Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Hepatitis E IGG/IGM

Facility

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589636
Hospital Revenue Code	301
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Cash Price	$55.20

Hepatitis E IGG/IGM

Facility

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589636
Hospital Revenue Code	301
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Arizona Complete Health Allwell	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$46.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.04
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$44.85
Rate for Payer: Devoted Health Medicare	$12.42
Rate for Payer: Humana of AZ Medicare	$11.04
Rate for Payer: Seven Corners Travel Insurance	$19.72
Rate for Payer: Southwest Service Administrators UFCW	$46.92
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: United Healthcare Commercial	$39.47
Rate for Payer: United Healthcare Medicare	$11.04
Rate for Payer: Veterans Affairs TRICARE	$10.93

Hepatitis E Virus (HEV) IgG/M LC

Facility

$257.00

Service Code	CPT 83883
Hospital Charge Code	22720193
Hospital Revenue Code	302
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Arizona Complete Health Allwell	$41.12
Rate for Payer: Banner UC Health Medicare	$41.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$174.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.12
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Devoted Health Medicare	$46.26
Rate for Payer: Humana of AZ Medicare	$41.12
Rate for Payer: Seven Corners Travel Insurance	$19.72
Rate for Payer: Southwest Service Administrators UFCW	$174.76
Rate for Payer: TriWest Medicare	$41.12
Rate for Payer: United Healthcare Commercial	$147.00
Rate for Payer: United Healthcare Medicare	$41.12
Rate for Payer: Veterans Affairs TRICARE	$40.71

Hepatitis E Virus (HEV) IgG/M LC

Facility

$257.00

Service Code	CPT 83883
Hospital Charge Code	22720193
Hospital Revenue Code	302
Min. Negotiated Rate	$231.30
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Cash Price	$205.60

Hepatitis Panel (4) LC

Facility

$1,144.00

Service Code	CPT 80074
Hospital Charge Code	1285754
Hospital Revenue Code	301
Min. Negotiated Rate	$69.06
Max. Negotiated Rate	$1,029.60
Rate for Payer: Aetna of AZ Commercial	$1,029.60
Rate for Payer: Arizona Complete Health Allwell	$183.04
Rate for Payer: Banner UC Health Medicare	$183.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$777.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$183.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$183.04
Rate for Payer: Cash Price	$915.20
Rate for Payer: Cash Price	$915.20
Rate for Payer: Cigna of AZ Commercial	$743.60
Rate for Payer: Devoted Health Medicare	$205.92
Rate for Payer: Humana of AZ Medicare	$183.04
Rate for Payer: Seven Corners Travel Insurance	$69.06
Rate for Payer: Southwest Service Administrators UFCW	$777.92
Rate for Payer: TriWest Medicare	$183.04
Rate for Payer: United Healthcare Commercial	$654.37
Rate for Payer: United Healthcare Medicare	$183.04
Rate for Payer: Veterans Affairs TRICARE	$181.21

Hepatitis Panel (4) LC

Facility

$1,144.00

Service Code	CPT 80074
Hospital Charge Code	1285754
Hospital Revenue Code	301
Min. Negotiated Rate	$1,029.60
Max. Negotiated Rate	$1,029.60
Rate for Payer: Aetna of AZ Commercial	$1,029.60
Rate for Payer: Cash Price	$915.20

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$22,455.69

Service Code	MSDRG 421
Min. Negotiated Rate	$22,455.69
Max. Negotiated Rate	$22,455.69
Rate for Payer: Seven Corners Travel Insurance	$22,455.69

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$44,033.85

Service Code	MSDRG 420
Min. Negotiated Rate	$44,033.85
Max. Negotiated Rate	$44,033.85
Rate for Payer: Seven Corners Travel Insurance	$44,033.85

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$18,088.75

Service Code	MSDRG 422
Min. Negotiated Rate	$18,088.75
Max. Negotiated Rate	$18,088.75
Rate for Payer: Seven Corners Travel Insurance	$18,088.75

Hep B Core Ab, IgM LC

Facility

$217.00

Service Code	CPT 86705
Hospital Charge Code	1906888
Hospital Revenue Code	302
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Arizona Complete Health Allwell	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$147.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.72
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Seven Corners Travel Insurance	$17.07
Rate for Payer: Southwest Service Administrators UFCW	$147.56
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: United Healthcare Commercial	$124.12
Rate for Payer: United Healthcare Medicare	$34.72
Rate for Payer: Veterans Affairs TRICARE	$34.37

Hep B Core Ab, IgM LC

Facility

$217.00

Service Code	CPT 86705
Hospital Charge Code	1906888
Hospital Revenue Code	302
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Cash Price	$173.60

Hep B Core Ab, Tot LC

Facility

$232.00

Service Code	CPT 86704
Hospital Charge Code	2087608
Hospital Revenue Code	302
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$208.80
Rate for Payer: Aetna of AZ Commercial	$208.80
Rate for Payer: Cash Price	$185.60

Hep B Core Ab, Tot LC

Facility

$232.00

Service Code	CPT 86704
Hospital Charge Code	2087608
Hospital Revenue Code	302
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$208.80
Rate for Payer: Aetna of AZ Commercial	$208.80
Rate for Payer: Arizona Complete Health Allwell	$37.12
Rate for Payer: Banner UC Health Medicare	$37.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$157.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.12
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cigna of AZ Commercial	$150.80
Rate for Payer: Devoted Health Medicare	$41.76
Rate for Payer: Humana of AZ Medicare	$37.12
Rate for Payer: Seven Corners Travel Insurance	$17.47
Rate for Payer: Southwest Service Administrators UFCW	$157.76
Rate for Payer: TriWest Medicare	$37.12
Rate for Payer: United Healthcare Commercial	$132.70
Rate for Payer: United Healthcare Medicare	$37.12
Rate for Payer: Veterans Affairs TRICARE	$36.75

Hep Be Ab LC

Facility

$169.00

Service Code	CPT 86707
Hospital Charge Code	6738654
Hospital Revenue Code	302
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna of AZ Commercial	$152.10
Rate for Payer: Cash Price	$135.20

Hep Be Ab LC

Facility

$169.00

Service Code	CPT 86707
Hospital Charge Code	6738654
Hospital Revenue Code	302
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna of AZ Commercial	$152.10
Rate for Payer: Arizona Complete Health Allwell	$27.04
Rate for Payer: Banner UC Health Medicare	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.04
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cigna of AZ Commercial	$109.85
Rate for Payer: Devoted Health Medicare	$30.42
Rate for Payer: Humana of AZ Medicare	$27.04
Rate for Payer: Seven Corners Travel Insurance	$16.78
Rate for Payer: Southwest Service Administrators UFCW	$114.92
Rate for Payer: TriWest Medicare	$27.04
Rate for Payer: United Healthcare Commercial	$96.67
Rate for Payer: United Healthcare Medicare	$27.04
Rate for Payer: Veterans Affairs TRICARE	$26.77

Hep B Surface Ab LC

Facility

$113.00

Service Code	CPT 86706
Hospital Charge Code	1285784
Hospital Revenue Code	302
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of AZ Commercial	$101.70
Rate for Payer: Aetna of AZ Commercial	$119.70
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$106.40

Hep B Surface Ab LC

Facility

$133.00

Service Code	CPT 86706
Hospital Charge Code	1285784
Hospital Revenue Code	302
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna of AZ Commercial	$119.70
Rate for Payer: Aetna of AZ Commercial	$101.70
Rate for Payer: Arizona Complete Health Allwell	$18.08
Rate for Payer: Arizona Complete Health Allwell	$21.28
Rate for Payer: Banner UC Health Medicare	$18.08
Rate for Payer: Banner UC Health Medicare	$21.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$90.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$76.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$21.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$21.28
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cigna of AZ Commercial	$86.45
Rate for Payer: Cigna of AZ Commercial	$73.45
Rate for Payer: Devoted Health Medicare	$23.94
Rate for Payer: Devoted Health Medicare	$20.34
Rate for Payer: Humana of AZ Medicare	$18.08
Rate for Payer: Humana of AZ Medicare	$21.28
Rate for Payer: Seven Corners Travel Insurance	$15.57
Rate for Payer: Seven Corners Travel Insurance	$15.57
Rate for Payer: Southwest Service Administrators UFCW	$76.84
Rate for Payer: Southwest Service Administrators UFCW	$90.44
Rate for Payer: TriWest Medicare	$18.08
Rate for Payer: TriWest Medicare	$21.28
Rate for Payer: United Healthcare Commercial	$76.08
Rate for Payer: United Healthcare Commercial	$64.64
Rate for Payer: United Healthcare Medicare	$18.08
Rate for Payer: United Healthcare Medicare	$21.28
Rate for Payer: Veterans Affairs TRICARE	$21.07
Rate for Payer: Veterans Affairs TRICARE	$17.90

.Hered Hemochroma, Please Note LC

Facility

$644.00

Service Code	CPT 81256
Hospital Charge Code	22311149
Hospital Revenue Code	301
Min. Negotiated Rate	$94.77
Max. Negotiated Rate	$579.60
Rate for Payer: Aetna of AZ Commercial	$579.60
Rate for Payer: Arizona Complete Health Allwell	$103.04
Rate for Payer: Banner UC Health Medicare	$103.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$437.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$103.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$103.04
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cigna of AZ Commercial	$418.60
Rate for Payer: Devoted Health Medicare	$115.92
Rate for Payer: Humana of AZ Medicare	$103.04
Rate for Payer: Seven Corners Travel Insurance	$94.77
Rate for Payer: Southwest Service Administrators UFCW	$437.92
Rate for Payer: TriWest Medicare	$103.04
Rate for Payer: United Healthcare Commercial	$368.37
Rate for Payer: United Healthcare Medicare	$103.04
Rate for Payer: Veterans Affairs TRICARE	$102.01

.Hered Hemochroma, Please Note LC

Facility

$644.00

Service Code	CPT 81256
Hospital Charge Code	22311149
Hospital Revenue Code	301
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$579.60
Rate for Payer: Aetna of AZ Commercial	$579.60
Rate for Payer: Cash Price	$515.20

Hered.Hemochromatosis, DNA LC

Facility

$751.00

Service Code	CPT 81256
Hospital Charge Code	2087610
Hospital Revenue Code	301
Min. Negotiated Rate	$675.90
Max. Negotiated Rate	$675.90
Rate for Payer: Aetna of AZ Commercial	$675.90
Rate for Payer: Cash Price	$600.80

Hered.Hemochromatosis, DNA LC

Facility

$751.00

Service Code	CPT 81256
Hospital Charge Code	2087610
Hospital Revenue Code	301
Min. Negotiated Rate	$94.77
Max. Negotiated Rate	$675.90
Rate for Payer: Aetna of AZ Commercial	$675.90
Rate for Payer: Arizona Complete Health Allwell	$120.16
Rate for Payer: Banner UC Health Medicare	$120.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$510.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$120.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$120.16
Rate for Payer: Cash Price	$600.80
Rate for Payer: Cash Price	$600.80
Rate for Payer: Cigna of AZ Commercial	$488.15
Rate for Payer: Devoted Health Medicare	$135.18
Rate for Payer: Humana of AZ Medicare	$120.16
Rate for Payer: Seven Corners Travel Insurance	$94.77
Rate for Payer: Southwest Service Administrators UFCW	$510.68
Rate for Payer: TriWest Medicare	$120.16
Rate for Payer: United Healthcare Commercial	$429.57
Rate for Payer: United Healthcare Medicare	$120.16
Rate for Payer: Veterans Affairs TRICARE	$118.96

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$21,743.56

Service Code	MSDRG 354
Min. Negotiated Rate	$21,743.56
Max. Negotiated Rate	$21,743.56
Rate for Payer: Seven Corners Travel Insurance	$21,743.56

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$37,505.85

Service Code	MSDRG 353
Min. Negotiated Rate	$37,505.85
Max. Negotiated Rate	$37,505.85
Rate for Payer: Seven Corners Travel Insurance	$37,505.85

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$17,398.17

Service Code	MSDRG 355
Min. Negotiated Rate	$17,398.17
Max. Negotiated Rate	$17,398.17
Rate for Payer: Seven Corners Travel Insurance	$17,398.17

Hernia Procedures Except Inguinal, Femoral And Umbilical

Facility

$26,146.09

Service Code	APR-DRG 2274
Hospital Charge Code	APRDRG2273
Min. Negotiated Rate	$26,146.09
Max. Negotiated Rate	$26,146.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,146.09
Rate for Payer: Mercy Care Medicaid	$26,146.09
Rate for Payer: NaphCare Correctional Healthcare	$26,146.09

Know your out-of-pocket cost for care.

All Charges