Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

00926 ANES RADICAL ORCHIECTOMY ING ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00926
Hospital Charge Code	22406166
Hospital Revenue Code	370
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Arizona Complete Health Allwell	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$202.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.68
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Devoted Health Medicare	$53.64
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Southwest Service Administrators UFCW	$202.64
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: United Healthcare Commercial	$170.46
Rate for Payer: United Healthcare Medicare	$47.68
Rate for Payer: Veterans Affairs TRICARE	$47.20

00926 ANES RADICAL ORCHIECTOMY INGUIN ADDITONAL MINUTES

Facility

$9.00

Service Code	CPT 00926
Hospital Charge Code	22406165
Hospital Revenue Code	370
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

00926 ANES RADICAL ORCHIECTOMY INGUIN ADDITONAL MINUTES

Facility

$9.00

Service Code	CPT 00926
Hospital Charge Code	22406165
Hospital Revenue Code	370
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

00926 ANES RADICAL ORCHIECTOMY INGUINAL BASE CHG AND 1ST MIN

Facility

$826.00

Service Code	CPT 00926
Hospital Charge Code	22406164
Hospital Revenue Code	370
Min. Negotiated Rate	$130.84
Max. Negotiated Rate	$743.40
Rate for Payer: Aetna of AZ Commercial	$743.40
Rate for Payer: Arizona Complete Health Allwell	$132.16
Rate for Payer: Banner UC Health Medicare	$132.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$561.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$132.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$132.16
Rate for Payer: Cash Price	$660.80
Rate for Payer: Cigna of AZ Commercial	$536.90
Rate for Payer: Devoted Health Medicare	$148.68
Rate for Payer: Humana of AZ Medicare	$132.16
Rate for Payer: Southwest Service Administrators UFCW	$561.68
Rate for Payer: TriWest Medicare	$132.16
Rate for Payer: United Healthcare Commercial	$472.47
Rate for Payer: United Healthcare Medicare	$132.16
Rate for Payer: Veterans Affairs TRICARE	$130.84

00926 ANES RADICAL ORCHIECTOMY INGUINAL BASE CHG AND 1ST MIN

Facility

$826.00

Service Code	CPT 00926
Hospital Charge Code	22406164
Hospital Revenue Code	370
Min. Negotiated Rate	$743.40
Max. Negotiated Rate	$743.40
Rate for Payer: Aetna of AZ Commercial	$743.40
Rate for Payer: Cash Price	$660.80

0092A Moderna 6-11yrs Second Dose Med Charge CQCH

Facility

$55.00

Service Code	CPT 0092A
Hospital Charge Code	27410184
Hospital Revenue Code	521
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

0092A Moderna 6-11yrs Second Dose Med Charge CQCH

Facility

$55.00

Service Code	CPT 0092A
Hospital Charge Code	27410184
Hospital Revenue Code	521
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

00930 ANES ORCHIOPEXY UNILAT OR BI ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00930
Hospital Charge Code	22406169
Hospital Revenue Code	370
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Cash Price	$238.40

00930 ANES ORCHIOPEXY UNILAT OR BI ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00930
Hospital Charge Code	22406169
Hospital Revenue Code	370
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Arizona Complete Health Allwell	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$202.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.68
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Devoted Health Medicare	$53.64
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Southwest Service Administrators UFCW	$202.64
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: United Healthcare Commercial	$170.46
Rate for Payer: United Healthcare Medicare	$47.68
Rate for Payer: Veterans Affairs TRICARE	$47.20

00930 ANES ORCHIOPEXY UNILAT OR BILAT ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00930
Hospital Charge Code	22406168
Hospital Revenue Code	370
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

00930 ANES ORCHIOPEXY UNILAT OR BILAT ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00930
Hospital Charge Code	22406168
Hospital Revenue Code	370
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

00938 ANES INSERTION OF PENILE PRO ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406172
Hospital Revenue Code	370
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Arizona Complete Health Allwell	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$202.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.68
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Devoted Health Medicare	$53.64
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Southwest Service Administrators UFCW	$202.64
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: United Healthcare Commercial	$170.46
Rate for Payer: United Healthcare Medicare	$47.68
Rate for Payer: Veterans Affairs TRICARE	$47.20

00938 ANES INSERTION OF PENILE PRO ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406172
Hospital Revenue Code	370
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Cash Price	$238.40

00938 ANES INSERTION OF PENILE PROSTH ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406171
Hospital Revenue Code	370
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

00938 ANES INSERTION OF PENILE PROSTH ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406171
Hospital Revenue Code	370
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

0093A Moderna 6-11yrs Third Dose Med Charge CQCH

Facility

$55.00

Service Code	CPT 0093A
Hospital Charge Code	27406982
Hospital Revenue Code	521
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

0093A Moderna 6-11yrs Third Dose Med Charge CQCH

Facility

$55.00

Service Code	CPT 0093A
Hospital Charge Code	27406982
Hospital Revenue Code	521
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

00940 ANES VAGINAL PROCEDURES ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00940
Hospital Charge Code	22406174
Hospital Revenue Code	370
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

00940 ANES VAGINAL PROCEDURES ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00940
Hospital Charge Code	22406174
Hospital Revenue Code	370
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

00940 ANES VAGINAL PROCEDURES ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00940
Hospital Charge Code	22406175
Hospital Revenue Code	370
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Cash Price	$238.40

00940 ANES VAGINAL PROCEDURES ADDTNL 0:30 CHARGE

Facility

$298.00

Service Code	CPT 00940
Hospital Charge Code	22406175
Hospital Revenue Code	370
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Arizona Complete Health Allwell	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$202.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.68
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Devoted Health Medicare	$53.64
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Southwest Service Administrators UFCW	$202.64
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: United Healthcare Commercial	$170.46
Rate for Payer: United Healthcare Medicare	$47.68
Rate for Payer: Veterans Affairs TRICARE	$47.20

00940 ANES VAGINAL PROCEDURES BASE CHARGE AND 1ST MINUTE

Facility

$746.00

Service Code	CPT 00940
Hospital Charge Code	22406173
Hospital Revenue Code	964
Min. Negotiated Rate	$118.17
Max. Negotiated Rate	$671.40
Rate for Payer: Aetna of AZ Commercial	$671.40
Rate for Payer: Arizona Complete Health Allwell	$119.36
Rate for Payer: Banner UC Health Medicare	$119.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$507.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$119.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$119.36
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cigna of AZ Commercial	$522.20
Rate for Payer: Devoted Health Medicare	$134.28
Rate for Payer: Humana of AZ Medicare	$119.36
Rate for Payer: Southwest Service Administrators UFCW	$507.28
Rate for Payer: TriWest Medicare	$119.36
Rate for Payer: United Healthcare Commercial	$426.71
Rate for Payer: United Healthcare Medicare	$119.36
Rate for Payer: United Healthcare New Mexico Commercial	$141.74
Rate for Payer: Veterans Affairs TRICARE	$118.17

00940 ANES VAGINAL PROCEDURES BASE CHARGE AND 1ST MINUTE

Facility

$746.00

Service Code	CPT 00940
Hospital Charge Code	22406173
Hospital Revenue Code	964
Min. Negotiated Rate	$671.40
Max. Negotiated Rate	$671.40
Rate for Payer: Aetna of AZ Commercial	$671.40
Rate for Payer: Cash Price	$596.80

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597459
Hospital Revenue Code	370
Min. Negotiated Rate	$531.90
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Cash Price	$472.80

00944 ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF

Facility

$591.00

Service Code	CPT 00944
Hospital Charge Code	23597457
Hospital Revenue Code	370
Min. Negotiated Rate	$93.61
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Arizona Complete Health Allwell	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$401.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$94.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$94.56
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Devoted Health Medicare	$106.38
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Southwest Service Administrators UFCW	$401.88
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: United Healthcare Commercial	$338.05
Rate for Payer: United Healthcare Medicare	$94.56
Rate for Payer: Veterans Affairs TRICARE	$93.61

Know your out-of-pocket cost for care.

All Charges