Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Preventive Medicine 1-4 years Established - 99392

Facility

$342.00

Service Code	CPT 99392
Hospital Charge Code	631692
Hospital Revenue Code	521
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of AZ Commercial	$307.80
Rate for Payer: Arizona Complete Health Allwell	$54.72
Rate for Payer: Banner UC Health Medicare	$54.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$232.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.50
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$54.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$54.72
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cigna of AZ Commercial	$239.40
Rate for Payer: Devoted Health Medicare	$61.56
Rate for Payer: Humana of AZ Medicare	$54.72
Rate for Payer: Mercy Care Medicaid	$27.50
Rate for Payer: NaphCare Correctional Healthcare	$27.50
Rate for Payer: Southwest Service Administrators UFCW	$232.56
Rate for Payer: TriWest Medicare	$54.72
Rate for Payer: United Healthcare Commercial	$195.62
Rate for Payer: United Healthcare Medicare	$54.72
Rate for Payer: Veterans Affairs TRICARE	$54.17

Preventive Medicine 1-4 years New - 99382

Facility

$370.00

Service Code	CPT 99382
Hospital Charge Code	631693
Hospital Revenue Code	521
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Cash Price	$296.00

Preventive Medicine 1-4 years New - 99382

Facility

$370.00

Service Code	CPT 99382
Hospital Charge Code	631693
Hospital Revenue Code	521
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Arizona Complete Health Allwell	$59.20
Rate for Payer: Banner UC Health Medicare	$59.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$251.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$59.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$59.20
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cigna of AZ Commercial	$259.00
Rate for Payer: Devoted Health Medicare	$66.60
Rate for Payer: Humana of AZ Medicare	$59.20
Rate for Payer: Mercy Care Medicaid	$31.31
Rate for Payer: NaphCare Correctional Healthcare	$31.31
Rate for Payer: Southwest Service Administrators UFCW	$251.60
Rate for Payer: TriWest Medicare	$59.20
Rate for Payer: United Healthcare Commercial	$211.64
Rate for Payer: United Healthcare Medicare	$59.20
Rate for Payer: Veterans Affairs TRICARE	$58.61

Preventive Medicine 18-39 years Established - 99395

Facility

$383.00

Service Code	CPT 99395
Hospital Charge Code	631696
Hospital Revenue Code	521
Min. Negotiated Rate	$344.70
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Cash Price	$306.40

Preventive Medicine 18-39 years Established - 99395

Facility

$383.00

Service Code	CPT 99395
Hospital Charge Code	631696
Hospital Revenue Code	521
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Arizona Complete Health Allwell	$61.28
Rate for Payer: Banner UC Health Medicare	$61.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$260.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$61.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$61.28
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cigna of AZ Commercial	$268.10
Rate for Payer: Devoted Health Medicare	$68.94
Rate for Payer: Humana of AZ Medicare	$61.28
Rate for Payer: Mercy Care Medicaid	$26.92
Rate for Payer: NaphCare Correctional Healthcare	$26.92
Rate for Payer: Southwest Service Administrators UFCW	$260.44
Rate for Payer: TriWest Medicare	$61.28
Rate for Payer: United Healthcare Commercial	$219.08
Rate for Payer: United Healthcare Medicare	$61.28
Rate for Payer: Veterans Affairs TRICARE	$60.67

Preventive Medicine 18-39 years New - 99385

Facility

$498.00

Service Code	CPT 99385
Hospital Charge Code	631697
Hospital Revenue Code	521
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$448.20
Rate for Payer: Aetna of AZ Commercial	$448.20
Rate for Payer: Arizona Complete Health Allwell	$79.68
Rate for Payer: Banner UC Health Medicare	$79.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$338.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.30
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$79.68
Rate for Payer: Cash Price	$398.40
Rate for Payer: Cash Price	$398.40
Rate for Payer: Cigna of AZ Commercial	$348.60
Rate for Payer: Devoted Health Medicare	$89.64
Rate for Payer: Humana of AZ Medicare	$79.68
Rate for Payer: Mercy Care Medicaid	$31.30
Rate for Payer: NaphCare Correctional Healthcare	$31.30
Rate for Payer: Southwest Service Administrators UFCW	$338.64
Rate for Payer: TriWest Medicare	$79.68
Rate for Payer: United Healthcare Commercial	$284.86
Rate for Payer: United Healthcare Medicare	$79.68
Rate for Payer: Veterans Affairs TRICARE	$78.88

Preventive Medicine 18-39 years New - 99385

Facility

$498.00

Service Code	CPT 99385
Hospital Charge Code	631697
Hospital Revenue Code	521
Min. Negotiated Rate	$448.20
Max. Negotiated Rate	$448.20
Rate for Payer: Aetna of AZ Commercial	$448.20
Rate for Payer: Cash Price	$398.40

Preventive Medicine < 1 year Established - 99391

Facility

$333.00

Service Code	CPT 99391
Hospital Charge Code	631704
Hospital Revenue Code	521
Min. Negotiated Rate	$27.21
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of AZ Commercial	$299.70
Rate for Payer: Arizona Complete Health Allwell	$53.28
Rate for Payer: Banner UC Health Medicare	$53.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$226.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.21
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.28
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cigna of AZ Commercial	$233.10
Rate for Payer: Devoted Health Medicare	$59.94
Rate for Payer: Humana of AZ Medicare	$53.28
Rate for Payer: Mercy Care Medicaid	$27.21
Rate for Payer: NaphCare Correctional Healthcare	$27.21
Rate for Payer: Southwest Service Administrators UFCW	$226.44
Rate for Payer: TriWest Medicare	$53.28
Rate for Payer: United Healthcare Commercial	$190.48
Rate for Payer: United Healthcare Medicare	$53.28
Rate for Payer: Veterans Affairs TRICARE	$52.75

Preventive Medicine < 1 year Established - 99391

Facility

$333.00

Service Code	CPT 99391
Hospital Charge Code	631704
Hospital Revenue Code	521
Min. Negotiated Rate	$299.70
Max. Negotiated Rate	$299.70
Rate for Payer: Aetna of AZ Commercial	$299.70
Rate for Payer: Cash Price	$266.40

Preventive Medicine < 1 year New - 99381

Facility

$434.00

Service Code	CPT 99381
Hospital Charge Code	631705
Hospital Revenue Code	521
Min. Negotiated Rate	$390.60
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Cash Price	$347.20

Preventive Medicine < 1 year New - 99381

Facility

$434.00

Service Code	CPT 99381
Hospital Charge Code	631705
Hospital Revenue Code	521
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Arizona Complete Health Allwell	$69.44
Rate for Payer: Banner UC Health Medicare	$69.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$295.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$69.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$69.44
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cigna of AZ Commercial	$303.80
Rate for Payer: Devoted Health Medicare	$78.12
Rate for Payer: Humana of AZ Medicare	$69.44
Rate for Payer: Mercy Care Medicaid	$31.31
Rate for Payer: NaphCare Correctional Healthcare	$31.31
Rate for Payer: Southwest Service Administrators UFCW	$295.12
Rate for Payer: TriWest Medicare	$69.44
Rate for Payer: United Healthcare Commercial	$248.25
Rate for Payer: United Healthcare Medicare	$69.44
Rate for Payer: Veterans Affairs TRICARE	$68.75

Preventive Medicine 40-64 years Established - 99396

Facility

$497.00

Service Code	CPT 99396
Hospital Charge Code	631698
Hospital Revenue Code	521
Min. Negotiated Rate	$27.21
Max. Negotiated Rate	$447.30
Rate for Payer: Aetna of AZ Commercial	$447.30
Rate for Payer: Arizona Complete Health Allwell	$79.52
Rate for Payer: Banner UC Health Medicare	$79.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$337.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.21
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$79.52
Rate for Payer: Cash Price	$397.60
Rate for Payer: Cash Price	$397.60
Rate for Payer: Cigna of AZ Commercial	$347.90
Rate for Payer: Devoted Health Medicare	$89.46
Rate for Payer: Humana of AZ Medicare	$79.52
Rate for Payer: Mercy Care Medicaid	$27.21
Rate for Payer: NaphCare Correctional Healthcare	$27.21
Rate for Payer: Southwest Service Administrators UFCW	$337.96
Rate for Payer: TriWest Medicare	$79.52
Rate for Payer: United Healthcare Commercial	$284.28
Rate for Payer: United Healthcare Medicare	$79.52
Rate for Payer: Veterans Affairs TRICARE	$78.72

Preventive Medicine 40-64 years Established - 99396

Facility

$497.00

Service Code	CPT 99396
Hospital Charge Code	631698
Hospital Revenue Code	521
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$447.30
Rate for Payer: Aetna of AZ Commercial	$447.30
Rate for Payer: Cash Price	$397.60

Preventive Medicine 40-64 years New - 99386

Facility

$592.00

Service Code	CPT 99386
Hospital Charge Code	631699
Hospital Revenue Code	521
Min. Negotiated Rate	$532.80
Max. Negotiated Rate	$532.80
Rate for Payer: Aetna of AZ Commercial	$532.80
Rate for Payer: Cash Price	$473.60

Preventive Medicine 40-64 years New - 99386

Facility

$592.00

Service Code	CPT 99386
Hospital Charge Code	631699
Hospital Revenue Code	521
Min. Negotiated Rate	$31.01
Max. Negotiated Rate	$532.80
Rate for Payer: Aetna of AZ Commercial	$532.80
Rate for Payer: Arizona Complete Health Allwell	$94.72
Rate for Payer: Banner UC Health Medicare	$94.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$402.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$94.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$94.72
Rate for Payer: Cash Price	$473.60
Rate for Payer: Cash Price	$473.60
Rate for Payer: Cigna of AZ Commercial	$414.40
Rate for Payer: Devoted Health Medicare	$106.56
Rate for Payer: Humana of AZ Medicare	$94.72
Rate for Payer: Mercy Care Medicaid	$31.01
Rate for Payer: NaphCare Correctional Healthcare	$31.01
Rate for Payer: Southwest Service Administrators UFCW	$402.56
Rate for Payer: TriWest Medicare	$94.72
Rate for Payer: United Healthcare Commercial	$338.62
Rate for Payer: United Healthcare Medicare	$94.72
Rate for Payer: Veterans Affairs TRICARE	$93.77

Preventive Medicine 5-11 years Established - 99393

Facility

$367.00

Service Code	CPT 99393
Hospital Charge Code	631700
Hospital Revenue Code	521
Min. Negotiated Rate	$330.30
Max. Negotiated Rate	$330.30
Rate for Payer: Aetna of AZ Commercial	$330.30
Rate for Payer: Cash Price	$293.60

Preventive Medicine 5-11 years Established - 99393

Facility

$367.00

Service Code	CPT 99393
Hospital Charge Code	631700
Hospital Revenue Code	521
Min. Negotiated Rate	$27.21
Max. Negotiated Rate	$330.30
Rate for Payer: Aetna of AZ Commercial	$330.30
Rate for Payer: Arizona Complete Health Allwell	$58.72
Rate for Payer: Banner UC Health Medicare	$58.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$249.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.21
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$58.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.72
Rate for Payer: Cash Price	$293.60
Rate for Payer: Cash Price	$293.60
Rate for Payer: Cigna of AZ Commercial	$256.90
Rate for Payer: Devoted Health Medicare	$66.06
Rate for Payer: Humana of AZ Medicare	$58.72
Rate for Payer: Mercy Care Medicaid	$27.21
Rate for Payer: NaphCare Correctional Healthcare	$27.21
Rate for Payer: Southwest Service Administrators UFCW	$249.56
Rate for Payer: TriWest Medicare	$58.72
Rate for Payer: United Healthcare Commercial	$209.92
Rate for Payer: United Healthcare Medicare	$58.72
Rate for Payer: Veterans Affairs TRICARE	$58.13

Preventive Medicine 5-11 years New - 99383

Facility

$379.00

Service Code	CPT 99383
Hospital Charge Code	631701
Hospital Revenue Code	521
Min. Negotiated Rate	$341.10
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Cash Price	$303.20

Preventive Medicine 5-11 years New - 99383

Facility

$379.00

Service Code	CPT 99383
Hospital Charge Code	631701
Hospital Revenue Code	521
Min. Negotiated Rate	$31.01
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Arizona Complete Health Allwell	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$257.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.64
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$265.30
Rate for Payer: Devoted Health Medicare	$68.22
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Mercy Care Medicaid	$31.01
Rate for Payer: NaphCare Correctional Healthcare	$31.01
Rate for Payer: Southwest Service Administrators UFCW	$257.72
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: United Healthcare Commercial	$216.79
Rate for Payer: United Healthcare Medicare	$60.64
Rate for Payer: Veterans Affairs TRICARE	$60.03

Preventive Medicine 65+ years Established - 99397

Facility

$525.00

Service Code	CPT 99397
Hospital Charge Code	631702
Hospital Revenue Code	521
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

Preventive Medicine 65+ years Established - 99397

Facility

$525.00

Service Code	CPT 99397
Hospital Charge Code	631702
Hospital Revenue Code	521
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.30
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Mercy Care Medicaid	$31.30
Rate for Payer: NaphCare Correctional Healthcare	$31.30
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

Preventive Medicine 65+ years New - 99387

Facility

$626.00

Service Code	CPT 99387
Hospital Charge Code	631703
Hospital Revenue Code	521
Min. Negotiated Rate	$34.82
Max. Negotiated Rate	$563.40
Rate for Payer: Aetna of AZ Commercial	$563.40
Rate for Payer: Arizona Complete Health Allwell	$100.16
Rate for Payer: Banner UC Health Medicare	$100.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$425.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34.82
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$100.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$100.16
Rate for Payer: Cash Price	$500.80
Rate for Payer: Cash Price	$500.80
Rate for Payer: Cigna of AZ Commercial	$438.20
Rate for Payer: Devoted Health Medicare	$112.68
Rate for Payer: Humana of AZ Medicare	$100.16
Rate for Payer: Mercy Care Medicaid	$34.82
Rate for Payer: NaphCare Correctional Healthcare	$34.82
Rate for Payer: Southwest Service Administrators UFCW	$425.68
Rate for Payer: TriWest Medicare	$100.16
Rate for Payer: United Healthcare Commercial	$358.07
Rate for Payer: United Healthcare Medicare	$100.16
Rate for Payer: Veterans Affairs TRICARE	$99.16

Preventive Medicine 65+ years New - 99387

Facility

$626.00

Service Code	CPT 99387
Hospital Charge Code	631703
Hospital Revenue Code	521
Min. Negotiated Rate	$563.40
Max. Negotiated Rate	$563.40
Rate for Payer: Aetna of AZ Commercial	$563.40
Rate for Payer: Cash Price	$500.80

Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S), Ind

Facility

$59.00

Service Code	CPT 99401
Hospital Charge Code	1303642
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Arizona Complete Health Allwell	$9.44
Rate for Payer: Banner UC Health Medicare	$9.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.44
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cigna of AZ Commercial	$41.30
Rate for Payer: Devoted Health Medicare	$10.62
Rate for Payer: Humana of AZ Medicare	$9.44
Rate for Payer: Mercy Care Medicaid	$13.13
Rate for Payer: NaphCare Correctional Healthcare	$13.13
Rate for Payer: Southwest Service Administrators UFCW	$40.12
Rate for Payer: TriWest Medicare	$9.44
Rate for Payer: United Healthcare Commercial	$33.75
Rate for Payer: United Healthcare Medicare	$9.44
Rate for Payer: Veterans Affairs TRICARE	$9.35

Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S), Ind

Facility

$59.00

Service Code	CPT 99401
Hospital Charge Code	1303642
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Cash Price	$47.20

Know your out-of-pocket cost for care.

All Charges