Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Hospice / IP Respite

Facility

$467.00

Hospital Charge Code	27621817
Hospital Revenue Code	301
Min. Negotiated Rate	$73.97
Max. Negotiated Rate	$420.30
Rate for Payer: Aetna of AZ Commercial	$420.30
Rate for Payer: Arizona Complete Health Allwell	$74.72
Rate for Payer: Banner UC Health Medicare	$74.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$317.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$74.72
Rate for Payer: Cash Price	$373.60
Rate for Payer: Cigna of AZ Commercial	$303.55
Rate for Payer: Devoted Health Medicare	$84.06
Rate for Payer: Humana of AZ Medicare	$74.72
Rate for Payer: Southwest Service Administrators UFCW	$317.56
Rate for Payer: TriWest Medicare	$74.72
Rate for Payer: United Healthcare Commercial	$267.12
Rate for Payer: United Healthcare Medicare	$74.72
Rate for Payer: Veterans Affairs TRICARE	$73.97

Hospice / IP Respite

Facility

$467.00

Hospital Charge Code	27621817
Hospital Revenue Code	301
Min. Negotiated Rate	$420.30
Max. Negotiated Rate	$420.30
Rate for Payer: Aetna of AZ Commercial	$420.30
Rate for Payer: Cash Price	$373.60

HPV Genotypes 16/18,45 LC

Facility

$183.35

Service Code	CPT 87624
Hospital Charge Code	22700957
Hospital Revenue Code	300
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$165.01
Rate for Payer: Aetna of AZ Commercial	$165.01
Rate for Payer: Arizona Complete Health Allwell	$29.34
Rate for Payer: Banner UC Health Medicare	$29.34
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$124.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.34
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.34
Rate for Payer: Cash Price	$146.68
Rate for Payer: Cash Price	$146.68
Rate for Payer: Cigna of AZ Commercial	$119.18
Rate for Payer: Devoted Health Medicare	$33.00
Rate for Payer: Humana of AZ Medicare	$29.34
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$124.68
Rate for Payer: TriWest Medicare	$29.34
Rate for Payer: United Healthcare Commercial	$104.88
Rate for Payer: United Healthcare Medicare	$29.34
Rate for Payer: Veterans Affairs TRICARE	$29.04

HPV Genotypes 16/18,45 LC

Facility

$183.35

Service Code	CPT 87624
Hospital Charge Code	22700957
Hospital Revenue Code	300
Min. Negotiated Rate	$165.01
Max. Negotiated Rate	$165.01
Rate for Payer: Aetna of AZ Commercial	$165.01
Rate for Payer: Cash Price	$146.68

HPV (human papillomavirus vaccine)

Facility

$385.00

Service Code	CPT 90651
Hospital Charge Code	6025406
Hospital Revenue Code	521
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna of AZ Commercial	$346.50
Rate for Payer: Arizona Complete Health Allwell	$61.60
Rate for Payer: Banner UC Health Medicare	$61.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$261.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$61.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$61.60
Rate for Payer: Cash Price	$308.00
Rate for Payer: Cigna of AZ Commercial	$269.50
Rate for Payer: Devoted Health Medicare	$69.30
Rate for Payer: Humana of AZ Medicare	$61.60
Rate for Payer: Southwest Service Administrators UFCW	$261.80
Rate for Payer: TriWest Medicare	$61.60
Rate for Payer: United Healthcare Commercial	$220.22
Rate for Payer: United Healthcare Medicare	$61.60
Rate for Payer: Veterans Affairs TRICARE	$60.98

HPV (human papillomavirus vaccine)

Facility

$385.00

Service Code	CPT 90651
Hospital Charge Code	6025406
Hospital Revenue Code	521
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna of AZ Commercial	$346.50
Rate for Payer: Cash Price	$308.00

H Pylori AB IgM LC

Facility

$216.00

Service Code	CPT 86677
Hospital Charge Code	3658178
Hospital Revenue Code	302
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Cash Price	$172.80

H Pylori AB IgM LC

Facility

$216.00

Service Code	CPT 86677
Hospital Charge Code	3658178
Hospital Revenue Code	302
Min. Negotiated Rate	$24.43
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Arizona Complete Health Allwell	$34.56
Rate for Payer: Banner UC Health Medicare	$34.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$146.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.56
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna of AZ Commercial	$140.40
Rate for Payer: Devoted Health Medicare	$38.88
Rate for Payer: Humana of AZ Medicare	$34.56
Rate for Payer: Seven Corners Travel Insurance	$24.43
Rate for Payer: Southwest Service Administrators UFCW	$146.88
Rate for Payer: TriWest Medicare	$34.56
Rate for Payer: United Healthcare Commercial	$123.55
Rate for Payer: United Healthcare Medicare	$34.56
Rate for Payer: Veterans Affairs TRICARE	$34.21

H. pylori Breath Test LC

Facility

$797.00

Service Code	CPT 83013
Hospital Charge Code	22240929
Hospital Revenue Code	301
Min. Negotiated Rate	$97.67
Max. Negotiated Rate	$717.30
Rate for Payer: Aetna of AZ Commercial	$717.30
Rate for Payer: Arizona Complete Health Allwell	$127.52
Rate for Payer: Banner UC Health Medicare	$127.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$541.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.52
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cigna of AZ Commercial	$518.05
Rate for Payer: Devoted Health Medicare	$143.46
Rate for Payer: Humana of AZ Medicare	$127.52
Rate for Payer: Seven Corners Travel Insurance	$97.67
Rate for Payer: Southwest Service Administrators UFCW	$541.96
Rate for Payer: TriWest Medicare	$127.52
Rate for Payer: United Healthcare Commercial	$455.88
Rate for Payer: United Healthcare Medicare	$127.52
Rate for Payer: Veterans Affairs TRICARE	$126.24

H. pylori Breath Test LC

Facility

$797.00

Service Code	CPT 83013
Hospital Charge Code	22240929
Hospital Revenue Code	301
Min. Negotiated Rate	$717.30
Max. Negotiated Rate	$717.30
Rate for Payer: Aetna of AZ Commercial	$717.30
Rate for Payer: Cash Price	$637.60

H. pylori IgG, Abs LC

Facility

$212.00

Service Code	CPT 86677
Hospital Charge Code	1285629
Hospital Revenue Code	302
Min. Negotiated Rate	$24.43
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Arizona Complete Health Allwell	$33.92
Rate for Payer: Banner UC Health Medicare	$33.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$144.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$33.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.92
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cigna of AZ Commercial	$137.80
Rate for Payer: Devoted Health Medicare	$38.16
Rate for Payer: Humana of AZ Medicare	$33.92
Rate for Payer: Seven Corners Travel Insurance	$24.43
Rate for Payer: Southwest Service Administrators UFCW	$144.16
Rate for Payer: TriWest Medicare	$33.92
Rate for Payer: United Healthcare Commercial	$121.26
Rate for Payer: United Healthcare Medicare	$33.92
Rate for Payer: Veterans Affairs TRICARE	$33.58

H. pylori IgG, Abs LC

Facility

$212.00

Service Code	CPT 86677
Hospital Charge Code	1285629
Hospital Revenue Code	302
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Cash Price	$169.60

H Pylori Rapid Urease

Facility

$201.00

Service Code	CPT 86677
Hospital Charge Code	22352509
Hospital Revenue Code	306
Min. Negotiated Rate	$180.90
Max. Negotiated Rate	$180.90
Rate for Payer: Aetna of AZ Commercial	$180.90
Rate for Payer: Cash Price	$160.80

H Pylori Rapid Urease

Facility

$201.00

Service Code	CPT 86677
Hospital Charge Code	22352509
Hospital Revenue Code	306
Min. Negotiated Rate	$24.43
Max. Negotiated Rate	$180.90
Rate for Payer: Aetna of AZ Commercial	$180.90
Rate for Payer: Arizona Complete Health Allwell	$32.16
Rate for Payer: Banner UC Health Medicare	$32.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$136.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.16
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cigna of AZ Commercial	$130.65
Rate for Payer: Devoted Health Medicare	$36.18
Rate for Payer: Humana of AZ Medicare	$32.16
Rate for Payer: Seven Corners Travel Insurance	$24.43
Rate for Payer: Southwest Service Administrators UFCW	$136.68
Rate for Payer: TriWest Medicare	$32.16
Rate for Payer: United Healthcare Commercial	$114.97
Rate for Payer: United Healthcare Medicare	$32.16
Rate for Payer: Veterans Affairs TRICARE	$31.84

H. pylori Stool Ag, EIA LC

Facility

$523.00

Service Code	CPT 87338
Hospital Charge Code	2029222
Hospital Revenue Code	306
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$470.70
Rate for Payer: Aetna of AZ Commercial	$470.70
Rate for Payer: Aetna of AZ Commercial	$366.30
Rate for Payer: Arizona Complete Health Allwell	$65.12
Rate for Payer: Arizona Complete Health Allwell	$83.68
Rate for Payer: Banner UC Health Medicare	$65.12
Rate for Payer: Banner UC Health Medicare	$83.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$355.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$276.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$83.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$83.68
Rate for Payer: Cash Price	$418.40
Rate for Payer: Cash Price	$325.60
Rate for Payer: Cash Price	$418.40
Rate for Payer: Cash Price	$325.60
Rate for Payer: Cigna of AZ Commercial	$339.95
Rate for Payer: Cigna of AZ Commercial	$264.55
Rate for Payer: Devoted Health Medicare	$94.14
Rate for Payer: Devoted Health Medicare	$73.26
Rate for Payer: Humana of AZ Medicare	$65.12
Rate for Payer: Humana of AZ Medicare	$83.68
Rate for Payer: Seven Corners Travel Insurance	$20.85
Rate for Payer: Seven Corners Travel Insurance	$20.85
Rate for Payer: Southwest Service Administrators UFCW	$276.76
Rate for Payer: Southwest Service Administrators UFCW	$355.64
Rate for Payer: TriWest Medicare	$65.12
Rate for Payer: TriWest Medicare	$83.68
Rate for Payer: United Healthcare Commercial	$299.16
Rate for Payer: United Healthcare Commercial	$232.80
Rate for Payer: United Healthcare Medicare	$65.12
Rate for Payer: United Healthcare Medicare	$83.68
Rate for Payer: Veterans Affairs TRICARE	$82.84
Rate for Payer: Veterans Affairs TRICARE	$64.47

H. pylori Stool Ag, EIA LC

Facility

$407.00

Service Code	CPT 87338
Hospital Charge Code	2029222
Hospital Revenue Code	306
Min. Negotiated Rate	$366.30
Max. Negotiated Rate	$366.30
Rate for Payer: Aetna of AZ Commercial	$366.30
Rate for Payer: Aetna of AZ Commercial	$470.70
Rate for Payer: Cash Price	$325.60
Rate for Payer: Cash Price	$418.40

HSV 1/2 PCR LC

Facility

$475.00

Service Code	CPT 87529
Hospital Charge Code	2087612
Hospital Revenue Code	301
Min. Negotiated Rate	$427.50
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Cash Price	$380.00

HSV 1/2 PCR LC

Facility

$475.00

Service Code	CPT 87529
Hospital Charge Code	2087612
Hospital Revenue Code	301
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna of AZ Commercial	$427.50
Rate for Payer: Arizona Complete Health Allwell	$76.00
Rate for Payer: Banner UC Health Medicare	$76.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$323.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$76.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cigna of AZ Commercial	$308.75
Rate for Payer: Devoted Health Medicare	$85.50
Rate for Payer: Humana of AZ Medicare	$76.00
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$323.00
Rate for Payer: TriWest Medicare	$76.00
Rate for Payer: United Healthcare Commercial	$271.70
Rate for Payer: United Healthcare Medicare	$76.00
Rate for Payer: Veterans Affairs TRICARE	$75.24

HSV 1 and 2 IgM Abs, Indirect LC

Facility

$601.00

Service Code	CPT 87529
Hospital Charge Code	2029112
Hospital Revenue Code	301
Min. Negotiated Rate	$540.90
Max. Negotiated Rate	$540.90
Rate for Payer: Aetna of AZ Commercial	$540.90
Rate for Payer: Cash Price	$480.80

HSV 1 and 2 IgM Abs, Indirect LC

Facility

$601.00

Service Code	CPT 87529
Hospital Charge Code	2029112
Hospital Revenue Code	301
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$540.90
Rate for Payer: Aetna of AZ Commercial	$540.90
Rate for Payer: Arizona Complete Health Allwell	$96.16
Rate for Payer: Banner UC Health Medicare	$96.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$408.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$96.16
Rate for Payer: Cash Price	$480.80
Rate for Payer: Cash Price	$480.80
Rate for Payer: Cigna of AZ Commercial	$390.65
Rate for Payer: Devoted Health Medicare	$108.18
Rate for Payer: Humana of AZ Medicare	$96.16
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$408.68
Rate for Payer: TriWest Medicare	$96.16
Rate for Payer: United Healthcare Commercial	$343.77
Rate for Payer: United Healthcare Medicare	$96.16
Rate for Payer: Veterans Affairs TRICARE	$95.20

HSV 1 and 2-Specific Ab, IgG LC

Facility

$155.00

Service Code	CPT 86695
Hospital Charge Code	1285647
Hospital Revenue Code	302
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

HSV 1 and 2-Specific Ab, IgG LC

Facility

$155.00

Service Code	CPT 86695
Hospital Charge Code	1285647
Hospital Revenue Code	302
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.80
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$100.75
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Seven Corners Travel Insurance	$19.13
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: Veterans Affairs TRICARE	$24.55

HSV 2 IGG

Facility

$241.00

Service Code	CPT 86696
Hospital Charge Code	22481479
Hospital Revenue Code	301
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$216.90
Rate for Payer: Aetna of AZ Commercial	$216.90
Rate for Payer: Arizona Complete Health Allwell	$38.56
Rate for Payer: Banner UC Health Medicare	$38.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$163.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.56
Rate for Payer: Cash Price	$192.80
Rate for Payer: Cash Price	$192.80
Rate for Payer: Cigna of AZ Commercial	$156.65
Rate for Payer: Devoted Health Medicare	$43.38
Rate for Payer: Humana of AZ Medicare	$38.56
Rate for Payer: Seven Corners Travel Insurance	$28.06
Rate for Payer: Southwest Service Administrators UFCW	$163.88
Rate for Payer: TriWest Medicare	$38.56
Rate for Payer: United Healthcare Commercial	$137.85
Rate for Payer: United Healthcare Medicare	$38.56
Rate for Payer: Veterans Affairs TRICARE	$38.17

HSV 2 IGG

Facility

$241.00

Service Code	CPT 86696
Hospital Charge Code	22481479
Hospital Revenue Code	301
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$216.90
Rate for Payer: Aetna of AZ Commercial	$216.90
Rate for Payer: Cash Price	$192.80

HSV Culture and Typing LC

Facility

$307.00

Service Code	CPT 87254
Hospital Charge Code	1906898
Hospital Revenue Code	306
Min. Negotiated Rate	$28.36
Max. Negotiated Rate	$276.30
Rate for Payer: Aetna of AZ Commercial	$276.30
Rate for Payer: Arizona Complete Health Allwell	$49.12
Rate for Payer: Banner UC Health Medicare	$49.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$208.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.12
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cigna of AZ Commercial	$199.55
Rate for Payer: Devoted Health Medicare	$55.26
Rate for Payer: Humana of AZ Medicare	$49.12
Rate for Payer: Seven Corners Travel Insurance	$28.36
Rate for Payer: Southwest Service Administrators UFCW	$208.76
Rate for Payer: TriWest Medicare	$49.12
Rate for Payer: United Healthcare Commercial	$175.60
Rate for Payer: United Healthcare Medicare	$49.12
Rate for Payer: Veterans Affairs TRICARE	$48.63

Know your out-of-pocket cost for care.

All Charges