Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Plasma Thawed CPD

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	1757552
Hospital Revenue Code	390
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$130.21
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Plasma Thawed CPD

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	1757552
Hospital Revenue Code	390
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE HYPOSPADIAS REPAIR WITH OR WITHOUT TRANSPLANTATION OF PREPUCE AND/OR SKIN FLAPS

Facility

$5,611.00

Service Code	CPT 54304
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.31
Max. Negotiated Rate	$5,611.00
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: United Healthcare Commercial	$5,611.00

Plastic repari of introitus

Facility

$1,300.00

Service Code	CPT 56800
Hospital Charge Code	27267829
Hospital Revenue Code	360
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna of AZ Commercial	$1,170.00
Rate for Payer: Cash Price	$1,040.00

Plastic repari of introitus

Facility

$1,300.00

Service Code	CPT 56800
Hospital Charge Code	27267829
Hospital Revenue Code	360
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$5,008.71
Rate for Payer: Aetna of AZ Commercial	$1,170.00
Rate for Payer: Arizona Complete Health Allwell	$208.00
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$884.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$208.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$208.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cigna of AZ Commercial	$650.00
Rate for Payer: Devoted Health Medicare	$234.00
Rate for Payer: Humana of AZ Medicare	$208.00
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: Southwest Service Administrators UFCW	$884.00
Rate for Payer: TriWest Medicare	$208.00
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$208.00
Rate for Payer: Veterans Affairs TRICARE	$205.92

Platelet Antibody Profile LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	23018011
Hospital Revenue Code	302
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Arizona Complete Health Allwell	$65.28
Rate for Payer: Banner UC Health Medicare	$65.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$277.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.28
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna of AZ Commercial	$265.20
Rate for Payer: Devoted Health Medicare	$73.44
Rate for Payer: Humana of AZ Medicare	$65.28
Rate for Payer: Seven Corners Travel Insurance	$26.64
Rate for Payer: Southwest Service Administrators UFCW	$277.44
Rate for Payer: TriWest Medicare	$65.28
Rate for Payer: United Healthcare Commercial	$233.38
Rate for Payer: United Healthcare Medicare	$65.28
Rate for Payer: Veterans Affairs TRICARE	$64.63

Platelet Antibody Profile LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	23018011
Hospital Revenue Code	302
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Cash Price	$326.40

Platelet Autoantibody Panel LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	22311202
Hospital Revenue Code	302
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Cash Price	$326.40

Platelet Autoantibody Panel LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	22311202
Hospital Revenue Code	302
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Arizona Complete Health Allwell	$65.28
Rate for Payer: Banner UC Health Medicare	$65.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$277.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.28
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna of AZ Commercial	$265.20
Rate for Payer: Devoted Health Medicare	$73.44
Rate for Payer: Humana of AZ Medicare	$65.28
Rate for Payer: Seven Corners Travel Insurance	$26.64
Rate for Payer: Southwest Service Administrators UFCW	$277.44
Rate for Payer: TriWest Medicare	$65.28
Rate for Payer: United Healthcare Commercial	$233.38
Rate for Payer: United Healthcare Medicare	$65.28
Rate for Payer: Veterans Affairs TRICARE	$64.63

Platelet Count

Facility

$89.00

Service Code	CPT 85049
Hospital Charge Code	633807
Hospital Revenue Code	305
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Aetna of AZ Commercial	$115.20
Rate for Payer: Arizona Complete Health Allwell	$20.48
Rate for Payer: Arizona Complete Health Allwell	$14.24
Rate for Payer: Banner UC Health Medicare	$20.48
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$60.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.24
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cigna of AZ Commercial	$57.85
Rate for Payer: Cigna of AZ Commercial	$83.20
Rate for Payer: Devoted Health Medicare	$16.02
Rate for Payer: Devoted Health Medicare	$23.04
Rate for Payer: Humana of AZ Medicare	$20.48
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Seven Corners Travel Insurance	$6.50
Rate for Payer: Seven Corners Travel Insurance	$6.50
Rate for Payer: Southwest Service Administrators UFCW	$87.04
Rate for Payer: Southwest Service Administrators UFCW	$60.52
Rate for Payer: TriWest Medicare	$20.48
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: United Healthcare Commercial	$50.91
Rate for Payer: United Healthcare Commercial	$73.22
Rate for Payer: United Healthcare Medicare	$20.48
Rate for Payer: United Healthcare Medicare	$14.24
Rate for Payer: Veterans Affairs TRICARE	$14.10
Rate for Payer: Veterans Affairs TRICARE	$20.28

Platelet Count

Facility

$128.00

Service Code	CPT 85049
Hospital Charge Code	633807
Hospital Revenue Code	305
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of AZ Commercial	$115.20
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$71.20

Platelets.

Facility

$129.00

Service Code	CPT 85595
Hospital Charge Code	22165974
Hospital Revenue Code	305
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Cash Price	$103.20

Platelets.

Facility

$129.00

Service Code	CPT 85595
Hospital Charge Code	22165974
Hospital Revenue Code	305
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: Veterans Affairs TRICARE	$20.43

PLETH TRACE

Facility

$483.00

Service Code	CPT 94726
Hospital Charge Code	3230228
Hospital Revenue Code	460
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Cash Price	$386.40

PLETH TRACE

Facility

$483.00

Service Code	CPT 94726
Hospital Charge Code	3230228
Hospital Revenue Code	460
Min. Negotiated Rate	$76.51
Max. Negotiated Rate	$577.38
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Arizona Complete Health Allwell	$77.28
Rate for Payer: Banner UC Health Medicare	$77.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$328.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$77.28
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$338.10
Rate for Payer: Devoted Health Medicare	$86.94
Rate for Payer: Humana of AZ Medicare	$77.28
Rate for Payer: Seven Corners Travel Insurance	$577.38
Rate for Payer: Southwest Service Administrators UFCW	$328.44
Rate for Payer: TriWest Medicare	$77.28
Rate for Payer: United Healthcare Commercial	$276.28
Rate for Payer: United Healthcare Medicare	$77.28
Rate for Payer: United Healthcare New Mexico Commercial	$91.77
Rate for Payer: Veterans Affairs TRICARE	$76.51

PLEURAL EFFUSION WITH CC

Facility

$12,888.50

Service Code	MSDRG 187
Min. Negotiated Rate	$12,888.50
Max. Negotiated Rate	$12,888.50
Rate for Payer: Seven Corners Travel Insurance	$12,888.50

PLEURAL EFFUSION WITH MCC

Facility

$20,142.30

Service Code	MSDRG 186
Min. Negotiated Rate	$20,142.30
Max. Negotiated Rate	$20,142.30
Rate for Payer: Seven Corners Travel Insurance	$20,142.30

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$9,443.21

Service Code	MSDRG 188
Min. Negotiated Rate	$9,443.21
Max. Negotiated Rate	$9,443.21
Rate for Payer: Seven Corners Travel Insurance	$9,443.21

PLUG FISTULA .7 COOK

Facility

$2,854.00

Hospital Charge Code	22955986
Hospital Revenue Code	272
Min. Negotiated Rate	$2,568.60
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Cash Price	$2,283.20

PLUG FISTULA .7 COOK

Facility

$2,854.00

Hospital Charge Code	22955986
Hospital Revenue Code	272
Min. Negotiated Rate	$452.07
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Arizona Complete Health Allwell	$456.64
Rate for Payer: Banner UC Health Medicare	$456.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,940.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$456.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$456.64
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Cigna of AZ Commercial	$1,997.80
Rate for Payer: Devoted Health Medicare	$513.72
Rate for Payer: Humana of AZ Medicare	$456.64
Rate for Payer: Southwest Service Administrators UFCW	$1,940.72
Rate for Payer: TriWest Medicare	$456.64
Rate for Payer: United Healthcare Commercial	$1,632.49
Rate for Payer: United Healthcare Medicare	$456.64
Rate for Payer: Veterans Affairs TRICARE	$452.07

PM BARBITURATES

Facility

$281.00

Service Code	CPT 80307
Hospital Charge Code	23293446
Hospital Revenue Code	301
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Cash Price	$224.80

PM BARBITURATES

Facility

$281.00

Service Code	CPT 80307
Hospital Charge Code	23293446
Hospital Revenue Code	301
Min. Negotiated Rate	$44.51
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Arizona Complete Health Allwell	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$191.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.96
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Devoted Health Medicare	$50.58
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Seven Corners Travel Insurance	$90.10
Rate for Payer: Southwest Service Administrators UFCW	$191.08
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: United Healthcare Commercial	$160.73
Rate for Payer: United Healthcare Medicare	$44.96
Rate for Payer: Veterans Affairs TRICARE	$44.51

PM Benzos:1-12

Facility

$217.00

Service Code	CPT 80346
Hospital Charge Code	23293443
Hospital Revenue Code	301
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Cash Price	$173.60

PM Benzos:1-12

Facility

$217.00

Service Code	CPT 80346
Hospital Charge Code	23293443
Hospital Revenue Code	301
Min. Negotiated Rate	$34.37
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Arizona Complete Health Allwell	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$147.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.72
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Southwest Service Administrators UFCW	$147.56
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: United Healthcare Commercial	$124.12
Rate for Payer: United Healthcare Medicare	$34.72
Rate for Payer: Veterans Affairs TRICARE	$34.37

PM CANNABINOIDS

Facility

$239.00

Service Code	CPT 80349
Hospital Charge Code	23293447
Hospital Revenue Code	301
Min. Negotiated Rate	$215.10
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Cash Price	$191.20

Know your out-of-pocket cost for care.

All Charges