 0:30 CHARGE

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406213
Hospital Revenue Code	370
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

00860 ANES LOWER ABDOMEN BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Service Code	CPT 00860
Hospital Charge Code	22406208
Hospital Revenue Code	964
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Cash Price	$392.00

00860 ANES LOWER ABDOMEN BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Service Code	CPT 00860
Hospital Charge Code	22406208
Hospital Revenue Code	964
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Arizona Complete Health Allwell	$78.40
Rate for Payer: Banner UC Health Medicare	$78.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$333.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$78.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$78.40
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cigna of AZ Commercial	$343.00
Rate for Payer: Devoted Health Medicare	$88.20
Rate for Payer: Humana of AZ Medicare	$78.40
Rate for Payer: Southwest Service Administrators UFCW	$333.20
Rate for Payer: TriWest Medicare	$78.40
Rate for Payer: United Healthcare Commercial	$280.28
Rate for Payer: United Healthcare Medicare	$78.40
Rate for Payer: United Healthcare New Mexico Commercial	$93.10
Rate for Payer: Veterans Affairs TRICARE	$77.62

00902 ANES ANORECTAL PROCEDURE ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406144
Hospital Revenue Code	370
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	$5.85
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

00902 ANES ANORECTAL PROCEDURE ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406144
Hospital Revenue Code	370
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

00902 ANES ANORECTAL PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406145
Hospital Revenue Code	370
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Cash Price	$238.40

00902 ANES ANORECTAL PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406145
Hospital Revenue Code	370
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Arizona Complete Health Allwell	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$202.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.68
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Devoted Health Medicare	$53.64
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Southwest Service Administrators UFCW	$202.64
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: United Healthcare Commercial	$170.46
Rate for Payer: United Healthcare Medicare	$47.68
Rate for Payer: Veterans Affairs TRICARE	$47.20

Know your out-of-pocket cost for care.

All Charges