Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

.Antiribosomal P Abs LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	22531163
Hospital Revenue Code	302
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 RNP/SMITH

Facility

$213.00

Service Code	CPT 86235
Hospital Charge Code	22664811
Hospital Revenue Code	302
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Cash Price	$170.40

ANTI RNP/SMITH

Facility

$213.00

Service Code	CPT 86235
Hospital Charge Code	22664811
Hospital Revenue Code	302
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Arizona Complete Health Allwell	$34.08
Rate for Payer: Banner UC Health Medicare	$34.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$144.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.08
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cigna of AZ Commercial	$138.45
Rate for Payer: Devoted Health Medicare	$38.34
Rate for Payer: Humana of AZ Medicare	$34.08
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$144.84
Rate for Payer: TriWest Medicare	$34.08
Rate for Payer: United Healthcare Commercial	$121.84
Rate for Payer: United Healthcare Medicare	$34.08
Rate for Payer: Veterans Affairs TRICARE	$33.74

ANTISCLERODERMA

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	22664812
Hospital Revenue Code	302
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

ANTISCLERODERMA

Facility

$114.00

Service Code	CPT 86235
Hospital Charge Code	22664812
Hospital Revenue Code	302
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

Antiscleroderma-70 Antibodies LC

Facility

$71.00

Service Code	CPT 86235
Hospital Charge Code	1905589
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

Antiscleroderma-70 Antibodies LC

Facility

$71.00

Service Code	CPT 86235
Hospital Charge Code	1905589
Hospital Revenue Code	302
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$46.15
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

Antistreptolysin O Ab LC

Facility

$227.00

Service Code	CPT 86060
Hospital Charge Code	1906788
Hospital Revenue Code	302
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Cash Price	$181.60

Antistreptolysin O Ab LC

Facility

$227.00

Service Code	CPT 86060
Hospital Charge Code	1906788
Hospital Revenue Code	302
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Arizona Complete Health Allwell	$36.32
Rate for Payer: Banner UC Health Medicare	$36.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$154.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.32
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cigna of AZ Commercial	$147.55
Rate for Payer: Devoted Health Medicare	$40.86
Rate for Payer: Humana of AZ Medicare	$36.32
Rate for Payer: Seven Corners Travel Insurance	$10.59
Rate for Payer: Southwest Service Administrators UFCW	$154.36
Rate for Payer: TriWest Medicare	$36.32
Rate for Payer: United Healthcare Commercial	$129.84
Rate for Payer: United Healthcare Medicare	$36.32
Rate for Payer: Veterans Affairs TRICARE	$35.96

Antithrombin Activity LC

Facility

$276.00

Service Code	CPT 85300
Hospital Charge Code	2029226
Hospital Revenue Code	305
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$248.40
Rate for Payer: Aetna of AZ Commercial	$248.40
Rate for Payer: Arizona Complete Health Allwell	$44.16
Rate for Payer: Banner UC Health Medicare	$44.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$187.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.16
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cigna of AZ Commercial	$179.40
Rate for Payer: Devoted Health Medicare	$49.68
Rate for Payer: Humana of AZ Medicare	$44.16
Rate for Payer: Seven Corners Travel Insurance	$17.18
Rate for Payer: Southwest Service Administrators UFCW	$187.68
Rate for Payer: TriWest Medicare	$44.16
Rate for Payer: United Healthcare Commercial	$157.87
Rate for Payer: United Healthcare Medicare	$44.16
Rate for Payer: Veterans Affairs TRICARE	$43.72

Antithrombin Activity LC

Facility

$276.00

Service Code	CPT 85300
Hospital Charge Code	2029226
Hospital Revenue Code	305
Min. Negotiated Rate	$248.40
Max. Negotiated Rate	$248.40
Rate for Payer: Aetna of AZ Commercial	$248.40
Rate for Payer: Cash Price	$220.80

Antithrombin Deficiency Profile LC

Facility

$444.00

Service Code	CPT 85300
Hospital Charge Code	22012108
Hospital Revenue Code	305
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$399.60
Rate for Payer: Aetna of AZ Commercial	$399.60
Rate for Payer: Arizona Complete Health Allwell	$71.04
Rate for Payer: Banner UC Health Medicare	$71.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$301.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$71.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$71.04
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cigna of AZ Commercial	$288.60
Rate for Payer: Devoted Health Medicare	$79.92
Rate for Payer: Humana of AZ Medicare	$71.04
Rate for Payer: Seven Corners Travel Insurance	$17.18
Rate for Payer: Southwest Service Administrators UFCW	$301.92
Rate for Payer: TriWest Medicare	$71.04
Rate for Payer: United Healthcare Commercial	$253.97
Rate for Payer: United Healthcare Medicare	$71.04
Rate for Payer: Veterans Affairs TRICARE	$70.33

Antithrombin Deficiency Profile LC

Facility

$444.00

Service Code	CPT 85300
Hospital Charge Code	22012108
Hospital Revenue Code	305
Min. Negotiated Rate	$399.60
Max. Negotiated Rate	$399.60
Rate for Payer: Aetna of AZ Commercial	$399.60
Rate for Payer: Cash Price	$355.20

antivenin (Crotalidae) polyvalent - Anavip [CQCH]

Facility

$1,166.62

Service Code	HCPCS J0841
Hospital Charge Code	215305345
Hospital Revenue Code	636
Min. Negotiated Rate	$1,049.96
Max. Negotiated Rate	$1,049.96
Rate for Payer: Aetna of AZ Commercial	$1,049.96
Rate for Payer: Cash Price	$933.30

antivenin (Crotalidae) polyvalent - Anavip [CQCH]

Facility

$1,166.62

Service Code	HCPCS J0841
Hospital Charge Code	215305345
Hospital Revenue Code	636
Min. Negotiated Rate	$184.79
Max. Negotiated Rate	$1,049.96
Rate for Payer: Aetna of AZ Commercial	$1,049.96
Rate for Payer: Arizona Complete Health Allwell	$186.66
Rate for Payer: Banner UC Health Medicare	$186.66
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$793.30
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$186.66
Rate for Payer: Care1st Health Plan Arizona Medicare	$186.66
Rate for Payer: Cash Price	$933.30
Rate for Payer: Cigna of AZ Commercial	$816.63
Rate for Payer: Devoted Health Medicare	$209.99
Rate for Payer: Humana of AZ Medicare	$186.66
Rate for Payer: Southwest Service Administrators UFCW	$793.30
Rate for Payer: TriWest Medicare	$186.66
Rate for Payer: United Healthcare Commercial	$667.31
Rate for Payer: United Healthcare Medicare	$186.66
Rate for Payer: United Healthcare New Mexico Commercial	$221.66
Rate for Payer: Veterans Affairs TRICARE	$184.79

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$88,890.96

Service Code	MSDRG 268
Min. Negotiated Rate	$88,890.96
Max. Negotiated Rate	$88,890.96
Rate for Payer: Seven Corners Travel Insurance	$88,890.96

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$54,581.23

Service Code	MSDRG 269
Min. Negotiated Rate	$54,581.23
Max. Negotiated Rate	$54,581.23
Rate for Payer: Seven Corners Travel Insurance	$54,581.23

Aph FFP ACDA

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	857632
Hospital Revenue Code	390
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

Aph FFP ACDA

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	857632
Hospital Revenue Code	390
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$130.21
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Aph FFP ACDA Thawed

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	1221767
Hospital Revenue Code	390
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$130.21
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Aph FFP ACDA Thawed

Facility

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	1221767
Hospital Revenue Code	390
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

Aph Plt ACDA LR

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857738
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857738
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Aph Plt ACDA LR 1

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857739
Hospital Revenue Code	390
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Cash Price	$1,300.00

Aph Plt ACDA LR 1

Facility

$1,625.00

Service Code	HCPCS P9034
Hospital Charge Code	857739
Hospital Revenue Code	390
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Arizona Complete Health Allwell	$260.00
Rate for Payer: Banner UC Health Medicare	$260.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,105.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$260.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$260.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Devoted Health Medicare	$292.50
Rate for Payer: Humana of AZ Medicare	$260.00
Rate for Payer: Seven Corners Travel Insurance	$467.92
Rate for Payer: Southwest Service Administrators UFCW	$1,105.00
Rate for Payer: TriWest Medicare	$260.00
Rate for Payer: United Healthcare Commercial	$929.50
Rate for Payer: United Healthcare Medicare	$260.00
Rate for Payer: Veterans Affairs TRICARE	$257.40

Know your out-of-pocket cost for care.

All Charges