Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Aldosterone LCMS, Serum LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	2029095
Hospital Revenue Code	301
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Cash Price	$386.40

Aldosterone LCMS, Serum LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	2029095
Hospital Revenue Code	301
Min. Negotiated Rate	$59.09
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Arizona Complete Health Allwell	$77.28
Rate for Payer: Banner UC Health Medicare	$77.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$328.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$77.28
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$313.95
Rate for Payer: Devoted Health Medicare	$86.94
Rate for Payer: Humana of AZ Medicare	$77.28
Rate for Payer: Seven Corners Travel Insurance	$59.09
Rate for Payer: Southwest Service Administrators UFCW	$328.44
Rate for Payer: TriWest Medicare	$77.28
Rate for Payer: United Healthcare Commercial	$276.28
Rate for Payer: United Healthcare Medicare	$77.28
Rate for Payer: Veterans Affairs TRICARE	$76.51

Aldosterone/Renin Ratio LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	22311172
Hospital Revenue Code	301
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Cash Price	$386.40

Aldosterone/Renin Ratio LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	22311172
Hospital Revenue Code	301
Min. Negotiated Rate	$59.09
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Arizona Complete Health Allwell	$77.28
Rate for Payer: Banner UC Health Medicare	$77.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$328.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$77.28
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$313.95
Rate for Payer: Devoted Health Medicare	$86.94
Rate for Payer: Humana of AZ Medicare	$77.28
Rate for Payer: Seven Corners Travel Insurance	$59.09
Rate for Payer: Southwest Service Administrators UFCW	$328.44
Rate for Payer: TriWest Medicare	$77.28
Rate for Payer: United Healthcare Commercial	$276.28
Rate for Payer: United Healthcare Medicare	$77.28
Rate for Payer: Veterans Affairs TRICARE	$76.51

alfuzosin 10 mg ER Tab [CQCH]

Facility

$0.14

Service Code	NDC 57237011490
Hospital Charge Code	105909840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of AZ Commercial	$0.09
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.08
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

alfuzosin 10 mg ER Tab [CQCH]

Facility

$0.14

Service Code	NDC 57237011490
Hospital Charge Code	105909840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Cash Price	$0.11

Alkaline Phosphatase

Facility

$106.00

Service Code	CPT 84075
Hospital Charge Code	633642
Hospital Revenue Code	301
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Cash Price	$84.80

Alkaline Phosphatase

Facility

$106.00

Service Code	CPT 84075
Hospital Charge Code	633642
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Arizona Complete Health Allwell	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.96
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$68.90
Rate for Payer: Devoted Health Medicare	$19.08
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$72.08
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: United Healthcare Commercial	$60.63
Rate for Payer: United Healthcare Medicare	$16.96
Rate for Payer: Veterans Affairs TRICARE	$16.79

Alk Phos Isoenzyme LC

Facility

$151.00

Service Code	CPT 84080
Hospital Charge Code	1905896
Hospital Revenue Code	301
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Cash Price	$120.80

Alk Phos Isoenzyme LC

Facility

$151.00

Service Code	CPT 84080
Hospital Charge Code	1905896
Hospital Revenue Code	301
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Arizona Complete Health Allwell	$24.16
Rate for Payer: Banner UC Health Medicare	$24.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.16
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Devoted Health Medicare	$27.18
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Seven Corners Travel Insurance	$21.43
Rate for Payer: Southwest Service Administrators UFCW	$102.68
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: United Healthcare Commercial	$86.37
Rate for Payer: United Healthcare Medicare	$24.16
Rate for Payer: Veterans Affairs TRICARE	$23.92

ALLERGEN CHOC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481451
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

ALLERGEN CHOC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481451
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

ALLERGEN CORN

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481452
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

ALLERGEN CORN

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481452
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

ALLERGEN EGG

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481453
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

ALLERGEN EGG

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481453
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

ALLERGEN FISH/SHELL MIX

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481454
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

ALLERGEN FISH/SHELL MIX

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481454
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

ALLERGEN MILK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481455
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
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	$10.40
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: Seven Corners Travel Insurance	$7.57
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

ALLERGEN MILK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481455
Hospital Revenue Code	302
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

ALLERGEN PORK

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481456
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

ALLERGEN PORK

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481456
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

Allergen Profile, Basic Food LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	1902246
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

Allergen Profile, Basic Food LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	1902246
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

Allergens(14) LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	28068399
Hospital Revenue Code	305
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

Know your out-of-pocket cost for care.

All Charges