Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

FIT

Facility

$106.00

Service Code	HCPCS G0328 QW
Hospital Charge Code	22068803
Hospital Revenue Code	301
Min. Negotiated Rate	$16.79
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Arizona Complete Health Allwell	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.96
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$68.90
Rate for Payer: Devoted Health Medicare	$19.08
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Seven Corners Travel Insurance	$26.17
Rate for Payer: Southwest Service Administrators UFCW	$72.08
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: United Healthcare Commercial	$60.63
Rate for Payer: United Healthcare Medicare	$16.96
Rate for Payer: Veterans Affairs TRICARE	$16.79

FIT

Facility

$106.00

Service Code	HCPCS G0328 QW
Hospital Charge Code	22068803
Hospital Revenue Code	301
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Cash Price	$84.80

flecainide 100 mg Tab [CQCH]

Facility

$0.67

Service Code	NDC 50268032115
Hospital Charge Code	112812246
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of AZ Commercial	$0.60
Rate for Payer: Arizona Complete Health Allwell	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.46
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.11
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.11
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cigna of AZ Commercial	$0.44
Rate for Payer: Devoted Health Medicare	$0.12
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Southwest Service Administrators UFCW	$0.46
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: United Healthcare Commercial	$0.38
Rate for Payer: United Healthcare Medicare	$0.11
Rate for Payer: Veterans Affairs TRICARE	$0.11

flecainide 100 mg Tab [CQCH]

Facility

$0.67

Service Code	NDC 50268032115
Hospital Charge Code	112812246
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of AZ Commercial	$0.60
Rate for Payer: Cash Price	$0.53

Fleets Saline Enema 133 mL [CQCH]

Facility

$0.99

Service Code	NDC 132020140
Hospital Charge Code	105941046
Hospital Revenue Code	251
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Cash Price	$0.79

Fleets Saline Enema 133 mL [CQCH]

Facility

$0.99

Service Code	NDC 132020140
Hospital Charge Code	105941046
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Arizona Complete Health Allwell	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.67
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.16
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of AZ Commercial	$0.64
Rate for Payer: Devoted Health Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Southwest Service Administrators UFCW	$0.67
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: United Healthcare Commercial	$0.57
Rate for Payer: United Healthcare Medicare	$0.16
Rate for Payer: Veterans Affairs TRICARE	$0.16

FLEXIBLE SIGMOIDOSCOPY

Facility

$482.00

Hospital Charge Code	1184683
Hospital Revenue Code	750
Min. Negotiated Rate	$433.80
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Cash Price	$385.60

FLEXIBLE SIGMOIDOSCOPY

Facility

$482.00

Hospital Charge Code	1184683
Hospital Revenue Code	750
Min. Negotiated Rate	$76.35
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Arizona Complete Health Allwell	$77.12
Rate for Payer: Banner UC Health Medicare	$77.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$327.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$77.12
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$337.40
Rate for Payer: Devoted Health Medicare	$86.76
Rate for Payer: Humana of AZ Medicare	$77.12
Rate for Payer: Southwest Service Administrators UFCW	$327.76
Rate for Payer: TriWest Medicare	$77.12
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$77.12
Rate for Payer: United Healthcare New Mexico Commercial	$91.58
Rate for Payer: Veterans Affairs TRICARE	$76.35

FLEXIVA PULSE ID 550

Facility

$3,162.25

Hospital Charge Code	27844713
Hospital Revenue Code	270
Min. Negotiated Rate	$2,846.03
Max. Negotiated Rate	$2,846.03
Rate for Payer: Aetna of AZ Commercial	$2,846.03
Rate for Payer: Cash Price	$2,529.80

FLEXIVA PULSE ID 550

Facility

$3,162.25

Hospital Charge Code	27844713
Hospital Revenue Code	270
Min. Negotiated Rate	$500.90
Max. Negotiated Rate	$2,846.03
Rate for Payer: Aetna of AZ Commercial	$2,846.03
Rate for Payer: Arizona Complete Health Allwell	$505.96
Rate for Payer: Banner UC Health Medicare	$505.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,150.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$505.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$505.96
Rate for Payer: Cash Price	$2,529.80
Rate for Payer: Cigna of AZ Commercial	$2,213.57
Rate for Payer: Devoted Health Medicare	$569.21
Rate for Payer: Humana of AZ Medicare	$505.96
Rate for Payer: Southwest Service Administrators UFCW	$2,150.33
Rate for Payer: TriWest Medicare	$505.96
Rate for Payer: United Healthcare Commercial	$1,808.81
Rate for Payer: United Healthcare Medicare	$505.96
Rate for Payer: Veterans Affairs TRICARE	$500.90

florastor 250mg cap [CQCH]

Facility

$0.53

Service Code	NDC 66825000201
Hospital Charge Code	108083252
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Aetna of AZ Commercial	$0.48
Rate for Payer: Cash Price	$0.42

florastor 250mg cap [CQCH]

Facility

$0.53

Service Code	NDC 66825000201
Hospital Charge Code	108083252
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.48
Rate for Payer: Aetna of AZ Commercial	$0.48
Rate for Payer: Arizona Complete Health Allwell	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.08
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of AZ Commercial	$0.34
Rate for Payer: Devoted Health Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Southwest Service Administrators UFCW	$0.36
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: United Healthcare Commercial	$0.30
Rate for Payer: United Healthcare Medicare	$0.08
Rate for Payer: Veterans Affairs TRICARE	$0.08

fluconazole 100 mg Tab [CQCH]

Facility

$1.57

Service Code	NDC 68084072801
Hospital Charge Code	105922853
Hospital Revenue Code	251
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of AZ Commercial	$1.41
Rate for Payer: Cash Price	$1.26

fluconazole 100 mg Tab [CQCH]

Facility

$1.57

Service Code	NDC 68084072801
Hospital Charge Code	105922853
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of AZ Commercial	$1.41
Rate for Payer: Arizona Complete Health Allwell	$0.25
Rate for Payer: Banner UC Health Medicare	$0.25
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.07
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.25
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.25
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of AZ Commercial	$1.02
Rate for Payer: Devoted Health Medicare	$0.28
Rate for Payer: Humana of AZ Medicare	$0.25
Rate for Payer: Southwest Service Administrators UFCW	$1.07
Rate for Payer: TriWest Medicare	$0.25
Rate for Payer: United Healthcare Commercial	$0.90
Rate for Payer: United Healthcare Medicare	$0.25
Rate for Payer: Veterans Affairs TRICARE	$0.25

fludrocortisone 0.1 mg Tab [CQCH]

Facility

$0.77

Service Code	NDC 50268033015
Hospital Charge Code	105922918
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Cash Price	$0.62

fludrocortisone 0.1 mg Tab [CQCH]

Facility

$0.77

Service Code	NDC 50268033015
Hospital Charge Code	105922918
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Arizona Complete Health Allwell	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.12
Rate for Payer: Cash Price	$0.62
Rate for Payer: Cigna of AZ Commercial	$0.50
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Southwest Service Administrators UFCW	$0.52
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: United Healthcare Commercial	$0.44
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: Veterans Affairs TRICARE	$0.12

FLUENT DISPOSABLE PACK

Facility

$990.00

Hospital Charge Code	27448974
Hospital Revenue Code	270
Min. Negotiated Rate	$156.82
Max. Negotiated Rate	$891.00
Rate for Payer: Aetna of AZ Commercial	$891.00
Rate for Payer: Arizona Complete Health Allwell	$158.40
Rate for Payer: Banner UC Health Medicare	$158.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$673.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$158.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$158.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cigna of AZ Commercial	$693.00
Rate for Payer: Devoted Health Medicare	$178.20
Rate for Payer: Humana of AZ Medicare	$158.40
Rate for Payer: Southwest Service Administrators UFCW	$673.20
Rate for Payer: TriWest Medicare	$158.40
Rate for Payer: United Healthcare Commercial	$566.28
Rate for Payer: United Healthcare Medicare	$158.40
Rate for Payer: Veterans Affairs TRICARE	$156.82

FLUENT DISPOSABLE PACK

Facility

$990.00

Hospital Charge Code	27448974
Hospital Revenue Code	270
Min. Negotiated Rate	$891.00
Max. Negotiated Rate	$891.00
Rate for Payer: Aetna of AZ Commercial	$891.00
Rate for Payer: Cash Price	$792.00

FLUID TRAP

Facility

$325.00

Hospital Charge Code	27770816
Hospital Revenue Code	270
Min. Negotiated Rate	$51.48
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna of AZ Commercial	$292.50
Rate for Payer: Arizona Complete Health Allwell	$52.00
Rate for Payer: Banner UC Health Medicare	$52.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$221.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cigna of AZ Commercial	$227.50
Rate for Payer: Devoted Health Medicare	$58.50
Rate for Payer: Humana of AZ Medicare	$52.00
Rate for Payer: Southwest Service Administrators UFCW	$221.00
Rate for Payer: TriWest Medicare	$52.00
Rate for Payer: United Healthcare Commercial	$185.90
Rate for Payer: United Healthcare Medicare	$52.00
Rate for Payer: Veterans Affairs TRICARE	$51.48

FLUID TRAP

Facility

$325.00

Hospital Charge Code	27770816
Hospital Revenue Code	270
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna of AZ Commercial	$292.50
Rate for Payer: Cash Price	$260.00

flumazenil 0.5 mg/5 mL IV Sol [CQCH]

Facility

$0.61

Service Code	NDC 63323042405
Hospital Charge Code	105922998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of AZ Commercial	$0.55
Rate for Payer: Cash Price	$0.49

flumazenil 0.5 mg/5 mL IV Sol [CQCH]

Facility

$0.61

Service Code	NDC 63323042405
Hospital Charge Code	105922998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of AZ Commercial	$0.55
Rate for Payer: Arizona Complete Health Allwell	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.41
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.10
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Southwest Service Administrators UFCW	$0.41
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: United Healthcare Commercial	$0.35
Rate for Payer: United Healthcare Medicare	$0.10
Rate for Payer: Veterans Affairs TRICARE	$0.10

fluorescein 1 mg ophthalmic Test strip [CQCH]

Facility

$0.93

Service Code	NDC 17238090011
Hospital Charge Code	105923065
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of AZ Commercial	$0.84
Rate for Payer: Arizona Complete Health Allwell	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.63
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.15
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.15
Rate for Payer: Cash Price	$0.74
Rate for Payer: Cigna of AZ Commercial	$0.60
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Southwest Service Administrators UFCW	$0.63
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: United Healthcare Commercial	$0.53
Rate for Payer: United Healthcare Medicare	$0.15
Rate for Payer: Veterans Affairs TRICARE	$0.15

fluorescein 1 mg ophthalmic Test strip [CQCH]

Facility

$0.93

Service Code	NDC 17238090011
Hospital Charge Code	105923065
Hospital Revenue Code	251
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of AZ Commercial	$0.84
Rate for Payer: Cash Price	$0.74

fluorescein-proparacaine ophthalmic 0.25%-0.5% Sol[CQCH]

Facility

$7.37

Service Code	NDC 54799050721
Hospital Charge Code	134270412
Hospital Revenue Code	251
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna of AZ Commercial	$6.63
Rate for Payer: Cash Price	$5.90

Know your out-of-pocket cost for care.

All Charges