Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

calcium carbonate 500 mg Chew Tab [CQCH]

Facility

$0.06

Service Code	NDC 66553000401
Hospital Charge Code	105914049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.03
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

calcium carbonate 500 mg Chew Tab [CQCH]

Facility

$0.06

Service Code	NDC 66553000401
Hospital Charge Code	105914049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Cash Price	$0.05

calcium carbonate 500 mg Tab (Oscal) [CQCH]

Facility

$0.03

Service Code	NDC 904188361
Hospital Charge Code	105914116
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Cash Price	$0.02

calcium carbonate 500 mg Tab (Oscal) [CQCH]

Facility

$0.03

Service Code	NDC 904188361
Hospital Charge Code	105914116
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

calcium chloride 1 gm/ 10 ml PFS [CQCH]

Facility

$0.62

Service Code	NDC 409163110
Hospital Charge Code	105914181
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Arizona Complete Health Allwell	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.42
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.10
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Southwest Service Administrators UFCW	$0.42
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: United Healthcare Commercial	$0.35
Rate for Payer: United Healthcare Medicare	$0.10
Rate for Payer: Veterans Affairs TRICARE	$0.10

calcium chloride 1 gm/ 10 ml PFS [CQCH]

Facility

$0.62

Service Code	NDC 409163110
Hospital Charge Code	105914181
Hospital Revenue Code	251
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Cash Price	$0.50

calcium gluconate 1 gm/ 10 mL Inj Sol [CQCH]

Facility

$0.77

Service Code	HCPCS J0610
Hospital Charge Code	105914248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Arizona Complete Health Allwell	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.12
Rate for Payer: Cash Price	$0.61
Rate for Payer: Cigna of AZ Commercial	$0.50
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Southwest Service Administrators UFCW	$0.52
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: United Healthcare Commercial	$0.44
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: Veterans Affairs TRICARE	$0.12

calcium gluconate 1 gm/ 10 mL Inj Sol [CQCH]

Facility

$0.77

Service Code	HCPCS J0610
Hospital Charge Code	105914248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Cash Price	$0.61

Calcium, Ionized, Serum LC

Facility

$163.00

Service Code	CPT 82330
Hospital Charge Code	1285782
Hospital Revenue Code	301
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Arizona Complete Health Allwell	$26.08
Rate for Payer: Banner UC Health Medicare	$26.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$110.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.08
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cigna of AZ Commercial	$105.95
Rate for Payer: Devoted Health Medicare	$29.34
Rate for Payer: Humana of AZ Medicare	$26.08
Rate for Payer: Seven Corners Travel Insurance	$19.84
Rate for Payer: Southwest Service Administrators UFCW	$110.84
Rate for Payer: TriWest Medicare	$26.08
Rate for Payer: United Healthcare Commercial	$93.24
Rate for Payer: United Healthcare Medicare	$26.08
Rate for Payer: Veterans Affairs TRICARE	$25.82

Calcium, Ionized, Serum LC

Facility

$163.00

Service Code	CPT 82330
Hospital Charge Code	1285782
Hospital Revenue Code	301
Min. Negotiated Rate	$146.70
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Cash Price	$130.40

Calcium Level Total

Facility

$74.00

Service Code	CPT 82310
Hospital Charge Code	633690
Hospital Revenue Code	301
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Cash Price	$59.20

Calcium Level Total

Facility

$74.00

Service Code	CPT 82310
Hospital Charge Code	633690
Hospital Revenue Code	301
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Arizona Complete Health Allwell	$11.84
Rate for Payer: Banner UC Health Medicare	$11.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$50.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.84
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$48.10
Rate for Payer: Devoted Health Medicare	$13.32
Rate for Payer: Humana of AZ Medicare	$11.84
Rate for Payer: Seven Corners Travel Insurance	$7.48
Rate for Payer: Southwest Service Administrators UFCW	$50.32
Rate for Payer: TriWest Medicare	$11.84
Rate for Payer: United Healthcare Commercial	$42.33
Rate for Payer: United Healthcare Medicare	$11.84
Rate for Payer: Veterans Affairs TRICARE	$11.72

CALCUCATCH

Facility

$18.00

Hospital Charge Code	22355206
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Cash Price	$14.40

CALCUCATCH

Facility

$18.00

Hospital Charge Code	22355206
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Arizona Complete Health Allwell	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.88
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Devoted Health Medicare	$3.24
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Southwest Service Administrators UFCW	$12.24
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: United Healthcare Commercial	$10.30
Rate for Payer: United Healthcare Medicare	$2.88
Rate for Payer: Veterans Affairs TRICARE	$2.85

CALCULI, URIN

Facility

$152.00

Service Code	CPT 82340
Hospital Charge Code	22481465
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
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	$8.74
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

CALCULI, URIN

Facility

$152.00

Service Code	CPT 82340
Hospital Charge Code	22481465
Hospital Revenue Code	301
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

Calculi, Urinary LC

Facility

$139.00

Service Code	CPT 82340
Hospital Charge Code	2029217
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Arizona Complete Health Allwell	$22.24
Rate for Payer: Banner UC Health Medicare	$22.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$94.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.24
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$90.35
Rate for Payer: Devoted Health Medicare	$25.02
Rate for Payer: Humana of AZ Medicare	$22.24
Rate for Payer: Seven Corners Travel Insurance	$8.74
Rate for Payer: Southwest Service Administrators UFCW	$94.52
Rate for Payer: TriWest Medicare	$22.24
Rate for Payer: United Healthcare Commercial	$79.51
Rate for Payer: United Healthcare Medicare	$22.24
Rate for Payer: Veterans Affairs TRICARE	$22.02

Calculi, Urinary LC

Facility

$139.00

Service Code	CPT 82340
Hospital Charge Code	2029217
Hospital Revenue Code	301
Min. Negotiated Rate	$125.10
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Cash Price	$111.20

Calculi, Urinary With Photograph LC

Facility

$108.00

Service Code	CPT 82365
Hospital Charge Code	23889064
Hospital Revenue Code	302
Min. Negotiated Rate	$17.11
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	$18.70
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

Calculi, Urinary With Photograph LC

Facility

$108.00

Service Code	CPT 82365
Hospital Charge Code	23889064
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

CALMOSEPTINE 2.50Z

Facility

$30.00

Hospital Charge Code	23288844
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Cash Price	$24.00

CALMOSEPTINE 2.50Z

Facility

$30.00

Hospital Charge Code	23288844
Hospital Revenue Code	272
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Arizona Complete Health Allwell	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$20.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Devoted Health Medicare	$5.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Southwest Service Administrators UFCW	$20.40
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: United Healthcare Commercial	$17.16
Rate for Payer: United Healthcare Medicare	$4.80
Rate for Payer: Veterans Affairs TRICARE	$4.75

Calprotectin Fecal LC

Facility

$355.00

Service Code	CPT 83993
Hospital Charge Code	6780842
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Aetna of AZ Commercial	$442.80
Rate for Payer: Arizona Complete Health Allwell	$78.72
Rate for Payer: Arizona Complete Health Allwell	$56.80
Rate for Payer: Banner UC Health Medicare	$78.72
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 Commercial	$334.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$56.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$78.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$56.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$78.72
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cigna of AZ Commercial	$319.80
Rate for Payer: Cigna of AZ Commercial	$230.75
Rate for Payer: Devoted Health Medicare	$88.56
Rate for Payer: Devoted Health Medicare	$63.90
Rate for Payer: Humana of AZ Medicare	$56.80
Rate for Payer: Humana of AZ Medicare	$78.72
Rate for Payer: Seven Corners Travel Insurance	$28.46
Rate for Payer: Seven Corners Travel Insurance	$28.46
Rate for Payer: Southwest Service Administrators UFCW	$334.56
Rate for Payer: Southwest Service Administrators UFCW	$241.40
Rate for Payer: TriWest Medicare	$56.80
Rate for Payer: TriWest Medicare	$78.72
Rate for Payer: United Healthcare Commercial	$203.06
Rate for Payer: United Healthcare Commercial	$281.42
Rate for Payer: United Healthcare Medicare	$56.80
Rate for Payer: United Healthcare Medicare	$78.72
Rate for Payer: Veterans Affairs TRICARE	$77.93
Rate for Payer: Veterans Affairs TRICARE	$56.23

Calprotectin Fecal LC

Facility

$492.00

Service Code	CPT 83993
Hospital Charge Code	6780842
Hospital Revenue Code	301
Min. Negotiated Rate	$442.80
Max. Negotiated Rate	$442.80
Rate for Payer: Aetna of AZ Commercial	$442.80
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cash Price	$284.00

CALR Mutation Analysis LC

Facility

$701.00

Service Code	CPT 81219
Hospital Charge Code	22311181
Hospital Revenue Code	302
Min. Negotiated Rate	$630.90
Max. Negotiated Rate	$630.90
Rate for Payer: Aetna of AZ Commercial	$630.90
Rate for Payer: Cash Price	$560.80

Know your out-of-pocket cost for care.

All Charges