Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Anterior Repair with graft

Facility

$1,305.00

Service Code	CPT 57267
Hospital Charge Code	27267805
Hospital Revenue Code	360
Min. Negotiated Rate	$206.71
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$1,174.50
Rate for Payer: Arizona Complete Health Allwell	$208.80
Rate for Payer: Banner UC Health Medicare	$208.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$887.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$208.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$208.80
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Cigna of AZ Commercial	$652.50
Rate for Payer: Devoted Health Medicare	$234.90
Rate for Payer: Humana of AZ Medicare	$208.80
Rate for Payer: Southwest Service Administrators UFCW	$887.40
Rate for Payer: TriWest Medicare	$208.80
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$208.80
Rate for Payer: Veterans Affairs TRICARE	$206.71

ANTI 68 KD

Facility

$408.00

Service Code	CPT 84181
Hospital Charge Code	23298042
Hospital Revenue Code	301
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Cash Price	$326.40

ANTI 68 KD

Facility

$408.00

Service Code	CPT 84181
Hospital Charge Code	23298042
Hospital Revenue Code	301
Min. Negotiated Rate	$24.69
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Arizona Complete Health Allwell	$65.28
Rate for Payer: Banner UC Health Medicare	$65.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$277.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.28
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna of AZ Commercial	$265.20
Rate for Payer: Devoted Health Medicare	$73.44
Rate for Payer: Humana of AZ Medicare	$65.28
Rate for Payer: Seven Corners Travel Insurance	$24.69
Rate for Payer: Southwest Service Administrators UFCW	$277.44
Rate for Payer: TriWest Medicare	$65.28
Rate for Payer: United Healthcare Commercial	$233.38
Rate for Payer: United Healthcare Medicare	$65.28
Rate for Payer: Veterans Affairs TRICARE	$64.63

Antibody Screen Tube

Facility

$117.00

Service Code	CPT 86850
Hospital Charge Code	1137983
Hospital Revenue Code	302
Min. Negotiated Rate	$105.30
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of AZ Commercial	$105.30
Rate for Payer: Cash Price	$93.60

Antibody Screen Tube

Facility

$117.00

Service Code	CPT 86850
Hospital Charge Code	1137983
Hospital Revenue Code	302
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna of AZ Commercial	$105.30
Rate for Payer: Arizona Complete Health Allwell	$18.72
Rate for Payer: Banner UC Health Medicare	$18.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$79.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.72
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna of AZ Commercial	$76.05
Rate for Payer: Devoted Health Medicare	$21.06
Rate for Payer: Humana of AZ Medicare	$18.72
Rate for Payer: Seven Corners Travel Insurance	$14.17
Rate for Payer: Southwest Service Administrators UFCW	$79.56
Rate for Payer: TriWest Medicare	$18.72
Rate for Payer: United Healthcare Commercial	$66.92
Rate for Payer: United Healthcare Medicare	$18.72
Rate for Payer: Veterans Affairs TRICARE	$18.53

ANTICARD IGA

Facility

$418.00

Service Code	CPT 86147
Hospital Charge Code	22481460
Hospital Revenue Code	302
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Arizona Complete Health Allwell	$66.88
Rate for Payer: Banner UC Health Medicare	$66.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$284.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.88
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cigna of AZ Commercial	$271.70
Rate for Payer: Devoted Health Medicare	$75.24
Rate for Payer: Humana of AZ Medicare	$66.88
Rate for Payer: Seven Corners Travel Insurance	$36.90
Rate for Payer: Southwest Service Administrators UFCW	$284.24
Rate for Payer: TriWest Medicare	$66.88
Rate for Payer: United Healthcare Commercial	$239.10
Rate for Payer: United Healthcare Medicare	$66.88
Rate for Payer: Veterans Affairs TRICARE	$66.21

ANTICARD IGA

Facility

$418.00

Service Code	CPT 86147
Hospital Charge Code	22481460
Hospital Revenue Code	302
Min. Negotiated Rate	$376.20
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Cash Price	$334.40

ANTICARD IGG

Facility

$418.00

Service Code	CPT 86147
Hospital Charge Code	22481461
Hospital Revenue Code	302
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Arizona Complete Health Allwell	$66.88
Rate for Payer: Banner UC Health Medicare	$66.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$284.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.88
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cigna of AZ Commercial	$271.70
Rate for Payer: Devoted Health Medicare	$75.24
Rate for Payer: Humana of AZ Medicare	$66.88
Rate for Payer: Seven Corners Travel Insurance	$36.90
Rate for Payer: Southwest Service Administrators UFCW	$284.24
Rate for Payer: TriWest Medicare	$66.88
Rate for Payer: United Healthcare Commercial	$239.10
Rate for Payer: United Healthcare Medicare	$66.88
Rate for Payer: Veterans Affairs TRICARE	$66.21

ANTICARD IGG

Facility

$418.00

Service Code	CPT 86147
Hospital Charge Code	22481461
Hospital Revenue Code	302
Min. Negotiated Rate	$376.20
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Cash Price	$334.40

ANTICARD IGM

Facility

$418.00

Service Code	CPT 86147
Hospital Charge Code	22481462
Hospital Revenue Code	302
Min. Negotiated Rate	$376.20
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Cash Price	$334.40

ANTICARD IGM

Facility

$418.00

Service Code	CPT 86147
Hospital Charge Code	22481462
Hospital Revenue Code	302
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Arizona Complete Health Allwell	$66.88
Rate for Payer: Banner UC Health Medicare	$66.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$284.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.88
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cigna of AZ Commercial	$271.70
Rate for Payer: Devoted Health Medicare	$75.24
Rate for Payer: Humana of AZ Medicare	$66.88
Rate for Payer: Seven Corners Travel Insurance	$36.90
Rate for Payer: Southwest Service Administrators UFCW	$284.24
Rate for Payer: TriWest Medicare	$66.88
Rate for Payer: United Healthcare Commercial	$239.10
Rate for Payer: United Healthcare Medicare	$66.88
Rate for Payer: Veterans Affairs TRICARE	$66.21

Anticardiolip Ab, IgA/G/M, Qn LC

Facility

$397.00

Service Code	CPT 86147
Hospital Charge Code	1905982
Hospital Revenue Code	302
Min. Negotiated Rate	$357.30
Max. Negotiated Rate	$357.30
Rate for Payer: Aetna of AZ Commercial	$357.30
Rate for Payer: Cash Price	$317.60

Anticardiolip Ab, IgA/G/M, Qn LC

Facility

$397.00

Service Code	CPT 86147
Hospital Charge Code	1905982
Hospital Revenue Code	302
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$357.30
Rate for Payer: Aetna of AZ Commercial	$357.30
Rate for Payer: Arizona Complete Health Allwell	$63.52
Rate for Payer: Banner UC Health Medicare	$63.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$269.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$63.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$63.52
Rate for Payer: Cash Price	$317.60
Rate for Payer: Cash Price	$317.60
Rate for Payer: Cigna of AZ Commercial	$258.05
Rate for Payer: Devoted Health Medicare	$71.46
Rate for Payer: Humana of AZ Medicare	$63.52
Rate for Payer: Seven Corners Travel Insurance	$36.90
Rate for Payer: Southwest Service Administrators UFCW	$269.96
Rate for Payer: TriWest Medicare	$63.52
Rate for Payer: United Healthcare Commercial	$227.08
Rate for Payer: United Healthcare Medicare	$63.52
Rate for Payer: Veterans Affairs TRICARE	$62.88

Anticardiolipin Ab, IgG/M, Qn LC

Facility

$366.00

Hospital Charge Code	1285796
Hospital Revenue Code	302
Min. Negotiated Rate	$329.40
Max. Negotiated Rate	$329.40
Rate for Payer: Aetna of AZ Commercial	$329.40
Rate for Payer: Cash Price	$292.80

Anticardiolipin Ab, IgG/M, Qn LC

Facility

$366.00

Hospital Charge Code	1285796
Hospital Revenue Code	302
Min. Negotiated Rate	$57.97
Max. Negotiated Rate	$329.40
Rate for Payer: Aetna of AZ Commercial	$329.40
Rate for Payer: Arizona Complete Health Allwell	$58.56
Rate for Payer: Banner UC Health Medicare	$58.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$248.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$58.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.56
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cigna of AZ Commercial	$237.90
Rate for Payer: Devoted Health Medicare	$65.88
Rate for Payer: Humana of AZ Medicare	$58.56
Rate for Payer: Southwest Service Administrators UFCW	$248.88
Rate for Payer: TriWest Medicare	$58.56
Rate for Payer: United Healthcare Commercial	$209.35
Rate for Payer: United Healthcare Medicare	$58.56
Rate for Payer: Veterans Affairs TRICARE	$57.97

.Anti-Centromere B Abs LC

Facility

$212.00

Service Code	CPT 86235
Hospital Charge Code	22531164
Hospital Revenue Code	302
Min. Negotiated Rate	$26.00
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	$26.00
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

.Anti-Centromere B Abs LC

Facility

$212.00

Service Code	CPT 86235
Hospital Charge Code	22531164
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

Anti-Centromere B Antibodies LC

Facility

$201.00

Service Code	CPT 86235
Hospital Charge Code	7328630
Hospital Revenue Code	302
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

Anti-Centromere B Antibodies LC

Facility

$201.00

Service Code	CPT 86235
Hospital Charge Code	7328630
Hospital Revenue Code	302
Min. Negotiated Rate	$26.00
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	$26.00
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

.Antichromatin Abs LC

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	22531156
Hospital Revenue Code	302
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of AZ Commercial	$101.70
Rate for Payer: Cash Price	$90.40

.Antichromatin Abs LC

Facility

$113.00

Service Code	CPT 86235
Hospital Charge Code	22531156
Hospital Revenue Code	302
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of AZ Commercial	$101.70
Rate for Payer: Arizona Complete Health Allwell	$18.08
Rate for Payer: Banner UC Health Medicare	$18.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$76.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.08
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cigna of AZ Commercial	$73.45
Rate for Payer: Devoted Health Medicare	$20.34
Rate for Payer: Humana of AZ Medicare	$18.08
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$76.84
Rate for Payer: TriWest Medicare	$18.08
Rate for Payer: United Healthcare Commercial	$64.64
Rate for Payer: United Healthcare Medicare	$18.08
Rate for Payer: Veterans Affairs TRICARE	$17.90

Anti-DNA(SS)IgG, Ab, Qn LC

Facility

$317.00

Service Code	CPT 86226
Hospital Charge Code	22311175
Hospital Revenue Code	302
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$285.30
Rate for Payer: Aetna of AZ Commercial	$285.30
Rate for Payer: Arizona Complete Health Allwell	$50.72
Rate for Payer: Banner UC Health Medicare	$50.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$215.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$50.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$50.72
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cigna of AZ Commercial	$206.05
Rate for Payer: Devoted Health Medicare	$57.06
Rate for Payer: Humana of AZ Medicare	$50.72
Rate for Payer: Seven Corners Travel Insurance	$17.56
Rate for Payer: Southwest Service Administrators UFCW	$215.56
Rate for Payer: TriWest Medicare	$50.72
Rate for Payer: United Healthcare Commercial	$181.32
Rate for Payer: United Healthcare Medicare	$50.72
Rate for Payer: Veterans Affairs TRICARE	$50.21

Anti-DNA(SS)IgG, Ab, Qn LC

Facility

$317.00

Service Code	CPT 86226
Hospital Charge Code	22311175
Hospital Revenue Code	302
Min. Negotiated Rate	$285.30
Max. Negotiated Rate	$285.30
Rate for Payer: Aetna of AZ Commercial	$285.30
Rate for Payer: Cash Price	$253.60

.Anti-dsDNA Antibodies LC

Facility

$119.00

Service Code	CPT 86225
Hospital Charge Code	3033504
Hospital Revenue Code	302
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of AZ Commercial	$107.10
Rate for Payer: Arizona Complete Health Allwell	$19.04
Rate for Payer: Banner UC Health Medicare	$19.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$80.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.04
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cigna of AZ Commercial	$77.35
Rate for Payer: Devoted Health Medicare	$21.42
Rate for Payer: Humana of AZ Medicare	$19.04
Rate for Payer: Seven Corners Travel Insurance	$19.92
Rate for Payer: Southwest Service Administrators UFCW	$80.92
Rate for Payer: TriWest Medicare	$19.04
Rate for Payer: United Healthcare Commercial	$68.07
Rate for Payer: United Healthcare Medicare	$19.04
Rate for Payer: Veterans Affairs TRICARE	$18.85

.Anti-dsDNA Antibodies LC

Facility

$119.00

Service Code	CPT 86225
Hospital Charge Code	3033504
Hospital Revenue Code	302
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna of AZ Commercial	$107.10
Rate for Payer: Cash Price	$95.20

Know your out-of-pocket cost for care.

All Charges