Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Basic Metabolic Panel Standard

Facility

$174.00

Service Code	CPT 80048 QW
Hospital Charge Code	22141043
Hospital Revenue Code	301
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$156.60
Rate for Payer: Aetna of AZ Commercial	$156.60
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$27.84
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Banner UC Health Medicare	$27.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$118.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Cigna of AZ Commercial	$113.10
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Devoted Health Medicare	$31.32
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Humana of AZ Medicare	$27.84
Rate for Payer: Seven Corners Travel Insurance	$12.27
Rate for Payer: Seven Corners Travel Insurance	$12.27
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: Southwest Service Administrators UFCW	$118.32
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: TriWest Medicare	$27.84
Rate for Payer: United Healthcare Commercial	$99.53
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: United Healthcare Medicare	$27.84
Rate for Payer: Veterans Affairs TRICARE	$20.43
Rate for Payer: Veterans Affairs TRICARE	$27.56

Basic Metabolic Panel Standard

Facility

$129.00

Service Code	CPT 80048 QW
Hospital Charge Code	22141043
Hospital Revenue Code	301
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Aetna of AZ Commercial	$156.60
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$139.20

BASIN WASH

Facility

$8.00

Hospital Charge Code	22355559
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

BASIN WASH

Facility

$8.00

Hospital Charge Code	22355559
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

BATH JOEY WIPE

Facility

$5.35

Hospital Charge Code	22355371
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna of AZ Commercial	$4.82
Rate for Payer: Arizona Complete Health Allwell	$0.86
Rate for Payer: Banner UC Health Medicare	$0.86
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.86
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.86
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna of AZ Commercial	$3.75
Rate for Payer: Devoted Health Medicare	$0.96
Rate for Payer: Humana of AZ Medicare	$0.86
Rate for Payer: Southwest Service Administrators UFCW	$3.64
Rate for Payer: TriWest Medicare	$0.86
Rate for Payer: United Healthcare Commercial	$3.06
Rate for Payer: United Healthcare Medicare	$0.86
Rate for Payer: Veterans Affairs TRICARE	$0.85

BATH JOEY WIPE

Facility

$5.35

Hospital Charge Code	22355371
Hospital Revenue Code	270
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$4.82
Rate for Payer: Aetna of AZ Commercial	$4.82
Rate for Payer: Cash Price	$4.28

BAYER MIRENA IUD 52MG

Facility

$2,925.00

Hospital Charge Code	27567258
Hospital Revenue Code	270
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$2,632.50
Rate for Payer: Aetna of AZ Commercial	$2,632.50
Rate for Payer: Cash Price	$2,340.00

BAYER MIRENA IUD 52MG

Facility

$2,925.00

Hospital Charge Code	27567258
Hospital Revenue Code	270
Min. Negotiated Rate	$463.32
Max. Negotiated Rate	$2,632.50
Rate for Payer: Aetna of AZ Commercial	$2,632.50
Rate for Payer: Arizona Complete Health Allwell	$468.00
Rate for Payer: Banner UC Health Medicare	$468.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,989.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$468.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$468.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Cigna of AZ Commercial	$2,047.50
Rate for Payer: Devoted Health Medicare	$526.50
Rate for Payer: Humana of AZ Medicare	$468.00
Rate for Payer: Southwest Service Administrators UFCW	$1,989.00
Rate for Payer: TriWest Medicare	$468.00
Rate for Payer: United Healthcare Commercial	$1,673.10
Rate for Payer: United Healthcare Medicare	$468.00
Rate for Payer: Veterans Affairs TRICARE	$463.32

BB ABO/RH/AB SCREEN

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	1165544
Hospital Revenue Code	302
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Cash Price	$68.00

BB ABO/RH/AB SCREEN

Facility

$85.00

Service Code	CPT 86900
Hospital Charge Code	1165544
Hospital Revenue Code	302
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Arizona Complete Health Allwell	$13.60
Rate for Payer: Banner UC Health Medicare	$13.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.60
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cigna of AZ Commercial	$55.25
Rate for Payer: Devoted Health Medicare	$15.30
Rate for Payer: Humana of AZ Medicare	$13.60
Rate for Payer: Seven Corners Travel Insurance	$4.34
Rate for Payer: Southwest Service Administrators UFCW	$57.80
Rate for Payer: TriWest Medicare	$13.60
Rate for Payer: United Healthcare Commercial	$48.62
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: Veterans Affairs TRICARE	$13.46

BB ANTIBODY SCREEN

Facility

$108.00

Service Code	CPT 86850
Hospital Charge Code	1422360
Hospital Revenue Code	302
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Cash Price	$86.40

BB ANTIBODY SCREEN

Facility

$108.00

Service Code	CPT 86850
Hospital Charge Code	1422360
Hospital Revenue Code	302
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Arizona Complete Health Allwell	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$73.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.28
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$70.20
Rate for Payer: Devoted Health Medicare	$19.44
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Seven Corners Travel Insurance	$14.17
Rate for Payer: Southwest Service Administrators UFCW	$73.44
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: United Healthcare Commercial	$61.78
Rate for Payer: United Healthcare Medicare	$17.28
Rate for Payer: Veterans Affairs TRICARE	$17.11

BB RED CELL ANTIGEN TYPING

Facility

$107.00

Service Code	CPT 86905
Hospital Charge Code	1481864
Hospital Revenue Code	302
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Cash Price	$85.60

BB RED CELL ANTIGEN TYPING

Facility

$107.00

Service Code	CPT 86905
Hospital Charge Code	1481864
Hospital Revenue Code	302
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Arizona Complete Health Allwell	$17.12
Rate for Payer: Banner UC Health Medicare	$17.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.12
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$69.55
Rate for Payer: Devoted Health Medicare	$19.26
Rate for Payer: Humana of AZ Medicare	$17.12
Rate for Payer: Seven Corners Travel Insurance	$5.55
Rate for Payer: Southwest Service Administrators UFCW	$72.76
Rate for Payer: TriWest Medicare	$17.12
Rate for Payer: United Healthcare Commercial	$61.20
Rate for Payer: United Healthcare Medicare	$17.12
Rate for Payer: Veterans Affairs TRICARE	$16.95

BCR-ABL (M-TH only) LC

Facility

$2,033.00

Service Code	CPT 81206
Hospital Charge Code	2769565
Hospital Revenue Code	301
Min. Negotiated Rate	$237.74
Max. Negotiated Rate	$1,829.70
Rate for Payer: Aetna of AZ Commercial	$1,829.70
Rate for Payer: Arizona Complete Health Allwell	$325.28
Rate for Payer: Banner UC Health Medicare	$325.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,382.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$325.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$325.28
Rate for Payer: Cash Price	$1,626.40
Rate for Payer: Cash Price	$1,626.40
Rate for Payer: Cigna of AZ Commercial	$1,321.45
Rate for Payer: Devoted Health Medicare	$365.94
Rate for Payer: Humana of AZ Medicare	$325.28
Rate for Payer: Seven Corners Travel Insurance	$237.74
Rate for Payer: Southwest Service Administrators UFCW	$1,382.44
Rate for Payer: TriWest Medicare	$325.28
Rate for Payer: United Healthcare Commercial	$1,162.88
Rate for Payer: United Healthcare Medicare	$325.28
Rate for Payer: Veterans Affairs TRICARE	$322.03

BCR-ABL (M-TH only) LC

Facility

$2,033.00

Service Code	CPT 81206
Hospital Charge Code	2769565
Hospital Revenue Code	301
Min. Negotiated Rate	$1,829.70
Max. Negotiated Rate	$1,829.70
Rate for Payer: Aetna of AZ Commercial	$1,829.70
Rate for Payer: Cash Price	$1,626.40

BD Bone Density DEXA Study

Facility

$739.00

Service Code	CPT 77080
Hospital Charge Code	1284605
Hospital Revenue Code	320
Min. Negotiated Rate	$36.65
Max. Negotiated Rate	$665.10
Rate for Payer: Aetna of AZ Commercial	$665.10
Rate for Payer: Arizona Complete Health Allwell	$118.24
Rate for Payer: Banner UC Health Medicare	$118.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$502.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$118.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.65
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cigna of AZ Commercial	$480.35
Rate for Payer: Devoted Health Medicare	$133.02
Rate for Payer: Humana of AZ Medicare	$118.24
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$502.52
Rate for Payer: TriWest Medicare	$118.24
Rate for Payer: United Healthcare Commercial	$422.71
Rate for Payer: United Healthcare Medicare	$118.24
Rate for Payer: Veterans Affairs TRICARE	$117.06

BD Bone Density DEXA Study

Facility

$739.00

Service Code	CPT 77080
Hospital Charge Code	1284605
Hospital Revenue Code	320
Min. Negotiated Rate	$665.10
Max. Negotiated Rate	$665.10
Rate for Payer: Aetna of AZ Commercial	$665.10
Rate for Payer: Cash Price	$591.20

BD Dexa Appendicular

Facility

$119.00

Service Code	CPT 77081
Hospital Charge Code	1005095
Hospital Revenue Code	320
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

BD Dexa Appendicular

Facility

$119.00

Service Code	CPT 77081
Hospital Charge Code	1005095
Hospital Revenue Code	320
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$134.65
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	$29.32
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	$134.65
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

bebtelovimab 175 mg/2 mL Sol[CQCH]

Facility

$1,050.00

Service Code	NDC 2758901
Hospital Charge Code	198470404
Hospital Revenue Code	250
Min. Negotiated Rate	$166.32
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna of AZ Commercial	$945.00
Rate for Payer: Arizona Complete Health Allwell	$168.00
Rate for Payer: Banner UC Health Medicare	$168.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$714.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$168.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$168.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Cigna of AZ Commercial	$682.50
Rate for Payer: Devoted Health Medicare	$189.00
Rate for Payer: Humana of AZ Medicare	$168.00
Rate for Payer: Southwest Service Administrators UFCW	$714.00
Rate for Payer: TriWest Medicare	$168.00
Rate for Payer: United Healthcare Commercial	$600.60
Rate for Payer: United Healthcare Medicare	$168.00
Rate for Payer: Veterans Affairs TRICARE	$166.32

bebtelovimab 175 mg/2 mL Sol[CQCH]

Facility

$1,050.00

Service Code	NDC 2758901
Hospital Charge Code	198470404
Hospital Revenue Code	250
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna of AZ Commercial	$945.00
Rate for Payer: Cash Price	$840.00

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$26,821.48

Service Code	MSDRG 886
Min. Negotiated Rate	$26,821.48
Max. Negotiated Rate	$26,821.48
Rate for Payer: Seven Corners Travel Insurance	$26,821.48

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71
Rate for Payer: NaphCare Correctional Healthcare	$6,018.71

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14
Rate for Payer: NaphCare Correctional Healthcare	$2,675.14

Know your out-of-pocket cost for care.

All Charges