Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Bill Anti gbm

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	23568532
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

Bill Anti gbm

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	23568532
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

Bill Anti-mullerian hormone

Facility

$374.00

Service Code	CPT 82397
Hospital Charge Code	23217725
Hospital Revenue Code	301
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Cash Price	$299.20

Bill Anti-mullerian hormone

Facility

$374.00

Service Code	CPT 82397
Hospital Charge Code	23217725
Hospital Revenue Code	301
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Arizona Complete Health Allwell	$59.84
Rate for Payer: Banner UC Health Medicare	$59.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$254.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$59.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$59.84
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cigna of AZ Commercial	$243.10
Rate for Payer: Devoted Health Medicare	$67.32
Rate for Payer: Humana of AZ Medicare	$59.84
Rate for Payer: Seven Corners Travel Insurance	$20.47
Rate for Payer: Southwest Service Administrators UFCW	$254.32
Rate for Payer: TriWest Medicare	$59.84
Rate for Payer: United Healthcare Commercial	$213.93
Rate for Payer: United Healthcare Medicare	$59.84
Rate for Payer: Veterans Affairs TRICARE	$59.24

Bill BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMM

Facility

$99.00

Service Code	CPT 82274
Hospital Charge Code	23621407
Hospital Revenue Code	301
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Arizona Complete Health Allwell	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$67.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.84
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$64.35
Rate for Payer: Devoted Health Medicare	$17.82
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Seven Corners Travel Insurance	$23.08
Rate for Payer: Southwest Service Administrators UFCW	$67.32
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: United Healthcare Commercial	$56.63
Rate for Payer: United Healthcare Medicare	$15.84
Rate for Payer: Veterans Affairs TRICARE	$15.68

Bill BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMM

Facility

$99.00

Service Code	CPT 82274
Hospital Charge Code	23621407
Hospital Revenue Code	301
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Cash Price	$79.20

Bill BRCAssure Comp

Facility

$5,269.00

Hospital Charge Code	23568393
Hospital Revenue Code	301
Min. Negotiated Rate	$834.61
Max. Negotiated Rate	$4,742.10
Rate for Payer: Aetna of AZ Commercial	$4,742.10
Rate for Payer: Arizona Complete Health Allwell	$843.04
Rate for Payer: Banner UC Health Medicare	$843.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,582.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$843.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$843.04
Rate for Payer: Cash Price	$4,215.20
Rate for Payer: Cigna of AZ Commercial	$3,424.85
Rate for Payer: Devoted Health Medicare	$948.42
Rate for Payer: Humana of AZ Medicare	$843.04
Rate for Payer: Southwest Service Administrators UFCW	$3,582.92
Rate for Payer: TriWest Medicare	$843.04
Rate for Payer: United Healthcare Commercial	$3,013.87
Rate for Payer: United Healthcare Medicare	$843.04
Rate for Payer: Veterans Affairs TRICARE	$834.61

Bill BRCAssure Comp

Facility

$5,269.00

Hospital Charge Code	23568393
Hospital Revenue Code	301
Min. Negotiated Rate	$4,742.10
Max. Negotiated Rate	$4,742.10
Rate for Payer: Aetna of AZ Commercial	$4,742.10
Rate for Payer: Cash Price	$4,215.20

Bill Capillary Draw

Facility

$34.00

Service Code	CPT 36416
Hospital Charge Code	10443835
Hospital Revenue Code	300
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.79
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$22.10
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39

Bill Capillary Draw

Facility

$34.00

Service Code	CPT 36416
Hospital Charge Code	10443835
Hospital Revenue Code	300
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Cash Price	$27.20

Bill CMV Quant DNA PCR

Facility

$320.00

Service Code	CPT 87497
Hospital Charge Code	23568396
Hospital Revenue Code	301
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna of AZ Commercial	$288.00
Rate for Payer: Arizona Complete Health Allwell	$51.20
Rate for Payer: Banner UC Health Medicare	$51.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$217.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$51.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$51.20
Rate for Payer: Cash Price	$256.00
Rate for Payer: Cash Price	$256.00
Rate for Payer: Cigna of AZ Commercial	$208.00
Rate for Payer: Devoted Health Medicare	$57.60
Rate for Payer: Humana of AZ Medicare	$51.20
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Southwest Service Administrators UFCW	$217.60
Rate for Payer: TriWest Medicare	$51.20
Rate for Payer: United Healthcare Commercial	$183.04
Rate for Payer: United Healthcare Medicare	$51.20
Rate for Payer: Veterans Affairs TRICARE	$50.69

Bill CMV Quant DNA PCR

Facility

$320.00

Service Code	CPT 87497
Hospital Charge Code	23568396
Hospital Revenue Code	301
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna of AZ Commercial	$288.00
Rate for Payer: Cash Price	$256.00

Bill Cryo Prep/Thaw

Facility

$177.00

Service Code	CPT 86931
Hospital Charge Code	22248792
Hospital Revenue Code	302
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

Bill Cryo Prep/Thaw

Facility

$177.00

Service Code	CPT 86931
Hospital Charge Code	22248792
Hospital Revenue Code	302
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$263.61
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	$263.61
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

Bill Culture ID Aerobie Confirm

Facility

$138.00

Service Code	CPT 87077
Hospital Charge Code	22374498
Hospital Revenue Code	306
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Arizona Complete Health Allwell	$22.08
Rate for Payer: Banner UC Health Medicare	$22.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$93.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.08
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cigna of AZ Commercial	$89.70
Rate for Payer: Devoted Health Medicare	$24.84
Rate for Payer: Humana of AZ Medicare	$22.08
Rate for Payer: Seven Corners Travel Insurance	$11.72
Rate for Payer: Southwest Service Administrators UFCW	$93.84
Rate for Payer: TriWest Medicare	$22.08
Rate for Payer: United Healthcare Commercial	$78.94
Rate for Payer: United Healthcare Medicare	$22.08
Rate for Payer: Veterans Affairs TRICARE	$21.86

Bill Culture ID Aerobie Confirm

Facility

$138.00

Service Code	CPT 87077
Hospital Charge Code	22374498
Hospital Revenue Code	306
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Cash Price	$110.40

Bill Culture Stool, Vibrio Only

Facility

$88.00

Service Code	CPT 87046
Hospital Charge Code	22374496
Hospital Revenue Code	306
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Cash Price	$70.40

Bill Culture Stool, Vibrio Only

Facility

$88.00

Service Code	CPT 87046
Hospital Charge Code	22374496
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Arizona Complete Health Allwell	$14.08
Rate for Payer: Banner UC Health Medicare	$14.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$59.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.08
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$57.20
Rate for Payer: Devoted Health Medicare	$15.84
Rate for Payer: Humana of AZ Medicare	$14.08
Rate for Payer: Seven Corners Travel Insurance	$13.69
Rate for Payer: Southwest Service Administrators UFCW	$59.84
Rate for Payer: TriWest Medicare	$14.08
Rate for Payer: United Healthcare Commercial	$50.34
Rate for Payer: United Healthcare Medicare	$14.08
Rate for Payer: Veterans Affairs TRICARE	$13.94

BILL CULTURE STOOL, YERSINIA ONLY

Facility

$116.00

Service Code	CPT 87046
Hospital Charge Code	22374494
Hospital Revenue Code	306
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Cash Price	$92.80

BILL CULTURE STOOL, YERSINIA ONLY

Facility

$116.00

Service Code	CPT 87046
Hospital Charge Code	22374494
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Arizona Complete Health Allwell	$18.56
Rate for Payer: Banner UC Health Medicare	$18.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$78.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.56
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$75.40
Rate for Payer: Devoted Health Medicare	$20.88
Rate for Payer: Humana of AZ Medicare	$18.56
Rate for Payer: Seven Corners Travel Insurance	$13.69
Rate for Payer: Southwest Service Administrators UFCW	$78.88
Rate for Payer: TriWest Medicare	$18.56
Rate for Payer: United Healthcare Commercial	$66.35
Rate for Payer: United Healthcare Medicare	$18.56
Rate for Payer: Veterans Affairs TRICARE	$18.37

Bill Cystic Fibrosis Profile

Facility

$252.00

Service Code	CPT 81220
Hospital Charge Code	23568394
Hospital Revenue Code	301
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna of AZ Commercial	$226.80
Rate for Payer: Cash Price	$201.60

Bill Cystic Fibrosis Profile

Facility

$252.00

Service Code	CPT 81220
Hospital Charge Code	23568394
Hospital Revenue Code	301
Min. Negotiated Rate	$39.92
Max. Negotiated Rate	$807.07
Rate for Payer: Aetna of AZ Commercial	$226.80
Rate for Payer: Arizona Complete Health Allwell	$40.32
Rate for Payer: Banner UC Health Medicare	$40.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$171.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.32
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cigna of AZ Commercial	$163.80
Rate for Payer: Devoted Health Medicare	$45.36
Rate for Payer: Humana of AZ Medicare	$40.32
Rate for Payer: Seven Corners Travel Insurance	$807.07
Rate for Payer: Southwest Service Administrators UFCW	$171.36
Rate for Payer: TriWest Medicare	$40.32
Rate for Payer: United Healthcare Commercial	$144.14
Rate for Payer: United Healthcare Medicare	$40.32
Rate for Payer: Veterans Affairs TRICARE	$39.92

Bill FFP Prep/Thaw

Facility

$255.00

Service Code	CPT 86927
Hospital Charge Code	22248793
Hospital Revenue Code	302
Min. Negotiated Rate	$40.39
Max. Negotiated Rate	$263.61
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Arizona Complete Health Allwell	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$173.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Devoted Health Medicare	$45.90
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Seven Corners Travel Insurance	$263.61
Rate for Payer: Southwest Service Administrators UFCW	$173.40
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: United Healthcare Commercial	$145.86
Rate for Payer: United Healthcare Medicare	$40.80
Rate for Payer: Veterans Affairs TRICARE	$40.39

Bill FFP Prep/Thaw

Facility

$255.00

Service Code	CPT 86927
Hospital Charge Code	22248793
Hospital Revenue Code	302
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Cash Price	$204.00

Bill Hep b dna quant

Facility

$1,416.00

Service Code	CPT 87912
Hospital Charge Code	23568533
Hospital Revenue Code	301
Min. Negotiated Rate	$224.29
Max. Negotiated Rate	$1,274.40
Rate for Payer: Aetna of AZ Commercial	$1,274.40
Rate for Payer: Arizona Complete Health Allwell	$226.56
Rate for Payer: Banner UC Health Medicare	$226.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$962.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$226.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$226.56
Rate for Payer: Cash Price	$1,132.80
Rate for Payer: Cash Price	$1,132.80
Rate for Payer: Cigna of AZ Commercial	$920.40
Rate for Payer: Devoted Health Medicare	$254.88
Rate for Payer: Humana of AZ Medicare	$226.56
Rate for Payer: Seven Corners Travel Insurance	$373.30
Rate for Payer: Southwest Service Administrators UFCW	$962.88
Rate for Payer: TriWest Medicare	$226.56
Rate for Payer: United Healthcare Commercial	$809.95
Rate for Payer: United Healthcare Medicare	$226.56
Rate for Payer: Veterans Affairs TRICARE	$224.29

Know your out-of-pocket cost for care.

All Charges