Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Hematocrit

Facility

$63.00

Service Code	CPT 85014
Hospital Charge Code	633742
Hospital Revenue Code	305
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Arizona Complete Health Allwell	$7.68
Rate for Payer: Arizona Complete Health Allwell	$10.08
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Banner UC Health Medicare	$10.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.08
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$40.95
Rate for Payer: Cigna of AZ Commercial	$31.20
Rate for Payer: Devoted Health Medicare	$11.34
Rate for Payer: Devoted Health Medicare	$8.64
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Humana of AZ Medicare	$10.08
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Southwest Service Administrators UFCW	$32.64
Rate for Payer: Southwest Service Administrators UFCW	$42.84
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: TriWest Medicare	$10.08
Rate for Payer: United Healthcare Commercial	$36.04
Rate for Payer: United Healthcare Commercial	$27.46
Rate for Payer: United Healthcare Medicare	$7.68
Rate for Payer: United Healthcare Medicare	$10.08
Rate for Payer: Veterans Affairs TRICARE	$9.98
Rate for Payer: Veterans Affairs TRICARE	$7.60

Hematocrit

Facility

$48.00

Service Code	CPT 85014
Hospital Charge Code	633742
Hospital Revenue Code	305
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$50.40

HEMATOCRIT

Facility

$66.00

Service Code	CPT 85014
Hospital Charge Code	22481477
Hospital Revenue Code	305
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Cash Price	$52.80

HEMATOCRIT

Facility

$66.00

Service Code	CPT 85014
Hospital Charge Code	22481477
Hospital Revenue Code	305
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Arizona Complete Health Allwell	$10.56
Rate for Payer: Banner UC Health Medicare	$10.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.56
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$42.90
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Humana of AZ Medicare	$10.56
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Southwest Service Administrators UFCW	$44.88
Rate for Payer: TriWest Medicare	$10.56
Rate for Payer: United Healthcare Commercial	$37.75
Rate for Payer: United Healthcare Medicare	$10.56
Rate for Payer: Veterans Affairs TRICARE	$10.45

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE PROXIMAL END

Facility

$1,305.00

Service Code	CPT 28160
Hospital Charge Code	24043273
Hospital Revenue Code	360
Min. Negotiated Rate	$136.33
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,174.50
Rate for Payer: Arizona Complete Health Allwell	$208.80
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$887.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$136.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$208.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$208.80
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cigna of AZ Commercial	$652.50
Rate for Payer: Devoted Health Medicare	$234.90
Rate for Payer: Humana of AZ Medicare	$208.80
Rate for Payer: Mercy Care Medicaid	$136.33
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$887.40
Rate for Payer: TriWest Medicare	$208.80
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$208.80
Rate for Payer: Veterans Affairs TRICARE	$206.71

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION TOE PROXIMAL END

Facility

$1,305.00

Service Code	CPT 28160
Hospital Charge Code	24043273
Hospital Revenue Code	360
Min. Negotiated Rate	$1,174.50
Max. Negotiated Rate	$1,174.50
Rate for Payer: Aetna of AZ Commercial	$1,174.50
Rate for Payer: Cash Price	$1,044.00

HEMO DRAIN 3/16

Facility

$185.00

Hospital Charge Code	22354978
Hospital Revenue Code	270
Min. Negotiated Rate	$29.30
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Arizona Complete Health Allwell	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.60
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$129.50
Rate for Payer: Devoted Health Medicare	$33.30
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Southwest Service Administrators UFCW	$125.80
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: United Healthcare Commercial	$105.82
Rate for Payer: United Healthcare Medicare	$29.60
Rate for Payer: Veterans Affairs TRICARE	$29.30

HEMO DRAIN 3/16

Facility

$185.00

Hospital Charge Code	22354978
Hospital Revenue Code	270
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Cash Price	$148.00

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	798796
Hospital Revenue Code	300
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$50.40

Hemoglobin

Facility

$63.00

Service Code	CPT 85018
Hospital Charge Code	798796
Hospital Revenue Code	300
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Arizona Complete Health Allwell	$10.08
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$10.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.08
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$40.95
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Devoted Health Medicare	$11.34
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Humana of AZ Medicare	$10.08
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: Southwest Service Administrators UFCW	$42.84
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: TriWest Medicare	$10.08
Rate for Payer: United Healthcare Commercial	$36.04
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: United Healthcare Medicare	$10.08
Rate for Payer: Veterans Affairs TRICARE	$9.98
Rate for Payer: Veterans Affairs TRICARE	$7.44

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	633741
Hospital Revenue Code	300
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

Hemoglobin

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	633741
Hospital Revenue Code	300
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

Hemoglobin A1C

Facility

$139.00

Service Code	CPT 83036
Hospital Charge Code	633743
Hospital Revenue Code	301
Min. Negotiated Rate	$125.10
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Cash Price	$111.20

Hemoglobin A1C

Facility

$139.00

Service Code	CPT 83036
Hospital Charge Code	633743
Hospital Revenue Code	301
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Arizona Complete Health Allwell	$22.24
Rate for Payer: Banner UC Health Medicare	$22.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$94.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.24
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$90.35
Rate for Payer: Devoted Health Medicare	$25.02
Rate for Payer: Humana of AZ Medicare	$22.24
Rate for Payer: Seven Corners Travel Insurance	$14.08
Rate for Payer: Southwest Service Administrators UFCW	$94.52
Rate for Payer: TriWest Medicare	$22.24
Rate for Payer: United Healthcare Commercial	$79.51
Rate for Payer: United Healthcare Medicare	$22.24
Rate for Payer: Veterans Affairs TRICARE	$22.02

Hemoglobin A1c LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	1285548
Hospital Revenue Code	301
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Arizona Complete Health Allwell	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$150.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.52
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$144.30
Rate for Payer: Devoted Health Medicare	$39.96
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Seven Corners Travel Insurance	$16.83
Rate for Payer: Southwest Service Administrators UFCW	$150.96
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: United Healthcare Commercial	$126.98
Rate for Payer: United Healthcare Medicare	$35.52
Rate for Payer: Veterans Affairs TRICARE	$35.16

Hemoglobin A1c LC

Facility

$222.00

Service Code	CPT 84590
Hospital Charge Code	1285548
Hospital Revenue Code	301
Min. Negotiated Rate	$199.80
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Cash Price	$177.60

.Hemoglobin A1c, Please Note LC

Facility

$234.00

Service Code	CPT 84590
Hospital Charge Code	22311148
Hospital Revenue Code	306
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna of AZ Commercial	$210.60
Rate for Payer: Cash Price	$187.20

.Hemoglobin A1c, Please Note LC

Facility

$234.00

Service Code	CPT 84590
Hospital Charge Code	22311148
Hospital Revenue Code	306
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna of AZ Commercial	$210.60
Rate for Payer: Arizona Complete Health Allwell	$37.44
Rate for Payer: Banner UC Health Medicare	$37.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$159.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.44
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna of AZ Commercial	$152.10
Rate for Payer: Devoted Health Medicare	$42.12
Rate for Payer: Humana of AZ Medicare	$37.44
Rate for Payer: Seven Corners Travel Insurance	$16.83
Rate for Payer: Southwest Service Administrators UFCW	$159.12
Rate for Payer: TriWest Medicare	$37.44
Rate for Payer: United Healthcare Commercial	$133.85
Rate for Payer: United Healthcare Medicare	$37.44
Rate for Payer: Veterans Affairs TRICARE	$37.07

Hemoglobin A1c Standard

Facility

$187.00

Service Code	CPT 83036
Hospital Charge Code	22146126
Hospital Revenue Code	301
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Arizona Complete Health Allwell	$29.92
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 Medicare	$29.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.92
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cigna of AZ Commercial	$121.55
Rate for Payer: Devoted Health Medicare	$33.66
Rate for Payer: Humana of AZ Medicare	$29.92
Rate for Payer: Seven Corners Travel Insurance	$14.08
Rate for Payer: Southwest Service Administrators UFCW	$127.16
Rate for Payer: TriWest Medicare	$29.92
Rate for Payer: United Healthcare Commercial	$106.96
Rate for Payer: United Healthcare Medicare	$29.92
Rate for Payer: Veterans Affairs TRICARE	$29.62

Hemoglobin A1c Standard

Facility

$187.00

Service Code	CPT 83036
Hospital Charge Code	22146126
Hospital Revenue Code	301
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Cash Price	$149.60

HEMOGLOBIN A2

Facility

$238.00

Service Code	CPT 84311
Hospital Charge Code	22481478
Hospital Revenue Code	301
Min. Negotiated Rate	$11.74
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Arizona Complete Health Allwell	$38.08
Rate for Payer: Banner UC Health Medicare	$38.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.08
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$154.70
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Humana of AZ Medicare	$38.08
Rate for Payer: Seven Corners Travel Insurance	$11.74
Rate for Payer: Southwest Service Administrators UFCW	$161.84
Rate for Payer: TriWest Medicare	$38.08
Rate for Payer: United Healthcare Commercial	$136.14
Rate for Payer: United Healthcare Medicare	$38.08
Rate for Payer: Veterans Affairs TRICARE	$37.70

HEMOGLOBIN A2

Facility

$238.00

Service Code	CPT 84311
Hospital Charge Code	22481478
Hospital Revenue Code	301
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Cash Price	$190.40

Hemoglobin - POC

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	22209754
Hospital Revenue Code	300
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

Hemoglobin - POC

Facility

$47.00

Service Code	CPT 85018
Hospital Charge Code	22209754
Hospital Revenue Code	300
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Seven Corners Travel Insurance	$3.44
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

Hemoglobin POC

Facility

$146.00

Service Code	CPT 83036
Hospital Charge Code	684350
Hospital Revenue Code	301
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$131.40
Rate for Payer: Aetna of AZ Commercial	$131.40
Rate for Payer: Arizona Complete Health Allwell	$23.36
Rate for Payer: Banner UC Health Medicare	$23.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$99.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.36
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cigna of AZ Commercial	$94.90
Rate for Payer: Devoted Health Medicare	$26.28
Rate for Payer: Humana of AZ Medicare	$23.36
Rate for Payer: Seven Corners Travel Insurance	$14.08
Rate for Payer: Southwest Service Administrators UFCW	$99.28
Rate for Payer: TriWest Medicare	$23.36
Rate for Payer: United Healthcare Commercial	$83.51
Rate for Payer: United Healthcare Medicare	$23.36
Rate for Payer: Veterans Affairs TRICARE	$23.13

Know your out-of-pocket cost for care.

All Charges