Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EAC

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143914
Hospital Revenue Code	301
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EAC

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143914
Hospital Revenue Code	301
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

Allergens w/Total IgE 11 LC

Facility

$1,180.00

Service Code	CPT 86003
Hospital Charge Code	23773230
Hospital Revenue Code	302
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna of AZ Commercial	$1,062.00
Rate for Payer: Cash Price	$944.00

Allergens w/Total IgE 11 LC

Facility

$1,180.00

Service Code	CPT 86003
Hospital Charge Code	23773230
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna of AZ Commercial	$1,062.00
Rate for Payer: Arizona Complete Health Allwell	$188.80
Rate for Payer: Banner UC Health Medicare	$188.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$802.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$188.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$188.80
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cigna of AZ Commercial	$767.00
Rate for Payer: Devoted Health Medicare	$212.40
Rate for Payer: Humana of AZ Medicare	$188.80
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$802.40
Rate for Payer: TriWest Medicare	$188.80
Rate for Payer: United Healthcare Commercial	$674.96
Rate for Payer: United Healthcare Medicare	$188.80
Rate for Payer: Veterans Affairs TRICARE	$186.91

Allergens w/Total IgE Area 12 LC

Facility

$131.00

Service Code	CPT 82785
Hospital Charge Code	22311173
Hospital Revenue Code	302
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Arizona Complete Health Allwell	$20.96
Rate for Payer: Banner UC Health Medicare	$20.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$89.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.96
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cigna of AZ Commercial	$85.15
Rate for Payer: Devoted Health Medicare	$23.58
Rate for Payer: Humana of AZ Medicare	$20.96
Rate for Payer: Seven Corners Travel Insurance	$23.87
Rate for Payer: Southwest Service Administrators UFCW	$89.08
Rate for Payer: TriWest Medicare	$20.96
Rate for Payer: United Healthcare Commercial	$74.93
Rate for Payer: United Healthcare Medicare	$20.96
Rate for Payer: Veterans Affairs TRICARE	$20.75

Allergens w/Total IgE Area 12 LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	23756989
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

Allergens w/Total IgE Area 12 LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	23756989
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

Allergens w/Total IgE Area 12 LC

Facility

$131.00

Service Code	CPT 82785
Hospital Charge Code	22311173
Hospital Revenue Code	302
Min. Negotiated Rate	$117.90
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Cash Price	$104.80

Allergens, Zone 16 LC

Facility

$1,750.00

Service Code	CPT 86003
Hospital Charge Code	22311174
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna of AZ Commercial	$1,575.00
Rate for Payer: Arizona Complete Health Allwell	$280.00
Rate for Payer: Banner UC Health Medicare	$280.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,190.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$280.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$280.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Cigna of AZ Commercial	$1,137.50
Rate for Payer: Devoted Health Medicare	$315.00
Rate for Payer: Humana of AZ Medicare	$280.00
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$1,190.00
Rate for Payer: TriWest Medicare	$280.00
Rate for Payer: United Healthcare Commercial	$1,001.00
Rate for Payer: United Healthcare Medicare	$280.00
Rate for Payer: Veterans Affairs TRICARE	$277.20

Allergens, Zone 16 LC

Facility

$1,750.00

Service Code	CPT 86003
Hospital Charge Code	22311174
Hospital Revenue Code	302
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna of AZ Commercial	$1,575.00
Rate for Payer: Cash Price	$1,400.00

Allergic Reactions

Facility

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$13,151.25
Max. Negotiated Rate	$13,151.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,151.25
Rate for Payer: Mercy Care Medicaid	$13,151.25
Rate for Payer: NaphCare Correctional Healthcare	$13,151.25

Allergic Reactions

Facility

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$13,151.25
Max. Negotiated Rate	$13,151.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,151.25
Rate for Payer: Mercy Care Medicaid	$13,151.25
Rate for Payer: NaphCare Correctional Healthcare	$13,151.25

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8112
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67
Rate for Payer: NaphCare Correctional Healthcare	$3,439.67

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11
Rate for Payer: NaphCare Correctional Healthcare	$2,311.11

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79
Rate for Payer: NaphCare Correctional Healthcare	$6,558.79

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67
Rate for Payer: NaphCare Correctional Healthcare	$3,439.67

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67
Rate for Payer: NaphCare Correctional Healthcare	$3,439.67

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8112
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79
Rate for Payer: NaphCare Correctional Healthcare	$6,558.79

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79
Rate for Payer: NaphCare Correctional Healthcare	$6,558.79

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8112
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11
Rate for Payer: NaphCare Correctional Healthcare	$2,311.11

Allergic Reactions

Facility

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$13,151.25
Max. Negotiated Rate	$13,151.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,151.25
Rate for Payer: Mercy Care Medicaid	$13,151.25
Rate for Payer: NaphCare Correctional Healthcare	$13,151.25

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67
Rate for Payer: NaphCare Correctional Healthcare	$3,439.67

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11
Rate for Payer: NaphCare Correctional Healthcare	$2,311.11

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79
Rate for Payer: NaphCare Correctional Healthcare	$6,558.79

Know your out-of-pocket cost for care.

All Charges