Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

US Color Doppler

Facility

$1,444.00

Service Code	CPT 93975
Hospital Charge Code	22427825
Hospital Revenue Code	921
Min. Negotiated Rate	$228.73
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna of AZ Commercial	$1,299.60
Rate for Payer: Arizona Complete Health Allwell	$231.04
Rate for Payer: Banner UC Health Medicare	$231.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$981.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$231.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$231.04
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Cigna of AZ Commercial	$1,010.80
Rate for Payer: Devoted Health Medicare	$259.92
Rate for Payer: Humana of AZ Medicare	$231.04
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$981.92
Rate for Payer: TriWest Medicare	$231.04
Rate for Payer: United Healthcare Commercial	$825.97
Rate for Payer: United Healthcare Medicare	$231.04
Rate for Payer: United Healthcare New Mexico Commercial	$274.36
Rate for Payer: Veterans Affairs TRICARE	$228.73

US Echo 2D Limited

Facility

$730.00

Service Code	CPT 93308
Hospital Charge Code	1883704
Hospital Revenue Code	402
Min. Negotiated Rate	$657.00
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of AZ Commercial	$657.00
Rate for Payer: Cash Price	$584.00

US Echo 2D Limited

Facility

$730.00

Service Code	CPT 93308
Hospital Charge Code	1883704
Hospital Revenue Code	402
Min. Negotiated Rate	$115.63
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of AZ Commercial	$657.00
Rate for Payer: Arizona Complete Health Allwell	$116.80
Rate for Payer: Banner UC Health Medicare	$116.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$496.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$116.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$116.80
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cigna of AZ Commercial	$511.00
Rate for Payer: Devoted Health Medicare	$131.40
Rate for Payer: Humana of AZ Medicare	$116.80
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$496.40
Rate for Payer: TriWest Medicare	$116.80
Rate for Payer: United Healthcare Commercial	$417.56
Rate for Payer: United Healthcare Medicare	$116.80
Rate for Payer: United Healthcare New Mexico Commercial	$138.70
Rate for Payer: Veterans Affairs TRICARE	$115.63

US Echocardiogram Complete

Facility

$832.00

Service Code	CPT 93320
Hospital Charge Code	1161150
Hospital Revenue Code	483
Min. Negotiated Rate	$131.79
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna of AZ Commercial	$748.80
Rate for Payer: Arizona Complete Health Allwell	$133.12
Rate for Payer: Banner UC Health Medicare	$133.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$565.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$133.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$133.12
Rate for Payer: Cash Price	$665.60
Rate for Payer: Cigna of AZ Commercial	$582.40
Rate for Payer: Devoted Health Medicare	$149.76
Rate for Payer: Humana of AZ Medicare	$133.12
Rate for Payer: Southwest Service Administrators UFCW	$565.76
Rate for Payer: TriWest Medicare	$133.12
Rate for Payer: United Healthcare Commercial	$475.90
Rate for Payer: United Healthcare Medicare	$133.12
Rate for Payer: United Healthcare New Mexico Commercial	$158.08
Rate for Payer: Veterans Affairs TRICARE	$131.79

US Echocardiogram Complete

Facility

$832.00

Service Code	CPT 93320
Hospital Charge Code	1161150
Hospital Revenue Code	483
Min. Negotiated Rate	$748.80
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna of AZ Commercial	$748.80
Rate for Payer: Cash Price	$665.60

US ECHO Complete

Facility

$2,486.00

Service Code	CPT 93306
Hospital Charge Code	10443714
Hospital Revenue Code	483
Min. Negotiated Rate	$393.78
Max. Negotiated Rate	$2,237.40
Rate for Payer: Aetna of AZ Commercial	$2,237.40
Rate for Payer: Arizona Complete Health Allwell	$397.76
Rate for Payer: Banner UC Health Medicare	$397.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,690.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$397.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$397.76
Rate for Payer: Cash Price	$1,988.80
Rate for Payer: Cash Price	$1,988.80
Rate for Payer: Cigna of AZ Commercial	$1,740.20
Rate for Payer: Devoted Health Medicare	$447.48
Rate for Payer: Humana of AZ Medicare	$397.76
Rate for Payer: Seven Corners Travel Insurance	$845.45
Rate for Payer: Southwest Service Administrators UFCW	$1,690.48
Rate for Payer: TriWest Medicare	$397.76
Rate for Payer: United Healthcare Commercial	$1,421.99
Rate for Payer: United Healthcare Medicare	$397.76
Rate for Payer: United Healthcare New Mexico Commercial	$472.34
Rate for Payer: Veterans Affairs TRICARE	$393.78

US ECHO Complete

Facility

$2,486.00

Service Code	CPT 93306
Hospital Charge Code	10443714
Hospital Revenue Code	483
Min. Negotiated Rate	$2,237.40
Max. Negotiated Rate	$2,237.40
Rate for Payer: Aetna of AZ Commercial	$2,237.40
Rate for Payer: Cash Price	$1,988.80

US ECHOGR Transrectal

Facility

$833.00

Service Code	CPT 76872
Hospital Charge Code	22577967
Hospital Revenue Code	402
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$749.70
Rate for Payer: Aetna of AZ Commercial	$749.70
Rate for Payer: Arizona Complete Health Allwell	$133.28
Rate for Payer: Banner UC Health Medicare	$133.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$566.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$133.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$133.28
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cigna of AZ Commercial	$583.10
Rate for Payer: Devoted Health Medicare	$149.94
Rate for Payer: Humana of AZ Medicare	$133.28
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$566.44
Rate for Payer: TriWest Medicare	$133.28
Rate for Payer: United Healthcare Commercial	$476.48
Rate for Payer: United Healthcare Medicare	$133.28
Rate for Payer: United Healthcare New Mexico Commercial	$158.27
Rate for Payer: Veterans Affairs TRICARE	$131.95

US ECHOGR Transrectal

Facility

$833.00

Service Code	CPT 76872
Hospital Charge Code	22577967
Hospital Revenue Code	402
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$749.70
Rate for Payer: Aetna of AZ Commercial	$749.70
Rate for Payer: Cash Price	$666.40

US Elastography

Facility

$840.00

Service Code	CPT 76981
Hospital Charge Code	22670156
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

US Elastography

Facility

$840.00

Service Code	CPT 76981
Hospital Charge Code	22670156
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

USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSI

Facility

$61.00

Service Code	CPT 99153
Hospital Charge Code	28272679
Hospital Revenue Code	710
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Cash Price	$48.80

USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSI

Facility

$61.00

Service Code	CPT 99153
Hospital Charge Code	28272679
Hospital Revenue Code	710
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Arizona Complete Health Allwell	$9.76
Rate for Payer: Banner UC Health Medicare	$9.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$41.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.76
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Devoted Health Medicare	$10.98
Rate for Payer: Humana of AZ Medicare	$9.76
Rate for Payer: Southwest Service Administrators UFCW	$41.48
Rate for Payer: TriWest Medicare	$9.76
Rate for Payer: United Healthcare Commercial	$34.89
Rate for Payer: United Healthcare Medicare	$9.76
Rate for Payer: United Healthcare New Mexico Commercial	$11.59
Rate for Payer: Veterans Affairs TRICARE	$9.66

USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSI

Facility

$61.00

Service Code	CPT 99152
Hospital Charge Code	28224520
Hospital Revenue Code	710
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Arizona Complete Health Allwell	$9.76
Rate for Payer: Banner UC Health Medicare	$9.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$41.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$39.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.76
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Devoted Health Medicare	$10.98
Rate for Payer: Humana of AZ Medicare	$9.76
Rate for Payer: Mercy Care Medicaid	$39.05
Rate for Payer: NaphCare Correctional Healthcare	$39.05
Rate for Payer: Southwest Service Administrators UFCW	$41.48
Rate for Payer: TriWest Medicare	$9.76
Rate for Payer: United Healthcare Commercial	$34.89
Rate for Payer: United Healthcare Medicare	$9.76
Rate for Payer: United Healthcare New Mexico Commercial	$11.59
Rate for Payer: Veterans Affairs TRICARE	$9.66

USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSI

Facility

$61.00

Service Code	CPT 99152
Hospital Charge Code	28224520
Hospital Revenue Code	710
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Cash Price	$48.80

US Fetal Biophysical Profile

Facility

$919.00

Service Code	CPT 76818
Hospital Charge Code	1007763
Hospital Revenue Code	402
Min. Negotiated Rate	$827.10
Max. Negotiated Rate	$827.10
Rate for Payer: Aetna of AZ Commercial	$827.10
Rate for Payer: Cash Price	$735.20

US Fetal Biophysical Profile

Facility

$919.00

Service Code	CPT 76818
Hospital Charge Code	1007763
Hospital Revenue Code	402
Min. Negotiated Rate	$145.57
Max. Negotiated Rate	$827.10
Rate for Payer: Aetna of AZ Commercial	$827.10
Rate for Payer: Arizona Complete Health Allwell	$147.04
Rate for Payer: Banner UC Health Medicare	$147.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$624.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$147.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$147.04
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cigna of AZ Commercial	$643.30
Rate for Payer: Devoted Health Medicare	$165.42
Rate for Payer: Humana of AZ Medicare	$147.04
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$624.92
Rate for Payer: TriWest Medicare	$147.04
Rate for Payer: United Healthcare Commercial	$525.67
Rate for Payer: United Healthcare Medicare	$147.04
Rate for Payer: United Healthcare New Mexico Commercial	$174.61
Rate for Payer: Veterans Affairs TRICARE	$145.57

US Fetal Eval Complete

Facility

$816.00

Service Code	CPT 76815
Hospital Charge Code	1007766
Hospital Revenue Code	402
Min. Negotiated Rate	$734.40
Max. Negotiated Rate	$734.40
Rate for Payer: Aetna of AZ Commercial	$734.40
Rate for Payer: Cash Price	$652.80

US Fetal Eval Complete

Facility

$816.00

Service Code	CPT 76815
Hospital Charge Code	1007766
Hospital Revenue Code	402
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$734.40
Rate for Payer: Aetna of AZ Commercial	$734.40
Rate for Payer: Arizona Complete Health Allwell	$130.56
Rate for Payer: Banner UC Health Medicare	$130.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$554.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$130.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$130.56
Rate for Payer: Cash Price	$652.80
Rate for Payer: Cash Price	$652.80
Rate for Payer: Cigna of AZ Commercial	$571.20
Rate for Payer: Devoted Health Medicare	$146.88
Rate for Payer: Humana of AZ Medicare	$130.56
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$554.88
Rate for Payer: TriWest Medicare	$130.56
Rate for Payer: United Healthcare Commercial	$466.75
Rate for Payer: United Healthcare Medicare	$130.56
Rate for Payer: United Healthcare New Mexico Commercial	$155.04
Rate for Payer: Veterans Affairs TRICARE	$129.25

US Gallbladder

Facility

$1,232.00

Service Code	CPT 76700
Hospital Charge Code	2214185
Hospital Revenue Code	402
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Aetna of AZ Commercial	$1,108.80
Rate for Payer: Cash Price	$985.60

US Gallbladder

Facility

$1,232.00

Service Code	CPT 76700
Hospital Charge Code	2214185
Hospital Revenue Code	402
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,108.80
Rate for Payer: Aetna of AZ Commercial	$1,108.80
Rate for Payer: Arizona Complete Health Allwell	$197.12
Rate for Payer: Banner UC Health Medicare	$197.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$837.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$197.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$197.12
Rate for Payer: Cash Price	$985.60
Rate for Payer: Cash Price	$985.60
Rate for Payer: Cigna of AZ Commercial	$862.40
Rate for Payer: Devoted Health Medicare	$221.76
Rate for Payer: Humana of AZ Medicare	$197.12
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$837.76
Rate for Payer: TriWest Medicare	$197.12
Rate for Payer: United Healthcare Commercial	$704.70
Rate for Payer: United Healthcare Medicare	$197.12
Rate for Payer: United Healthcare New Mexico Commercial	$234.08
Rate for Payer: Veterans Affairs TRICARE	$195.15

US Guided Liver Biopsy

Facility

$876.00

Service Code	CPT 76942
Hospital Charge Code	1163747
Hospital Revenue Code	402
Min. Negotiated Rate	$138.76
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Arizona Complete Health Allwell	$140.16
Rate for Payer: Banner UC Health Medicare	$140.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$595.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$140.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$140.16
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cigna of AZ Commercial	$613.20
Rate for Payer: Devoted Health Medicare	$157.68
Rate for Payer: Humana of AZ Medicare	$140.16
Rate for Payer: Southwest Service Administrators UFCW	$595.68
Rate for Payer: TriWest Medicare	$140.16
Rate for Payer: United Healthcare Commercial	$501.07
Rate for Payer: United Healthcare Medicare	$140.16
Rate for Payer: United Healthcare New Mexico Commercial	$166.44
Rate for Payer: Veterans Affairs TRICARE	$138.76

US Guided Liver Biopsy

Facility

$876.00

Service Code	CPT 76942
Hospital Charge Code	1163747
Hospital Revenue Code	402
Min. Negotiated Rate	$788.40
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Cash Price	$700.80

US Guided Lung Biopsy

Facility

$681.00

Service Code	CPT 76942
Hospital Charge Code	1163750
Hospital Revenue Code	402
Min. Negotiated Rate	$107.87
Max. Negotiated Rate	$612.90
Rate for Payer: Aetna of AZ Commercial	$612.90
Rate for Payer: Arizona Complete Health Allwell	$108.96
Rate for Payer: Banner UC Health Medicare	$108.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$463.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$108.96
Rate for Payer: Cash Price	$544.80
Rate for Payer: Cigna of AZ Commercial	$476.70
Rate for Payer: Devoted Health Medicare	$122.58
Rate for Payer: Humana of AZ Medicare	$108.96
Rate for Payer: Southwest Service Administrators UFCW	$463.08
Rate for Payer: TriWest Medicare	$108.96
Rate for Payer: United Healthcare Commercial	$389.53
Rate for Payer: United Healthcare Medicare	$108.96
Rate for Payer: United Healthcare New Mexico Commercial	$129.39
Rate for Payer: Veterans Affairs TRICARE	$107.87

US Guided Lung Biopsy

Facility

$681.00

Service Code	CPT 76942
Hospital Charge Code	1163750
Hospital Revenue Code	402
Min. Negotiated Rate	$612.90
Max. Negotiated Rate	$612.90
Rate for Payer: Aetna of AZ Commercial	$612.90
Rate for Payer: Cash Price	$544.80

Know your out-of-pocket cost for care.

All Charges