Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

Bill Hep b genotype

Facility

$546.00

Service Code	CPT 87912
Hospital Charge Code	23568534
Hospital Revenue Code	301
Min. Negotiated Rate	$86.49
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Arizona Complete Health Allwell	$87.36
Rate for Payer: Banner UC Health Medicare	$87.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$371.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$87.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$87.36
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cigna of AZ Commercial	$354.90
Rate for Payer: Devoted Health Medicare	$98.28
Rate for Payer: Humana of AZ Medicare	$87.36
Rate for Payer: Seven Corners Travel Insurance	$373.30
Rate for Payer: Southwest Service Administrators UFCW	$371.28
Rate for Payer: TriWest Medicare	$87.36
Rate for Payer: United Healthcare Commercial	$312.31
Rate for Payer: United Healthcare Medicare	$87.36
Rate for Payer: Veterans Affairs TRICARE	$86.49

Bill Hep b genotype

Facility

$546.00

Service Code	CPT 87912
Hospital Charge Code	23568534
Hospital Revenue Code	301
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Cash Price	$436.80

Bill HIV-1 RNA

Facility

$653.00

Service Code	CPT 87536
Hospital Charge Code	22985134
Hospital Revenue Code	306
Min. Negotiated Rate	$587.70
Max. Negotiated Rate	$587.70
Rate for Payer: Aetna of AZ Commercial	$587.70
Rate for Payer: Cash Price	$522.40

Bill HIV-1 RNA

Facility

$653.00

Service Code	CPT 87536
Hospital Charge Code	22985134
Hospital Revenue Code	306
Min. Negotiated Rate	$103.44
Max. Negotiated Rate	$587.70
Rate for Payer: Aetna of AZ Commercial	$587.70
Rate for Payer: Arizona Complete Health Allwell	$104.48
Rate for Payer: Banner UC Health Medicare	$104.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$444.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$104.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$104.48
Rate for Payer: Cash Price	$522.40
Rate for Payer: Cash Price	$522.40
Rate for Payer: Cigna of AZ Commercial	$424.45
Rate for Payer: Devoted Health Medicare	$117.54
Rate for Payer: Humana of AZ Medicare	$104.48
Rate for Payer: Seven Corners Travel Insurance	$123.39
Rate for Payer: Southwest Service Administrators UFCW	$444.04
Rate for Payer: TriWest Medicare	$104.48
Rate for Payer: United Healthcare Commercial	$373.52
Rate for Payer: United Healthcare Medicare	$104.48
Rate for Payer: Veterans Affairs TRICARE	$103.44

Bill Ige Dog dander

Facility

$76.00

Service Code	CPT 86003
Hospital Charge Code	23217726
Hospital Revenue Code	301
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Arizona Complete Health Allwell	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.16
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Devoted Health Medicare	$13.68
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$51.68
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: United Healthcare Commercial	$43.47
Rate for Payer: United Healthcare Medicare	$12.16
Rate for Payer: Veterans Affairs TRICARE	$12.04

Bill Ige Dog dander

Facility

$76.00

Service Code	CPT 86003
Hospital Charge Code	23217726
Hospital Revenue Code	301
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Cash Price	$60.80

Bill Irradiation

Facility

$44.00

Service Code	CPT 86945
Hospital Charge Code	4176274
Hospital Revenue Code	390
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Cash Price	$35.20

Bill Irradiation

Facility

$44.00

Service Code	CPT 86945
Hospital Charge Code	4176274
Hospital Revenue Code	390
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$57.80
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Arizona Complete Health Allwell	$7.04
Rate for Payer: Banner UC Health Medicare	$7.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$29.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.04
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$28.60
Rate for Payer: Devoted Health Medicare	$7.92
Rate for Payer: Humana of AZ Medicare	$7.04
Rate for Payer: Seven Corners Travel Insurance	$57.80
Rate for Payer: Southwest Service Administrators UFCW	$29.92
Rate for Payer: TriWest Medicare	$7.04
Rate for Payer: United Healthcare Commercial	$25.17
Rate for Payer: United Healthcare Medicare	$7.04
Rate for Payer: Veterans Affairs TRICARE	$6.97

Bill Observed Chain of Custody

Facility

$47.00

Service Code	CPT 81001
Hospital Charge Code	22511902
Hospital Revenue Code	300
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

Bill Observed Chain of Custody

Facility

$47.00

Service Code	CPT 81001
Hospital Charge Code	22511902
Hospital Revenue Code	300
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Seven Corners Travel Insurance	$4.60
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

Bill Only Antigen Testing

Facility

$237.00

Service Code	CPT 86903
Hospital Charge Code	1807550
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

Bill Only Antigen Testing

Facility

$237.00

Service Code	CPT 86903
Hospital Charge Code	1807550
Hospital Revenue Code	302
Min. Negotiated Rate	$37.54
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: 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: 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

Bill Organic Acid Analysis

Facility

$284.00

Service Code	CPT 83919
Hospital Charge Code	23568395
Hospital Revenue Code	301
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Cash Price	$227.20

Bill Organic Acid Analysis

Facility

$284.00

Service Code	CPT 83919
Hospital Charge Code	23568395
Hospital Revenue Code	301
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Arizona Complete Health Allwell	$45.44
Rate for Payer: Banner UC Health Medicare	$45.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$193.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.44
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cigna of AZ Commercial	$184.60
Rate for Payer: Devoted Health Medicare	$51.12
Rate for Payer: Humana of AZ Medicare	$45.44
Rate for Payer: Seven Corners Travel Insurance	$23.85
Rate for Payer: Southwest Service Administrators UFCW	$193.12
Rate for Payer: TriWest Medicare	$45.44
Rate for Payer: United Healthcare Commercial	$162.45
Rate for Payer: United Healthcare Medicare	$45.44
Rate for Payer: Veterans Affairs TRICARE	$44.99

Bill PROCALCITONIN (PCT)

Facility

$200.00

Service Code	CPT 84145
Hospital Charge Code	23568450
Hospital Revenue Code	301
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Arizona Complete Health Allwell	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$136.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$130.00
Rate for Payer: Devoted Health Medicare	$36.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Seven Corners Travel Insurance	$39.47
Rate for Payer: Southwest Service Administrators UFCW	$136.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: United Healthcare Commercial	$114.40
Rate for Payer: United Healthcare Medicare	$32.00
Rate for Payer: Veterans Affairs TRICARE	$31.68

Bill PROCALCITONIN (PCT)

Facility

$200.00

Service Code	CPT 84145
Hospital Charge Code	23568450
Hospital Revenue Code	301
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Cash Price	$160.00

Bill Venous Draw

Facility

$41.00

Service Code	CPT 36415
Hospital Charge Code	16751369
Hospital Revenue Code	300
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

Bill Venous Draw

Facility

$41.00

Service Code	CPT 36415
Hospital Charge Code	16751369
Hospital Revenue Code	300
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

BINDER ABDOMINAL 10-IN UNIV

Facility

$42.00

Service Code	HCPCS A4462
Hospital Charge Code	22354188
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Cash Price	$33.60

BINDER ABDOMINAL 10-IN UNIV

Facility

$42.00

Service Code	HCPCS A4462
Hospital Charge Code	22354188
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Arizona Complete Health Allwell	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.72
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$6.72
Rate for Payer: Southwest Service Administrators UFCW	$28.56
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: United Healthcare Commercial	$24.02
Rate for Payer: United Healthcare Medicare	$6.72
Rate for Payer: Veterans Affairs TRICARE	$6.65

BINDER ABDOMINAL 9-IN UNIV

Facility

$97.00

Service Code	HCPCS A4462
Hospital Charge Code	22354274
Hospital Revenue Code	270
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Cash Price	$77.60

BINDER ABDOMINAL 9-IN UNIV

Facility

$97.00

Service Code	HCPCS A4462
Hospital Charge Code	22354274
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$31,783.04

Service Code	MSDRG 478
Min. Negotiated Rate	$31,783.04
Max. Negotiated Rate	$31,783.04
Rate for Payer: Seven Corners Travel Insurance	$31,783.04

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$44,647.72

Service Code	MSDRG 477
Min. Negotiated Rate	$44,647.72
Max. Negotiated Rate	$44,647.72
Rate for Payer: Seven Corners Travel Insurance	$44,647.72

Know your out-of-pocket cost for care.

All Charges