Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Anti-dsDNA Antibodies LC

Facility

$155.00

Service Code	CPT 86225
Hospital Charge Code	1905934
Hospital Revenue Code	302
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.80
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$100.75
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Seven Corners Travel Insurance	$19.92
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: Veterans Affairs TRICARE	$24.55

Anti-dsDNA Antibodies LC

Facility

$155.00

Service Code	CPT 86225
Hospital Charge Code	1905934
Hospital Revenue Code	302
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

Antigen Type

Facility

$158.00

Service Code	CPT 86902
Hospital Charge Code	22245939
Hospital Revenue Code	302
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Arizona Complete Health Allwell	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$107.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.28
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$102.70
Rate for Payer: Devoted Health Medicare	$28.44
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Seven Corners Travel Insurance	$9.21
Rate for Payer: Southwest Service Administrators UFCW	$107.44
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: United Healthcare Commercial	$90.38
Rate for Payer: United Healthcare Medicare	$25.28
Rate for Payer: Veterans Affairs TRICARE	$25.03

Antigen Type

Facility

$158.00

Service Code	CPT 86902
Hospital Charge Code	22245939
Hospital Revenue Code	302
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Cash Price	$126.40

Antigen Type w/ Charge

Facility

$237.00

Service Code	CPT 86885
Hospital Charge Code	22172090
Hospital Revenue Code	302
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Arizona Complete Health Allwell	$37.92
Rate for Payer: Banner UC Health Medicare	$37.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.92
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Devoted Health Medicare	$42.66
Rate for Payer: Humana of AZ Medicare	$37.92
Rate for Payer: Seven Corners Travel Insurance	$8.29
Rate for Payer: Southwest Service Administrators UFCW	$161.16
Rate for Payer: TriWest Medicare	$37.92
Rate for Payer: United Healthcare Commercial	$135.56
Rate for Payer: United Healthcare Medicare	$37.92
Rate for Payer: Veterans Affairs TRICARE	$37.54

Antigen Type w/ Charge

Facility

$237.00

Service Code	CPT 86885
Hospital Charge Code	22172090
Hospital Revenue Code	302
Min. Negotiated Rate	$213.30
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Cash Price	$189.60

ANTI GLIADIN AB IGG

Facility

$1,422.00

Service Code	CPT 83516
Hospital Charge Code	22481459
Hospital Revenue Code	301
Min. Negotiated Rate	$1,279.80
Max. Negotiated Rate	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,858.50
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cash Price	$1,652.00

ANTI GLIADIN AB IGG

Facility

$2,065.00

Service Code	CPT 83516
Hospital Charge Code	22481459
Hospital Revenue Code	301
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$1,858.50
Rate for Payer: Aetna of AZ Commercial	$1,858.50
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Arizona Complete Health Allwell	$227.52
Rate for Payer: Arizona Complete Health Allwell	$330.40
Rate for Payer: Banner UC Health Medicare	$227.52
Rate for Payer: Banner UC Health Medicare	$330.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,404.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$966.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$330.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$330.40
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cigna of AZ Commercial	$1,342.25
Rate for Payer: Cigna of AZ Commercial	$924.30
Rate for Payer: Devoted Health Medicare	$371.70
Rate for Payer: Devoted Health Medicare	$255.96
Rate for Payer: Humana of AZ Medicare	$227.52
Rate for Payer: Humana of AZ Medicare	$330.40
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$966.96
Rate for Payer: Southwest Service Administrators UFCW	$1,404.20
Rate for Payer: TriWest Medicare	$227.52
Rate for Payer: TriWest Medicare	$330.40
Rate for Payer: United Healthcare Commercial	$1,181.18
Rate for Payer: United Healthcare Commercial	$813.38
Rate for Payer: United Healthcare Medicare	$227.52
Rate for Payer: United Healthcare Medicare	$330.40
Rate for Payer: Veterans Affairs TRICARE	$327.10
Rate for Payer: Veterans Affairs TRICARE	$225.24

Antihistone Antibodies LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	16937587
Hospital Revenue Code	301
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Arizona Complete Health Allwell	$227.20
Rate for Payer: Banner UC Health Medicare	$227.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$965.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.20
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cigna of AZ Commercial	$923.00
Rate for Payer: Devoted Health Medicare	$255.60
Rate for Payer: Humana of AZ Medicare	$227.20
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$965.60
Rate for Payer: TriWest Medicare	$227.20
Rate for Payer: United Healthcare Commercial	$812.24
Rate for Payer: United Healthcare Medicare	$227.20
Rate for Payer: Veterans Affairs TRICARE	$224.93

Antihistone Antibodies LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	16937587
Hospital Revenue Code	301
Min. Negotiated Rate	$1,278.00
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Cash Price	$1,136.00

.Anti-Jo-1 LC

Facility

$259.00

Service Code	CPT 86235
Hospital Charge Code	22531162
Hospital Revenue Code	302
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Cash Price	$207.20

.Anti-Jo-1 LC

Facility

$259.00

Service Code	CPT 86235
Hospital Charge Code	22531162
Hospital Revenue Code	302
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Arizona Complete Health Allwell	$41.44
Rate for Payer: Banner UC Health Medicare	$41.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$176.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.44
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$168.35
Rate for Payer: Devoted Health Medicare	$46.62
Rate for Payer: Humana of AZ Medicare	$41.44
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$176.12
Rate for Payer: TriWest Medicare	$41.44
Rate for Payer: United Healthcare Commercial	$148.15
Rate for Payer: United Healthcare Medicare	$41.44
Rate for Payer: Veterans Affairs TRICARE	$41.03

Anti-Jo-1 LC

Facility

$246.00

Service Code	CPT 86235
Hospital Charge Code	1285794
Hospital Revenue Code	302
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Arizona Complete Health Allwell	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$167.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.36
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$159.90
Rate for Payer: Devoted Health Medicare	$44.28
Rate for Payer: Humana of AZ Medicare	$39.36
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$167.28
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: United Healthcare Commercial	$140.71
Rate for Payer: United Healthcare Medicare	$39.36
Rate for Payer: Veterans Affairs TRICARE	$38.97

Anti-Jo-1 LC

Facility

$246.00

Service Code	CPT 86235
Hospital Charge Code	1285794
Hospital Revenue Code	302
Min. Negotiated Rate	$221.40
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Cash Price	$196.80

Anti-Mullerian Hormone LC

Facility

$355.00

Service Code	CPT 82397
Hospital Charge Code	3486207
Hospital Revenue Code	300
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Cash Price	$284.00

Anti-Mullerian Hormone LC

Facility

$355.00

Service Code	CPT 82397
Hospital Charge Code	3486207
Hospital Revenue Code	300
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Arizona Complete Health Allwell	$56.80
Rate for Payer: Banner UC Health Medicare	$56.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$241.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$56.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$56.80
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cigna of AZ Commercial	$230.75
Rate for Payer: Devoted Health Medicare	$63.90
Rate for Payer: Humana of AZ Medicare	$56.80
Rate for Payer: Seven Corners Travel Insurance	$20.47
Rate for Payer: Southwest Service Administrators UFCW	$241.40
Rate for Payer: TriWest Medicare	$56.80
Rate for Payer: United Healthcare Commercial	$203.06
Rate for Payer: United Healthcare Medicare	$56.80
Rate for Payer: Veterans Affairs TRICARE	$56.23

Antineutrophil Cytoplasmic Ab LC

Facility

$698.00

Service Code	CPT 86256
Hospital Charge Code	1285639
Hospital Revenue Code	302
Min. Negotiated Rate	$628.20
Max. Negotiated Rate	$628.20
Rate for Payer: Aetna of AZ Commercial	$628.20
Rate for Payer: Cash Price	$558.40

Antineutrophil Cytoplasmic Ab LC

Facility

$698.00

Service Code	CPT 86256
Hospital Charge Code	1285639
Hospital Revenue Code	302
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$628.20
Rate for Payer: Aetna of AZ Commercial	$628.20
Rate for Payer: Arizona Complete Health Allwell	$111.68
Rate for Payer: Banner UC Health Medicare	$111.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$474.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$111.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$111.68
Rate for Payer: Cash Price	$558.40
Rate for Payer: Cash Price	$558.40
Rate for Payer: Cigna of AZ Commercial	$453.70
Rate for Payer: Devoted Health Medicare	$125.64
Rate for Payer: Humana of AZ Medicare	$111.68
Rate for Payer: Seven Corners Travel Insurance	$17.47
Rate for Payer: Southwest Service Administrators UFCW	$474.64
Rate for Payer: TriWest Medicare	$111.68
Rate for Payer: United Healthcare Commercial	$399.26
Rate for Payer: United Healthcare Medicare	$111.68
Rate for Payer: Veterans Affairs TRICARE	$110.56

Antinuclear Antibodies Direct LC

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	1285669
Hospital Revenue Code	300
Min. Negotiated Rate	$136.80
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Cash Price	$121.60

Antinuclear Antibodies Direct LC

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	1285669
Hospital Revenue Code	300
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Arizona Complete Health Allwell	$24.32
Rate for Payer: Banner UC Health Medicare	$24.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$103.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.32
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cigna of AZ Commercial	$98.80
Rate for Payer: Devoted Health Medicare	$27.36
Rate for Payer: Humana of AZ Medicare	$24.32
Rate for Payer: Seven Corners Travel Insurance	$17.53
Rate for Payer: Southwest Service Administrators UFCW	$103.36
Rate for Payer: TriWest Medicare	$24.32
Rate for Payer: United Healthcare Commercial	$86.94
Rate for Payer: United Healthcare Medicare	$24.32
Rate for Payer: Veterans Affairs TRICARE	$24.08

Antinuclear Antibodies, IFA LC

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	1285670
Hospital Revenue Code	300
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Arizona Complete Health Allwell	$24.32
Rate for Payer: Banner UC Health Medicare	$24.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$103.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.32
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cigna of AZ Commercial	$98.80
Rate for Payer: Devoted Health Medicare	$27.36
Rate for Payer: Humana of AZ Medicare	$24.32
Rate for Payer: Seven Corners Travel Insurance	$17.53
Rate for Payer: Southwest Service Administrators UFCW	$103.36
Rate for Payer: TriWest Medicare	$24.32
Rate for Payer: United Healthcare Commercial	$86.94
Rate for Payer: United Healthcare Medicare	$24.32
Rate for Payer: Veterans Affairs TRICARE	$24.08

Antinuclear Antibodies, IFA LC

Facility

$152.00

Service Code	CPT 86038
Hospital Charge Code	1285670
Hospital Revenue Code	300
Min. Negotiated Rate	$136.80
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Cash Price	$121.60

Antipancreatic Islet Cells LC

Facility

$287.00

Service Code	CPT 86341
Hospital Charge Code	6780997
Hospital Revenue Code	302
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna of AZ Commercial	$258.30
Rate for Payer: Cash Price	$229.60

Antipancreatic Islet Cells LC

Facility

$287.00

Service Code	CPT 86341
Hospital Charge Code	6780997
Hospital Revenue Code	302
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna of AZ Commercial	$258.30
Rate for Payer: Arizona Complete Health Allwell	$45.92
Rate for Payer: Banner UC Health Medicare	$45.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$195.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.92
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cigna of AZ Commercial	$186.55
Rate for Payer: Devoted Health Medicare	$51.66
Rate for Payer: Humana of AZ Medicare	$45.92
Rate for Payer: Seven Corners Travel Insurance	$34.18
Rate for Payer: Southwest Service Administrators UFCW	$195.16
Rate for Payer: TriWest Medicare	$45.92
Rate for Payer: United Healthcare Commercial	$164.16
Rate for Payer: United Healthcare Medicare	$45.92
Rate for Payer: Veterans Affairs TRICARE	$45.46

.Antiribosomal P Abs LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	22531163
Hospital Revenue Code	302
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Arizona Complete Health Allwell	$227.20
Rate for Payer: Banner UC Health Medicare	$227.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$965.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.20
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cigna of AZ Commercial	$923.00
Rate for Payer: Devoted Health Medicare	$255.60
Rate for Payer: Humana of AZ Medicare	$227.20
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$965.60
Rate for Payer: TriWest Medicare	$227.20
Rate for Payer: United Healthcare Commercial	$812.24
Rate for Payer: United Healthcare Medicare	$227.20
Rate for Payer: Veterans Affairs TRICARE	$224.93

Know your out-of-pocket cost for care.

All Charges