Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

US Aorta Duplex Complete

Facility

$828.00

Service Code	CPT 76770
Hospital Charge Code	1007704
Hospital Revenue Code	402
Min. Negotiated Rate	$131.16
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Arizona Complete Health Allwell	$132.48
Rate for Payer: Banner UC Health Medicare	$132.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$563.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$132.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$132.48
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cigna of AZ Commercial	$579.60
Rate for Payer: Devoted Health Medicare	$149.04
Rate for Payer: Humana of AZ Medicare	$132.48
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$563.04
Rate for Payer: TriWest Medicare	$132.48
Rate for Payer: United Healthcare Commercial	$473.62
Rate for Payer: United Healthcare Medicare	$132.48
Rate for Payer: United Healthcare New Mexico Commercial	$157.32
Rate for Payer: Veterans Affairs TRICARE	$131.16

US Aorta Duplex Complete

Facility

$828.00

Service Code	CPT 76770
Hospital Charge Code	1007704
Hospital Revenue Code	402
Min. Negotiated Rate	$745.20
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Cash Price	$662.40

US Aspiration Guidance

Facility

$895.00

Service Code	CPT 76942
Hospital Charge Code	1007706
Hospital Revenue Code	402
Min. Negotiated Rate	$805.50
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Cash Price	$716.00

US Aspiration Guidance

Facility

$895.00

Service Code	CPT 76942
Hospital Charge Code	1007706
Hospital Revenue Code	402
Min. Negotiated Rate	$141.77
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Arizona Complete Health Allwell	$143.20
Rate for Payer: Banner UC Health Medicare	$143.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$608.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$143.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$143.20
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cigna of AZ Commercial	$626.50
Rate for Payer: Devoted Health Medicare	$161.10
Rate for Payer: Humana of AZ Medicare	$143.20
Rate for Payer: Southwest Service Administrators UFCW	$608.60
Rate for Payer: TriWest Medicare	$143.20
Rate for Payer: United Healthcare Commercial	$511.94
Rate for Payer: United Healthcare Medicare	$143.20
Rate for Payer: United Healthcare New Mexico Commercial	$170.05
Rate for Payer: Veterans Affairs TRICARE	$141.77

US Biopsy Needle Guided

Facility

$778.00

Service Code	CPT 76942
Hospital Charge Code	1007709
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

US Biopsy Needle Guided

Facility

$778.00

Service Code	CPT 76942
Hospital Charge Code	1007709
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 Breast Bilateral Complete

Facility

$803.00

Service Code	CPT 76641 50
Hospital Charge Code	22009074
Hospital Revenue Code	402
Min. Negotiated Rate	$722.70
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Cash Price	$642.40

US Breast Bilateral Complete

Facility

$803.00

Service Code	CPT 76641 50
Hospital Charge Code	22009074
Hospital Revenue Code	402
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Arizona Complete Health Allwell	$128.48
Rate for Payer: Banner UC Health Medicare	$128.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$546.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$128.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$128.48
Rate for Payer: Cash Price	$642.40
Rate for Payer: Cigna of AZ Commercial	$562.10
Rate for Payer: Devoted Health Medicare	$144.54
Rate for Payer: Humana of AZ Medicare	$128.48
Rate for Payer: Southwest Service Administrators UFCW	$546.04
Rate for Payer: TriWest Medicare	$128.48
Rate for Payer: United Healthcare Commercial	$459.32
Rate for Payer: United Healthcare Medicare	$128.48
Rate for Payer: United Healthcare New Mexico Commercial	$152.57
Rate for Payer: Veterans Affairs TRICARE	$127.20

US Breast Bilateral Complete.

Facility

$845.00

Service Code	CPT 76641 50
Hospital Charge Code	22009086
Hospital Revenue Code	402
Min. Negotiated Rate	$133.85
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Arizona Complete Health Allwell	$135.20
Rate for Payer: Banner UC Health Medicare	$135.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$574.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$135.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$135.20
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Devoted Health Medicare	$152.10
Rate for Payer: Humana of AZ Medicare	$135.20
Rate for Payer: Southwest Service Administrators UFCW	$574.60
Rate for Payer: TriWest Medicare	$135.20
Rate for Payer: United Healthcare Commercial	$483.34
Rate for Payer: United Healthcare Medicare	$135.20
Rate for Payer: United Healthcare New Mexico Commercial	$160.55
Rate for Payer: Veterans Affairs TRICARE	$133.85

US Breast Bilateral Complete.

Facility

$845.00

Service Code	CPT 76641 50
Hospital Charge Code	22009086
Hospital Revenue Code	402
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Cash Price	$676.00

US Breast Bilateral Limited

Facility

$683.00

Service Code	CPT 76642 50
Hospital Charge Code	21076256
Hospital Revenue Code	402
Min. Negotiated Rate	$108.19
Max. Negotiated Rate	$614.70
Rate for Payer: Aetna of AZ Commercial	$614.70
Rate for Payer: Arizona Complete Health Allwell	$109.28
Rate for Payer: Banner UC Health Medicare	$109.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$464.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$109.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$109.28
Rate for Payer: Cash Price	$546.40
Rate for Payer: Cigna of AZ Commercial	$478.10
Rate for Payer: Devoted Health Medicare	$122.94
Rate for Payer: Humana of AZ Medicare	$109.28
Rate for Payer: Southwest Service Administrators UFCW	$464.44
Rate for Payer: TriWest Medicare	$109.28
Rate for Payer: United Healthcare Commercial	$390.68
Rate for Payer: United Healthcare Medicare	$109.28
Rate for Payer: United Healthcare New Mexico Commercial	$129.77
Rate for Payer: Veterans Affairs TRICARE	$108.19

US Breast Bilateral Limited

Facility

$683.00

Service Code	CPT 76642 50
Hospital Charge Code	21076256
Hospital Revenue Code	402
Min. Negotiated Rate	$614.70
Max. Negotiated Rate	$614.70
Rate for Payer: Aetna of AZ Commercial	$614.70
Rate for Payer: Cash Price	$546.40

US Breast Bilateral Limited.

Facility

$802.00

Service Code	CPT 76641 50
Hospital Charge Code	21231067
Hospital Revenue Code	402
Min. Negotiated Rate	$721.80
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Cash Price	$641.60

US Breast Bilateral Limited.

Facility

$802.00

Service Code	CPT 76641 50
Hospital Charge Code	21231067
Hospital Revenue Code	402
Min. Negotiated Rate	$127.04
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Arizona Complete Health Allwell	$128.32
Rate for Payer: Banner UC Health Medicare	$128.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$545.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$128.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$128.32
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cigna of AZ Commercial	$561.40
Rate for Payer: Devoted Health Medicare	$144.36
Rate for Payer: Humana of AZ Medicare	$128.32
Rate for Payer: Southwest Service Administrators UFCW	$545.36
Rate for Payer: TriWest Medicare	$128.32
Rate for Payer: United Healthcare Commercial	$458.74
Rate for Payer: United Healthcare Medicare	$128.32
Rate for Payer: United Healthcare New Mexico Commercial	$152.38
Rate for Payer: Veterans Affairs TRICARE	$127.04

US Breast Left Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009077
Hospital Revenue Code	402
Min. Negotiated Rate	$133.85
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Arizona Complete Health Allwell	$135.20
Rate for Payer: Banner UC Health Medicare	$135.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$574.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$135.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$135.20
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Devoted Health Medicare	$152.10
Rate for Payer: Humana of AZ Medicare	$135.20
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$574.60
Rate for Payer: TriWest Medicare	$135.20
Rate for Payer: United Healthcare Commercial	$483.34
Rate for Payer: United Healthcare Medicare	$135.20
Rate for Payer: United Healthcare New Mexico Commercial	$160.55
Rate for Payer: Veterans Affairs TRICARE	$133.85

US Breast Left Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009077
Hospital Revenue Code	402
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Cash Price	$676.00

US Breast Left Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076259
Hospital Revenue Code	402
Min. Negotiated Rate	$113.10
Max. Negotiated Rate	$642.60
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 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: Seven Corners Travel Insurance	$134.65
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: United Healthcare New Mexico Commercial	$135.66
Rate for Payer: Veterans Affairs TRICARE	$113.10

US Breast Left Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076259
Hospital Revenue Code	402
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

US Breast Right Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009080
Hospital Revenue Code	402
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Cash Price	$676.00

US Breast Right Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009080
Hospital Revenue Code	402
Min. Negotiated Rate	$133.85
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Arizona Complete Health Allwell	$135.20
Rate for Payer: Banner UC Health Medicare	$135.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$574.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$135.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$135.20
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Devoted Health Medicare	$152.10
Rate for Payer: Humana of AZ Medicare	$135.20
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$574.60
Rate for Payer: TriWest Medicare	$135.20
Rate for Payer: United Healthcare Commercial	$483.34
Rate for Payer: United Healthcare Medicare	$135.20
Rate for Payer: United Healthcare New Mexico Commercial	$160.55
Rate for Payer: Veterans Affairs TRICARE	$133.85

US Breast Right Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076262
Hospital Revenue Code	402
Min. Negotiated Rate	$113.10
Max. Negotiated Rate	$642.60
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 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: Seven Corners Travel Insurance	$134.65
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: United Healthcare New Mexico Commercial	$135.66
Rate for Payer: Veterans Affairs TRICARE	$113.10

US Breast Right Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076262
Hospital Revenue Code	402
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

US Carotid Doppler Bilateral

Facility

$1,574.00

Service Code	CPT 93880
Hospital Charge Code	1021625
Hospital Revenue Code	921
Min. Negotiated Rate	$1,416.60
Max. Negotiated Rate	$1,416.60
Rate for Payer: Aetna of AZ Commercial	$1,416.60
Rate for Payer: Cash Price	$1,259.20

US Carotid Doppler Bilateral

Facility

$1,574.00

Service Code	CPT 93880
Hospital Charge Code	1021625
Hospital Revenue Code	921
Min. Negotiated Rate	$249.32
Max. Negotiated Rate	$1,416.60
Rate for Payer: Aetna of AZ Commercial	$1,416.60
Rate for Payer: Arizona Complete Health Allwell	$251.84
Rate for Payer: Banner UC Health Medicare	$251.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,070.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$251.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$251.84
Rate for Payer: Cash Price	$1,259.20
Rate for Payer: Cash Price	$1,259.20
Rate for Payer: Cigna of AZ Commercial	$1,101.80
Rate for Payer: Devoted Health Medicare	$283.32
Rate for Payer: Humana of AZ Medicare	$251.84
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,070.32
Rate for Payer: TriWest Medicare	$251.84
Rate for Payer: United Healthcare Commercial	$900.33
Rate for Payer: United Healthcare Medicare	$251.84
Rate for Payer: United Healthcare New Mexico Commercial	$299.06
Rate for Payer: Veterans Affairs TRICARE	$249.32

US Color Doppler

Facility

$1,444.00

Service Code	CPT 93975
Hospital Charge Code	22427825
Hospital Revenue Code	921
Min. Negotiated Rate	$1,299.60
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna of AZ Commercial	$1,299.60
Rate for Payer: Cash Price	$1,155.20

Know your out-of-pocket cost for care.

All Charges