Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOGLOB E

Facility

$206.00

Service Code	CPT 82785
Hospital Charge Code	22481482
Hospital Revenue Code	301
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Arizona Complete Health Allwell	$32.96
Rate for Payer: Banner UC Health Medicare	$32.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$140.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.96
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cigna of AZ Commercial	$133.90
Rate for Payer: Devoted Health Medicare	$37.08
Rate for Payer: Humana of AZ Medicare	$32.96
Rate for Payer: Seven Corners Travel Insurance	$23.87
Rate for Payer: Southwest Service Administrators UFCW	$140.08
Rate for Payer: TriWest Medicare	$32.96
Rate for Payer: United Healthcare Commercial	$117.83
Rate for Payer: United Healthcare Medicare	$32.96
Rate for Payer: Veterans Affairs TRICARE	$32.63

IMMUNOGLOB E

Facility

$206.00

Service Code	CPT 82785
Hospital Charge Code	22481482
Hospital Revenue Code	301
Min. Negotiated Rate	$185.40
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Cash Price	$164.80

IMMUNOGLOB G

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481483
Hospital Revenue Code	301
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Arizona Complete Health Allwell	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$81.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Devoted Health Medicare	$21.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$81.60
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: United Healthcare Commercial	$68.64
Rate for Payer: United Healthcare Medicare	$19.20
Rate for Payer: Veterans Affairs TRICARE	$19.01

IMMUNOGLOB G

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481483
Hospital Revenue Code	301
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Cash Price	$96.00

IMMUNOGLOB M

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481484
Hospital Revenue Code	301
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Cash Price	$96.00

IMMUNOGLOB M

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481484
Hospital Revenue Code	301
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Arizona Complete Health Allwell	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$81.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Devoted Health Medicare	$21.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$81.60
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: United Healthcare Commercial	$68.64
Rate for Payer: United Healthcare Medicare	$19.20
Rate for Payer: Veterans Affairs TRICARE	$19.01

Immunoglobulin A, Quant. Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	3658179
Hospital Revenue Code	301
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Commercial	$149.40
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$132.80

Immunoglobulin A, Quant. Serum LC

Facility

$166.00

Service Code	CPT 82784
Hospital Charge Code	3658179
Hospital Revenue Code	301
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$149.40
Rate for Payer: Aetna of AZ Commercial	$149.40
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Arizona Complete Health Allwell	$26.56
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$26.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$112.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.56
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$107.90
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$29.88
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Humana of AZ Medicare	$26.56
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: Southwest Service Administrators UFCW	$112.88
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: TriWest Medicare	$26.56
Rate for Payer: United Healthcare Commercial	$94.95
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: United Healthcare Medicare	$26.56
Rate for Payer: Veterans Affairs TRICARE	$26.29
Rate for Payer: Veterans Affairs TRICARE	$18.06

Immunoglobulin E, Total LC

Facility

$196.00

Service Code	CPT 82785
Hospital Charge Code	1906908
Hospital Revenue Code	301
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of AZ Commercial	$176.40
Rate for Payer: Cash Price	$156.80

Immunoglobulin E, Total LC

Facility

$196.00

Service Code	CPT 82785
Hospital Charge Code	1906908
Hospital Revenue Code	301
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of AZ Commercial	$176.40
Rate for Payer: Arizona Complete Health Allwell	$31.36
Rate for Payer: Banner UC Health Medicare	$31.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$133.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.36
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cigna of AZ Commercial	$127.40
Rate for Payer: Devoted Health Medicare	$35.28
Rate for Payer: Humana of AZ Medicare	$31.36
Rate for Payer: Seven Corners Travel Insurance	$23.87
Rate for Payer: Southwest Service Administrators UFCW	$133.28
Rate for Payer: TriWest Medicare	$31.36
Rate for Payer: United Healthcare Commercial	$112.11
Rate for Payer: United Healthcare Medicare	$31.36
Rate for Payer: Veterans Affairs TRICARE	$31.05

Immunoglobulin G, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2029176
Hospital Revenue Code	301
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

Immunoglobulin G, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2029176
Hospital Revenue Code	301
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

Immunoglobulin M, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	1906912
Hospital Revenue Code	301
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

Immunoglobulin M, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	1906912
Hospital Revenue Code	301
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

Immunoglobulins A/E/G/M, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2087616
Hospital Revenue Code	302
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

Immunoglobulins A/E/G/M, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2087616
Hospital Revenue Code	302
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

Immunoglobulins A/G/M, Qn, Ser LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2087617
Hospital Revenue Code	301
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Arizona Complete Health Allwell	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$81.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Devoted Health Medicare	$21.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Seven Corners Travel Insurance	$13.48
Rate for Payer: Southwest Service Administrators UFCW	$81.60
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: United Healthcare Commercial	$68.64
Rate for Payer: United Healthcare Medicare	$19.20
Rate for Payer: Veterans Affairs TRICARE	$19.01

Immunoglobulins A/G/M, Qn, Ser LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2087617
Hospital Revenue Code	301
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Cash Price	$96.00

IMMUNOHISTOCHEM ADD ANTI STAIN

Facility

$1,244.00

Service Code	CPT 88341
Hospital Charge Code	22545751
Hospital Revenue Code	310
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Arizona Complete Health Allwell	$199.04
Rate for Payer: Banner UC Health Medicare	$199.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$845.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$199.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$68.16
Rate for Payer: Cash Price	$995.20
Rate for Payer: Cash Price	$995.20
Rate for Payer: Cigna of AZ Commercial	$808.60
Rate for Payer: Devoted Health Medicare	$223.92
Rate for Payer: Humana of AZ Medicare	$199.04
Rate for Payer: Southwest Service Administrators UFCW	$845.92
Rate for Payer: TriWest Medicare	$199.04
Rate for Payer: United Healthcare Commercial	$711.57
Rate for Payer: United Healthcare Medicare	$199.04
Rate for Payer: Veterans Affairs TRICARE	$197.05

IMMUNOHISTOCHEM ADD ANTI STAIN

Facility

$1,244.00

Service Code	CPT 88341
Hospital Charge Code	22545751
Hospital Revenue Code	310
Min. Negotiated Rate	$1,119.60
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Cash Price	$995.20

IMMUNOHISTOCHEMISTRY

Facility

$1,563.00

Service Code	CPT 88342
Hospital Charge Code	22545725
Hospital Revenue Code	310
Min. Negotiated Rate	$79.81
Max. Negotiated Rate	$1,406.70
Rate for Payer: Aetna of AZ Commercial	$1,406.70
Rate for Payer: Arizona Complete Health Allwell	$250.08
Rate for Payer: Banner UC Health Medicare	$250.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,062.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$250.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$79.81
Rate for Payer: Cash Price	$1,250.40
Rate for Payer: Cash Price	$1,250.40
Rate for Payer: Cigna of AZ Commercial	$1,015.95
Rate for Payer: Devoted Health Medicare	$281.34
Rate for Payer: Humana of AZ Medicare	$250.08
Rate for Payer: Seven Corners Travel Insurance	$263.61
Rate for Payer: Southwest Service Administrators UFCW	$1,062.84
Rate for Payer: TriWest Medicare	$250.08
Rate for Payer: United Healthcare Commercial	$894.04
Rate for Payer: United Healthcare Medicare	$250.08
Rate for Payer: Veterans Affairs TRICARE	$247.58

IMMUNOHISTOCHEMISTRY

Facility

$1,563.00

Service Code	CPT 88342
Hospital Charge Code	22545725
Hospital Revenue Code	310
Min. Negotiated Rate	$1,406.70
Max. Negotiated Rate	$1,406.70
Rate for Payer: Aetna of AZ Commercial	$1,406.70
Rate for Payer: Cash Price	$1,250.40

.IMMUNO INFAB

Facility

$73.00

Service Code	CPT 86317
Hospital Charge Code	22481446
Hospital Revenue Code	302
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Arizona Complete Health Allwell	$11.68
Rate for Payer: Banner UC Health Medicare	$11.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$49.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.68
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cigna of AZ Commercial	$47.45
Rate for Payer: Devoted Health Medicare	$13.14
Rate for Payer: Humana of AZ Medicare	$11.68
Rate for Payer: Seven Corners Travel Insurance	$21.74
Rate for Payer: Southwest Service Administrators UFCW	$49.64
Rate for Payer: TriWest Medicare	$11.68
Rate for Payer: United Healthcare Commercial	$41.76
Rate for Payer: United Healthcare Medicare	$11.68
Rate for Payer: Veterans Affairs TRICARE	$11.56

.IMMUNO INFAB

Facility

$73.00

Service Code	CPT 86317
Hospital Charge Code	22481446
Hospital Revenue Code	302
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Cash Price	$58.40

Implantable Heart Assist Systems

Facility

$78,199.79

Service Code	APR-DRG 1612
Hospital Charge Code	APRDRG1614
Min. Negotiated Rate	$78,199.79
Max. Negotiated Rate	$78,199.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$78,199.79
Rate for Payer: Mercy Care Medicaid	$78,199.79
Rate for Payer: NaphCare Correctional Healthcare	$78,199.79

Know your out-of-pocket cost for care.

All Charges