Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ULTRASOUND OF LEG ARTERIES AT REST AND AFTER EXERCISE

Facility

$811.00

Service Code	CPT 93924
Hospital Charge Code	28277679
Hospital Revenue Code	730
Min. Negotiated Rate	$729.90
Max. Negotiated Rate	$729.90
Rate for Payer: Aetna of AZ Commercial	$729.90
Rate for Payer: Cash Price	$648.80

ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY

Facility

$840.00

Service Code	CPT 76981
Hospital Charge Code	22282742
Hospital Revenue Code	402
Min. Negotiated Rate	$133.06
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna of AZ Commercial	$756.00
Rate for Payer: Arizona Complete Health Allwell	$134.40
Rate for Payer: Banner UC Health Medicare	$134.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$571.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$134.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$134.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cigna of AZ Commercial	$588.00
Rate for Payer: Devoted Health Medicare	$151.20
Rate for Payer: Humana of AZ Medicare	$134.40
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$571.20
Rate for Payer: TriWest Medicare	$134.40
Rate for Payer: United Healthcare Commercial	$480.48
Rate for Payer: United Healthcare Medicare	$134.40
Rate for Payer: United Healthcare New Mexico Commercial	$159.60
Rate for Payer: Veterans Affairs TRICARE	$133.06

ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY

Facility

$840.00

Service Code	CPT 76981
Hospital Charge Code	22282742
Hospital Revenue Code	402
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna of AZ Commercial	$756.00
Rate for Payer: Cash Price	$672.00

ULTRASOUND SCAN OF PELVIC REGION THROUGH RECTUM

Facility

$554.00

Service Code	CPT 76872
Hospital Charge Code	27880811
Hospital Revenue Code	521
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna of AZ Commercial	$498.60
Rate for Payer: Arizona Complete Health Allwell	$88.64
Rate for Payer: Banner UC Health Medicare	$88.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$376.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$88.64
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cigna of AZ Commercial	$387.80
Rate for Payer: Devoted Health Medicare	$99.72
Rate for Payer: Humana of AZ Medicare	$88.64
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$376.72
Rate for Payer: TriWest Medicare	$88.64
Rate for Payer: United Healthcare Commercial	$316.89
Rate for Payer: United Healthcare Medicare	$88.64
Rate for Payer: Veterans Affairs TRICARE	$87.75

ULTRASOUND SCAN OF PELVIC REGION THROUGH RECTUM

Facility

$554.00

Service Code	CPT 76872
Hospital Charge Code	27880811
Hospital Revenue Code	521
Min. Negotiated Rate	$498.60
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna of AZ Commercial	$498.60
Rate for Payer: Cash Price	$443.20

ULTRASOUND STUDY OF ARM AND LEG ARTERIES

Facility

$417.00

Service Code	CPT 93922
Hospital Charge Code	28276349
Hospital Revenue Code	730
Min. Negotiated Rate	$375.30
Max. Negotiated Rate	$375.30
Rate for Payer: Aetna of AZ Commercial	$375.30
Rate for Payer: Cash Price	$333.60

ULTRASOUND STUDY OF ARM AND LEG ARTERIES

Facility

$417.00

Service Code	CPT 93922
Hospital Charge Code	28276349
Hospital Revenue Code	730
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$375.30
Rate for Payer: Aetna of AZ Commercial	$375.30
Rate for Payer: Arizona Complete Health Allwell	$66.72
Rate for Payer: Banner UC Health Medicare	$66.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$283.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.72
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cigna of AZ Commercial	$291.90
Rate for Payer: Devoted Health Medicare	$75.06
Rate for Payer: Humana of AZ Medicare	$66.72
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$283.56
Rate for Payer: TriWest Medicare	$66.72
Rate for Payer: United Healthcare Commercial	$238.52
Rate for Payer: United Healthcare Medicare	$66.72
Rate for Payer: United Healthcare New Mexico Commercial	$79.23
Rate for Payer: Veterans Affairs TRICARE	$66.05

Ultrasound, transrectal;

Facility

$3,373.00

Service Code	CPT 76872
Hospital Revenue Code	360
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$3,373.00
Rate for Payer: Banner UC Health Medicare	$31.31
Rate for Payer: NaphCare Correctional Healthcare	$31.31
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: United Healthcare Commercial	$3,373.00

Ultrasound, transrectal;

Facility

$3,373.00

Service Code	CPT 76872
Hospital Revenue Code	490
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$3,373.00
Rate for Payer: Banner UC Health Medicare	$31.31
Rate for Payer: NaphCare Correctional Healthcare	$31.31
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: United Healthcare Commercial	$3,373.00

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$17,850.54

Service Code	MSDRG 383
Min. Negotiated Rate	$17,850.54
Max. Negotiated Rate	$17,850.54
Rate for Payer: Seven Corners Travel Insurance	$17,850.54

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$11,186.75

Service Code	MSDRG 384
Min. Negotiated Rate	$11,186.75
Max. Negotiated Rate	$11,186.75
Rate for Payer: Seven Corners Travel Insurance	$11,186.75

UNIHEART LO FLOW NEB

Facility

$41.00

Hospital Charge Code	22355556
Hospital Revenue Code	270
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

UNIHEART LO FLOW NEB

Facility

$41.00

Hospital Charge Code	22355556
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

UNIVERSAL NASAL TUBING 70MM

Facility

$72.00

Hospital Charge Code	27664818
Hospital Revenue Code	270
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Arizona Complete Health Allwell	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.52
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Devoted Health Medicare	$12.96
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Southwest Service Administrators UFCW	$48.96
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: United Healthcare Commercial	$41.18
Rate for Payer: United Healthcare Medicare	$11.52
Rate for Payer: Veterans Affairs TRICARE	$11.40

UNIVERSAL NASAL TUBING 70MM

Facility

$72.00

Hospital Charge Code	27664818
Hospital Revenue Code	270
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Cash Price	$57.60

UNIVERSAL SOFT URETERAL STENT SET 6FRX22CM

Facility

$525.00

Hospital Charge Code	27753960
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

UNIVERSAL SOFT URETERAL STENT SET 6FRX22CM

Facility

$525.00

Hospital Charge Code	27753960
Hospital Revenue Code	270
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FR X 24CM

Facility

$525.00

Hospital Charge Code	27751228
Hospital Revenue Code	270
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FR X 24CM

Facility

$525.00

Hospital Charge Code	27751228
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

UNIVERSAL SOFT URETERAL STENT SET 6FRX26CM

Facility

$525.00

Hospital Charge Code	27753961
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

UNIVERSAL SOFT URETERAL STENT SET 6FRX26CM

Facility

$525.00

Hospital Charge Code	27753961
Hospital Revenue Code	270
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

UNIVERSAL SOFT URETERAL STENT SET 6FRX28CM

Facility

$525.00

Hospital Charge Code	27753962
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

UNIVERSAL SOFT URETERAL STENT SET 6FRX28CM

Facility

$525.00

Hospital Charge Code	27753962
Hospital Revenue Code	270
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

UNIVERSAL TROCAR 5MM

Facility

$524.00

Hospital Charge Code	22546418
Hospital Revenue Code	272
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$471.60
Rate for Payer: Aetna of AZ Commercial	$471.60
Rate for Payer: Arizona Complete Health Allwell	$83.84
Rate for Payer: Banner UC Health Medicare	$83.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$356.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$83.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$83.84
Rate for Payer: Cash Price	$419.20
Rate for Payer: Cigna of AZ Commercial	$366.80
Rate for Payer: Devoted Health Medicare	$94.32
Rate for Payer: Humana of AZ Medicare	$83.84
Rate for Payer: Southwest Service Administrators UFCW	$356.32
Rate for Payer: TriWest Medicare	$83.84
Rate for Payer: United Healthcare Commercial	$299.73
Rate for Payer: United Healthcare Medicare	$83.84
Rate for Payer: Veterans Affairs TRICARE	$83.00

UNIVERSAL TROCAR 5MM

Facility

$524.00

Hospital Charge Code	22546418
Hospital Revenue Code	272
Min. Negotiated Rate	$471.60
Max. Negotiated Rate	$471.60
Rate for Payer: Aetna of AZ Commercial	$471.60
Rate for Payer: Cash Price	$419.20

Know your out-of-pocket cost for care.

All Charges