Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

AFC GENERIC ADD-ON

Facility

$99.00

Service Code	CPT 86901
Hospital Charge Code	22543271
Hospital Revenue Code	302
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Arizona Complete Health Allwell	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$67.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.84
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Devoted Health Medicare	$17.82
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Seven Corners Travel Insurance	$4.34
Rate for Payer: Southwest Service Administrators UFCW	$67.32
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: United Healthcare Commercial	$56.63
Rate for Payer: United Healthcare Medicare	$15.84
Rate for Payer: Veterans Affairs TRICARE	$15.68

Affinity

Facility

$11,218.00

Service Code	HCPCS Q4159
Hospital Charge Code	24383280
Hospital Revenue Code	636
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$10,096.20
Rate for Payer: Aetna of AZ Commercial	$10,096.20
Rate for Payer: Arizona Complete Health Allwell	$1,794.88
Rate for Payer: Banner UC Health Medicare	$1,794.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7,628.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,794.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,794.88
Rate for Payer: Cash Price	$8,974.40
Rate for Payer: Cash Price	$8,974.40
Rate for Payer: Cigna of AZ Commercial	$7,852.60
Rate for Payer: Devoted Health Medicare	$2,019.24
Rate for Payer: Humana of AZ Medicare	$1,794.88
Rate for Payer: Seven Corners Travel Insurance	$192.55
Rate for Payer: Southwest Service Administrators UFCW	$7,628.24
Rate for Payer: TriWest Medicare	$1,794.88
Rate for Payer: United Healthcare Commercial	$6,416.70
Rate for Payer: United Healthcare Medicare	$1,794.88
Rate for Payer: United Healthcare New Mexico Commercial	$2,131.42
Rate for Payer: Veterans Affairs TRICARE	$1,776.93

Affinity

Facility

$11,218.00

Service Code	HCPCS Q4159
Hospital Charge Code	24383280
Hospital Revenue Code	636
Min. Negotiated Rate	$10,096.20
Max. Negotiated Rate	$10,096.20
Rate for Payer: Aetna of AZ Commercial	$10,096.20
Rate for Payer: Cash Price	$8,974.40

AFP, Serum, Tumor Marker LC

Facility

$365.00

Service Code	CPT 82105
Hospital Charge Code	1905891
Hospital Revenue Code	301
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Arizona Complete Health Allwell	$58.40
Rate for Payer: Banner UC Health Medicare	$58.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$248.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$58.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.40
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cigna of AZ Commercial	$237.25
Rate for Payer: Devoted Health Medicare	$65.70
Rate for Payer: Humana of AZ Medicare	$58.40
Rate for Payer: Seven Corners Travel Insurance	$24.32
Rate for Payer: Southwest Service Administrators UFCW	$248.20
Rate for Payer: TriWest Medicare	$58.40
Rate for Payer: United Healthcare Commercial	$208.78
Rate for Payer: United Healthcare Medicare	$58.40
Rate for Payer: Veterans Affairs TRICARE	$57.82

AFP, Serum, Tumor Marker LC

Facility

$331.00

Service Code	CPT 82105
Hospital Charge Code	1905887
Hospital Revenue Code	301
Min. Negotiated Rate	$297.90
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Commercial	$399.60
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$355.20

AFP, Serum, Tumor Marker LC

Facility

$444.00

Service Code	CPT 82105
Hospital Charge Code	1905887
Hospital Revenue Code	301
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$399.60
Rate for Payer: Aetna of AZ Commercial	$399.60
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Arizona Complete Health Allwell	$52.96
Rate for Payer: Arizona Complete Health Allwell	$71.04
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Banner UC Health Medicare	$71.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$301.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$225.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$71.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$71.04
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$288.60
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Devoted Health Medicare	$79.92
Rate for Payer: Devoted Health Medicare	$59.58
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Humana of AZ Medicare	$71.04
Rate for Payer: Seven Corners Travel Insurance	$24.32
Rate for Payer: Seven Corners Travel Insurance	$24.32
Rate for Payer: Southwest Service Administrators UFCW	$225.08
Rate for Payer: Southwest Service Administrators UFCW	$301.92
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: TriWest Medicare	$71.04
Rate for Payer: United Healthcare Commercial	$253.97
Rate for Payer: United Healthcare Commercial	$189.33
Rate for Payer: United Healthcare Medicare	$52.96
Rate for Payer: United Healthcare Medicare	$71.04
Rate for Payer: Veterans Affairs TRICARE	$70.33
Rate for Payer: Veterans Affairs TRICARE	$52.43

AFP, Serum, Tumor Marker LC

Facility

$365.00

Service Code	CPT 82105
Hospital Charge Code	1905891
Hospital Revenue Code	301
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Cash Price	$292.00

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$14,624.45

Service Code	MSDRG 560
Min. Negotiated Rate	$14,624.45
Max. Negotiated Rate	$14,624.45
Rate for Payer: Seven Corners Travel Insurance	$14,624.45

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$24,102.23

Service Code	MSDRG 559
Min. Negotiated Rate	$24,102.23
Max. Negotiated Rate	$24,102.23
Rate for Payer: Seven Corners Travel Insurance	$24,102.23

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$10,541.79

Service Code	MSDRG 561
Min. Negotiated Rate	$10,541.79
Max. Negotiated Rate	$10,541.79
Rate for Payer: Seven Corners Travel Insurance	$10,541.79

AFTERCARE WITH CC/MCC

Facility

$15,430.33

Service Code	MSDRG 949
Min. Negotiated Rate	$15,430.33
Max. Negotiated Rate	$15,430.33
Rate for Payer: Seven Corners Travel Insurance	$15,430.33

AFTERCARE WITHOUT CC/MCC

Facility

$8,309.14

Service Code	MSDRG 950
Min. Negotiated Rate	$8,309.14
Max. Negotiated Rate	$8,309.14
Rate for Payer: Seven Corners Travel Insurance	$8,309.14

After Hours Visit - 99050

Facility

$243.00

Service Code	CPT 99050
Hospital Charge Code	631588
Hospital Revenue Code	521
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$218.70
Rate for Payer: Aetna of AZ Commercial	$218.70
Rate for Payer: Arizona Complete Health Allwell	$38.88
Rate for Payer: Banner UC Health Medicare	$38.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$165.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.88
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cigna of AZ Commercial	$170.10
Rate for Payer: Devoted Health Medicare	$43.74
Rate for Payer: Humana of AZ Medicare	$38.88
Rate for Payer: Southwest Service Administrators UFCW	$165.24
Rate for Payer: TriWest Medicare	$38.88
Rate for Payer: United Healthcare Commercial	$139.00
Rate for Payer: United Healthcare Medicare	$38.88
Rate for Payer: Veterans Affairs TRICARE	$38.49

After Hours Visit - 99050

Facility

$243.00

Service Code	CPT 99050
Hospital Charge Code	631588
Hospital Revenue Code	521
Min. Negotiated Rate	$218.70
Max. Negotiated Rate	$218.70
Rate for Payer: Aetna of AZ Commercial	$218.70
Rate for Payer: Cash Price	$194.40

AICD GENERATOR PROCEDURES

Facility

$58,965.12

Service Code	MSDRG 245
Min. Negotiated Rate	$58,965.12
Max. Negotiated Rate	$58,965.12
Rate for Payer: Seven Corners Travel Insurance	$58,965.12

AICD LEAD PROCEDURES

Facility

$46,762.12

Service Code	MSDRG 265
Min. Negotiated Rate	$46,762.12
Max. Negotiated Rate	$46,762.12
Rate for Payer: Seven Corners Travel Insurance	$46,762.12

AIRSPIRAL BREATHING TUBE AND CHAMBER

Facility

$231.00

Hospital Charge Code	24154229
Hospital Revenue Code	270
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Cash Price	$184.80

AIRSPIRAL BREATHING TUBE AND CHAMBER

Facility

$231.00

Hospital Charge Code	24154229
Hospital Revenue Code	270
Min. Negotiated Rate	$36.59
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Arizona Complete Health Allwell	$36.96
Rate for Payer: Banner UC Health Medicare	$36.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$157.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.96
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cigna of AZ Commercial	$161.70
Rate for Payer: Devoted Health Medicare	$41.58
Rate for Payer: Humana of AZ Medicare	$36.96
Rate for Payer: Southwest Service Administrators UFCW	$157.08
Rate for Payer: TriWest Medicare	$36.96
Rate for Payer: United Healthcare Commercial	$132.13
Rate for Payer: United Healthcare Medicare	$36.96
Rate for Payer: Veterans Affairs TRICARE	$36.59

AIRWAY ADAPTERS PHILIPS

Facility

$95.00

Hospital Charge Code	24157863
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Arizona Complete Health Allwell	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$64.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.20
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Devoted Health Medicare	$17.10
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Southwest Service Administrators UFCW	$64.60
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: United Healthcare Commercial	$54.34
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: Veterans Affairs TRICARE	$15.05

AIRWAY ADAPTERS PHILIPS

Facility

$95.00

Hospital Charge Code	24157863
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Cash Price	$76.00

Alanine Aminotransferase

Facility

$124.00

Service Code	CPT 84460
Hospital Charge Code	633632
Hospital Revenue Code	301
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Seven Corners Travel Insurance	$7.68
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: Veterans Affairs TRICARE	$19.64

Alanine Aminotransferase

Facility

$124.00

Service Code	CPT 84460
Hospital Charge Code	633632
Hospital Revenue Code	301
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Cash Price	$99.20

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$124.00

Service Code	CPT 82043
Hospital Charge Code	16875114
Hospital Revenue Code	301
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Cash Price	$99.20

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$124.00

Service Code	CPT 82043
Hospital Charge Code	16875114
Hospital Revenue Code	301
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Seven Corners Travel Insurance	$8.38
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: Veterans Affairs TRICARE	$19.64

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$130.00

Service Code	CPT 82043
Hospital Charge Code	23294369
Hospital Revenue Code	301
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Cash Price	$104.00

Know your out-of-pocket cost for care.

All Charges