Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

REMOVAL OF POSTSURGICAL TIGHTENING OF BLADDER NECK

Facility

$1,681.00

Service Code	CPT 52640
Hospital Charge Code	30283552
Hospital Revenue Code	360
Min. Negotiated Rate	$266.27
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,512.90
Rate for Payer: Arizona Complete Health Allwell	$268.96
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,143.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$268.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$268.96
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cigna of AZ Commercial	$840.50
Rate for Payer: Devoted Health Medicare	$302.58
Rate for Payer: Humana of AZ Medicare	$268.96
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$1,143.08
Rate for Payer: TriWest Medicare	$268.96
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$268.96
Rate for Payer: Veterans Affairs TRICARE	$266.27

REMOVAL OF POSTSURGICAL TIGHTENING OF BLADDER NECK

Facility

$1,681.00

Service Code	CPT 52640
Hospital Charge Code	30283552
Hospital Revenue Code	360
Min. Negotiated Rate	$1,512.90
Max. Negotiated Rate	$1,512.90
Rate for Payer: Aetna of AZ Commercial	$1,512.90
Rate for Payer: Cash Price	$1,344.80

REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THRO

Facility

$3,812.00

Service Code	CPT 52601
Hospital Charge Code	27881570
Hospital Revenue Code	360
Min. Negotiated Rate	$603.82
Max. Negotiated Rate	$8,296.15
Rate for Payer: Aetna of AZ Commercial	$3,430.80
Rate for Payer: Arizona Complete Health Allwell	$609.92
Rate for Payer: Banner UC Health Medicare	$1,977.90
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,592.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$609.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$609.92
Rate for Payer: Cash Price	$3,049.60
Rate for Payer: Cash Price	$3,049.60
Rate for Payer: Cash Price	$3,049.60
Rate for Payer: Cigna of AZ Commercial	$1,906.00
Rate for Payer: Devoted Health Medicare	$686.16
Rate for Payer: Humana of AZ Medicare	$609.92
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	$2,592.16
Rate for Payer: TriWest Medicare	$609.92
Rate for Payer: United Healthcare Commercial	$5,611.00
Rate for Payer: United Healthcare Medicare	$609.92
Rate for Payer: Veterans Affairs TRICARE	$603.82

REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THRO

Facility

$3,812.00

Service Code	CPT 52601
Hospital Charge Code	27881570
Hospital Revenue Code	360
Min. Negotiated Rate	$3,430.80
Max. Negotiated Rate	$3,430.80
Rate for Payer: Aetna of AZ Commercial	$3,430.80
Rate for Payer: Cash Price	$3,049.60

Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; each Addtl Ten Lesions

Facility

$107.00

Service Code	CPT 11201
Hospital Charge Code	729107
Hospital Revenue Code	521
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Arizona Complete Health Allwell	$17.12
Rate for Payer: Banner UC Health Medicare	$17.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2.50
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.12
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$74.90
Rate for Payer: Devoted Health Medicare	$19.26
Rate for Payer: Humana of AZ Medicare	$17.12
Rate for Payer: Mercy Care Medicaid	$2.50
Rate for Payer: NaphCare Correctional Healthcare	$2.50
Rate for Payer: Southwest Service Administrators UFCW	$72.76
Rate for Payer: TriWest Medicare	$17.12
Rate for Payer: United Healthcare Commercial	$61.20
Rate for Payer: United Healthcare Medicare	$17.12
Rate for Payer: Veterans Affairs TRICARE	$16.95

Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; each Addtl Ten Lesions

Facility

$107.00

Service Code	CPT 11201
Hospital Charge Code	729107
Hospital Revenue Code	521
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Cash Price	$85.60

Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to w/15 Lesions C

Facility

$300.00

Service Code	CPT 11200
Hospital Charge Code	729105
Hospital Revenue Code	521
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$310.43
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Arizona Complete Health Allwell	$48.00
Rate for Payer: Banner UC Health Medicare	$48.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$204.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16.81
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cigna of AZ Commercial	$210.00
Rate for Payer: Devoted Health Medicare	$54.00
Rate for Payer: Humana of AZ Medicare	$48.00
Rate for Payer: Mercy Care Medicaid	$16.81
Rate for Payer: NaphCare Correctional Healthcare	$16.81
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$204.00
Rate for Payer: TriWest Medicare	$48.00
Rate for Payer: United Healthcare Commercial	$171.60
Rate for Payer: United Healthcare Medicare	$48.00
Rate for Payer: Veterans Affairs TRICARE	$47.52

Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to w/15 Lesions C

Facility

$300.00

Service Code	CPT 11200
Hospital Charge Code	729105
Hospital Revenue Code	521
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Cash Price	$240.00

REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP

Facility

$3,098.00

Service Code	CPT 36589
Hospital Revenue Code	360
Min. Negotiated Rate	$28.94
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	$28.94
Rate for Payer: Mercy Care Medicaid	$28.94
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 /revision of generator

Facility

$688.00

Service Code	CPT 64595
Hospital Charge Code	27267840
Hospital Revenue Code	360
Min. Negotiated Rate	$619.20
Max. Negotiated Rate	$619.20
Rate for Payer: Aetna of AZ Commercial	$619.20
Rate for Payer: Cash Price	$550.40

Removal /revision of generator

Facility

$688.00

Service Code	CPT 64595
Hospital Charge Code	27267840
Hospital Revenue Code	360
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$5,409.41
Rate for Payer: Aetna of AZ Commercial	$619.20
Rate for Payer: Arizona Complete Health Allwell	$110.08
Rate for Payer: Banner UC Health Medicare	$1,327.81
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$467.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$108.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$110.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$110.08
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cigna of AZ Commercial	$344.00
Rate for Payer: Devoted Health Medicare	$123.84
Rate for Payer: Humana of AZ Medicare	$110.08
Rate for Payer: Mercy Care Medicaid	$108.08
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	$467.84
Rate for Payer: TriWest Medicare	$110.08
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$110.08
Rate for Payer: Veterans Affairs TRICARE	$108.98

Remove Lesion, Face/Lid/Ear/Nose/Lip 1.1 to 2.0 cm Charge

Facility

$714.00

Service Code	CPT 11442
Hospital Charge Code	713723
Hospital Revenue Code	521
Min. Negotiated Rate	$48.99
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Arizona Complete Health Allwell	$114.24
Rate for Payer: Banner UC Health Medicare	$114.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$485.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$48.99
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$114.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$114.24
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cigna of AZ Commercial	$499.80
Rate for Payer: Devoted Health Medicare	$128.52
Rate for Payer: Humana of AZ Medicare	$114.24
Rate for Payer: Mercy Care Medicaid	$48.99
Rate for Payer: NaphCare Correctional Healthcare	$48.99
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$485.52
Rate for Payer: TriWest Medicare	$114.24
Rate for Payer: United Healthcare Commercial	$408.41
Rate for Payer: United Healthcare Medicare	$114.24
Rate for Payer: Veterans Affairs TRICARE	$113.10

Remove Lesion, Face/Lid/Ear/Nose/Lip 1.1 to 2.0 cm Charge

Facility

$714.00

Service Code	CPT 11442
Hospital Charge Code	713723
Hospital Revenue Code	521
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Cash Price	$571.20

Remove Lesion, Face/Lid/Ear/Nose/Lip 2.1 to 3.0 cm Charge

Facility

$700.00

Service Code	CPT 11443
Hospital Charge Code	713725
Hospital Revenue Code	521
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Cash Price	$560.00

Remove Lesion, Face/Lid/Ear/Nose/Lip 2.1 to 3.0 cm Charge

Facility

$700.00

Service Code	CPT 11443
Hospital Charge Code	713725
Hospital Revenue Code	521
Min. Negotiated Rate	$51.86
Max. Negotiated Rate	$2,555.47
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Arizona Complete Health Allwell	$112.00
Rate for Payer: Banner UC Health Medicare	$112.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$476.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$51.86
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$112.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$112.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cigna of AZ Commercial	$490.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Humana of AZ Medicare	$112.00
Rate for Payer: Mercy Care Medicaid	$51.86
Rate for Payer: NaphCare Correctional Healthcare	$51.86
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$476.00
Rate for Payer: TriWest Medicare	$112.00
Rate for Payer: United Healthcare Commercial	$400.40
Rate for Payer: United Healthcare Medicare	$112.00
Rate for Payer: Veterans Affairs TRICARE	$110.88

Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge

Facility

$404.00

Service Code	CPT 11440
Hospital Charge Code	713719
Hospital Revenue Code	521
Min. Negotiated Rate	$363.60
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Cash Price	$323.20

Remove Lesion, Face/Lid/Ear/Nose/Lip <.5 cm Charge

Facility

$404.00

Service Code	CPT 11440
Hospital Charge Code	713719
Hospital Revenue Code	521
Min. Negotiated Rate	$37.91
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Arizona Complete Health Allwell	$64.64
Rate for Payer: Banner UC Health Medicare	$64.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$274.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$37.91
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$64.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$64.64
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cigna of AZ Commercial	$282.80
Rate for Payer: Devoted Health Medicare	$72.72
Rate for Payer: Humana of AZ Medicare	$64.64
Rate for Payer: Mercy Care Medicaid	$37.91
Rate for Payer: NaphCare Correctional Healthcare	$37.91
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$274.72
Rate for Payer: TriWest Medicare	$64.64
Rate for Payer: United Healthcare Commercial	$231.09
Rate for Payer: United Healthcare Medicare	$64.64
Rate for Payer: Veterans Affairs TRICARE	$63.99

Remove Lesion, Face/Lid/Ear/Nose/Lip .6 to 1.0 cm Charge

Facility

$481.00

Service Code	CPT 11441
Hospital Charge Code	713721
Hospital Revenue Code	521
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$1,095.68
Rate for Payer: Aetna of AZ Commercial	$432.90
Rate for Payer: Arizona Complete Health Allwell	$76.96
Rate for Payer: Banner UC Health Medicare	$76.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$327.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$42.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.96
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cigna of AZ Commercial	$336.70
Rate for Payer: Devoted Health Medicare	$86.58
Rate for Payer: Humana of AZ Medicare	$76.96
Rate for Payer: Mercy Care Medicaid	$42.92
Rate for Payer: NaphCare Correctional Healthcare	$42.92
Rate for Payer: Seven Corners Travel Insurance	$1,095.68
Rate for Payer: Southwest Service Administrators UFCW	$327.08
Rate for Payer: TriWest Medicare	$76.96
Rate for Payer: United Healthcare Commercial	$275.13
Rate for Payer: United Healthcare Medicare	$76.96
Rate for Payer: Veterans Affairs TRICARE	$76.19

Remove Lesion, Face/Lid/Ear/Nose/Lip .6 to 1.0 cm Charge

Facility

$481.00

Service Code	CPT 11441
Hospital Charge Code	713721
Hospital Revenue Code	521
Min. Negotiated Rate	$432.90
Max. Negotiated Rate	$432.90
Rate for Payer: Aetna of AZ Commercial	$432.90
Rate for Payer: Cash Price	$384.80

Remove Lesion, Scalp/Neck/Hand/Foot 1.1 to 2.0 cm Charge

Facility

$636.00

Service Code	CPT 11422
Hospital Charge Code	713711
Hospital Revenue Code	521
Min. Negotiated Rate	$572.40
Max. Negotiated Rate	$572.40
Rate for Payer: Aetna of AZ Commercial	$572.40
Rate for Payer: Cash Price	$508.80

Remove Lesion, Scalp/Neck/Hand/Foot 1.1 to 2.0 cm Charge

Facility

$636.00

Service Code	CPT 11422
Hospital Charge Code	713711
Hospital Revenue Code	521
Min. Negotiated Rate	$45.78
Max. Negotiated Rate	$2,555.47
Rate for Payer: Aetna of AZ Commercial	$572.40
Rate for Payer: Arizona Complete Health Allwell	$101.76
Rate for Payer: Banner UC Health Medicare	$101.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$432.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$45.78
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$101.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$101.76
Rate for Payer: Cash Price	$508.80
Rate for Payer: Cash Price	$508.80
Rate for Payer: Cigna of AZ Commercial	$445.20
Rate for Payer: Devoted Health Medicare	$114.48
Rate for Payer: Humana of AZ Medicare	$101.76
Rate for Payer: Mercy Care Medicaid	$45.78
Rate for Payer: NaphCare Correctional Healthcare	$45.78
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$432.48
Rate for Payer: TriWest Medicare	$101.76
Rate for Payer: United Healthcare Commercial	$363.79
Rate for Payer: United Healthcare Medicare	$101.76
Rate for Payer: Veterans Affairs TRICARE	$100.74

Remove Lesion, Scalp/Neck/Hand/Foot 2.1 to 3.0 cm Charge

Facility

$790.00

Service Code	CPT 11423
Hospital Charge Code	713713
Hospital Revenue Code	521
Min. Negotiated Rate	$711.00
Max. Negotiated Rate	$711.00
Rate for Payer: Aetna of AZ Commercial	$711.00
Rate for Payer: Cash Price	$632.00

Remove Lesion, Scalp/Neck/Hand/Foot 2.1 to 3.0 cm Charge

Facility

$790.00

Service Code	CPT 11423
Hospital Charge Code	713713
Hospital Revenue Code	521
Min. Negotiated Rate	$50.79
Max. Negotiated Rate	$2,555.47
Rate for Payer: Aetna of AZ Commercial	$711.00
Rate for Payer: Arizona Complete Health Allwell	$126.40
Rate for Payer: Banner UC Health Medicare	$126.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$537.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$50.79
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$126.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$126.40
Rate for Payer: Cash Price	$632.00
Rate for Payer: Cash Price	$632.00
Rate for Payer: Cigna of AZ Commercial	$553.00
Rate for Payer: Devoted Health Medicare	$142.20
Rate for Payer: Humana of AZ Medicare	$126.40
Rate for Payer: Mercy Care Medicaid	$50.79
Rate for Payer: NaphCare Correctional Healthcare	$50.79
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$537.20
Rate for Payer: TriWest Medicare	$126.40
Rate for Payer: United Healthcare Commercial	$451.88
Rate for Payer: United Healthcare Medicare	$126.40
Rate for Payer: Veterans Affairs TRICARE	$125.14

Remove Lesion, Scalp/Neck/Hand/Foot >4.0 cm Charge

Facility

$910.00

Service Code	CPT 11426
Hospital Charge Code	713717
Hospital Revenue Code	521
Min. Negotiated Rate	$819.00
Max. Negotiated Rate	$819.00
Rate for Payer: Aetna of AZ Commercial	$819.00
Rate for Payer: Cash Price	$728.00

Remove Lesion, Scalp/Neck/Hand/Foot >4.0 cm Charge

Facility

$910.00

Service Code	CPT 11426
Hospital Charge Code	713717
Hospital Revenue Code	521
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$4,494.38
Rate for Payer: Aetna of AZ Commercial	$819.00
Rate for Payer: Arizona Complete Health Allwell	$145.60
Rate for Payer: Banner UC Health Medicare	$145.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$618.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$64.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$145.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$145.60
Rate for Payer: Cash Price	$728.00
Rate for Payer: Cash Price	$728.00
Rate for Payer: Cigna of AZ Commercial	$637.00
Rate for Payer: Devoted Health Medicare	$163.80
Rate for Payer: Humana of AZ Medicare	$145.60
Rate for Payer: Mercy Care Medicaid	$64.02
Rate for Payer: NaphCare Correctional Healthcare	$64.02
Rate for Payer: Seven Corners Travel Insurance	$4,494.38
Rate for Payer: Southwest Service Administrators UFCW	$618.80
Rate for Payer: TriWest Medicare	$145.60
Rate for Payer: United Healthcare Commercial	$520.52
Rate for Payer: United Healthcare Medicare	$145.60
Rate for Payer: Veterans Affairs TRICARE	$144.14

Know your out-of-pocket cost for care.

All Charges