Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P

Facility

$6,340.00

Service Code	CPT 54406
Hospital Charge Code	23173229
Hospital Revenue Code	982
Min. Negotiated Rate	$1,004.26
Max. Negotiated Rate	$5,706.00
Rate for Payer: Aetna of AZ Commercial	$5,706.00
Rate for Payer: Arizona Complete Health Allwell	$1,014.40
Rate for Payer: Banner UC Health Medicare	$1,014.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,311.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,014.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,014.40
Rate for Payer: Cash Price	$5,072.00
Rate for Payer: Cash Price	$5,072.00
Rate for Payer: Cigna of AZ Commercial	$4,438.00
Rate for Payer: Devoted Health Medicare	$1,141.20
Rate for Payer: Humana of AZ Medicare	$1,014.40
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$4,311.20
Rate for Payer: TriWest Medicare	$1,014.40
Rate for Payer: United Healthcare Commercial	$3,626.48
Rate for Payer: United Healthcare Medicare	$1,014.40
Rate for Payer: United Healthcare New Mexico Commercial	$1,204.60
Rate for Payer: Veterans Affairs TRICARE	$1,004.26

REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE P

Facility

$6,340.00

Service Code	CPT 54406
Hospital Charge Code	23173229
Hospital Revenue Code	982
Min. Negotiated Rate	$5,706.00
Max. Negotiated Rate	$5,706.00
Rate for Payer: Aetna of AZ Commercial	$5,706.00
Rate for Payer: Cash Price	$5,072.00

REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D

Facility

$82.00

Service Code	CPT 97602
Hospital Charge Code	24049292
Hospital Revenue Code	360
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Arizona Complete Health Allwell	$13.12
Rate for Payer: Banner UC Health Medicare	$13.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$55.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.12
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$41.00
Rate for Payer: Devoted Health Medicare	$14.76
Rate for Payer: Humana of AZ Medicare	$13.12
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$55.76
Rate for Payer: TriWest Medicare	$13.12
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$13.12
Rate for Payer: Veterans Affairs TRICARE	$12.99

REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D

Facility

$82.00

Service Code	CPT 97602
Hospital Charge Code	24049292
Hospital Revenue Code	360
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Cash Price	$65.60

REMOVAL OF FOREIGN BODIES OF ESOPHAGUS, STOMACH, AND/OR UPPE

Facility

$894.00

Service Code	CPT 43247
Hospital Charge Code	28256621
Hospital Revenue Code	360
Min. Negotiated Rate	$141.61
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$804.60
Rate for Payer: Arizona Complete Health Allwell	$143.04
Rate for Payer: Banner UC Health Medicare	$343.75
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$607.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$207.46
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$143.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$143.04
Rate for Payer: Cash Price	$715.20
Rate for Payer: Cash Price	$715.20
Rate for Payer: Cash Price	$715.20
Rate for Payer: Cigna of AZ Commercial	$447.00
Rate for Payer: Devoted Health Medicare	$160.92
Rate for Payer: Humana of AZ Medicare	$143.04
Rate for Payer: Mercy Care Medicaid	$207.46
Rate for Payer: NaphCare Correctional Healthcare	$343.75
Rate for Payer: Seven Corners Travel Insurance	$1,403.35
Rate for Payer: Southwest Service Administrators UFCW	$607.92
Rate for Payer: TriWest Medicare	$143.04
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$143.04
Rate for Payer: Veterans Affairs TRICARE	$141.61

REMOVAL OF FOREIGN BODIES OF ESOPHAGUS, STOMACH, AND/OR UPPE

Facility

$894.00

Service Code	CPT 43247
Hospital Charge Code	28256621
Hospital Revenue Code	360
Min. Negotiated Rate	$804.60
Max. Negotiated Rate	$804.60
Rate for Payer: Aetna of AZ Commercial	$804.60
Rate for Payer: Cash Price	$715.20

Removal of Foreign Body, Foot; Subcutaneous Charge

Facility

$314.00

Service Code	CPT 28190
Hospital Charge Code	730315
Hospital Revenue Code	521
Min. Negotiated Rate	$49.74
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$282.60
Rate for Payer: Arizona Complete Health Allwell	$50.24
Rate for Payer: Banner UC Health Medicare	$50.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$213.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$104.95
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$50.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$50.24
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cigna of AZ Commercial	$219.80
Rate for Payer: Devoted Health Medicare	$56.52
Rate for Payer: Humana of AZ Medicare	$50.24
Rate for Payer: Mercy Care Medicaid	$104.95
Rate for Payer: NaphCare Correctional Healthcare	$104.95
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$213.52
Rate for Payer: TriWest Medicare	$50.24
Rate for Payer: United Healthcare Commercial	$179.61
Rate for Payer: United Healthcare Medicare	$50.24
Rate for Payer: Veterans Affairs TRICARE	$49.74

Removal of Foreign Body, Foot; Subcutaneous Charge

Facility

$314.00

Service Code	CPT 28190
Hospital Charge Code	730315
Hospital Revenue Code	521
Min. Negotiated Rate	$282.60
Max. Negotiated Rate	$282.60
Rate for Payer: Aetna of AZ Commercial	$282.60
Rate for Payer: Cash Price	$251.20

REMOVAL OF GROWTH OF MUSCLE OF PELVIS AND HIP, 5.0 CM OR MOR

Facility

$3,797.00

Service Code	CPT 27045
Hospital Charge Code	28131052
Hospital Revenue Code	360
Min. Negotiated Rate	$3,417.30
Max. Negotiated Rate	$3,417.30
Rate for Payer: Aetna of AZ Commercial	$3,417.30
Rate for Payer: Cash Price	$3,037.60

REMOVAL OF GROWTH OF MUSCLE OF PELVIS AND HIP, 5.0 CM OR MOR

Facility

$3,797.00

Service Code	CPT 27045
Hospital Charge Code	28131052
Hospital Revenue Code	360
Min. Negotiated Rate	$601.44
Max. Negotiated Rate	$4,494.38
Rate for Payer: Aetna of AZ Commercial	$3,417.30
Rate for Payer: Arizona Complete Health Allwell	$607.52
Rate for Payer: Banner UC Health Medicare	$751.83
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,581.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$607.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$607.52
Rate for Payer: Cash Price	$3,037.60
Rate for Payer: Cash Price	$3,037.60
Rate for Payer: Cash Price	$3,037.60
Rate for Payer: Cigna of AZ Commercial	$1,898.50
Rate for Payer: Devoted Health Medicare	$683.46
Rate for Payer: Humana of AZ Medicare	$607.52
Rate for Payer: NaphCare Correctional Healthcare	$751.83
Rate for Payer: Seven Corners Travel Insurance	$4,494.38
Rate for Payer: Southwest Service Administrators UFCW	$2,581.96
Rate for Payer: TriWest Medicare	$607.52
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$607.52
Rate for Payer: Veterans Affairs TRICARE	$601.44

REMOVAL OF GROWTH UNDER SKIN OF BACK OR LOWER SIDES, 3.0 CM

Facility

$2,437.00

Service Code	CPT 21931
Hospital Charge Code	28134682
Hospital Revenue Code	360
Min. Negotiated Rate	$386.02
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$2,193.30
Rate for Payer: Arizona Complete Health Allwell	$389.92
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,657.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$389.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$389.92
Rate for Payer: Cash Price	$1,949.60
Rate for Payer: Cash Price	$1,949.60
Rate for Payer: Cash Price	$1,949.60
Rate for Payer: Cigna of AZ Commercial	$1,218.50
Rate for Payer: Devoted Health Medicare	$438.66
Rate for Payer: Humana of AZ Medicare	$389.92
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$1,657.16
Rate for Payer: TriWest Medicare	$389.92
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$389.92
Rate for Payer: Veterans Affairs TRICARE	$386.02

REMOVAL OF GROWTH UNDER SKIN OF BACK OR LOWER SIDES, 3.0 CM

Facility

$2,437.00

Service Code	CPT 21931
Hospital Charge Code	28134682
Hospital Revenue Code	360
Min. Negotiated Rate	$2,193.30
Max. Negotiated Rate	$2,193.30
Rate for Payer: Aetna of AZ Commercial	$2,193.30
Rate for Payer: Cash Price	$1,949.60

REMOVAL OF GROWTH UNDER SKIN OF BACK OR LOWER SIDES, LESS TH

Facility

$1,897.00

Service Code	CPT 21930
Hospital Charge Code	28133131
Hospital Revenue Code	360
Min. Negotiated Rate	$136.33
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$1,707.30
Rate for Payer: Arizona Complete Health Allwell	$303.52
Rate for Payer: Banner UC Health Medicare	$189.18
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,289.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$136.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$303.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$303.52
Rate for Payer: Cash Price	$1,517.60
Rate for Payer: Cash Price	$1,517.60
Rate for Payer: Cash Price	$1,517.60
Rate for Payer: Cigna of AZ Commercial	$948.50
Rate for Payer: Devoted Health Medicare	$341.46
Rate for Payer: Humana of AZ Medicare	$303.52
Rate for Payer: Mercy Care Medicaid	$136.33
Rate for Payer: NaphCare Correctional Healthcare	$189.18
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$1,289.96
Rate for Payer: TriWest Medicare	$303.52
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$303.52
Rate for Payer: Veterans Affairs TRICARE	$300.48

REMOVAL OF GROWTH UNDER SKIN OF BACK OR LOWER SIDES, LESS TH

Facility

$1,897.00

Service Code	CPT 21930
Hospital Charge Code	28133131
Hospital Revenue Code	360
Min. Negotiated Rate	$1,707.30
Max. Negotiated Rate	$1,707.30
Rate for Payer: Aetna of AZ Commercial	$1,707.30
Rate for Payer: Cash Price	$1,517.60

REMOVAL OF GROWTH UNDER SKIN OF FOREARM OR WRIST, LESS THAN

Facility

$1,658.00

Service Code	CPT 25075
Hospital Charge Code	28131049
Hospital Revenue Code	360
Min. Negotiated Rate	$1,492.20
Max. Negotiated Rate	$1,492.20
Rate for Payer: Aetna of AZ Commercial	$1,492.20
Rate for Payer: Cash Price	$1,326.40

REMOVAL OF GROWTH UNDER SKIN OF FOREARM OR WRIST, LESS THAN

Facility

$1,658.00

Service Code	CPT 25075
Hospital Charge Code	28131049
Hospital Revenue Code	360
Min. Negotiated Rate	$195.60
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna of AZ Commercial	$1,492.20
Rate for Payer: Arizona Complete Health Allwell	$265.28
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,127.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$195.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$265.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$265.28
Rate for Payer: Cash Price	$1,326.40
Rate for Payer: Cash Price	$1,326.40
Rate for Payer: Cash Price	$1,326.40
Rate for Payer: Cigna of AZ Commercial	$829.00
Rate for Payer: Devoted Health Medicare	$298.44
Rate for Payer: Humana of AZ Medicare	$265.28
Rate for Payer: Mercy Care Medicaid	$195.60
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$1,127.44
Rate for Payer: TriWest Medicare	$265.28
Rate for Payer: United Healthcare Commercial	$3,596.00
Rate for Payer: United Healthcare Medicare	$265.28
Rate for Payer: Veterans Affairs TRICARE	$262.63

REMOVAL OF GROWTH UNDER SKIN OF PELVIS AND HIP, 3.0 CM OR MO

Facility

$2,434.00

Service Code	CPT 27043
Hospital Charge Code	28127419
Hospital Revenue Code	360
Min. Negotiated Rate	$2,190.60
Max. Negotiated Rate	$2,190.60
Rate for Payer: Aetna of AZ Commercial	$2,190.60
Rate for Payer: Cash Price	$1,947.20

REMOVAL OF GROWTH UNDER SKIN OF PELVIS AND HIP, 3.0 CM OR MO

Facility

$2,434.00

Service Code	CPT 27043
Hospital Charge Code	28127419
Hospital Revenue Code	360
Min. Negotiated Rate	$385.55
Max. Negotiated Rate	$4,494.38
Rate for Payer: Aetna of AZ Commercial	$2,190.60
Rate for Payer: Arizona Complete Health Allwell	$389.44
Rate for Payer: Banner UC Health Medicare	$751.83
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,655.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$389.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$389.44
Rate for Payer: Cash Price	$1,947.20
Rate for Payer: Cash Price	$1,947.20
Rate for Payer: Cash Price	$1,947.20
Rate for Payer: Cigna of AZ Commercial	$1,217.00
Rate for Payer: Devoted Health Medicare	$438.12
Rate for Payer: Humana of AZ Medicare	$389.44
Rate for Payer: NaphCare Correctional Healthcare	$751.83
Rate for Payer: Seven Corners Travel Insurance	$4,494.38
Rate for Payer: Southwest Service Administrators UFCW	$1,655.12
Rate for Payer: TriWest Medicare	$389.44
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$389.44
Rate for Payer: Veterans Affairs TRICARE	$385.55

REMOVAL OF GROWTH UNDER SKIN OF THIGH OR KNEE, 3.0 CM OR MOR

Facility

$1,642.00

Service Code	CPT 27327
Hospital Charge Code	28133132
Hospital Revenue Code	360
Min. Negotiated Rate	$1,477.80
Max. Negotiated Rate	$1,477.80
Rate for Payer: Aetna of AZ Commercial	$1,477.80
Rate for Payer: Cash Price	$1,313.60

REMOVAL OF GROWTH UNDER SKIN OF THIGH OR KNEE, 3.0 CM OR MOR

Facility

$1,642.00

Service Code	CPT 27327
Hospital Charge Code	28133132
Hospital Revenue Code	360
Min. Negotiated Rate	$179.56
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,477.80
Rate for Payer: Arizona Complete Health Allwell	$262.72
Rate for Payer: Banner UC Health Medicare	$450.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,116.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$179.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$262.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$262.72
Rate for Payer: Cash Price	$1,313.60
Rate for Payer: Cash Price	$1,313.60
Rate for Payer: Cash Price	$1,313.60
Rate for Payer: Cigna of AZ Commercial	$821.00
Rate for Payer: Devoted Health Medicare	$295.56
Rate for Payer: Humana of AZ Medicare	$262.72
Rate for Payer: Mercy Care Medicaid	$179.56
Rate for Payer: NaphCare Correctional Healthcare	$450.44
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$1,116.56
Rate for Payer: TriWest Medicare	$262.72
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$262.72
Rate for Payer: Veterans Affairs TRICARE	$260.09

Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)

Facility

$4,494.38

Service Code	CPT 20680
Hospital Revenue Code	360
Min. Negotiated Rate	$177.47
Max. Negotiated Rate	$4,494.38
Rate for Payer: Banner UC Health Medicare	$751.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$177.47
Rate for Payer: Mercy Care Medicaid	$177.47
Rate for Payer: NaphCare Correctional Healthcare	$751.83
Rate for Payer: Seven Corners Travel Insurance	$4,494.38
Rate for Payer: United Healthcare Commercial	$4,169.00

REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$3,098.00

Service Code	CPT 32552
Hospital Revenue Code	360
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$3,098.00
Rate for Payer: Banner UC Health Medicare	$206.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26.85
Rate for Payer: Mercy Care Medicaid	$26.85
Rate for Payer: NaphCare Correctional Healthcare	$206.17
Rate for Payer: Seven Corners Travel Insurance	$970.60
Rate for Payer: United Healthcare Commercial	$3,098.00

REMOVAL OF INTRAUTERINE DEVICE (IUD)

Facility

$2,671.00

Service Code	CPT 58301
Hospital Revenue Code	360
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$2,671.00
Rate for Payer: Banner UC Health Medicare	$34.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$43.93
Rate for Payer: Mercy Care Medicaid	$43.93
Rate for Payer: NaphCare Correctional Healthcare	$34.71
Rate for Payer: Seven Corners Travel Insurance	$471.50
Rate for Payer: United Healthcare Commercial	$2,671.00

Removal of lead

Facility

$740.00

Service Code	CPT 64585
Hospital Charge Code	27281907
Hospital Revenue Code	360
Min. Negotiated Rate	$666.00
Max. Negotiated Rate	$666.00
Rate for Payer: Aetna of AZ Commercial	$666.00
Rate for Payer: Cash Price	$592.00

Removal of lead

Facility

$740.00

Service Code	CPT 64585
Hospital Charge Code	27281907
Hospital Revenue Code	360
Min. Negotiated Rate	$96.24
Max. Negotiated Rate	$5,409.41
Rate for Payer: Aetna of AZ Commercial	$666.00
Rate for Payer: Arizona Complete Health Allwell	$118.40
Rate for Payer: Banner UC Health Medicare	$1,327.81
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$503.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$96.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$118.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$118.40
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cigna of AZ Commercial	$370.00
Rate for Payer: Devoted Health Medicare	$133.20
Rate for Payer: Humana of AZ Medicare	$118.40
Rate for Payer: Mercy Care Medicaid	$96.24
Rate for Payer: NaphCare Correctional Healthcare	$1,327.81
Rate for Payer: Seven Corners Travel Insurance	$5,409.41
Rate for Payer: Southwest Service Administrators UFCW	$503.20
Rate for Payer: TriWest Medicare	$118.40
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$118.40
Rate for Payer: Veterans Affairs TRICARE	$117.22

Know your out-of-pocket cost for care.

All Charges