Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

citalopram 20 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904608561
Hospital Charge Code	105916535
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

Citric Acid (Citrate), Urine LC

Facility

$327.00

Service Code	CPT 82507
Hospital Charge Code	2029186
Hospital Revenue Code	302
Min. Negotiated Rate	$40.31
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Arizona Complete Health Allwell	$52.32
Rate for Payer: Banner UC Health Medicare	$52.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$222.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.32
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cigna of AZ Commercial	$212.55
Rate for Payer: Devoted Health Medicare	$58.86
Rate for Payer: Humana of AZ Medicare	$52.32
Rate for Payer: Seven Corners Travel Insurance	$40.31
Rate for Payer: Southwest Service Administrators UFCW	$222.36
Rate for Payer: TriWest Medicare	$52.32
Rate for Payer: United Healthcare Commercial	$187.04
Rate for Payer: United Healthcare Medicare	$52.32
Rate for Payer: Veterans Affairs TRICARE	$51.80

Citric Acid (Citrate), Urine LC

Facility

$327.00

Service Code	CPT 82507
Hospital Charge Code	2029186
Hospital Revenue Code	302
Min. Negotiated Rate	$294.30
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna of AZ Commercial	$294.30
Rate for Payer: Cash Price	$261.60

citric acid-sodium citrate Oral Sol 30 mL UD [CQCH]

Facility

$0.02

Service Code	NDC 121059530
Hospital Charge Code	105916602
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
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	$0.01
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	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

citric acid-sodium citrate Oral Sol 30 mL UD [CQCH]

Facility

$0.02

Service Code	NDC 121059530
Hospital Charge Code	105916602
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Cash Price	$0.02

CK ISOENZYMES

Facility

$160.00

Service Code	CPT 82552
Hospital Charge Code	22481468
Hospital Revenue Code	301
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Arizona Complete Health Allwell	$25.60
Rate for Payer: Banner UC Health Medicare	$25.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$108.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cigna of AZ Commercial	$104.00
Rate for Payer: Devoted Health Medicare	$28.80
Rate for Payer: Humana of AZ Medicare	$25.60
Rate for Payer: Seven Corners Travel Insurance	$19.42
Rate for Payer: Southwest Service Administrators UFCW	$108.80
Rate for Payer: TriWest Medicare	$25.60
Rate for Payer: United Healthcare Commercial	$91.52
Rate for Payer: United Healthcare Medicare	$25.60
Rate for Payer: Veterans Affairs TRICARE	$25.34

CK ISOENZYMES

Facility

$160.00

Service Code	CPT 82552
Hospital Charge Code	22481468
Hospital Revenue Code	301
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Cash Price	$128.00

CK-MB

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	9091368
Hospital Revenue Code	301
Min. Negotiated Rate	$288.90
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Cash Price	$256.80

CK-MB

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	9091368
Hospital Revenue Code	301
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Arizona Complete Health Allwell	$51.36
Rate for Payer: Banner UC Health Medicare	$51.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$218.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$51.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$51.36
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$208.65
Rate for Payer: Devoted Health Medicare	$57.78
Rate for Payer: Humana of AZ Medicare	$51.36
Rate for Payer: Seven Corners Travel Insurance	$16.75
Rate for Payer: Southwest Service Administrators UFCW	$218.28
Rate for Payer: TriWest Medicare	$51.36
Rate for Payer: United Healthcare Commercial	$183.61
Rate for Payer: United Healthcare Medicare	$51.36
Rate for Payer: Veterans Affairs TRICARE	$50.85

CKMB

Facility

$337.00

Service Code	CPT 82553
Hospital Charge Code	22481469
Hospital Revenue Code	301
Min. Negotiated Rate	$303.30
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Cash Price	$269.60

CKMB

Facility

$337.00

Service Code	CPT 82553
Hospital Charge Code	22481469
Hospital Revenue Code	301
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Arizona Complete Health Allwell	$53.92
Rate for Payer: Banner UC Health Medicare	$53.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$229.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.92
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cigna of AZ Commercial	$219.05
Rate for Payer: Devoted Health Medicare	$60.66
Rate for Payer: Humana of AZ Medicare	$53.92
Rate for Payer: Seven Corners Travel Insurance	$16.75
Rate for Payer: Southwest Service Administrators UFCW	$229.16
Rate for Payer: TriWest Medicare	$53.92
Rate for Payer: United Healthcare Commercial	$192.76
Rate for Payer: United Healthcare Medicare	$53.92
Rate for Payer: Veterans Affairs TRICARE	$53.38

CK, Total+Isoenzymes, Serum LC

Facility

$78.00

Service Code	CPT 82550
Hospital Charge Code	2087571
Hospital Revenue Code	301
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Arizona Complete Health Allwell	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.48
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Seven Corners Travel Insurance	$9.44
Rate for Payer: Southwest Service Administrators UFCW	$53.04
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: United Healthcare Commercial	$44.62
Rate for Payer: United Healthcare Medicare	$12.48
Rate for Payer: Veterans Affairs TRICARE	$12.36

CK, Total+Isoenzymes, Serum LC

Facility

$78.00

Service Code	CPT 82550
Hospital Charge Code	2087571
Hospital Revenue Code	301
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Cash Price	$62.40

CLEANER WOUND BIOLEX 6OZ

Facility

$46.00

Hospital Charge Code	27567551
Hospital Revenue Code	270
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Cash Price	$36.80

CLEANER WOUND BIOLEX 6OZ

Facility

$46.00

Hospital Charge Code	27567551
Hospital Revenue Code	270
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Arizona Complete Health Allwell	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.36
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Devoted Health Medicare	$8.28
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Southwest Service Administrators UFCW	$31.28
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: United Healthcare Commercial	$26.31
Rate for Payer: United Healthcare Medicare	$7.36
Rate for Payer: Veterans Affairs TRICARE	$7.29

CLEANER WOUND BIOLEX 6OZ

Facility

$48.00

Hospital Charge Code	22355158
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

CLEANER WOUND BIOLEX 6OZ

Facility

$48.00

Hospital Charge Code	22355158
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

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18
Rate for Payer: NaphCare Correctional Healthcare	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18
Rate for Payer: NaphCare Correctional Healthcare	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89
Rate for Payer: NaphCare Correctional Healthcare	$5,557.89

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18
Rate for Payer: NaphCare Correctional Healthcare	$5,099.18

Cleft Lip And Palate Repair

Facility

$8,627.92

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$8,627.92
Max. Negotiated Rate	$8,627.92
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,627.92
Rate for Payer: Mercy Care Medicaid	$8,627.92
Rate for Payer: NaphCare Correctional Healthcare	$8,627.92

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89
Rate for Payer: NaphCare Correctional Healthcare	$5,557.89

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78
Rate for Payer: NaphCare Correctional Healthcare	$19,327.78

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78
Rate for Payer: NaphCare Correctional Healthcare	$19,327.78

Know your out-of-pocket cost for care.

All Charges