Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

C CSF

Facility

$116.00

Service Code	CPT 87070
Hospital Charge Code	858011
Hospital Revenue Code	306
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Cash Price	$92.80

C CSF

Facility

$116.00

Service Code	CPT 87070
Hospital Charge Code	858011
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Arizona Complete Health Allwell	$18.56
Rate for Payer: Banner UC Health Medicare	$18.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$78.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.56
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$75.40
Rate for Payer: Devoted Health Medicare	$20.88
Rate for Payer: Humana of AZ Medicare	$18.56
Rate for Payer: Seven Corners Travel Insurance	$12.50
Rate for Payer: Southwest Service Administrators UFCW	$78.88
Rate for Payer: TriWest Medicare	$18.56
Rate for Payer: United Healthcare Commercial	$66.35
Rate for Payer: United Healthcare Medicare	$18.56
Rate for Payer: Veterans Affairs TRICARE	$18.37

CD4/CD8 Ratio Profile LC

Facility

$556.00

Service Code	CPT 86360
Hospital Charge Code	2269448
Hospital Revenue Code	306
Min. Negotiated Rate	$500.40
Max. Negotiated Rate	$500.40
Rate for Payer: Aetna of AZ Commercial	$500.40
Rate for Payer: Cash Price	$444.80

CD4/CD8 Ratio Profile LC

Facility

$556.00

Service Code	CPT 86360
Hospital Charge Code	2269448
Hospital Revenue Code	306
Min. Negotiated Rate	$68.12
Max. Negotiated Rate	$500.40
Rate for Payer: Aetna of AZ Commercial	$500.40
Rate for Payer: Arizona Complete Health Allwell	$88.96
Rate for Payer: Banner UC Health Medicare	$88.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$378.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$88.96
Rate for Payer: Cash Price	$444.80
Rate for Payer: Cash Price	$444.80
Rate for Payer: Cigna of AZ Commercial	$361.40
Rate for Payer: Devoted Health Medicare	$100.08
Rate for Payer: Humana of AZ Medicare	$88.96
Rate for Payer: Seven Corners Travel Insurance	$68.12
Rate for Payer: Southwest Service Administrators UFCW	$378.08
Rate for Payer: TriWest Medicare	$88.96
Rate for Payer: United Healthcare Commercial	$318.03
Rate for Payer: United Healthcare Medicare	$88.96
Rate for Payer: Veterans Affairs TRICARE	$88.07

CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR

Facility

$279.00

Service Code	HCPCS U0002
Hospital Charge Code	23934512
Hospital Revenue Code	301
Min. Negotiated Rate	$251.10
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Cash Price	$223.20

CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR

Facility

$279.00

Service Code	HCPCS U0002
Hospital Charge Code	23934512
Hospital Revenue Code	301
Min. Negotiated Rate	$44.19
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Arizona Complete Health Allwell	$44.64
Rate for Payer: Banner UC Health Medicare	$44.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$189.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.64
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna of AZ Commercial	$181.35
Rate for Payer: Devoted Health Medicare	$50.22
Rate for Payer: Humana of AZ Medicare	$44.64
Rate for Payer: Seven Corners Travel Insurance	$74.40
Rate for Payer: Southwest Service Administrators UFCW	$189.72
Rate for Payer: TriWest Medicare	$44.64
Rate for Payer: United Healthcare Commercial	$159.59
Rate for Payer: United Healthcare Medicare	$44.64
Rate for Payer: Veterans Affairs TRICARE	$44.19

CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR

Facility

$197.00

Service Code	HCPCS U0001
Hospital Charge Code	23934510
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Arizona Complete Health Allwell	$31.52
Rate for Payer: Banner UC Health Medicare	$31.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$133.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.52
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cigna of AZ Commercial	$128.05
Rate for Payer: Devoted Health Medicare	$35.46
Rate for Payer: Humana of AZ Medicare	$31.52
Rate for Payer: Seven Corners Travel Insurance	$52.08
Rate for Payer: Southwest Service Administrators UFCW	$133.96
Rate for Payer: TriWest Medicare	$31.52
Rate for Payer: United Healthcare Commercial	$112.68
Rate for Payer: United Healthcare Medicare	$31.52
Rate for Payer: Veterans Affairs TRICARE	$31.20

CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR

Facility

$197.00

Service Code	HCPCS U0001
Hospital Charge Code	23934510
Hospital Revenue Code	301
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Cash Price	$157.60

C Diff Ag and Toxin

Facility

$159.00

Service Code	CPT 87324
Hospital Charge Code	22414087
Hospital Revenue Code	306
Min. Negotiated Rate	$17.37
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Arizona Complete Health Allwell	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$108.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.44
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$103.35
Rate for Payer: Devoted Health Medicare	$28.62
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Seven Corners Travel Insurance	$17.37
Rate for Payer: Southwest Service Administrators UFCW	$108.12
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: United Healthcare Commercial	$90.95
Rate for Payer: United Healthcare Medicare	$25.44
Rate for Payer: Veterans Affairs TRICARE	$25.19

C Diff Ag and Toxin

Facility

$159.00

Service Code	CPT 87324
Hospital Charge Code	22414087
Hospital Revenue Code	306
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Cash Price	$127.20

C. Diff Antigen and Toxin

Facility

$77.00

Service Code	CPT 87449
Hospital Charge Code	21986571
Hospital Revenue Code	306
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Arizona Complete Health Allwell	$12.32
Rate for Payer: Banner UC Health Medicare	$12.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$52.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.32
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$50.05
Rate for Payer: Devoted Health Medicare	$13.86
Rate for Payer: Humana of AZ Medicare	$12.32
Rate for Payer: Seven Corners Travel Insurance	$17.37
Rate for Payer: Southwest Service Administrators UFCW	$52.36
Rate for Payer: TriWest Medicare	$12.32
Rate for Payer: United Healthcare Commercial	$44.04
Rate for Payer: United Healthcare Medicare	$12.32
Rate for Payer: Veterans Affairs TRICARE	$12.20

C. Diff Antigen and Toxin

Facility

$77.00

Service Code	CPT 87449
Hospital Charge Code	21986571
Hospital Revenue Code	306
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Cash Price	$61.60

C. difficile Toxin Gene NAA LC

Facility

$441.00

Service Code	CPT 87493
Hospital Charge Code	21661560
Hospital Revenue Code	301
Min. Negotiated Rate	$54.04
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of AZ Commercial	$396.90
Rate for Payer: Arizona Complete Health Allwell	$70.56
Rate for Payer: Banner UC Health Medicare	$70.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$299.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$70.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$70.56
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cigna of AZ Commercial	$286.65
Rate for Payer: Devoted Health Medicare	$79.38
Rate for Payer: Humana of AZ Medicare	$70.56
Rate for Payer: Seven Corners Travel Insurance	$54.04
Rate for Payer: Southwest Service Administrators UFCW	$299.88
Rate for Payer: TriWest Medicare	$70.56
Rate for Payer: United Healthcare Commercial	$252.25
Rate for Payer: United Healthcare Medicare	$70.56
Rate for Payer: Veterans Affairs TRICARE	$69.85

C. difficile Toxin Gene NAA LC

Facility

$441.00

Service Code	CPT 87493
Hospital Charge Code	21661560
Hospital Revenue Code	301
Min. Negotiated Rate	$396.90
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna of AZ Commercial	$396.90
Rate for Payer: Cash Price	$352.80

C DIFF TOX GENE

Facility

$282.00

Service Code	CPT 87493
Hospital Charge Code	23298043
Hospital Revenue Code	301
Min. Negotiated Rate	$253.80
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Cash Price	$225.60

C DIFF TOX GENE

Facility

$282.00

Service Code	CPT 87493
Hospital Charge Code	23298043
Hospital Revenue Code	301
Min. Negotiated Rate	$44.67
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Arizona Complete Health Allwell	$45.12
Rate for Payer: Banner UC Health Medicare	$45.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$191.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.12
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Devoted Health Medicare	$50.76
Rate for Payer: Humana of AZ Medicare	$45.12
Rate for Payer: Seven Corners Travel Insurance	$54.04
Rate for Payer: Southwest Service Administrators UFCW	$191.76
Rate for Payer: TriWest Medicare	$45.12
Rate for Payer: United Healthcare Commercial	$161.30
Rate for Payer: United Healthcare Medicare	$45.12
Rate for Payer: Veterans Affairs TRICARE	$44.67

C DIFF TOXINS SEND OUT

Facility

$77.00

Service Code	CPT 87449
Hospital Charge Code	22531674
Hospital Revenue Code	301
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Arizona Complete Health Allwell	$12.32
Rate for Payer: Banner UC Health Medicare	$12.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$52.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.32
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$50.05
Rate for Payer: Devoted Health Medicare	$13.86
Rate for Payer: Humana of AZ Medicare	$12.32
Rate for Payer: Seven Corners Travel Insurance	$17.37
Rate for Payer: Southwest Service Administrators UFCW	$52.36
Rate for Payer: TriWest Medicare	$12.32
Rate for Payer: United Healthcare Commercial	$44.04
Rate for Payer: United Healthcare Medicare	$12.32
Rate for Payer: Veterans Affairs TRICARE	$12.20

C DIFF TOXINS SEND OUT

Facility

$77.00

Service Code	CPT 87449
Hospital Charge Code	22531674
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Cash Price	$61.60

CEA LC

Facility

$236.00

Service Code	CPT 82378
Hospital Charge Code	2269423
Hospital Revenue Code	301
Min. Negotiated Rate	$212.40
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Cash Price	$188.80

CEA LC

Facility

$236.00

Service Code	CPT 82378
Hospital Charge Code	2269423
Hospital Revenue Code	301
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Arizona Complete Health Allwell	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$160.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.76
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$153.40
Rate for Payer: Devoted Health Medicare	$42.48
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Seven Corners Travel Insurance	$27.49
Rate for Payer: Southwest Service Administrators UFCW	$160.48
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: United Healthcare Commercial	$134.99
Rate for Payer: United Healthcare Medicare	$37.76
Rate for Payer: Veterans Affairs TRICARE	$37.38

ceFAZolin 1 gm Inj [CQCH]

Facility

$0.63

Service Code	HCPCS J0690
Hospital Charge Code	105914847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Arizona Complete Health Allwell	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.43
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.10
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of AZ Commercial	$0.41
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Southwest Service Administrators UFCW	$0.43
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: United Healthcare Commercial	$0.36
Rate for Payer: United Healthcare Medicare	$0.10
Rate for Payer: Veterans Affairs TRICARE	$0.10

ceFAZolin 1 gm Inj [CQCH]

Facility

$0.63

Service Code	HCPCS J0690
Hospital Charge Code	105914847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Cash Price	$0.51

ceFAZolin 1 gm IVPB[CQCH]

Facility

$3.34

Service Code	HCPCS J0690
Hospital Charge Code	135817684
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna of AZ Commercial	$3.01
Rate for Payer: Arizona Complete Health Allwell	$0.53
Rate for Payer: Banner UC Health Medicare	$0.53
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.27
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.53
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.53
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cigna of AZ Commercial	$2.17
Rate for Payer: Devoted Health Medicare	$0.60
Rate for Payer: Humana of AZ Medicare	$0.53
Rate for Payer: Southwest Service Administrators UFCW	$2.27
Rate for Payer: TriWest Medicare	$0.53
Rate for Payer: United Healthcare Commercial	$1.91
Rate for Payer: United Healthcare Medicare	$0.53
Rate for Payer: Veterans Affairs TRICARE	$0.53

ceFAZolin 1 gm IVPB[CQCH]

Facility

$3.34

Service Code	HCPCS J0690
Hospital Charge Code	135817684
Hospital Revenue Code	250
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna of AZ Commercial	$3.01
Rate for Payer: Cash Price	$2.67

ceFAZolin 2 gm REC [CQCH]

Facility

$4.28

Service Code	HCPCS J0690
Hospital Charge Code	213338088
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna of AZ Commercial	$3.85
Rate for Payer: Arizona Complete Health Allwell	$0.68
Rate for Payer: Banner UC Health Medicare	$0.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.91
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.68
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cigna of AZ Commercial	$2.78
Rate for Payer: Devoted Health Medicare	$0.77
Rate for Payer: Humana of AZ Medicare	$0.68
Rate for Payer: Southwest Service Administrators UFCW	$2.91
Rate for Payer: TriWest Medicare	$0.68
Rate for Payer: United Healthcare Commercial	$2.45
Rate for Payer: United Healthcare Medicare	$0.68
Rate for Payer: Veterans Affairs TRICARE	$0.68

Know your out-of-pocket cost for care.

All Charges