Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cocaine Abuse And Dependence

Facility

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06
Rate for Payer: NaphCare Correctional Healthcare	$2,586.06

Cocaine Abuse And Dependence

Facility

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25
Rate for Payer: NaphCare Correctional Healthcare	$2,327.25

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17
Rate for Payer: NaphCare Correctional Healthcare	$12,860.17

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17
Rate for Payer: NaphCare Correctional Healthcare	$12,860.17

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60
Rate for Payer: NaphCare Correctional Healthcare	$4,609.60

Cocaine Abuse And Dependence

Facility

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06
Rate for Payer: NaphCare Correctional Healthcare	$2,586.06

Cocaine Abuse And Dependence

Facility

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25
Rate for Payer: NaphCare Correctional Healthcare	$2,327.25

Cocaine Abuse And Dependence

Facility

$12,860.17

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$12,860.17
Max. Negotiated Rate	$12,860.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,860.17
Rate for Payer: Mercy Care Medicaid	$12,860.17
Rate for Payer: NaphCare Correctional Healthcare	$12,860.17

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60
Rate for Payer: NaphCare Correctional Healthcare	$4,609.60

Cocaine Abuse And Dependence

Facility

$4,609.60

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$4,609.60
Max. Negotiated Rate	$4,609.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,609.60
Rate for Payer: Mercy Care Medicaid	$4,609.60
Rate for Payer: NaphCare Correctional Healthcare	$4,609.60

COCAINE METABOLITE

Facility

$237.00

Hospital Charge Code	23294367
Hospital Revenue Code	301
Min. Negotiated Rate	$37.54
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Arizona Complete Health Allwell	$37.92
Rate for Payer: Banner UC Health Medicare	$37.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.92
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Devoted Health Medicare	$42.66
Rate for Payer: Humana of AZ Medicare	$37.92
Rate for Payer: Southwest Service Administrators UFCW	$161.16
Rate for Payer: TriWest Medicare	$37.92
Rate for Payer: United Healthcare Commercial	$135.56
Rate for Payer: United Healthcare Medicare	$37.92
Rate for Payer: Veterans Affairs TRICARE	$37.54

COCAINE METABOLITE

Facility

$237.00

Hospital Charge Code	23294367
Hospital Revenue Code	301
Min. Negotiated Rate	$213.30
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Cash Price	$189.60

Coccidioides Abs, IgG/IgM, EIA LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22311185
Hospital Revenue Code	309
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Cash Price	$113.60

Coccidioides Abs, IgG/IgM, EIA LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22311185
Hospital Revenue Code	309
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Arizona Complete Health Allwell	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$96.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.72
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Devoted Health Medicare	$25.56
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Seven Corners Travel Insurance	$16.63
Rate for Payer: Southwest Service Administrators UFCW	$96.56
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: United Healthcare Commercial	$81.22
Rate for Payer: United Healthcare Medicare	$22.72
Rate for Payer: Veterans Affairs TRICARE	$22.49

.Coccidioides Abs, Qn, DID LC

Facility

$109.00

Service Code	CPT 86635
Hospital Charge Code	22311141
Hospital Revenue Code	302
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Cash Price	$87.20

.Coccidioides Abs, Qn, DID LC

Facility

$109.00

Service Code	CPT 86635
Hospital Charge Code	22311141
Hospital Revenue Code	302
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Arizona Complete Health Allwell	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$74.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.44
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$70.85
Rate for Payer: Devoted Health Medicare	$19.62
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Seven Corners Travel Insurance	$16.63
Rate for Payer: Southwest Service Administrators UFCW	$74.12
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: United Healthcare Commercial	$62.35
Rate for Payer: United Healthcare Medicare	$17.44
Rate for Payer: Veterans Affairs TRICARE	$17.27

Coccidioides Abs, Qn, DID LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22242102
Hospital Revenue Code	309
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Arizona Complete Health Allwell	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$96.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.72
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Devoted Health Medicare	$25.56
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Seven Corners Travel Insurance	$16.63
Rate for Payer: Southwest Service Administrators UFCW	$96.56
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: United Healthcare Commercial	$81.22
Rate for Payer: United Healthcare Medicare	$22.72
Rate for Payer: Veterans Affairs TRICARE	$22.49

Coccidioides Abs, Qn, DID LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	22242102
Hospital Revenue Code	309
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Cash Price	$113.60

Coccidioides CF Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311187
Hospital Revenue Code	302
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Arizona Complete Health Allwell	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$91.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$21.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$21.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$87.75
Rate for Payer: Devoted Health Medicare	$24.30
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Seven Corners Travel Insurance	$16.63
Rate for Payer: Southwest Service Administrators UFCW	$91.80
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: United Healthcare Commercial	$77.22
Rate for Payer: United Healthcare Medicare	$21.60
Rate for Payer: Veterans Affairs TRICARE	$21.38

Coccidioides CF Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311187
Hospital Revenue Code	302
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Cash Price	$108.00

Coccidioides ID Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311188
Hospital Revenue Code	302
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Cash Price	$108.00

Coccidioides ID Antibody LC

Facility

$135.00

Service Code	CPT 86635
Hospital Charge Code	22311188
Hospital Revenue Code	302
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Arizona Complete Health Allwell	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$91.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$21.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$21.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$87.75
Rate for Payer: Devoted Health Medicare	$24.30
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Seven Corners Travel Insurance	$16.63
Rate for Payer: Southwest Service Administrators UFCW	$91.80
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: United Healthcare Commercial	$77.22
Rate for Payer: United Healthcare Medicare	$21.60
Rate for Payer: Veterans Affairs TRICARE	$21.38

Coccidioides Immitis Antibodies LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	17541370
Hospital Revenue Code	302
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Arizona Complete Health Allwell	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$96.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.72
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Devoted Health Medicare	$25.56
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Seven Corners Travel Insurance	$16.63
Rate for Payer: Southwest Service Administrators UFCW	$96.56
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: United Healthcare Commercial	$81.22
Rate for Payer: United Healthcare Medicare	$22.72
Rate for Payer: Veterans Affairs TRICARE	$22.49

Coccidioides Immitis Antibodies LC

Facility

$142.00

Service Code	CPT 86635
Hospital Charge Code	17541370
Hospital Revenue Code	302
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Cash Price	$113.60

codeine-guaiFENesin 20 mg-200 mg/10 mL UD Oral Syrup

Facility

$0.03

Service Code	NDC 50383008712
Hospital Charge Code	105917195
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

Know your out-of-pocket cost for care.

All Charges