Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

$12,378.31

Service Code	APR-DRG 4654
Hospital Charge Code	APRDRG4653
Min. Negotiated Rate	$12,378.31
Max. Negotiated Rate	$12,378.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,378.31
Rate for Payer: Mercy Care Medicaid	$12,378.31
Rate for Payer: NaphCare Correctional Healthcare	$12,378.31

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

$12,378.31

Service Code	APR-DRG 4654
Hospital Charge Code	APRDRG4652
Min. Negotiated Rate	$12,378.31
Max. Negotiated Rate	$12,378.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,378.31
Rate for Payer: Mercy Care Medicaid	$12,378.31
Rate for Payer: NaphCare Correctional Healthcare	$12,378.31

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

$3,523.83

Service Code	APR-DRG 4651
Hospital Charge Code	APRDRG4652
Min. Negotiated Rate	$3,523.83
Max. Negotiated Rate	$3,523.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,523.83
Rate for Payer: Mercy Care Medicaid	$3,523.83
Rate for Payer: NaphCare Correctional Healthcare	$3,523.83

URINARY STONES WITH MCC

Facility

$17,391.85

Service Code	MSDRG 693
Min. Negotiated Rate	$17,391.85
Max. Negotiated Rate	$17,391.85
Rate for Payer: Seven Corners Travel Insurance	$17,391.85

URINARY STONES WITHOUT MCC

Facility

$10,260.50

Service Code	MSDRG 694
Min. Negotiated Rate	$10,260.50
Max. Negotiated Rate	$10,260.50
Rate for Payer: Seven Corners Travel Insurance	$10,260.50

Urine Culture

Facility

$231.00

Service Code	CPT 87086
Hospital Charge Code	850756
Hospital Revenue Code	306
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$131.20

Urine Culture

Facility

$164.00

Service Code	CPT 87086
Hospital Charge Code	850756
Hospital Revenue Code	306
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Arizona Complete Health Allwell	$36.96
Rate for Payer: Arizona Complete Health Allwell	$26.24
Rate for Payer: Banner UC Health Medicare	$36.96
Rate for Payer: Banner UC Health Medicare	$26.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$111.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$157.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.96
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cigna of AZ Commercial	$150.15
Rate for Payer: Cigna of AZ Commercial	$106.60
Rate for Payer: Devoted Health Medicare	$41.58
Rate for Payer: Devoted Health Medicare	$29.52
Rate for Payer: Humana of AZ Medicare	$26.24
Rate for Payer: Humana of AZ Medicare	$36.96
Rate for Payer: Seven Corners Travel Insurance	$11.70
Rate for Payer: Seven Corners Travel Insurance	$11.70
Rate for Payer: Southwest Service Administrators UFCW	$157.08
Rate for Payer: Southwest Service Administrators UFCW	$111.52
Rate for Payer: TriWest Medicare	$26.24
Rate for Payer: TriWest Medicare	$36.96
Rate for Payer: United Healthcare Commercial	$93.81
Rate for Payer: United Healthcare Commercial	$132.13
Rate for Payer: United Healthcare Medicare	$26.24
Rate for Payer: United Healthcare Medicare	$36.96
Rate for Payer: Veterans Affairs TRICARE	$36.59
Rate for Payer: Veterans Affairs TRICARE	$25.98

Urine Culture, Urology Extended Workup LC

Facility

$164.00

Service Code	CPT 87086
Hospital Charge Code	22311196
Hospital Revenue Code	306
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Cash Price	$131.20

Urine Culture, Urology Extended Workup LC

Facility

$164.00

Service Code	CPT 87086
Hospital Charge Code	22311196
Hospital Revenue Code	306
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Arizona Complete Health Allwell	$26.24
Rate for Payer: Banner UC Health Medicare	$26.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$111.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.24
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cigna of AZ Commercial	$106.60
Rate for Payer: Devoted Health Medicare	$29.52
Rate for Payer: Humana of AZ Medicare	$26.24
Rate for Payer: Seven Corners Travel Insurance	$11.70
Rate for Payer: Southwest Service Administrators UFCW	$111.52
Rate for Payer: TriWest Medicare	$26.24
Rate for Payer: United Healthcare Commercial	$93.81
Rate for Payer: United Healthcare Medicare	$26.24
Rate for Payer: Veterans Affairs TRICARE	$25.98

Urine Dipstick POC

Facility

$30.00

Service Code	CPT 81002
Hospital Charge Code	607619
Hospital Revenue Code	521
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Cash Price	$24.00

Urine Dipstick POC

Facility

$30.00

Service Code	CPT 81002
Hospital Charge Code	607619
Hospital Revenue Code	521
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Arizona Complete Health Allwell	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$20.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Devoted Health Medicare	$5.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Seven Corners Travel Insurance	$5.05
Rate for Payer: Southwest Service Administrators UFCW	$20.40
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: United Healthcare Commercial	$17.16
Rate for Payer: United Healthcare Medicare	$4.80
Rate for Payer: Veterans Affairs TRICARE	$4.75

Urine Drug Screen Standard

Facility

$380.00

Service Code	CPT 80307
Hospital Charge Code	22141048
Hospital Revenue Code	301
Min. Negotiated Rate	$60.19
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna of AZ Commercial	$342.00
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Arizona Complete Health Allwell	$117.60
Rate for Payer: Arizona Complete Health Allwell	$60.80
Rate for Payer: Banner UC Health Medicare	$117.60
Rate for Payer: Banner UC Health Medicare	$60.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$258.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$499.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$117.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$117.60
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cigna of AZ Commercial	$477.75
Rate for Payer: Cigna of AZ Commercial	$247.00
Rate for Payer: Devoted Health Medicare	$132.30
Rate for Payer: Devoted Health Medicare	$68.40
Rate for Payer: Humana of AZ Medicare	$60.80
Rate for Payer: Humana of AZ Medicare	$117.60
Rate for Payer: Seven Corners Travel Insurance	$90.10
Rate for Payer: Seven Corners Travel Insurance	$90.10
Rate for Payer: Southwest Service Administrators UFCW	$499.80
Rate for Payer: Southwest Service Administrators UFCW	$258.40
Rate for Payer: TriWest Medicare	$60.80
Rate for Payer: TriWest Medicare	$117.60
Rate for Payer: United Healthcare Commercial	$217.36
Rate for Payer: United Healthcare Commercial	$420.42
Rate for Payer: United Healthcare Medicare	$60.80
Rate for Payer: United Healthcare Medicare	$117.60
Rate for Payer: Veterans Affairs TRICARE	$116.42
Rate for Payer: Veterans Affairs TRICARE	$60.19

Urine Drug Screen Standard

Facility

$735.00

Service Code	CPT 80307
Hospital Charge Code	22141048
Hospital Revenue Code	301
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Aetna of AZ Commercial	$342.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$304.00

Urine Pregnancy Test POC

Facility

$159.00

Service Code	CPT 81025 QW
Hospital Charge Code	607621
Hospital Revenue Code	300
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Cash Price	$127.20

Urine Pregnancy Test POC

Facility

$159.00

Service Code	CPT 81025 QW
Hospital Charge Code	607621
Hospital Revenue Code	300
Min. Negotiated Rate	$25.19
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Arizona Complete Health Allwell	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$108.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.44
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$103.35
Rate for Payer: Devoted Health Medicare	$28.62
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Southwest Service Administrators UFCW	$108.12
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: United Healthcare Commercial	$90.95
Rate for Payer: United Healthcare Medicare	$25.44
Rate for Payer: Veterans Affairs TRICARE	$25.19

Urine Volume

Facility

$47.00

Service Code	CPT 81050
Hospital Charge Code	1137707
Hospital Revenue Code	301
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

Urine Volume

Facility

$47.00

Service Code	CPT 81050
Hospital Charge Code	1137707
Hospital Revenue Code	301
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Seven Corners Travel Insurance	$5.28
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

Uroflowmetry- Complex

Facility

$79.00

Service Code	CPT 51741
Hospital Charge Code	27291783
Hospital Revenue Code	360
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Cash Price	$63.20

Uroflowmetry- Complex

Facility

$79.00

Service Code	CPT 51741
Hospital Charge Code	27291783
Hospital Revenue Code	360
Min. Negotiated Rate	$12.51
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Arizona Complete Health Allwell	$12.64
Rate for Payer: Banner UC Health Medicare	$12.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.64
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$39.50
Rate for Payer: Devoted Health Medicare	$14.22
Rate for Payer: Humana of AZ Medicare	$12.64
Rate for Payer: Seven Corners Travel Insurance	$334.09
Rate for Payer: Southwest Service Administrators UFCW	$53.72
Rate for Payer: TriWest Medicare	$12.64
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$12.64
Rate for Payer: Veterans Affairs TRICARE	$12.51

US Abdomen Complete

Facility

$1,472.00

Service Code	CPT 76700
Hospital Charge Code	823404
Hospital Revenue Code	402
Min. Negotiated Rate	$1,324.80
Max. Negotiated Rate	$1,324.80
Rate for Payer: Aetna of AZ Commercial	$1,324.80
Rate for Payer: Cash Price	$1,177.60

US Abdomen Complete

Facility

$1,472.00

Service Code	CPT 76700
Hospital Charge Code	823404
Hospital Revenue Code	402
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,324.80
Rate for Payer: Aetna of AZ Commercial	$1,324.80
Rate for Payer: Arizona Complete Health Allwell	$235.52
Rate for Payer: Banner UC Health Medicare	$235.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,000.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$235.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$235.52
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cigna of AZ Commercial	$1,030.40
Rate for Payer: Devoted Health Medicare	$264.96
Rate for Payer: Humana of AZ Medicare	$235.52
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$1,000.96
Rate for Payer: TriWest Medicare	$235.52
Rate for Payer: United Healthcare Commercial	$841.98
Rate for Payer: United Healthcare Medicare	$235.52
Rate for Payer: United Healthcare New Mexico Commercial	$279.68
Rate for Payer: Veterans Affairs TRICARE	$233.16

US Abdomen Limited

Facility

$692.00

Service Code	CPT 76705
Hospital Charge Code	823406
Hospital Revenue Code	402
Min. Negotiated Rate	$622.80
Max. Negotiated Rate	$622.80
Rate for Payer: Aetna of AZ Commercial	$622.80
Rate for Payer: Cash Price	$553.60

US Abdomen Limited

Facility

$692.00

Service Code	CPT 76705
Hospital Charge Code	823406
Hospital Revenue Code	402
Min. Negotiated Rate	$109.61
Max. Negotiated Rate	$622.80
Rate for Payer: Aetna of AZ Commercial	$622.80
Rate for Payer: Arizona Complete Health Allwell	$110.72
Rate for Payer: Banner UC Health Medicare	$110.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$470.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$110.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$110.72
Rate for Payer: Cash Price	$553.60
Rate for Payer: Cash Price	$553.60
Rate for Payer: Cigna of AZ Commercial	$484.40
Rate for Payer: Devoted Health Medicare	$124.56
Rate for Payer: Humana of AZ Medicare	$110.72
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$470.56
Rate for Payer: TriWest Medicare	$110.72
Rate for Payer: United Healthcare Commercial	$395.82
Rate for Payer: United Healthcare Medicare	$110.72
Rate for Payer: United Healthcare New Mexico Commercial	$131.48
Rate for Payer: Veterans Affairs TRICARE	$109.61

US Amniocentesis

Facility

$778.00

Service Code	CPT 76946
Hospital Charge Code	10864721
Hospital Revenue Code	402
Min. Negotiated Rate	$123.24
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Arizona Complete Health Allwell	$124.48
Rate for Payer: Banner UC Health Medicare	$124.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$529.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$124.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$124.48
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cigna of AZ Commercial	$544.60
Rate for Payer: Devoted Health Medicare	$140.04
Rate for Payer: Humana of AZ Medicare	$124.48
Rate for Payer: Southwest Service Administrators UFCW	$529.04
Rate for Payer: TriWest Medicare	$124.48
Rate for Payer: United Healthcare Commercial	$445.02
Rate for Payer: United Healthcare Medicare	$124.48
Rate for Payer: United Healthcare New Mexico Commercial	$147.82
Rate for Payer: Veterans Affairs TRICARE	$123.24

US Amniocentesis

Facility

$778.00

Service Code	CPT 76946
Hospital Charge Code	10864721
Hospital Revenue Code	402
Min. Negotiated Rate	$700.20
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Cash Price	$622.40

Know your out-of-pocket cost for care.

All Charges