Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ROTATIONS MORCELLATOR 4.8MM WL 355MM

Facility

$5,257.15

Hospital Charge Code	27839759
Hospital Revenue Code	270
Min. Negotiated Rate	$832.73
Max. Negotiated Rate	$4,731.44
Rate for Payer: Aetna of AZ Commercial	$4,731.44
Rate for Payer: Arizona Complete Health Allwell	$841.14
Rate for Payer: Banner UC Health Medicare	$841.14
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,574.86
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$841.14
Rate for Payer: Care1st Health Plan Arizona Medicare	$841.14
Rate for Payer: Cash Price	$4,205.72
Rate for Payer: Cigna of AZ Commercial	$3,680.01
Rate for Payer: Devoted Health Medicare	$946.29
Rate for Payer: Humana of AZ Medicare	$841.14
Rate for Payer: Southwest Service Administrators UFCW	$3,574.86
Rate for Payer: TriWest Medicare	$841.14
Rate for Payer: United Healthcare Commercial	$3,007.09
Rate for Payer: United Healthcare Medicare	$841.14
Rate for Payer: Veterans Affairs TRICARE	$832.73

ROTH NET

Facility

$440.00

Hospital Charge Code	22354323
Hospital Revenue Code	270
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Arizona Complete Health Allwell	$70.40
Rate for Payer: Banner UC Health Medicare	$70.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$299.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$70.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$70.40
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cigna of AZ Commercial	$308.00
Rate for Payer: Devoted Health Medicare	$79.20
Rate for Payer: Humana of AZ Medicare	$70.40
Rate for Payer: Southwest Service Administrators UFCW	$299.20
Rate for Payer: TriWest Medicare	$70.40
Rate for Payer: United Healthcare Commercial	$251.68
Rate for Payer: United Healthcare Medicare	$70.40
Rate for Payer: Veterans Affairs TRICARE	$69.70

ROTH NET

Facility

$440.00

Hospital Charge Code	22354323
Hospital Revenue Code	270
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Cash Price	$352.00

ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH

Facility

$78.00

Service Code	CPT 93000
Hospital Charge Code	28223081
Hospital Revenue Code	730
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Cash Price	$62.40

ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH

Facility

$78.00

Service Code	CPT 93000
Hospital Charge Code	28223081
Hospital Revenue Code	730
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Arizona Complete Health Allwell	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.48
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Southwest Service Administrators UFCW	$53.04
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: United Healthcare Commercial	$44.62
Rate for Payer: United Healthcare Medicare	$12.48
Rate for Payer: United Healthcare New Mexico Commercial	$14.82
Rate for Payer: Veterans Affairs TRICARE	$12.36

RPR LC

Facility

$62.00

Service Code	CPT 86592
Hospital Charge Code	2269415
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$49.60

RPR LC

Facility

$62.00

Service Code	CPT 86592
Hospital Charge Code	2269415
Hospital Revenue Code	302
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Arizona Complete Health Allwell	$14.24
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$60.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Cigna of AZ Commercial	$57.85
Rate for Payer: Devoted Health Medicare	$16.02
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$6.19
Rate for Payer: Seven Corners Travel Insurance	$6.19
Rate for Payer: Southwest Service Administrators UFCW	$60.52
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Commercial	$50.91
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: United Healthcare Medicare	$14.24
Rate for Payer: Veterans Affairs TRICARE	$14.10
Rate for Payer: Veterans Affairs TRICARE	$9.82

.RPR Qn+TP Abs LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	22311166
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Cash Price	$52.00

.RPR Qn+TP Abs LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	22311166
Hospital Revenue Code	302
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Arizona Complete Health Allwell	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.40
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Devoted Health Medicare	$11.70
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Seven Corners Travel Insurance	$6.19
Rate for Payer: Southwest Service Administrators UFCW	$44.20
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: United Healthcare Commercial	$37.18
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: Veterans Affairs TRICARE	$10.30

.RPR, Quant LC

Facility

$65.00

Service Code	CPT 86593
Hospital Charge Code	3033479
Hospital Revenue Code	302
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Arizona Complete Health Allwell	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.40
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Devoted Health Medicare	$11.70
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Seven Corners Travel Insurance	$6.38
Rate for Payer: Southwest Service Administrators UFCW	$44.20
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: United Healthcare Commercial	$37.18
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: Veterans Affairs TRICARE	$10.30

.RPR, Quant LC

Facility

$65.00

Service Code	CPT 86593
Hospital Charge Code	3033479
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Cash Price	$52.00

RPR, Rfx Qn RPR/Confirm TP LC

Facility

$64.00

Service Code	CPT 86592
Hospital Charge Code	22201655
Hospital Revenue Code	302
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Cash Price	$51.20

RPR, Rfx Qn RPR/Confirm TP LC

Facility

$64.00

Service Code	CPT 86592
Hospital Charge Code	22201655
Hospital Revenue Code	302
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Arizona Complete Health Allwell	$10.24
Rate for Payer: Banner UC Health Medicare	$10.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$43.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.24
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cigna of AZ Commercial	$41.60
Rate for Payer: Devoted Health Medicare	$11.52
Rate for Payer: Humana of AZ Medicare	$10.24
Rate for Payer: Seven Corners Travel Insurance	$6.19
Rate for Payer: Southwest Service Administrators UFCW	$43.52
Rate for Payer: TriWest Medicare	$10.24
Rate for Payer: United Healthcare Commercial	$36.61
Rate for Payer: United Healthcare Medicare	$10.24
Rate for Payer: Veterans Affairs TRICARE	$10.14

RT Continuous Neb Subsequent Charge

Facility

$321.00

Service Code	CPT 94645
Hospital Charge Code	3230232
Hospital Revenue Code	410
Min. Negotiated Rate	$288.90
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Cash Price	$256.80

RT Continuous Neb Subsequent Charge

Facility

$321.00

Service Code	CPT 94645
Hospital Charge Code	3230232
Hospital Revenue Code	410
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Arizona Complete Health Allwell	$51.36
Rate for Payer: Banner UC Health Medicare	$51.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$218.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$51.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$51.36
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$224.70
Rate for Payer: Devoted Health Medicare	$57.78
Rate for Payer: Humana of AZ Medicare	$51.36
Rate for Payer: Southwest Service Administrators UFCW	$218.28
Rate for Payer: TriWest Medicare	$51.36
Rate for Payer: United Healthcare Commercial	$183.61
Rate for Payer: United Healthcare Medicare	$51.36
Rate for Payer: United Healthcare New Mexico Commercial	$60.99
Rate for Payer: Veterans Affairs TRICARE	$50.85

RT ETC02 Monitoring Charge

Facility

$605.00

Service Code	HCPCS G0238
Hospital Charge Code	1886873
Hospital Revenue Code	410
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$544.50
Rate for Payer: Aetna of AZ Commercial	$544.50
Rate for Payer: Arizona Complete Health Allwell	$96.80
Rate for Payer: Banner UC Health Medicare	$96.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$411.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$96.80
Rate for Payer: Cash Price	$484.00
Rate for Payer: Cash Price	$484.00
Rate for Payer: Cigna of AZ Commercial	$423.50
Rate for Payer: Devoted Health Medicare	$108.90
Rate for Payer: Humana of AZ Medicare	$96.80
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$411.40
Rate for Payer: TriWest Medicare	$96.80
Rate for Payer: United Healthcare Commercial	$346.06
Rate for Payer: United Healthcare Medicare	$96.80
Rate for Payer: United Healthcare New Mexico Commercial	$114.95
Rate for Payer: Veterans Affairs TRICARE	$95.83

RT ETC02 Monitoring Charge

Facility

$605.00

Service Code	HCPCS G0238
Hospital Charge Code	1886873
Hospital Revenue Code	410
Min. Negotiated Rate	$544.50
Max. Negotiated Rate	$544.50
Rate for Payer: Aetna of AZ Commercial	$544.50
Rate for Payer: Cash Price	$484.00

RT Ventilator Services - Subs Charge

Facility

$2,715.00

Service Code	CPT 94003
Hospital Charge Code	1886948
Hospital Revenue Code	410
Min. Negotiated Rate	$2,443.50
Max. Negotiated Rate	$2,443.50
Rate for Payer: Aetna of AZ Commercial	$2,443.50
Rate for Payer: Cash Price	$2,172.00

RT Ventilator Services - Subs Charge

Facility

$2,715.00

Service Code	CPT 94003
Hospital Charge Code	1886948
Hospital Revenue Code	410
Min. Negotiated Rate	$430.06
Max. Negotiated Rate	$2,443.50
Rate for Payer: Aetna of AZ Commercial	$2,443.50
Rate for Payer: Arizona Complete Health Allwell	$434.40
Rate for Payer: Banner UC Health Medicare	$434.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,846.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$434.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$434.40
Rate for Payer: Cash Price	$2,172.00
Rate for Payer: Cash Price	$2,172.00
Rate for Payer: Cigna of AZ Commercial	$1,900.50
Rate for Payer: Devoted Health Medicare	$488.70
Rate for Payer: Humana of AZ Medicare	$434.40
Rate for Payer: Seven Corners Travel Insurance	$955.88
Rate for Payer: Southwest Service Administrators UFCW	$1,846.20
Rate for Payer: TriWest Medicare	$434.40
Rate for Payer: United Healthcare Commercial	$1,552.98
Rate for Payer: United Healthcare Medicare	$434.40
Rate for Payer: United Healthcare New Mexico Commercial	$515.85
Rate for Payer: Veterans Affairs TRICARE	$430.06

Rubella Antibodies, IgG LC

Facility

$172.00

Service Code	CPT 86762
Hospital Charge Code	2029257
Hospital Revenue Code	302
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

Rubella Antibodies, IgG LC

Facility

$172.00

Service Code	CPT 86762
Hospital Charge Code	2029257
Hospital Revenue Code	302
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.52
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Seven Corners Travel Insurance	$20.87
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: Veterans Affairs TRICARE	$27.24

Rubella Antibody, IgM LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2446665
Hospital Revenue Code	302
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

Rubella Antibody, IgM LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2446665
Hospital Revenue Code	302
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.96
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Seven Corners Travel Insurance	$20.87
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: Veterans Affairs TRICARE	$28.67

RUBELLA IGG

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	22481502
Hospital Revenue Code	302
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

RUBELLA IGG

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	22481502
Hospital Revenue Code	302
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.96
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Seven Corners Travel Insurance	$20.87
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: Veterans Affairs TRICARE	$28.67

Know your out-of-pocket cost for care.

All Charges