Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

RBC CPD 500 LR Irr

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857652
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

RBC CPD AS1 500 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857663
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

RBC CPD AS1 500 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857663
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

RBC CPD AS1 500 LR Irr

Facility

$761.00

Service Code	HCPCS P9016
Hospital Charge Code	857630
Hospital Revenue Code	390
Min. Negotiated Rate	$684.90
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Cash Price	$608.80

RBC CPD AS1 500 LR Irr

Facility

$761.00

Service Code	HCPCS P9016
Hospital Charge Code	857630
Hospital Revenue Code	390
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Arizona Complete Health Allwell	$121.76
Rate for Payer: Banner UC Health Medicare	$121.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$517.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$121.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$121.76
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cigna of AZ Commercial	$494.65
Rate for Payer: Devoted Health Medicare	$136.98
Rate for Payer: Humana of AZ Medicare	$121.76
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$517.48
Rate for Payer: TriWest Medicare	$121.76
Rate for Payer: United Healthcare Commercial	$435.29
Rate for Payer: United Healthcare Medicare	$121.76
Rate for Payer: Veterans Affairs TRICARE	$120.54

RECHARGER BELT

Facility

$263.00

Hospital Charge Code	27400598
Hospital Revenue Code	270
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$236.70
Rate for Payer: Aetna of AZ Commercial	$236.70
Rate for Payer: Arizona Complete Health Allwell	$42.08
Rate for Payer: Banner UC Health Medicare	$42.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$178.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.08
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cigna of AZ Commercial	$184.10
Rate for Payer: Devoted Health Medicare	$47.34
Rate for Payer: Humana of AZ Medicare	$42.08
Rate for Payer: Southwest Service Administrators UFCW	$178.84
Rate for Payer: TriWest Medicare	$42.08
Rate for Payer: United Healthcare Commercial	$150.44
Rate for Payer: United Healthcare Medicare	$42.08
Rate for Payer: Veterans Affairs TRICARE	$41.66

RECHARGER BELT

Facility

$263.00

Hospital Charge Code	27400598
Hospital Revenue Code	270
Min. Negotiated Rate	$236.70
Max. Negotiated Rate	$236.70
Rate for Payer: Aetna of AZ Commercial	$236.70
Rate for Payer: Cash Price	$210.40

RECHARGER KIT

Facility

$7,088.00

Hospital Charge Code	27400597
Hospital Revenue Code	270
Min. Negotiated Rate	$6,379.20
Max. Negotiated Rate	$6,379.20
Rate for Payer: Aetna of AZ Commercial	$6,379.20
Rate for Payer: Cash Price	$5,670.40

RECHARGER KIT

Facility

$7,088.00

Hospital Charge Code	27400597
Hospital Revenue Code	270
Min. Negotiated Rate	$1,122.74
Max. Negotiated Rate	$6,379.20
Rate for Payer: Aetna of AZ Commercial	$6,379.20
Rate for Payer: Arizona Complete Health Allwell	$1,134.08
Rate for Payer: Banner UC Health Medicare	$1,134.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,819.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,134.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,134.08
Rate for Payer: Cash Price	$5,670.40
Rate for Payer: Cigna of AZ Commercial	$4,961.60
Rate for Payer: Devoted Health Medicare	$1,275.84
Rate for Payer: Humana of AZ Medicare	$1,134.08
Rate for Payer: Southwest Service Administrators UFCW	$4,819.84
Rate for Payer: TriWest Medicare	$1,134.08
Rate for Payer: United Healthcare Commercial	$4,054.34
Rate for Payer: United Healthcare Medicare	$1,134.08
Rate for Payer: Veterans Affairs TRICARE	$1,122.74

RECONSTRUCTION (ADVANCEMENT) POSTERIOR TIBIAL TENDON WITH EXCISION OF

Facility

$2,375.00

Service Code	CPT 28238
Hospital Charge Code	24043294
Hospital Revenue Code	360
Min. Negotiated Rate	$176.78
Max. Negotiated Rate	$11,227.32
Rate for Payer: Aetna of AZ Commercial	$2,137.50
Rate for Payer: Arizona Complete Health Allwell	$380.00
Rate for Payer: Banner UC Health Medicare	$3,026.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,615.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$176.78
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$380.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$380.00
Rate for Payer: Cash Price	$1,900.00
Rate for Payer: Cash Price	$1,900.00
Rate for Payer: Cash Price	$1,900.00
Rate for Payer: Cigna of AZ Commercial	$1,187.50
Rate for Payer: Devoted Health Medicare	$427.50
Rate for Payer: Humana of AZ Medicare	$380.00
Rate for Payer: Mercy Care Medicaid	$176.78
Rate for Payer: NaphCare Correctional Healthcare	$3,026.13
Rate for Payer: Seven Corners Travel Insurance	$11,227.32
Rate for Payer: Southwest Service Administrators UFCW	$1,615.00
Rate for Payer: TriWest Medicare	$380.00
Rate for Payer: United Healthcare Commercial	$6,508.00
Rate for Payer: United Healthcare Medicare	$380.00
Rate for Payer: Veterans Affairs TRICARE	$376.20

RECONSTRUCTION (ADVANCEMENT) POSTERIOR TIBIAL TENDON WITH EXCISION OF

Facility

$2,375.00

Service Code	CPT 28238
Hospital Charge Code	24043294
Hospital Revenue Code	360
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna of AZ Commercial	$2,137.50
Rate for Payer: Cash Price	$1,900.00

RECONSTRUCTION ANGULAR DEFORMITY OF TOE SOFT TISSUE PROCEDURES ONLY

Facility

$1,644.00

Service Code	CPT 28313
Hospital Charge Code	24043320
Hospital Revenue Code	360
Min. Negotiated Rate	$1,479.60
Max. Negotiated Rate	$1,479.60
Rate for Payer: Aetna of AZ Commercial	$1,479.60
Rate for Payer: Cash Price	$1,315.20

RECONSTRUCTION ANGULAR DEFORMITY OF TOE SOFT TISSUE PROCEDURES ONLY

Facility

$1,644.00

Service Code	CPT 28313
Hospital Charge Code	24043320
Hospital Revenue Code	360
Min. Negotiated Rate	$163.87
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,479.60
Rate for Payer: Arizona Complete Health Allwell	$263.04
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,117.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$163.87
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$263.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$263.04
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cigna of AZ Commercial	$822.00
Rate for Payer: Devoted Health Medicare	$295.92
Rate for Payer: Humana of AZ Medicare	$263.04
Rate for Payer: Mercy Care Medicaid	$163.87
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$1,117.92
Rate for Payer: TriWest Medicare	$263.04
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$263.04
Rate for Payer: Veterans Affairs TRICARE	$260.41

RECONSTRUCTION OF URETHRA IN MALE

Facility

$5,021.00

Service Code	CPT 53410
Hospital Charge Code	28169290
Hospital Revenue Code	360
Min. Negotiated Rate	$795.33
Max. Negotiated Rate	$8,296.15
Rate for Payer: Aetna of AZ Commercial	$4,518.90
Rate for Payer: Arizona Complete Health Allwell	$803.36
Rate for Payer: Banner UC Health Medicare	$1,977.90
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,414.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$803.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$803.36
Rate for Payer: Cash Price	$4,016.80
Rate for Payer: Cash Price	$4,016.80
Rate for Payer: Cash Price	$4,016.80
Rate for Payer: Cigna of AZ Commercial	$2,510.50
Rate for Payer: Devoted Health Medicare	$903.78
Rate for Payer: Humana of AZ Medicare	$803.36
Rate for Payer: NaphCare Correctional Healthcare	$1,977.90
Rate for Payer: Seven Corners Travel Insurance	$8,296.15
Rate for Payer: Southwest Service Administrators UFCW	$3,414.28
Rate for Payer: TriWest Medicare	$803.36
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$803.36
Rate for Payer: Veterans Affairs TRICARE	$795.33

RECONSTRUCTION OF URETHRA IN MALE

Facility

$5,021.00

Service Code	CPT 53410
Hospital Charge Code	28169290
Hospital Revenue Code	360
Min. Negotiated Rate	$4,518.90
Max. Negotiated Rate	$4,518.90
Rate for Payer: Aetna of AZ Commercial	$4,518.90
Rate for Payer: Cash Price	$4,016.80

RECTAL RESECTION WITH CC

Facility

$30,270.91

Service Code	MSDRG 333
Min. Negotiated Rate	$30,270.91
Max. Negotiated Rate	$30,270.91
Rate for Payer: Seven Corners Travel Insurance	$30,270.91

RECTAL RESECTION WITH MCC

Facility

$46,794.44

Service Code	MSDRG 332
Min. Negotiated Rate	$46,794.44
Max. Negotiated Rate	$46,794.44
Rate for Payer: Seven Corners Travel Insurance	$46,794.44

RECTAL RESECTION WITHOUT CC/MCC

Facility

$21,168.46

Service Code	MSDRG 334
Min. Negotiated Rate	$21,168.46
Max. Negotiated Rate	$21,168.46
Rate for Payer: Seven Corners Travel Insurance	$21,168.46

Rectovaginal Fistula closure abdominal

Facility

$5,324.00

Service Code	CPT 57305
Hospital Charge Code	27291797
Hospital Revenue Code	360
Min. Negotiated Rate	$4,791.60
Max. Negotiated Rate	$4,791.60
Rate for Payer: Aetna of AZ Commercial	$4,791.60
Rate for Payer: Cash Price	$4,259.20

Rectovaginal Fistula closure abdominal

Facility

$5,324.00

Service Code	CPT 57305
Hospital Charge Code	27291797
Hospital Revenue Code	360
Min. Negotiated Rate	$843.32
Max. Negotiated Rate	$4,791.60
Rate for Payer: Aetna of AZ Commercial	$4,791.60
Rate for Payer: Arizona Complete Health Allwell	$851.84
Rate for Payer: Banner UC Health Medicare	$851.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,620.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$851.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$851.84
Rate for Payer: Cash Price	$4,259.20
Rate for Payer: Cash Price	$4,259.20
Rate for Payer: Cigna of AZ Commercial	$2,662.00
Rate for Payer: Devoted Health Medicare	$958.32
Rate for Payer: Humana of AZ Medicare	$851.84
Rate for Payer: Southwest Service Administrators UFCW	$3,620.32
Rate for Payer: TriWest Medicare	$851.84
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$851.84
Rate for Payer: Veterans Affairs TRICARE	$843.32

Rectovaginal Fistula closure vaginal

Facility

$3,287.00

Service Code	CPT 57300
Hospital Charge Code	27291796
Hospital Revenue Code	360
Min. Negotiated Rate	$2,958.30
Max. Negotiated Rate	$2,958.30
Rate for Payer: Aetna of AZ Commercial	$2,958.30
Rate for Payer: Cash Price	$2,629.60

Rectovaginal Fistula closure vaginal

Facility

$3,287.00

Service Code	CPT 57300
Hospital Charge Code	27291796
Hospital Revenue Code	360
Min. Negotiated Rate	$520.66
Max. Negotiated Rate	$5,008.71
Rate for Payer: Aetna of AZ Commercial	$2,958.30
Rate for Payer: Arizona Complete Health Allwell	$525.92
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,235.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$525.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$525.92
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cigna of AZ Commercial	$1,643.50
Rate for Payer: Devoted Health Medicare	$591.66
Rate for Payer: Humana of AZ Medicare	$525.92
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	$2,235.16
Rate for Payer: TriWest Medicare	$525.92
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$525.92
Rate for Payer: Veterans Affairs TRICARE	$520.66

Rectovaginal Fistula with colostomy

Facility

$5,535.00

Service Code	CPT 57307
Hospital Charge Code	27267821
Hospital Revenue Code	360
Min. Negotiated Rate	$4,981.50
Max. Negotiated Rate	$4,981.50
Rate for Payer: Aetna of AZ Commercial	$4,981.50
Rate for Payer: Cash Price	$4,428.00

Rectovaginal Fistula with colostomy

Facility

$5,535.00

Service Code	CPT 57307
Hospital Charge Code	27267821
Hospital Revenue Code	360
Min. Negotiated Rate	$876.74
Max. Negotiated Rate	$4,981.50
Rate for Payer: Aetna of AZ Commercial	$4,981.50
Rate for Payer: Arizona Complete Health Allwell	$885.60
Rate for Payer: Banner UC Health Medicare	$885.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,763.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$885.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$885.60
Rate for Payer: Cash Price	$4,428.00
Rate for Payer: Cash Price	$4,428.00
Rate for Payer: Cigna of AZ Commercial	$2,767.50
Rate for Payer: Devoted Health Medicare	$996.30
Rate for Payer: Humana of AZ Medicare	$885.60
Rate for Payer: Southwest Service Administrators UFCW	$3,763.80
Rate for Payer: TriWest Medicare	$885.60
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$885.60
Rate for Payer: Veterans Affairs TRICARE	$876.74

RED BLOOD CELL DISORDERS WITH MCC

Facility

$18,149.56

Service Code	MSDRG 811
Min. Negotiated Rate	$18,149.56
Max. Negotiated Rate	$18,149.56
Rate for Payer: Seven Corners Travel Insurance	$18,149.56

Know your out-of-pocket cost for care.

All Charges