Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE

Facility

$10,016.75

Service Code	CPT 49593
Hospital Revenue Code	490
Min. Negotiated Rate	$2,423.12
Max. Negotiated Rate	$10,016.75
Rate for Payer: Banner UC Health Medicare	$2,423.12
Rate for Payer: NaphCare Correctional Healthcare	$2,423.12
Rate for Payer: Seven Corners Travel Insurance	$10,016.75
Rate for Payer: United Healthcare Commercial	$3,373.00

Facility

$10,016.75

Service Code	CPT 49593
Hospital Revenue Code	360
Min. Negotiated Rate	$2,423.12
Max. Negotiated Rate	$10,016.75
Rate for Payer: Banner UC Health Medicare	$2,423.12
Rate for Payer: NaphCare Correctional Healthcare	$2,423.12
Rate for Payer: Seven Corners Travel Insurance	$10,016.75
Rate for Payer: United Healthcare Commercial	$3,373.00

Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, Spigelian), any approach (i.e., open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible

Facility

$5,539.84

Service Code	CPT 49591
Hospital Revenue Code	360
Min. Negotiated Rate	$1,221.04
Max. Negotiated Rate	$5,539.84
Rate for Payer: Banner UC Health Medicare	$1,221.04
Rate for Payer: NaphCare Correctional Healthcare	$1,221.04
Rate for Payer: Seven Corners Travel Insurance	$5,539.84
Rate for Payer: United Healthcare Commercial	$3,373.00

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE

Facility

$5,539.84

Service Code	CPT 49613
Hospital Revenue Code	360
Min. Negotiated Rate	$1,221.04
Max. Negotiated Rate	$5,539.84
Rate for Payer: Banner UC Health Medicare	$1,221.04
Rate for Payer: NaphCare Correctional Healthcare	$1,221.04
Rate for Payer: Seven Corners Travel Insurance	$5,539.84
Rate for Payer: United Healthcare Commercial	$3,373.00

REPAIR OF FLUID COLLECTION IN TESTICLE AND SPERM RESERVOIR

Facility

$1,985.00

Service Code	CPT 55060
Hospital Charge Code	27802896
Hospital Revenue Code	360
Min. Negotiated Rate	$314.42
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Arizona Complete Health Allwell	$317.60
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,349.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$317.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$317.60
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cigna of AZ Commercial	$992.50
Rate for Payer: Devoted Health Medicare	$357.30
Rate for Payer: Humana of AZ Medicare	$317.60
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	$1,349.80
Rate for Payer: TriWest Medicare	$317.60
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$317.60
Rate for Payer: Veterans Affairs TRICARE	$314.42

REPAIR OF FLUID COLLECTION IN TESTICLE AND SPERM RESERVOIR

Facility

$1,985.00

Service Code	CPT 55060
Hospital Charge Code	27802896
Hospital Revenue Code	360
Min. Negotiated Rate	$1,786.50
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Cash Price	$1,588.00

REPAIR OF STRICTURE IN KIDNEY USING AN ENDOSCOPE

Facility

$1,777.00

Service Code	CPT 52343
Hospital Charge Code	28068481
Hospital Revenue Code	360
Min. Negotiated Rate	$1,599.30
Max. Negotiated Rate	$1,599.30
Rate for Payer: Aetna of AZ Commercial	$1,599.30
Rate for Payer: Cash Price	$1,421.60

REPAIR OF STRICTURE IN KIDNEY USING AN ENDOSCOPE

Facility

$1,777.00

Service Code	CPT 52343
Hospital Charge Code	28068481
Hospital Revenue Code	360
Min. Negotiated Rate	$281.48
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,599.30
Rate for Payer: Arizona Complete Health Allwell	$284.32
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,208.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$284.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$284.32
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Cigna of AZ Commercial	$888.50
Rate for Payer: Devoted Health Medicare	$319.86
Rate for Payer: Humana of AZ Medicare	$284.32
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	$1,208.36
Rate for Payer: TriWest Medicare	$284.32
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$284.32
Rate for Payer: Veterans Affairs TRICARE	$281.48

REPAIR OF STRICTURE IN KIDNEY WITH EXAM OF URINARY TRACT USI

Facility

$2,261.10

Service Code	CPT 52346
Hospital Charge Code	28133133
Hospital Revenue Code	360
Min. Negotiated Rate	$358.16
Max. Negotiated Rate	$8,296.15
Rate for Payer: Aetna of AZ Commercial	$2,034.99
Rate for Payer: Arizona Complete Health Allwell	$361.78
Rate for Payer: Banner UC Health Medicare	$1,977.90
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,537.55
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$361.78
Rate for Payer: Care1st Health Plan Arizona Medicare	$361.78
Rate for Payer: Cash Price	$1,808.88
Rate for Payer: Cash Price	$1,808.88
Rate for Payer: Cash Price	$1,808.88
Rate for Payer: Cigna of AZ Commercial	$1,130.55
Rate for Payer: Devoted Health Medicare	$407.00
Rate for Payer: Humana of AZ Medicare	$361.78
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	$1,537.55
Rate for Payer: TriWest Medicare	$361.78
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$361.78
Rate for Payer: Veterans Affairs TRICARE	$358.16

REPAIR OF STRICTURE IN KIDNEY WITH EXAM OF URINARY TRACT USI

Facility

$2,261.10

Service Code	CPT 52346
Hospital Charge Code	28133133
Hospital Revenue Code	360
Min. Negotiated Rate	$2,034.99
Max. Negotiated Rate	$2,034.99
Rate for Payer: Aetna of AZ Commercial	$2,034.99
Rate for Payer: Cash Price	$1,808.88

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,452.00

Service Code	CPT 23410
Hospital Charge Code	27371853
Hospital Revenue Code	360
Min. Negotiated Rate	$4,006.80
Max. Negotiated Rate	$4,006.80
Rate for Payer: Aetna of AZ Commercial	$4,006.80
Rate for Payer: Cash Price	$3,561.60

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,452.00

Service Code	CPT 23410
Hospital Charge Code	27371853
Hospital Revenue Code	360
Min. Negotiated Rate	$705.20
Max. Negotiated Rate	$11,227.32
Rate for Payer: Aetna of AZ Commercial	$4,006.80
Rate for Payer: Arizona Complete Health Allwell	$712.32
Rate for Payer: Banner UC Health Medicare	$3,026.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,027.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$712.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$712.32
Rate for Payer: Cash Price	$3,561.60
Rate for Payer: Cash Price	$3,561.60
Rate for Payer: Cash Price	$3,561.60
Rate for Payer: Cigna of AZ Commercial	$2,226.00
Rate for Payer: Devoted Health Medicare	$801.36
Rate for Payer: Humana of AZ Medicare	$712.32
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	$3,027.36
Rate for Payer: TriWest Medicare	$712.32
Rate for Payer: United Healthcare Commercial	$5,611.00
Rate for Payer: United Healthcare Medicare	$712.32
Rate for Payer: Veterans Affairs TRICARE	$705.20

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,625.00

Service Code	CPT 23412
Hospital Charge Code	27368692
Hospital Revenue Code	360
Min. Negotiated Rate	$732.60
Max. Negotiated Rate	$11,227.32
Rate for Payer: Aetna of AZ Commercial	$4,162.50
Rate for Payer: Arizona Complete Health Allwell	$740.00
Rate for Payer: Banner UC Health Medicare	$3,026.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,145.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$740.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$740.00
Rate for Payer: Cash Price	$3,700.00
Rate for Payer: Cash Price	$3,700.00
Rate for Payer: Cash Price	$3,700.00
Rate for Payer: Cigna of AZ Commercial	$2,312.50
Rate for Payer: Devoted Health Medicare	$832.50
Rate for Payer: Humana of AZ Medicare	$740.00
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	$3,145.00
Rate for Payer: TriWest Medicare	$740.00
Rate for Payer: United Healthcare Commercial	$5,611.00
Rate for Payer: United Healthcare Medicare	$740.00
Rate for Payer: Veterans Affairs TRICARE	$732.60

REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROC

Facility

$4,625.00

Service Code	CPT 23412
Hospital Charge Code	27368692
Hospital Revenue Code	360
Min. Negotiated Rate	$4,162.50
Max. Negotiated Rate	$4,162.50
Rate for Payer: Aetna of AZ Commercial	$4,162.50
Rate for Payer: Cash Price	$3,700.00

REPAIR OF URETHRA AND URINARY OPENING

Facility

$2,122.00

Service Code	CPT 53450
Hospital Charge Code	30512444
Hospital Revenue Code	360
Min. Negotiated Rate	$1,909.80
Max. Negotiated Rate	$1,909.80
Rate for Payer: Aetna of AZ Commercial	$1,909.80
Rate for Payer: Cash Price	$1,697.60

REPAIR OF URETHRA AND URINARY OPENING

Facility

$2,122.00

Service Code	CPT 53450
Hospital Charge Code	30512444
Hospital Revenue Code	360
Min. Negotiated Rate	$336.12
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,909.80
Rate for Payer: Arizona Complete Health Allwell	$339.52
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,442.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$339.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$339.52
Rate for Payer: Cash Price	$1,697.60
Rate for Payer: Cash Price	$1,697.60
Rate for Payer: Cash Price	$1,697.60
Rate for Payer: Cigna of AZ Commercial	$1,061.00
Rate for Payer: Devoted Health Medicare	$381.96
Rate for Payer: Humana of AZ Medicare	$339.52
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	$1,442.96
Rate for Payer: TriWest Medicare	$339.52
Rate for Payer: United Healthcare Commercial	$4,838.00
Rate for Payer: United Healthcare Medicare	$339.52
Rate for Payer: Veterans Affairs TRICARE	$336.12

Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 2.5 cm >

Facility

$513.00

Service Code	CPT 12011
Hospital Charge Code	713879
Hospital Revenue Code	521
Min. Negotiated Rate	$461.70
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of AZ Commercial	$461.70
Rate for Payer: Cash Price	$410.40

Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 2.5 cm >

Facility

$513.00

Service Code	CPT 12011
Hospital Charge Code	713879
Hospital Revenue Code	521
Min. Negotiated Rate	$60.08
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of AZ Commercial	$461.70
Rate for Payer: Arizona Complete Health Allwell	$82.08
Rate for Payer: Banner UC Health Medicare	$82.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$348.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$60.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$82.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$82.08
Rate for Payer: Cash Price	$410.40
Rate for Payer: Cash Price	$410.40
Rate for Payer: Cigna of AZ Commercial	$359.10
Rate for Payer: Devoted Health Medicare	$92.34
Rate for Payer: Humana of AZ Medicare	$82.08
Rate for Payer: Mercy Care Medicaid	$60.08
Rate for Payer: NaphCare Correctional Healthcare	$60.08
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$348.84
Rate for Payer: TriWest Medicare	$82.08
Rate for Payer: United Healthcare Commercial	$293.44
Rate for Payer: United Healthcare Medicare	$82.08
Rate for Payer: Veterans Affairs TRICARE	$81.26

Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 2.6 cm t

Facility

$337.00

Service Code	CPT 12013
Hospital Charge Code	713881
Hospital Revenue Code	521
Min. Negotiated Rate	$303.30
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Cash Price	$269.60

Repair Simple Face, Ears, Eyelids, Nose, Lips and/or Mucous Membranes; 2.6 cm t

Facility

$337.00

Service Code	CPT 12013
Hospital Charge Code	713881
Hospital Revenue Code	521
Min. Negotiated Rate	$53.38
Max. Negotiated Rate	$310.43
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Arizona Complete Health Allwell	$53.92
Rate for Payer: Banner UC Health Medicare	$53.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$229.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$62.22
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.92
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cigna of AZ Commercial	$235.90
Rate for Payer: Devoted Health Medicare	$60.66
Rate for Payer: Humana of AZ Medicare	$53.92
Rate for Payer: Mercy Care Medicaid	$62.22
Rate for Payer: NaphCare Correctional Healthcare	$62.22
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$229.16
Rate for Payer: TriWest Medicare	$53.92
Rate for Payer: United Healthcare Commercial	$192.76
Rate for Payer: United Healthcare Medicare	$53.92
Rate for Payer: Veterans Affairs TRICARE	$53.38

Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm >

Facility

$439.00

Service Code	CPT 12001
Hospital Charge Code	713867
Hospital Revenue Code	521
Min. Negotiated Rate	$395.10
Max. Negotiated Rate	$395.10
Rate for Payer: Aetna of AZ Commercial	$395.10
Rate for Payer: Cash Price	$351.20

Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.5 cm >

Facility

$439.00

Service Code	CPT 12001
Hospital Charge Code	713867
Hospital Revenue Code	521
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$395.10
Rate for Payer: Aetna of AZ Commercial	$395.10
Rate for Payer: Arizona Complete Health Allwell	$70.24
Rate for Payer: Banner UC Health Medicare	$70.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$298.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52.21
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$70.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$70.24
Rate for Payer: Cash Price	$351.20
Rate for Payer: Cash Price	$351.20
Rate for Payer: Cigna of AZ Commercial	$307.30
Rate for Payer: Devoted Health Medicare	$79.02
Rate for Payer: Humana of AZ Medicare	$70.24
Rate for Payer: Mercy Care Medicaid	$52.21
Rate for Payer: NaphCare Correctional Healthcare	$52.21
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$298.52
Rate for Payer: TriWest Medicare	$70.24
Rate for Payer: United Healthcare Commercial	$251.11
Rate for Payer: United Healthcare Medicare	$70.24
Rate for Payer: Veterans Affairs TRICARE	$69.54

Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm t

Facility

$539.00

Service Code	CPT 12002
Hospital Charge Code	713869
Hospital Revenue Code	521
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$485.10
Rate for Payer: Aetna of AZ Commercial	$485.10
Rate for Payer: Arizona Complete Health Allwell	$86.24
Rate for Payer: Banner UC Health Medicare	$86.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$366.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$58.65
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$86.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$86.24
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cigna of AZ Commercial	$377.30
Rate for Payer: Devoted Health Medicare	$97.02
Rate for Payer: Humana of AZ Medicare	$86.24
Rate for Payer: Mercy Care Medicaid	$58.65
Rate for Payer: NaphCare Correctional Healthcare	$58.65
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$366.52
Rate for Payer: TriWest Medicare	$86.24
Rate for Payer: United Healthcare Commercial	$308.31
Rate for Payer: United Healthcare Medicare	$86.24
Rate for Payer: Veterans Affairs TRICARE	$85.38

Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 2.6 cm t

Facility

$539.00

Service Code	CPT 12002
Hospital Charge Code	713869
Hospital Revenue Code	521
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$485.10
Rate for Payer: Aetna of AZ Commercial	$485.10
Rate for Payer: Cash Price	$431.20

Repair Simple Scalp, Neck, Axillae, Ext. Genital, Trunk and/or Extrem; 7.6 cm t

Facility

$414.00

Service Code	CPT 12004
Hospital Charge Code	713871
Hospital Revenue Code	521
Min. Negotiated Rate	$372.60
Max. Negotiated Rate	$372.60
Rate for Payer: Aetna of AZ Commercial	$372.60
Rate for Payer: Cash Price	$331.20

Know your out-of-pocket cost for care.

All Charges