Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CALR Mutation Analysis LC

Facility

$701.00

Service Code	CPT 81219
Hospital Charge Code	22311181
Hospital Revenue Code	302
Min. Negotiated Rate	$111.04
Max. Negotiated Rate	$630.90
Rate for Payer: Aetna of AZ Commercial	$630.90
Rate for Payer: Arizona Complete Health Allwell	$112.16
Rate for Payer: Banner UC Health Medicare	$112.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$476.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$112.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$112.16
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cigna of AZ Commercial	$455.65
Rate for Payer: Devoted Health Medicare	$126.18
Rate for Payer: Humana of AZ Medicare	$112.16
Rate for Payer: Seven Corners Travel Insurance	$176.36
Rate for Payer: Southwest Service Administrators UFCW	$476.68
Rate for Payer: TriWest Medicare	$112.16
Rate for Payer: United Healthcare Commercial	$400.97
Rate for Payer: United Healthcare Medicare	$112.16
Rate for Payer: Veterans Affairs TRICARE	$111.04

CAMPYLOBACTER AG

Facility

$112.00

Service Code	CPT 87899
Hospital Charge Code	22422554
Hospital Revenue Code	306
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$149.60

CAMPYLOBACTER AG

Facility

$187.00

Service Code	CPT 87899
Hospital Charge Code	22422554
Hospital Revenue Code	306
Min. Negotiated Rate	$23.30
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Arizona Complete Health Allwell	$17.92
Rate for Payer: Arizona Complete Health Allwell	$29.92
Rate for Payer: Banner UC Health Medicare	$17.92
Rate for Payer: Banner UC Health Medicare	$29.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$127.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$76.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.92
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cigna of AZ Commercial	$121.55
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Devoted Health Medicare	$33.66
Rate for Payer: Devoted Health Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$17.92
Rate for Payer: Humana of AZ Medicare	$29.92
Rate for Payer: Seven Corners Travel Insurance	$23.30
Rate for Payer: Seven Corners Travel Insurance	$23.30
Rate for Payer: Southwest Service Administrators UFCW	$76.16
Rate for Payer: Southwest Service Administrators UFCW	$127.16
Rate for Payer: TriWest Medicare	$17.92
Rate for Payer: TriWest Medicare	$29.92
Rate for Payer: United Healthcare Commercial	$106.96
Rate for Payer: United Healthcare Commercial	$64.06
Rate for Payer: United Healthcare Medicare	$17.92
Rate for Payer: United Healthcare Medicare	$29.92
Rate for Payer: Veterans Affairs TRICARE	$29.62
Rate for Payer: Veterans Affairs TRICARE	$17.74

.Campylobacter Cult Result LC

Facility

$83.00

Service Code	CPT 87899
Hospital Charge Code	1294563
Hospital Revenue Code	301
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Cash Price	$66.40

.Campylobacter Cult Result LC

Facility

$83.00

Service Code	CPT 87899
Hospital Charge Code	1294563
Hospital Revenue Code	301
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Arizona Complete Health Allwell	$13.28
Rate for Payer: Banner UC Health Medicare	$13.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$56.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.28
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Devoted Health Medicare	$14.94
Rate for Payer: Humana of AZ Medicare	$13.28
Rate for Payer: Seven Corners Travel Insurance	$23.30
Rate for Payer: Southwest Service Administrators UFCW	$56.44
Rate for Payer: TriWest Medicare	$13.28
Rate for Payer: United Healthcare Commercial	$47.48
Rate for Payer: United Healthcare Medicare	$13.28
Rate for Payer: Veterans Affairs TRICARE	$13.15

Canalith Repositioning Procedure Units

Facility

$203.00

Service Code	CPT 95992 GP
Hospital Charge Code	22229728
Hospital Revenue Code	424
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Arizona Complete Health Allwell	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.16
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Devoted Health Medicare	$36.54
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Mercy Care Medicaid	$6.97
Rate for Payer: NaphCare Correctional Healthcare	$6.97
Rate for Payer: Southwest Service Administrators UFCW	$138.04
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: United Healthcare Commercial	$116.12
Rate for Payer: United Healthcare Medicare	$32.48
Rate for Payer: United Healthcare New Mexico Commercial	$38.57
Rate for Payer: Veterans Affairs TRICARE	$32.16

Canalith Repositioning Procedure Units

Facility

$203.00

Service Code	CPT 95992 GP
Hospital Charge Code	22229728
Hospital Revenue Code	424
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Cash Price	$162.40

Cancer Antigen (CA) 125 LC

Facility

$649.00

Service Code	CPT 86304
Hospital Charge Code	1285563
Hospital Revenue Code	302
Min. Negotiated Rate	$30.17
Max. Negotiated Rate	$584.10
Rate for Payer: Aetna of AZ Commercial	$584.10
Rate for Payer: Arizona Complete Health Allwell	$103.84
Rate for Payer: Banner UC Health Medicare	$103.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$441.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$103.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$103.84
Rate for Payer: Cash Price	$519.20
Rate for Payer: Cash Price	$519.20
Rate for Payer: Cigna of AZ Commercial	$421.85
Rate for Payer: Devoted Health Medicare	$116.82
Rate for Payer: Humana of AZ Medicare	$103.84
Rate for Payer: Seven Corners Travel Insurance	$30.17
Rate for Payer: Southwest Service Administrators UFCW	$441.32
Rate for Payer: TriWest Medicare	$103.84
Rate for Payer: United Healthcare Commercial	$371.23
Rate for Payer: United Healthcare Medicare	$103.84
Rate for Payer: Veterans Affairs TRICARE	$102.80

Cancer Antigen (CA) 125 LC

Facility

$649.00

Service Code	CPT 86304
Hospital Charge Code	1285563
Hospital Revenue Code	302
Min. Negotiated Rate	$584.10
Max. Negotiated Rate	$584.10
Rate for Payer: Aetna of AZ Commercial	$584.10
Rate for Payer: Cash Price	$519.20

CANDIDA AB IGG, IGA, IGM, ELISA

Facility

$268.00

Service Code	CPT 86628
Hospital Charge Code	23294373
Hospital Revenue Code	301
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Cash Price	$214.40

CANDIDA AB IGG, IGA, IGM, ELISA

Facility

$268.00

Service Code	CPT 86628
Hospital Charge Code	23294373
Hospital Revenue Code	301
Min. Negotiated Rate	$17.41
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Arizona Complete Health Allwell	$42.88
Rate for Payer: Banner UC Health Medicare	$42.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$182.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.88
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cigna of AZ Commercial	$174.20
Rate for Payer: Devoted Health Medicare	$48.24
Rate for Payer: Humana of AZ Medicare	$42.88
Rate for Payer: Seven Corners Travel Insurance	$17.41
Rate for Payer: Southwest Service Administrators UFCW	$182.24
Rate for Payer: TriWest Medicare	$42.88
Rate for Payer: United Healthcare Commercial	$153.30
Rate for Payer: United Healthcare Medicare	$42.88
Rate for Payer: Veterans Affairs TRICARE	$42.45

Candida Abs Ql LC

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	6780771
Hospital Revenue Code	302
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Cash Price	$204.00

Candida Abs Ql LC

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	6780771
Hospital Revenue Code	302
Min. Negotiated Rate	$17.41
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Arizona Complete Health Allwell	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$173.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Devoted Health Medicare	$45.90
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Seven Corners Travel Insurance	$17.41
Rate for Payer: Southwest Service Administrators UFCW	$173.40
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: United Healthcare Commercial	$145.86
Rate for Payer: United Healthcare Medicare	$40.80
Rate for Payer: Veterans Affairs TRICARE	$40.39

CANISTER STRYKER REF#502-100-000

Facility

$55.00

Hospital Charge Code	22355508
Hospital Revenue Code	270
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

CANISTER STRYKER REF#502-100-000

Facility

$55.00

Hospital Charge Code	22355508
Hospital Revenue Code	270
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

CANNULA NASAL ADULT

Facility

$5.00

Service Code	HCPCS A7034
Hospital Charge Code	22355589
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Cash Price	$4.00

CANNULA NASAL ADULT

Facility

$5.00

Service Code	HCPCS A7034
Hospital Charge Code	22355589
Hospital Revenue Code	270
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Arizona Complete Health Allwell	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.80
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Southwest Service Administrators UFCW	$3.40
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: United Healthcare Commercial	$2.86
Rate for Payer: United Healthcare Medicare	$0.80
Rate for Payer: Veterans Affairs TRICARE	$0.79

CANNULA OZIMIZER PENDANT

Facility

$150.00

Hospital Charge Code	24139386
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Arizona Complete Health Allwell	$24.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cigna of AZ Commercial	$105.00
Rate for Payer: Devoted Health Medicare	$27.00
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Southwest Service Administrators UFCW	$102.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: United Healthcare Commercial	$85.80
Rate for Payer: United Healthcare Medicare	$24.00
Rate for Payer: Veterans Affairs TRICARE	$23.76

CANNULA OZIMIZER PENDANT

Facility

$150.00

Hospital Charge Code	24139386
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Cash Price	$120.00

CANNULATED DRILL BIT FS3010

Facility

$2,452.00

Hospital Charge Code	27565273
Hospital Revenue Code	270
Min. Negotiated Rate	$388.40
Max. Negotiated Rate	$2,206.80
Rate for Payer: Aetna of AZ Commercial	$2,206.80
Rate for Payer: Arizona Complete Health Allwell	$392.32
Rate for Payer: Banner UC Health Medicare	$392.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,667.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$392.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$392.32
Rate for Payer: Cash Price	$1,961.60
Rate for Payer: Cigna of AZ Commercial	$1,716.40
Rate for Payer: Devoted Health Medicare	$441.36
Rate for Payer: Humana of AZ Medicare	$392.32
Rate for Payer: Southwest Service Administrators UFCW	$1,667.36
Rate for Payer: TriWest Medicare	$392.32
Rate for Payer: United Healthcare Commercial	$1,402.54
Rate for Payer: United Healthcare Medicare	$392.32
Rate for Payer: Veterans Affairs TRICARE	$388.40

CANNULATED DRILL BIT FS3010

Facility

$2,452.00

Hospital Charge Code	27565273
Hospital Revenue Code	270
Min. Negotiated Rate	$2,206.80
Max. Negotiated Rate	$2,206.80
Rate for Payer: Aetna of AZ Commercial	$2,206.80
Rate for Payer: Cash Price	$1,961.60

CANNULATED DRILL BIT FS4030

Facility

$1,756.00

Hospital Charge Code	27565272
Hospital Revenue Code	270
Min. Negotiated Rate	$1,580.40
Max. Negotiated Rate	$1,580.40
Rate for Payer: Aetna of AZ Commercial	$1,580.40
Rate for Payer: Cash Price	$1,404.80

CANNULATED DRILL BIT FS4030

Facility

$1,756.00

Hospital Charge Code	27565272
Hospital Revenue Code	270
Min. Negotiated Rate	$278.15
Max. Negotiated Rate	$1,580.40
Rate for Payer: Aetna of AZ Commercial	$1,580.40
Rate for Payer: Arizona Complete Health Allwell	$280.96
Rate for Payer: Banner UC Health Medicare	$280.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,194.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$280.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$280.96
Rate for Payer: Cash Price	$1,404.80
Rate for Payer: Cigna of AZ Commercial	$1,229.20
Rate for Payer: Devoted Health Medicare	$316.08
Rate for Payer: Humana of AZ Medicare	$280.96
Rate for Payer: Southwest Service Administrators UFCW	$1,194.08
Rate for Payer: TriWest Medicare	$280.96
Rate for Payer: United Healthcare Commercial	$1,004.43
Rate for Payer: United Healthcare Medicare	$280.96
Rate for Payer: Veterans Affairs TRICARE	$278.15

Ca+PTH Intact LC

Facility

$78.00

Service Code	CPT 82310
Hospital Charge Code	2269455
Hospital Revenue Code	301
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Arizona Complete Health Allwell	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.48
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Seven Corners Travel Insurance	$7.48
Rate for Payer: Southwest Service Administrators UFCW	$53.04
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: United Healthcare Commercial	$44.62
Rate for Payer: United Healthcare Medicare	$12.48
Rate for Payer: Veterans Affairs TRICARE	$12.36

Ca+PTH Intact LC

Facility

$78.00

Service Code	CPT 82310
Hospital Charge Code	2269455
Hospital Revenue Code	301
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Cash Price	$62.40

Know your out-of-pocket cost for care.

All Charges