Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

chlordiazePOXIDE 25 mg Cap [CQCH]

Facility

$0.52

Service Code	NDC 555015902
Hospital Charge Code	105916113
Hospital Revenue Code	251
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of AZ Commercial	$0.47
Rate for Payer: Cash Price	$0.42

Chloride Level

Facility

$75.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Cash Price	$60.00

Chloride Level

Facility

$75.00

Service Code	CPT 82435
Hospital Charge Code	633621
Hospital Revenue Code	301
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Arizona Complete Health Allwell	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$48.75
Rate for Payer: Devoted Health Medicare	$13.50
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Seven Corners Travel Insurance	$6.67
Rate for Payer: Southwest Service Administrators UFCW	$51.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: United Healthcare Commercial	$42.90
Rate for Payer: United Healthcare Medicare	$12.00
Rate for Payer: Veterans Affairs TRICARE	$11.88

CHLORIDE URIN

Facility

$71.00

Service Code	CPT 82436
Hospital Charge Code	22481466
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$46.15
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Seven Corners Travel Insurance	$8.34
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

CHLORIDE URIN

Facility

$71.00

Service Code	CPT 82436
Hospital Charge Code	22481466
Hospital Revenue Code	301
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

chlorproMAZINE 25 mg/mL Sol[CQCH]

Facility

$24.18

Service Code	HCPCS J3230
Hospital Charge Code	136256467
Hospital Revenue Code	250
Min. Negotiated Rate	$21.76
Max. Negotiated Rate	$21.76
Rate for Payer: Aetna of AZ Commercial	$21.76
Rate for Payer: Cash Price	$19.35

chlorproMAZINE 25 mg/mL Sol[CQCH]

Facility

$24.18

Service Code	HCPCS J3230
Hospital Charge Code	136256467
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$21.76
Rate for Payer: Aetna of AZ Commercial	$21.76
Rate for Payer: Arizona Complete Health Allwell	$3.87
Rate for Payer: Banner UC Health Medicare	$3.87
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$16.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.87
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.87
Rate for Payer: Cash Price	$19.35
Rate for Payer: Cigna of AZ Commercial	$15.72
Rate for Payer: Devoted Health Medicare	$4.35
Rate for Payer: Humana of AZ Medicare	$3.87
Rate for Payer: Southwest Service Administrators UFCW	$16.44
Rate for Payer: TriWest Medicare	$3.87
Rate for Payer: United Healthcare Commercial	$13.83
Rate for Payer: United Healthcare Medicare	$3.87
Rate for Payer: Veterans Affairs TRICARE	$3.83

chlorproMAZINE 50 mg inj Sol [CQCH]

Facility

$11.65

Service Code	HCPCS J3230
Hospital Charge Code	108650203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna of AZ Commercial	$10.48
Rate for Payer: Arizona Complete Health Allwell	$1.86
Rate for Payer: Banner UC Health Medicare	$1.86
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.86
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.86
Rate for Payer: Cash Price	$9.32
Rate for Payer: Cigna of AZ Commercial	$7.57
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Humana of AZ Medicare	$1.86
Rate for Payer: Southwest Service Administrators UFCW	$7.92
Rate for Payer: TriWest Medicare	$1.86
Rate for Payer: United Healthcare Commercial	$6.66
Rate for Payer: United Healthcare Medicare	$1.86
Rate for Payer: Veterans Affairs TRICARE	$1.85

chlorproMAZINE 50 mg inj Sol [CQCH]

Facility

$11.65

Service Code	HCPCS J3230
Hospital Charge Code	108650203
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna of AZ Commercial	$10.48
Rate for Payer: Cash Price	$9.32

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31
Rate for Payer: NaphCare Correctional Healthcare	$8,723.31

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21
Rate for Payer: NaphCare Correctional Healthcare	$6,917.21

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31
Rate for Payer: NaphCare Correctional Healthcare	$8,723.31

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27
Rate for Payer: NaphCare Correctional Healthcare	$11,408.27

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$23,209.33
Max. Negotiated Rate	$23,209.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,209.33
Rate for Payer: Mercy Care Medicaid	$23,209.33
Rate for Payer: NaphCare Correctional Healthcare	$23,209.33

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27
Rate for Payer: NaphCare Correctional Healthcare	$11,408.27

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2632
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31
Rate for Payer: NaphCare Correctional Healthcare	$8,723.31

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27
Rate for Payer: NaphCare Correctional Healthcare	$11,408.27

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$23,209.33
Max. Negotiated Rate	$23,209.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,209.33
Rate for Payer: Mercy Care Medicaid	$23,209.33
Rate for Payer: NaphCare Correctional Healthcare	$23,209.33

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$23,209.33
Max. Negotiated Rate	$23,209.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,209.33
Rate for Payer: Mercy Care Medicaid	$23,209.33
Rate for Payer: NaphCare Correctional Healthcare	$23,209.33

Cholecystectomy

Facility

$8,723.31

Service Code	APR-DRG 2632
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$8,723.31
Max. Negotiated Rate	$8,723.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,723.31
Rate for Payer: Mercy Care Medicaid	$8,723.31
Rate for Payer: NaphCare Correctional Healthcare	$8,723.31

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2633
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21
Rate for Payer: NaphCare Correctional Healthcare	$6,917.21

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21
Rate for Payer: NaphCare Correctional Healthcare	$6,917.21

Cholecystectomy

Facility

$6,917.21

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$6,917.21
Max. Negotiated Rate	$6,917.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,917.21
Rate for Payer: Mercy Care Medicaid	$6,917.21
Rate for Payer: NaphCare Correctional Healthcare	$6,917.21

Cholecystectomy

Facility

$11,408.27

Service Code	APR-DRG 2633
Hospital Charge Code	APRDRG2634
Min. Negotiated Rate	$11,408.27
Max. Negotiated Rate	$11,408.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,408.27
Rate for Payer: Mercy Care Medicaid	$11,408.27
Rate for Payer: NaphCare Correctional Healthcare	$11,408.27

Cholecystectomy

Facility

$23,209.33

Service Code	APR-DRG 2634
Hospital Charge Code	APRDRG2631
Min. Negotiated Rate	$23,209.33
Max. Negotiated Rate	$23,209.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$23,209.33
Rate for Payer: Mercy Care Medicaid	$23,209.33
Rate for Payer: NaphCare Correctional Healthcare	$23,209.33

Know your out-of-pocket cost for care.

All Charges