Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CAPTIVATOR COLD SNARE

Facility

$72.00

Hospital Charge Code	23833620
Hospital Revenue Code	270
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Arizona Complete Health Allwell	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.52
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Devoted Health Medicare	$12.96
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Southwest Service Administrators UFCW	$48.96
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: United Healthcare Commercial	$41.18
Rate for Payer: United Healthcare Medicare	$11.52
Rate for Payer: Veterans Affairs TRICARE	$11.40

CAPTIVATOR COLD SNARE

Facility

$72.00

Hospital Charge Code	23833620
Hospital Revenue Code	270
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Cash Price	$57.60

captopril 25 mg Tab [CQCH]

Facility

$0.83

Service Code	NDC 51079086420
Hospital Charge Code	105914325
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of AZ Commercial	$0.75
Rate for Payer: Arizona Complete Health Allwell	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.13
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.13
Rate for Payer: Cash Price	$0.66
Rate for Payer: Cigna of AZ Commercial	$0.54
Rate for Payer: Devoted Health Medicare	$0.15
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Southwest Service Administrators UFCW	$0.56
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: United Healthcare Commercial	$0.47
Rate for Payer: United Healthcare Medicare	$0.13
Rate for Payer: Veterans Affairs TRICARE	$0.13

captopril 25 mg Tab [CQCH]

Facility

$0.83

Service Code	NDC 51079086420
Hospital Charge Code	105914325
Hospital Revenue Code	251
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna of AZ Commercial	$0.75
Rate for Payer: Cash Price	$0.66

CAPTURA THREE PRONG GRASPER 2.8

Facility

$1,098.50

Hospital Charge Code	29573822
Hospital Revenue Code	270
Min. Negotiated Rate	$988.65
Max. Negotiated Rate	$988.65
Rate for Payer: Aetna of AZ Commercial	$988.65
Rate for Payer: Cash Price	$878.80

CAPTURA THREE PRONG GRASPER 2.8

Facility

$1,098.50

Hospital Charge Code	29573822
Hospital Revenue Code	270
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$988.65
Rate for Payer: Aetna of AZ Commercial	$988.65
Rate for Payer: Arizona Complete Health Allwell	$175.76
Rate for Payer: Banner UC Health Medicare	$175.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$746.98
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$175.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$175.76
Rate for Payer: Cash Price	$878.80
Rate for Payer: Cigna of AZ Commercial	$768.95
Rate for Payer: Devoted Health Medicare	$197.73
Rate for Payer: Humana of AZ Medicare	$175.76
Rate for Payer: Southwest Service Administrators UFCW	$746.98
Rate for Payer: TriWest Medicare	$175.76
Rate for Payer: United Healthcare Commercial	$628.34
Rate for Payer: United Healthcare Medicare	$175.76
Rate for Payer: Veterans Affairs TRICARE	$174.00

carBAMazepine 200 mg Tab [CQCH]

Facility

$0.45

Service Code	NDC 904617261
Hospital Charge Code	105914390
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Arizona Complete Health Allwell	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.07
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.29
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.31
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.26
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.07

carBAMazepine 200 mg Tab [CQCH]

Facility

$0.45

Service Code	NDC 904617261
Hospital Charge Code	105914390
Hospital Revenue Code	251
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Cash Price	$0.36

Carbamazepine Level

Facility

$218.00

Service Code	CPT 80156
Hospital Charge Code	633694
Hospital Revenue Code	301
Min. Negotiated Rate	$21.13
Max. Negotiated Rate	$196.20
Rate for Payer: Aetna of AZ Commercial	$196.20
Rate for Payer: Arizona Complete Health Allwell	$34.88
Rate for Payer: Banner UC Health Medicare	$34.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$148.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.88
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cigna of AZ Commercial	$141.70
Rate for Payer: Devoted Health Medicare	$39.24
Rate for Payer: Humana of AZ Medicare	$34.88
Rate for Payer: Seven Corners Travel Insurance	$21.13
Rate for Payer: Southwest Service Administrators UFCW	$148.24
Rate for Payer: TriWest Medicare	$34.88
Rate for Payer: United Healthcare Commercial	$124.70
Rate for Payer: United Healthcare Medicare	$34.88
Rate for Payer: Veterans Affairs TRICARE	$34.53

Carbamazepine Level

Facility

$218.00

Service Code	CPT 80156
Hospital Charge Code	633694
Hospital Revenue Code	301
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$196.20
Rate for Payer: Aetna of AZ Commercial	$196.20
Rate for Payer: Cash Price	$174.40

carbidopa-levodopa 10 mg-100 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 63739004610
Hospital Charge Code	105914455
Hospital Revenue Code	251
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Cash Price	$0.16

carbidopa-levodopa 10 mg-100 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 63739004610
Hospital Charge Code	105914455
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.14
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.11
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

carbidopa-levodopa 25 mg-100 mg DIS Tablet [CQCH]

Facility

$0.84

Service Code	NDC 47335018788
Hospital Charge Code	126238058
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Arizona Complete Health Allwell	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.57
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.13
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.13
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of AZ Commercial	$0.55
Rate for Payer: Devoted Health Medicare	$0.15
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Southwest Service Administrators UFCW	$0.57
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: United Healthcare Commercial	$0.48
Rate for Payer: United Healthcare Medicare	$0.13
Rate for Payer: Veterans Affairs TRICARE	$0.13

carbidopa-levodopa 25 mg-100 mg DIS Tablet [CQCH]

Facility

$0.84

Service Code	NDC 47335018788
Hospital Charge Code	126238058
Hospital Revenue Code	251
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Cash Price	$0.68

carbidopa-levodopa 25 mg-100 mg ER Tab [CQCH]

Facility

$0.22

Service Code	NDC 51079097820
Hospital Charge Code	105914520
Hospital Revenue Code	251
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Cash Price	$0.18

carbidopa-levodopa 25 mg-100 mg ER Tab [CQCH]

Facility

$0.22

Service Code	NDC 51079097820
Hospital Charge Code	105914520
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.15
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.13
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.03

carbidopa-levodopa 25 mg-100 mg Tab-IR[CQCH]

Facility

$0.19

Service Code	NDC 904725761
Hospital Charge Code	105914587
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Cash Price	$0.15

carbidopa-levodopa 25 mg-100 mg Tab-IR[CQCH]

Facility

$0.19

Service Code	NDC 904725761
Hospital Charge Code	105914587
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.11
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

carbidopa-levodopa 25 mg-250 mg IR Tab [CQCH]

Facility

$0.29

Service Code	NDC 60687083601
Hospital Charge Code	107994470
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Arizona Complete Health Allwell	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.05
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.05
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of AZ Commercial	$0.19
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Southwest Service Administrators UFCW	$0.20
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: United Healthcare Commercial	$0.17
Rate for Payer: United Healthcare Medicare	$0.05
Rate for Payer: Veterans Affairs TRICARE	$0.05

carbidopa-levodopa 25 mg-250 mg IR Tab [CQCH]

Facility

$0.29

Service Code	NDC 60687083601
Hospital Charge Code	107994470
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Cash Price	$0.23

Carbohydrate Antigen 19-9 LC

Facility

$245.00

Service Code	CPT 86301
Hospital Charge Code	2269492
Hospital Revenue Code	302
Min. Negotiated Rate	$30.17
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Arizona Complete Health Allwell	$39.20
Rate for Payer: Banner UC Health Medicare	$39.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$166.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.20
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cigna of AZ Commercial	$159.25
Rate for Payer: Devoted Health Medicare	$44.10
Rate for Payer: Humana of AZ Medicare	$39.20
Rate for Payer: Seven Corners Travel Insurance	$30.17
Rate for Payer: Southwest Service Administrators UFCW	$166.60
Rate for Payer: TriWest Medicare	$39.20
Rate for Payer: United Healthcare Commercial	$140.14
Rate for Payer: United Healthcare Medicare	$39.20
Rate for Payer: Veterans Affairs TRICARE	$38.81

Carbohydrate Antigen 19-9 LC

Facility

$245.00

Service Code	CPT 86301
Hospital Charge Code	2269492
Hospital Revenue Code	302
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Cash Price	$196.00

Carbon Dioxide Level

Facility

$107.00

Service Code	CPT 82374
Hospital Charge Code	633626
Hospital Revenue Code	301
Min. Negotiated Rate	$7.08
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	$7.08
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

Carbon Dioxide Level

Facility

$107.00

Service Code	CPT 82374
Hospital Charge Code	633626
Hospital Revenue Code	301
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

Carbon Monoxide, Blood LC

Facility

$62.00

Service Code	CPT 82375
Hospital Charge Code	2029215
Hospital Revenue Code	302
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

Know your out-of-pocket cost for care.

All Charges