Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

87900 HIV-1 Quant PCR

Facility

$999.00

Service Code	CPT 87900
Hospital Charge Code	23173798
Hospital Revenue Code	306
Min. Negotiated Rate	$158.24
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Arizona Complete Health Allwell	$159.84
Rate for Payer: Banner UC Health Medicare	$159.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$679.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$159.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$159.84
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cigna of AZ Commercial	$649.35
Rate for Payer: Devoted Health Medicare	$179.82
Rate for Payer: Humana of AZ Medicare	$159.84
Rate for Payer: Seven Corners Travel Insurance	$189.01
Rate for Payer: Southwest Service Administrators UFCW	$679.32
Rate for Payer: TriWest Medicare	$159.84
Rate for Payer: United Healthcare Commercial	$571.43
Rate for Payer: United Healthcare Medicare	$159.84
Rate for Payer: Veterans Affairs TRICARE	$158.24

87901 HIV-1 Quant PCR

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	23173796
Hospital Revenue Code	306
Min. Negotiated Rate	$237.92
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Arizona Complete Health Allwell	$240.32
Rate for Payer: Banner UC Health Medicare	$240.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,021.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$240.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$240.32
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cigna of AZ Commercial	$976.30
Rate for Payer: Devoted Health Medicare	$270.36
Rate for Payer: Humana of AZ Medicare	$240.32
Rate for Payer: Seven Corners Travel Insurance	$373.30
Rate for Payer: Southwest Service Administrators UFCW	$1,021.36
Rate for Payer: TriWest Medicare	$240.32
Rate for Payer: United Healthcare Commercial	$859.14
Rate for Payer: United Healthcare Medicare	$240.32
Rate for Payer: Veterans Affairs TRICARE	$237.92

87901 HIV-1 Quant PCR

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	23173796
Hospital Revenue Code	306
Min. Negotiated Rate	$1,351.80
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Cash Price	$1,201.60

87906 HIV-1 Genosure Archive

Facility

$999.00

Service Code	CPT 87901
Hospital Charge Code	23173795
Hospital Revenue Code	306
Min. Negotiated Rate	$158.24
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Arizona Complete Health Allwell	$159.84
Rate for Payer: Banner UC Health Medicare	$159.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$679.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$159.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$159.84
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cigna of AZ Commercial	$649.35
Rate for Payer: Devoted Health Medicare	$179.82
Rate for Payer: Humana of AZ Medicare	$159.84
Rate for Payer: Seven Corners Travel Insurance	$373.30
Rate for Payer: Southwest Service Administrators UFCW	$679.32
Rate for Payer: TriWest Medicare	$159.84
Rate for Payer: United Healthcare Commercial	$571.43
Rate for Payer: United Healthcare Medicare	$159.84
Rate for Payer: Veterans Affairs TRICARE	$158.24

87906 HIV-1 Genosure Archive

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173794
Hospital Revenue Code	301
Min. Negotiated Rate	$87.28
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Arizona Complete Health Allwell	$88.16
Rate for Payer: Banner UC Health Medicare	$88.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$374.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$88.16
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Devoted Health Medicare	$99.18
Rate for Payer: Humana of AZ Medicare	$88.16
Rate for Payer: Seven Corners Travel Insurance	$186.66
Rate for Payer: Southwest Service Administrators UFCW	$374.68
Rate for Payer: TriWest Medicare	$88.16
Rate for Payer: United Healthcare Commercial	$315.17
Rate for Payer: United Healthcare Medicare	$88.16
Rate for Payer: Veterans Affairs TRICARE	$87.28

87906 HIV-1 Genosure Archive

Facility

$999.00

Service Code	CPT 87901
Hospital Charge Code	23173795
Hospital Revenue Code	306
Min. Negotiated Rate	$899.10
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Cash Price	$799.20

87906 HIV-1 Genosure Archive

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173794
Hospital Revenue Code	301
Min. Negotiated Rate	$495.90
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Cash Price	$440.80

87906 HIV-1 Quant PCR

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173797
Hospital Revenue Code	301
Min. Negotiated Rate	$495.90
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Cash Price	$440.80

87906 HIV-1 Quant PCR

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173797
Hospital Revenue Code	301
Min. Negotiated Rate	$87.28
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Arizona Complete Health Allwell	$88.16
Rate for Payer: Banner UC Health Medicare	$88.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$374.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$88.16
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Devoted Health Medicare	$99.18
Rate for Payer: Humana of AZ Medicare	$88.16
Rate for Payer: Seven Corners Travel Insurance	$186.66
Rate for Payer: Southwest Service Administrators UFCW	$374.68
Rate for Payer: TriWest Medicare	$88.16
Rate for Payer: United Healthcare Commercial	$315.17
Rate for Payer: United Healthcare Medicare	$88.16
Rate for Payer: Veterans Affairs TRICARE	$87.28

88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$4,067.00

Service Code	CPT 88184
Hospital Charge Code	23568455
Hospital Revenue Code	301
Min. Negotiated Rate	$58.25
Max. Negotiated Rate	$3,660.30
Rate for Payer: Aetna of AZ Commercial	$3,660.30
Rate for Payer: Arizona Complete Health Allwell	$650.72
Rate for Payer: Banner UC Health Medicare	$650.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,765.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$650.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.25
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Cigna of AZ Commercial	$2,643.55
Rate for Payer: Devoted Health Medicare	$732.06
Rate for Payer: Humana of AZ Medicare	$650.72
Rate for Payer: Seven Corners Travel Insurance	$554.61
Rate for Payer: Southwest Service Administrators UFCW	$2,765.56
Rate for Payer: TriWest Medicare	$650.72
Rate for Payer: United Healthcare Commercial	$2,326.32
Rate for Payer: United Healthcare Medicare	$650.72
Rate for Payer: Veterans Affairs TRICARE	$644.21

88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$4,067.00

Service Code	CPT 88184
Hospital Charge Code	23568455
Hospital Revenue Code	301
Min. Negotiated Rate	$3,660.30
Max. Negotiated Rate	$3,660.30
Rate for Payer: Aetna of AZ Commercial	$3,660.30
Rate for Payer: Cash Price	$3,253.60

88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$65.00

Service Code	CPT 88185
Hospital Charge Code	23568456
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Cash Price	$52.00

88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR

Facility

$65.00

Service Code	CPT 88185
Hospital Charge Code	23568456
Hospital Revenue Code	301
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Arizona Complete Health Allwell	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Devoted Health Medicare	$11.70
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Southwest Service Administrators UFCW	$44.20
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: United Healthcare Commercial	$37.18
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: Veterans Affairs TRICARE	$10.30

88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS

Facility

$190.00

Service Code	CPT 88189
Hospital Charge Code	23568457
Hospital Revenue Code	301
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of AZ Commercial	$171.00
Rate for Payer: Arizona Complete Health Allwell	$30.40
Rate for Payer: Banner UC Health Medicare	$30.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$129.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$30.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cigna of AZ Commercial	$123.50
Rate for Payer: Devoted Health Medicare	$34.20
Rate for Payer: Humana of AZ Medicare	$30.40
Rate for Payer: Southwest Service Administrators UFCW	$129.20
Rate for Payer: TriWest Medicare	$30.40
Rate for Payer: United Healthcare Commercial	$108.68
Rate for Payer: United Healthcare Medicare	$30.40
Rate for Payer: Veterans Affairs TRICARE	$30.10

88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS

Facility

$190.00

Service Code	CPT 88189
Hospital Charge Code	23568457
Hospital Revenue Code	301
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of AZ Commercial	$171.00
Rate for Payer: Cash Price	$152.00

90380 RSV 0.5 ML

Facility

$600.00

Service Code	CPT 90380
Hospital Charge Code	28136994
Hospital Revenue Code	636
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Arizona Complete Health Allwell	$96.00
Rate for Payer: Banner UC Health Medicare	$96.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$408.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$96.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cigna of AZ Commercial	$420.00
Rate for Payer: Devoted Health Medicare	$108.00
Rate for Payer: Humana of AZ Medicare	$96.00
Rate for Payer: Southwest Service Administrators UFCW	$408.00
Rate for Payer: TriWest Medicare	$96.00
Rate for Payer: United Healthcare Commercial	$343.20
Rate for Payer: United Healthcare Medicare	$96.00
Rate for Payer: United Healthcare New Mexico Commercial	$114.00
Rate for Payer: Veterans Affairs TRICARE	$95.04

90380 RSV 0.5 ML

Facility

$600.00

Service Code	CPT 90380
Hospital Charge Code	28136994
Hospital Revenue Code	636
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Cash Price	$480.00

90380 RSV VACCINE 0.5ML

Facility

$520.00

Service Code	CPT 90380
Hospital Charge Code	28143533
Hospital Revenue Code	521
Min. Negotiated Rate	$82.37
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Arizona Complete Health Allwell	$83.20
Rate for Payer: Banner UC Health Medicare	$83.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$353.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$83.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$83.20
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cigna of AZ Commercial	$364.00
Rate for Payer: Devoted Health Medicare	$93.60
Rate for Payer: Humana of AZ Medicare	$83.20
Rate for Payer: Southwest Service Administrators UFCW	$353.60
Rate for Payer: TriWest Medicare	$83.20
Rate for Payer: United Healthcare Commercial	$297.44
Rate for Payer: United Healthcare Medicare	$83.20
Rate for Payer: Veterans Affairs TRICARE	$82.37

90380 RSV VACCINE 0.5ML

Facility

$520.00

Service Code	CPT 90380
Hospital Charge Code	28143533
Hospital Revenue Code	521
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Cash Price	$416.00

90381 RSV 1ML

Facility

$600.00

Service Code	CPT 90381
Hospital Charge Code	28138370
Hospital Revenue Code	636
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Arizona Complete Health Allwell	$96.00
Rate for Payer: Banner UC Health Medicare	$96.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$408.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$96.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cigna of AZ Commercial	$420.00
Rate for Payer: Devoted Health Medicare	$108.00
Rate for Payer: Humana of AZ Medicare	$96.00
Rate for Payer: Southwest Service Administrators UFCW	$408.00
Rate for Payer: TriWest Medicare	$96.00
Rate for Payer: United Healthcare Commercial	$343.20
Rate for Payer: United Healthcare Medicare	$96.00
Rate for Payer: United Healthcare New Mexico Commercial	$114.00
Rate for Payer: Veterans Affairs TRICARE	$95.04

90381 RSV 1ML

Facility

$600.00

Service Code	CPT 90381
Hospital Charge Code	28138370
Hospital Revenue Code	636
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Cash Price	$480.00

90381 RSV Vaccine 1ML

Facility

$520.00

Service Code	CPT 90381
Hospital Charge Code	28137939
Hospital Revenue Code	521
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Cash Price	$416.00

90381 RSV Vaccine 1ML

Facility

$520.00

Service Code	CPT 90381
Hospital Charge Code	28137939
Hospital Revenue Code	521
Min. Negotiated Rate	$82.37
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna of AZ Commercial	$468.00
Rate for Payer: Arizona Complete Health Allwell	$83.20
Rate for Payer: Banner UC Health Medicare	$83.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$353.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$83.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$83.20
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cigna of AZ Commercial	$364.00
Rate for Payer: Devoted Health Medicare	$93.60
Rate for Payer: Humana of AZ Medicare	$83.20
Rate for Payer: Southwest Service Administrators UFCW	$353.60
Rate for Payer: TriWest Medicare	$83.20
Rate for Payer: United Healthcare Commercial	$297.44
Rate for Payer: United Healthcare Medicare	$83.20
Rate for Payer: Veterans Affairs TRICARE	$82.37

90460 Immunization administration with counseling 1st vaccine

Facility

$46.00

Service Code	CPT 90460
Hospital Charge Code	15961928
Hospital Revenue Code	521
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Cash Price	$36.80

90460 Immunization administration with counseling 1st vaccine

Facility

$46.00

Service Code	CPT 90460
Hospital Charge Code	15961928
Hospital Revenue Code	521
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Arizona Complete Health Allwell	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.36
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Devoted Health Medicare	$8.28
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Southwest Service Administrators UFCW	$31.28
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: United Healthcare Commercial	$26.31
Rate for Payer: United Healthcare Medicare	$7.36
Rate for Payer: Veterans Affairs TRICARE	$7.29

Know your out-of-pocket cost for care.

All Charges