Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Carnitine, Total and Free LC

Facility

$305.00

Service Code	CPT 82379
Hospital Charge Code	2029258
Hospital Revenue Code	301
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Arizona Complete Health Allwell	$48.80
Rate for Payer: Banner UC Health Medicare	$48.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$207.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.80
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cigna of AZ Commercial	$198.25
Rate for Payer: Devoted Health Medicare	$54.90
Rate for Payer: Humana of AZ Medicare	$48.80
Rate for Payer: Seven Corners Travel Insurance	$24.46
Rate for Payer: Southwest Service Administrators UFCW	$207.40
Rate for Payer: TriWest Medicare	$48.80
Rate for Payer: United Healthcare Commercial	$174.46
Rate for Payer: United Healthcare Medicare	$48.80
Rate for Payer: Veterans Affairs TRICARE	$48.31

Carnitine, Total and Free LC

Facility

$305.00

Service Code	CPT 82379
Hospital Charge Code	2029258
Hospital Revenue Code	301
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Cash Price	$244.00

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$30,895.15

Service Code	MSDRG 035
Min. Negotiated Rate	$30,895.15
Max. Negotiated Rate	$30,895.15
Rate for Payer: Seven Corners Travel Insurance	$30,895.15

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$50,025.46

Service Code	MSDRG 034
Min. Negotiated Rate	$50,025.46
Max. Negotiated Rate	$50,025.46
Rate for Payer: Seven Corners Travel Insurance	$50,025.46

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$25,109.04

Service Code	MSDRG 036
Min. Negotiated Rate	$25,109.04
Max. Negotiated Rate	$25,109.04
Rate for Payer: Seven Corners Travel Insurance	$25,109.04

carvedilol 12.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904630261
Hospital Charge Code	105914717
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

carvedilol 12.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904630261
Hospital Charge Code	105914717
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

carvedilol 3.125 mg Tab UD [CQCH]

Facility

$0.08

Service Code	NDC 904630061
Hospital Charge Code	107994520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
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	$0.05
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	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.05
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

carvedilol 3.125 mg Tab UD [CQCH]

Facility

$0.08

Service Code	NDC 904630061
Hospital Charge Code	107994520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Cash Price	$0.06

carvedilol 6.25 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 904630161
Hospital Charge Code	105914782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Cash Price	$0.06

carvedilol 6.25 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 904630161
Hospital Charge Code	105914782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
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	$0.05
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	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.05
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

Catalase

Facility

$83.00

Service Code	CPT 86403
Hospital Charge Code	634031
Hospital Revenue Code	301
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Cash Price	$66.40

Catalase

Facility

$83.00

Service Code	CPT 86403
Hospital Charge Code	634031
Hospital Revenue Code	301
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Arizona Complete Health Allwell	$13.28
Rate for Payer: Banner UC Health Medicare	$13.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$56.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.28
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Devoted Health Medicare	$14.94
Rate for Payer: Humana of AZ Medicare	$13.28
Rate for Payer: Seven Corners Travel Insurance	$16.73
Rate for Payer: Southwest Service Administrators UFCW	$56.44
Rate for Payer: TriWest Medicare	$13.28
Rate for Payer: United Healthcare Commercial	$47.48
Rate for Payer: United Healthcare Medicare	$13.28
Rate for Payer: Veterans Affairs TRICARE	$13.15

CATCHER BAGS

Facility

$62.00

Hospital Charge Code	22354919
Hospital Revenue Code	270
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

CATCHER BAGS

Facility

$62.00

Hospital Charge Code	22354919
Hospital Revenue Code	270
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

Catecholamines, Plasma LC

Facility

$365.00

Service Code	CPT 82384
Hospital Charge Code	2029228
Hospital Revenue Code	301
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Arizona Complete Health Allwell	$58.40
Rate for Payer: Banner UC Health Medicare	$58.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$248.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$58.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$58.40
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cigna of AZ Commercial	$237.25
Rate for Payer: Devoted Health Medicare	$65.70
Rate for Payer: Humana of AZ Medicare	$58.40
Rate for Payer: Seven Corners Travel Insurance	$36.61
Rate for Payer: Southwest Service Administrators UFCW	$248.20
Rate for Payer: TriWest Medicare	$58.40
Rate for Payer: United Healthcare Commercial	$208.78
Rate for Payer: United Healthcare Medicare	$58.40
Rate for Payer: Veterans Affairs TRICARE	$57.82

Catecholamines, Plasma LC

Facility

$365.00

Service Code	CPT 82384
Hospital Charge Code	2029228
Hospital Revenue Code	301
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Cash Price	$292.00

Catecholamines,Ur.,Free,24 Hr LC

Facility

$312.00

Service Code	CPT 82384
Hospital Charge Code	2029235
Hospital Revenue Code	301
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Arizona Complete Health Allwell	$49.92
Rate for Payer: Banner UC Health Medicare	$49.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$212.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.92
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cigna of AZ Commercial	$202.80
Rate for Payer: Devoted Health Medicare	$56.16
Rate for Payer: Humana of AZ Medicare	$49.92
Rate for Payer: Seven Corners Travel Insurance	$36.61
Rate for Payer: Southwest Service Administrators UFCW	$212.16
Rate for Payer: TriWest Medicare	$49.92
Rate for Payer: United Healthcare Commercial	$178.46
Rate for Payer: United Healthcare Medicare	$49.92
Rate for Payer: Veterans Affairs TRICARE	$49.42

Catecholamines,Ur.,Free,24 Hr LC

Facility

$312.00

Service Code	CPT 82384
Hospital Charge Code	2029235
Hospital Revenue Code	301
Min. Negotiated Rate	$280.80
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Cash Price	$249.60

CATH, CLOSED SUCTION,14FR,DBL, ETT,24HR

Facility

$61.00

Hospital Charge Code	23028277
Hospital Revenue Code	272
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Cash Price	$48.80

CATH, CLOSED SUCTION,14FR,DBL, ETT,24HR

Facility

$61.00

Hospital Charge Code	23028277
Hospital Revenue Code	272
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Arizona Complete Health Allwell	$9.76
Rate for Payer: Banner UC Health Medicare	$9.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$41.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.76
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Devoted Health Medicare	$10.98
Rate for Payer: Humana of AZ Medicare	$9.76
Rate for Payer: Southwest Service Administrators UFCW	$41.48
Rate for Payer: TriWest Medicare	$9.76
Rate for Payer: United Healthcare Commercial	$34.89
Rate for Payer: United Healthcare Medicare	$9.76
Rate for Payer: Veterans Affairs TRICARE	$9.66

CATH COUDE TIEMANN 12F

Facility

$48.00

Service Code	HCPCS A4340
Hospital Charge Code	22355182
Hospital Revenue Code	270
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Cash Price	$38.40

CATH COUDE TIEMANN 12F

Facility

$48.00

Service Code	HCPCS A4340
Hospital Charge Code	22355182
Hospital Revenue Code	270
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Arizona Complete Health Allwell	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.68
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Devoted Health Medicare	$8.64
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Southwest Service Administrators UFCW	$32.64
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: United Healthcare Commercial	$27.46
Rate for Payer: United Healthcare Medicare	$7.68
Rate for Payer: Veterans Affairs TRICARE	$7.60

CATH COUDE TIEMANN 14F

Facility

$48.00

Service Code	HCPCS A4340
Hospital Charge Code	22355162
Hospital Revenue Code	270
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Cash Price	$38.40

CATH COUDE TIEMANN 14F

Facility

$48.00

Service Code	HCPCS A4340
Hospital Charge Code	22355162
Hospital Revenue Code	270
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Arizona Complete Health Allwell	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.68
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Devoted Health Medicare	$8.64
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Southwest Service Administrators UFCW	$32.64
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: United Healthcare Commercial	$27.46
Rate for Payer: United Healthcare Medicare	$7.68
Rate for Payer: Veterans Affairs TRICARE	$7.60

Know your out-of-pocket cost for care.

All Charges