Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

US Head/Neck Soft Tissue

Facility

$938.00

Service Code	CPT 76536
Hospital Charge Code	823428
Hospital Revenue Code	402
Min. Negotiated Rate	$148.58
Max. Negotiated Rate	$844.20
Rate for Payer: Aetna of AZ Commercial	$844.20
Rate for Payer: Arizona Complete Health Allwell	$150.08
Rate for Payer: Banner UC Health Medicare	$150.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$637.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$150.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$150.08
Rate for Payer: Cash Price	$750.40
Rate for Payer: Cash Price	$750.40
Rate for Payer: Cigna of AZ Commercial	$656.60
Rate for Payer: Devoted Health Medicare	$168.84
Rate for Payer: Humana of AZ Medicare	$150.08
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$637.84
Rate for Payer: TriWest Medicare	$150.08
Rate for Payer: United Healthcare Commercial	$536.54
Rate for Payer: United Healthcare Medicare	$150.08
Rate for Payer: United Healthcare New Mexico Commercial	$178.22
Rate for Payer: Veterans Affairs TRICARE	$148.58

US Head/Neck Soft Tissue

Facility

$938.00

Service Code	CPT 76536
Hospital Charge Code	823428
Hospital Revenue Code	402
Min. Negotiated Rate	$844.20
Max. Negotiated Rate	$844.20
Rate for Payer: Aetna of AZ Commercial	$844.20
Rate for Payer: Cash Price	$750.40

US LE Arterial Duplex Bilateral

Facility

$2,047.00

Service Code	CPT 93925
Hospital Charge Code	823436
Hospital Revenue Code	921
Min. Negotiated Rate	$324.24
Max. Negotiated Rate	$1,842.30
Rate for Payer: Aetna of AZ Commercial	$1,842.30
Rate for Payer: Arizona Complete Health Allwell	$327.52
Rate for Payer: Banner UC Health Medicare	$327.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,391.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$327.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$327.52
Rate for Payer: Cash Price	$1,637.60
Rate for Payer: Cash Price	$1,637.60
Rate for Payer: Cigna of AZ Commercial	$1,432.90
Rate for Payer: Devoted Health Medicare	$368.46
Rate for Payer: Humana of AZ Medicare	$327.52
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,391.96
Rate for Payer: TriWest Medicare	$327.52
Rate for Payer: United Healthcare Commercial	$1,170.88
Rate for Payer: United Healthcare Medicare	$327.52
Rate for Payer: United Healthcare New Mexico Commercial	$388.93
Rate for Payer: Veterans Affairs TRICARE	$324.24

US LE Arterial Duplex Bilateral

Facility

$2,047.00

Service Code	CPT 93925
Hospital Charge Code	823436
Hospital Revenue Code	921
Min. Negotiated Rate	$1,842.30
Max. Negotiated Rate	$1,842.30
Rate for Payer: Aetna of AZ Commercial	$1,842.30
Rate for Payer: Cash Price	$1,637.60

US LE Arterial Duplex Left

Facility

$1,164.00

Service Code	CPT 93926
Hospital Charge Code	823438
Hospital Revenue Code	921
Min. Negotiated Rate	$1,047.60
Max. Negotiated Rate	$1,047.60
Rate for Payer: Aetna of AZ Commercial	$1,047.60
Rate for Payer: Cash Price	$931.20

US LE Arterial Duplex Left

Facility

$1,164.00

Service Code	CPT 93926
Hospital Charge Code	823438
Hospital Revenue Code	921
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,047.60
Rate for Payer: Aetna of AZ Commercial	$1,047.60
Rate for Payer: Arizona Complete Health Allwell	$186.24
Rate for Payer: Banner UC Health Medicare	$186.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$791.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$186.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$186.24
Rate for Payer: Cash Price	$931.20
Rate for Payer: Cash Price	$931.20
Rate for Payer: Cigna of AZ Commercial	$814.80
Rate for Payer: Devoted Health Medicare	$209.52
Rate for Payer: Humana of AZ Medicare	$186.24
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$791.52
Rate for Payer: TriWest Medicare	$186.24
Rate for Payer: United Healthcare Commercial	$665.81
Rate for Payer: United Healthcare Medicare	$186.24
Rate for Payer: United Healthcare New Mexico Commercial	$221.16
Rate for Payer: Veterans Affairs TRICARE	$184.38

US LE Arterial Duplex Right

Facility

$862.00

Service Code	CPT 93926
Hospital Charge Code	823440
Hospital Revenue Code	921
Min. Negotiated Rate	$775.80
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Cash Price	$689.60

US LE Arterial Duplex Right

Facility

$862.00

Service Code	CPT 93926
Hospital Charge Code	823440
Hospital Revenue Code	921
Min. Negotiated Rate	$136.54
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Arizona Complete Health Allwell	$137.92
Rate for Payer: Banner UC Health Medicare	$137.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$586.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$137.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$137.92
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cigna of AZ Commercial	$603.40
Rate for Payer: Devoted Health Medicare	$155.16
Rate for Payer: Humana of AZ Medicare	$137.92
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$586.16
Rate for Payer: TriWest Medicare	$137.92
Rate for Payer: United Healthcare Commercial	$493.06
Rate for Payer: United Healthcare Medicare	$137.92
Rate for Payer: United Healthcare New Mexico Commercial	$163.78
Rate for Payer: Veterans Affairs TRICARE	$136.54

US LE Venous Duplex Bilateral

Facility

$1,728.00

Service Code	CPT 93970
Hospital Charge Code	823442
Hospital Revenue Code	921
Min. Negotiated Rate	$273.72
Max. Negotiated Rate	$1,555.20
Rate for Payer: Aetna of AZ Commercial	$1,555.20
Rate for Payer: Arizona Complete Health Allwell	$276.48
Rate for Payer: Banner UC Health Medicare	$276.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,175.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$276.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$276.48
Rate for Payer: Cash Price	$1,382.40
Rate for Payer: Cash Price	$1,382.40
Rate for Payer: Cigna of AZ Commercial	$1,209.60
Rate for Payer: Devoted Health Medicare	$311.04
Rate for Payer: Humana of AZ Medicare	$276.48
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,175.04
Rate for Payer: TriWest Medicare	$276.48
Rate for Payer: United Healthcare Commercial	$988.42
Rate for Payer: United Healthcare Medicare	$276.48
Rate for Payer: United Healthcare New Mexico Commercial	$328.32
Rate for Payer: Veterans Affairs TRICARE	$273.72

US LE Venous Duplex Bilateral

Facility

$1,728.00

Service Code	CPT 93970
Hospital Charge Code	823442
Hospital Revenue Code	921
Min. Negotiated Rate	$1,555.20
Max. Negotiated Rate	$1,555.20
Rate for Payer: Aetna of AZ Commercial	$1,555.20
Rate for Payer: Cash Price	$1,382.40

US LE Venous Duplex Left

Facility

$1,104.00

Service Code	CPT 93971
Hospital Charge Code	823444
Hospital Revenue Code	921
Min. Negotiated Rate	$993.60
Max. Negotiated Rate	$993.60
Rate for Payer: Aetna of AZ Commercial	$993.60
Rate for Payer: Cash Price	$883.20

US LE Venous Duplex Left

Facility

$1,104.00

Service Code	CPT 93971
Hospital Charge Code	823444
Hospital Revenue Code	921
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$993.60
Rate for Payer: Aetna of AZ Commercial	$993.60
Rate for Payer: Arizona Complete Health Allwell	$176.64
Rate for Payer: Banner UC Health Medicare	$176.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$750.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$176.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$176.64
Rate for Payer: Cash Price	$883.20
Rate for Payer: Cash Price	$883.20
Rate for Payer: Cigna of AZ Commercial	$772.80
Rate for Payer: Devoted Health Medicare	$198.72
Rate for Payer: Humana of AZ Medicare	$176.64
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$750.72
Rate for Payer: TriWest Medicare	$176.64
Rate for Payer: United Healthcare Commercial	$631.49
Rate for Payer: United Healthcare Medicare	$176.64
Rate for Payer: United Healthcare New Mexico Commercial	$209.76
Rate for Payer: Veterans Affairs TRICARE	$174.87

US LE Venous Duplex Right

Facility

$1,181.28

Service Code	CPT 93971
Hospital Charge Code	823446
Hospital Revenue Code	921
Min. Negotiated Rate	$1,063.15
Max. Negotiated Rate	$1,063.15
Rate for Payer: Aetna of AZ Commercial	$1,063.15
Rate for Payer: Cash Price	$945.02

US LE Venous Duplex Right

Facility

$1,181.28

Service Code	CPT 93971
Hospital Charge Code	823446
Hospital Revenue Code	921
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,063.15
Rate for Payer: Aetna of AZ Commercial	$1,063.15
Rate for Payer: Arizona Complete Health Allwell	$189.00
Rate for Payer: Banner UC Health Medicare	$189.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$803.27
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$189.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$189.00
Rate for Payer: Cash Price	$945.02
Rate for Payer: Cash Price	$945.02
Rate for Payer: Cigna of AZ Commercial	$826.90
Rate for Payer: Devoted Health Medicare	$212.63
Rate for Payer: Humana of AZ Medicare	$189.00
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$803.27
Rate for Payer: TriWest Medicare	$189.00
Rate for Payer: United Healthcare Commercial	$675.69
Rate for Payer: United Healthcare Medicare	$189.00
Rate for Payer: United Healthcare New Mexico Commercial	$224.44
Rate for Payer: Veterans Affairs TRICARE	$187.11

US Liver

Facility

$1,161.00

Service Code	CPT 76700
Hospital Charge Code	2214209
Hospital Revenue Code	402
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,044.90
Rate for Payer: Aetna of AZ Commercial	$1,044.90
Rate for Payer: Arizona Complete Health Allwell	$185.76
Rate for Payer: Banner UC Health Medicare	$185.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$789.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$185.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$185.76
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cigna of AZ Commercial	$812.70
Rate for Payer: Devoted Health Medicare	$208.98
Rate for Payer: Humana of AZ Medicare	$185.76
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$789.48
Rate for Payer: TriWest Medicare	$185.76
Rate for Payer: United Healthcare Commercial	$664.09
Rate for Payer: United Healthcare Medicare	$185.76
Rate for Payer: United Healthcare New Mexico Commercial	$220.59
Rate for Payer: Veterans Affairs TRICARE	$183.90

US Liver

Facility

$1,161.00

Service Code	CPT 76700
Hospital Charge Code	2214209
Hospital Revenue Code	402
Min. Negotiated Rate	$1,044.90
Max. Negotiated Rate	$1,044.90
Rate for Payer: Aetna of AZ Commercial	$1,044.90
Rate for Payer: Cash Price	$928.80

US OB<14weeks add gestational

Facility

$696.00

Service Code	CPT 76810
Hospital Charge Code	3166180
Hospital Revenue Code	402
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$626.40
Rate for Payer: Aetna of AZ Commercial	$626.40
Rate for Payer: Arizona Complete Health Allwell	$111.36
Rate for Payer: Banner UC Health Medicare	$111.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$473.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$111.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$111.36
Rate for Payer: Cash Price	$556.80
Rate for Payer: Cigna of AZ Commercial	$487.20
Rate for Payer: Devoted Health Medicare	$125.28
Rate for Payer: Humana of AZ Medicare	$111.36
Rate for Payer: Southwest Service Administrators UFCW	$473.28
Rate for Payer: TriWest Medicare	$111.36
Rate for Payer: United Healthcare Commercial	$398.11
Rate for Payer: United Healthcare Medicare	$111.36
Rate for Payer: United Healthcare New Mexico Commercial	$132.24
Rate for Payer: Veterans Affairs TRICARE	$110.25

US OB<14weeks add gestational

Facility

$696.00

Service Code	CPT 76810
Hospital Charge Code	3166180
Hospital Revenue Code	402
Min. Negotiated Rate	$626.40
Max. Negotiated Rate	$626.40
Rate for Payer: Aetna of AZ Commercial	$626.40
Rate for Payer: Cash Price	$556.80

US OB Complete

Facility

$1,474.00

Service Code	CPT 76805
Hospital Charge Code	1007785
Hospital Revenue Code	402
Min. Negotiated Rate	$1,326.60
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Cash Price	$1,179.20

US OB Complete

Facility

$1,474.00

Service Code	CPT 76805
Hospital Charge Code	1007785
Hospital Revenue Code	402
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Arizona Complete Health Allwell	$235.84
Rate for Payer: Banner UC Health Medicare	$235.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,002.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$235.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$235.84
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cigna of AZ Commercial	$1,031.80
Rate for Payer: Devoted Health Medicare	$265.32
Rate for Payer: Humana of AZ Medicare	$235.84
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$1,002.32
Rate for Payer: TriWest Medicare	$235.84
Rate for Payer: United Healthcare Commercial	$843.13
Rate for Payer: United Healthcare Medicare	$235.84
Rate for Payer: United Healthcare New Mexico Commercial	$280.06
Rate for Payer: Veterans Affairs TRICARE	$233.48

US OB Detailed Multi

Facility

$412.00

Service Code	CPT 76815
Hospital Charge Code	1525535
Hospital Revenue Code	402
Min. Negotiated Rate	$370.80
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Cash Price	$329.60

US OB Detailed Multi

Facility

$412.00

Service Code	CPT 76815
Hospital Charge Code	1525535
Hospital Revenue Code	402
Min. Negotiated Rate	$65.26
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Arizona Complete Health Allwell	$65.92
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$280.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.92
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cigna of AZ Commercial	$288.40
Rate for Payer: Devoted Health Medicare	$74.16
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$280.16
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: United Healthcare Commercial	$235.66
Rate for Payer: United Healthcare Medicare	$65.92
Rate for Payer: United Healthcare New Mexico Commercial	$78.28
Rate for Payer: Veterans Affairs TRICARE	$65.26

US OB Follow-Up/Repeat

Facility

$832.00

Service Code	CPT 76816
Hospital Charge Code	1284669
Hospital Revenue Code	402
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: 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: Seven Corners Travel Insurance	$161.76
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 OB Follow-Up/Repeat

Facility

$832.00

Service Code	CPT 76816
Hospital Charge Code	1284669
Hospital Revenue Code	402
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 OB Transvaginal < 14 Wks Single Gest

Facility

$1,036.00

Service Code	CPT 76801
Hospital Charge Code	2214215
Hospital Revenue Code	402
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$932.40
Rate for Payer: Aetna of AZ Commercial	$932.40
Rate for Payer: Arizona Complete Health Allwell	$165.76
Rate for Payer: Banner UC Health Medicare	$165.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$704.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$165.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$165.76
Rate for Payer: Cash Price	$828.80
Rate for Payer: Cash Price	$828.80
Rate for Payer: Cigna of AZ Commercial	$725.20
Rate for Payer: Devoted Health Medicare	$186.48
Rate for Payer: Humana of AZ Medicare	$165.76
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$704.48
Rate for Payer: TriWest Medicare	$165.76
Rate for Payer: United Healthcare Commercial	$592.59
Rate for Payer: United Healthcare Medicare	$165.76
Rate for Payer: United Healthcare New Mexico Commercial	$196.84
Rate for Payer: Veterans Affairs TRICARE	$164.10

Know your out-of-pocket cost for care.

All Charges