Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

FOLEY CATH 30CC 20FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796435
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Arizona Complete Health Allwell	$15.35
Rate for Payer: Banner UC Health Medicare	$15.35
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.35
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.35
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cigna of AZ Commercial	$67.17
Rate for Payer: Devoted Health Medicare	$17.27
Rate for Payer: Humana of AZ Medicare	$15.35
Rate for Payer: Southwest Service Administrators UFCW	$65.25
Rate for Payer: TriWest Medicare	$15.35
Rate for Payer: United Healthcare Commercial	$54.88
Rate for Payer: United Healthcare Medicare	$15.35
Rate for Payer: Veterans Affairs TRICARE	$15.20

FOLEY CATH 30CC 24FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796433
Hospital Revenue Code	270
Min. Negotiated Rate	$86.36
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Cash Price	$76.76

FOLEY CATH 30CC 24FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796433
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Arizona Complete Health Allwell	$15.35
Rate for Payer: Banner UC Health Medicare	$15.35
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.35
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.35
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cigna of AZ Commercial	$67.17
Rate for Payer: Devoted Health Medicare	$17.27
Rate for Payer: Humana of AZ Medicare	$15.35
Rate for Payer: Southwest Service Administrators UFCW	$65.25
Rate for Payer: TriWest Medicare	$15.35
Rate for Payer: United Healthcare Commercial	$54.88
Rate for Payer: United Healthcare Medicare	$15.35
Rate for Payer: Veterans Affairs TRICARE	$15.20

FOLEY CATH LATEX 18FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215468
Hospital Revenue Code	270
Min. Negotiated Rate	$76.21
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Cash Price	$67.74

FOLEY CATH LATEX 18FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215468
Hospital Revenue Code	270
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Arizona Complete Health Allwell	$13.55
Rate for Payer: Banner UC Health Medicare	$13.55
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.55
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.55
Rate for Payer: Cash Price	$67.74
Rate for Payer: Cigna of AZ Commercial	$59.28
Rate for Payer: Devoted Health Medicare	$15.24
Rate for Payer: Humana of AZ Medicare	$13.55
Rate for Payer: Southwest Service Administrators UFCW	$57.58
Rate for Payer: TriWest Medicare	$13.55
Rate for Payer: United Healthcare Commercial	$48.44
Rate for Payer: United Healthcare Medicare	$13.55
Rate for Payer: Veterans Affairs TRICARE	$13.41

FOLEY CATH LATEX 20FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215467
Hospital Revenue Code	270
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Arizona Complete Health Allwell	$13.55
Rate for Payer: Banner UC Health Medicare	$13.55
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.55
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.55
Rate for Payer: Cash Price	$67.74
Rate for Payer: Cigna of AZ Commercial	$59.28
Rate for Payer: Devoted Health Medicare	$15.24
Rate for Payer: Humana of AZ Medicare	$13.55
Rate for Payer: Southwest Service Administrators UFCW	$57.58
Rate for Payer: TriWest Medicare	$13.55
Rate for Payer: United Healthcare Commercial	$48.44
Rate for Payer: United Healthcare Medicare	$13.55
Rate for Payer: Veterans Affairs TRICARE	$13.41

FOLEY CATH LATEX 20FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215467
Hospital Revenue Code	270
Min. Negotiated Rate	$76.21
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Cash Price	$67.74

FOLEY CATH LATEX 22FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215470
Hospital Revenue Code	270
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Arizona Complete Health Allwell	$13.55
Rate for Payer: Banner UC Health Medicare	$13.55
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.55
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.55
Rate for Payer: Cash Price	$67.74
Rate for Payer: Cigna of AZ Commercial	$59.28
Rate for Payer: Devoted Health Medicare	$15.24
Rate for Payer: Humana of AZ Medicare	$13.55
Rate for Payer: Southwest Service Administrators UFCW	$57.58
Rate for Payer: TriWest Medicare	$13.55
Rate for Payer: United Healthcare Commercial	$48.44
Rate for Payer: United Healthcare Medicare	$13.55
Rate for Payer: Veterans Affairs TRICARE	$13.41

FOLEY CATH LATEX 22FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215470
Hospital Revenue Code	270
Min. Negotiated Rate	$76.21
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Cash Price	$67.74

FOLEY CATH LATEX 24FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215469
Hospital Revenue Code	270
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Arizona Complete Health Allwell	$13.55
Rate for Payer: Banner UC Health Medicare	$13.55
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.55
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.55
Rate for Payer: Cash Price	$67.74
Rate for Payer: Cigna of AZ Commercial	$59.28
Rate for Payer: Devoted Health Medicare	$15.24
Rate for Payer: Humana of AZ Medicare	$13.55
Rate for Payer: Southwest Service Administrators UFCW	$57.58
Rate for Payer: TriWest Medicare	$13.55
Rate for Payer: United Healthcare Commercial	$48.44
Rate for Payer: United Healthcare Medicare	$13.55
Rate for Payer: Veterans Affairs TRICARE	$13.41

FOLEY CATH LATEX 24FR 5CC 3 WAY

Facility

$84.68

Hospital Charge Code	28215469
Hospital Revenue Code	270
Min. Negotiated Rate	$76.21
Max. Negotiated Rate	$76.21
Rate for Payer: Aetna of AZ Commercial	$76.21
Rate for Payer: Cash Price	$67.74

folic acid 1 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 62584089701
Hospital Charge Code	105923258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.07
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

folic acid 1 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 62584089701
Hospital Charge Code	105923258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Cash Price	$0.10

folic acid 5 mg/mL Inj Sol [CQCH]

Facility

$2.04

Service Code	NDC 39822110001
Hospital Charge Code	105923323
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of AZ Commercial	$1.84
Rate for Payer: Arizona Complete Health Allwell	$0.33
Rate for Payer: Banner UC Health Medicare	$0.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.39
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.33
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.33
Rate for Payer: Cash Price	$1.63
Rate for Payer: Cigna of AZ Commercial	$1.33
Rate for Payer: Devoted Health Medicare	$0.37
Rate for Payer: Humana of AZ Medicare	$0.33
Rate for Payer: Southwest Service Administrators UFCW	$1.39
Rate for Payer: TriWest Medicare	$0.33
Rate for Payer: United Healthcare Commercial	$1.17
Rate for Payer: United Healthcare Medicare	$0.33
Rate for Payer: Veterans Affairs TRICARE	$0.32

folic acid 5 mg/mL Inj Sol [CQCH]

Facility

$2.04

Service Code	NDC 39822110001
Hospital Charge Code	105923323
Hospital Revenue Code	251
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of AZ Commercial	$1.84
Rate for Payer: Cash Price	$1.63

Folic Acid(FOLATE)

Facility

$181.00

Service Code	CPT 82746
Hospital Charge Code	22540594
Hospital Revenue Code	301
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

Folic Acid(FOLATE)

Facility

$181.00

Service Code	CPT 82746
Hospital Charge Code	22540594
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.96
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Seven Corners Travel Insurance	$21.32
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: Veterans Affairs TRICARE	$28.67

Food Allergy Profile LC

Facility

$1,062.00

Service Code	CPT 86003
Hospital Charge Code	22201915
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$955.80
Rate for Payer: Aetna of AZ Commercial	$955.80
Rate for Payer: Arizona Complete Health Allwell	$169.92
Rate for Payer: Banner UC Health Medicare	$169.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$722.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$169.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$169.92
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cigna of AZ Commercial	$690.30
Rate for Payer: Devoted Health Medicare	$191.16
Rate for Payer: Humana of AZ Medicare	$169.92
Rate for Payer: Seven Corners Travel Insurance	$7.57
Rate for Payer: Southwest Service Administrators UFCW	$722.16
Rate for Payer: TriWest Medicare	$169.92
Rate for Payer: United Healthcare Commercial	$607.46
Rate for Payer: United Healthcare Medicare	$169.92
Rate for Payer: Veterans Affairs TRICARE	$168.22

Food Allergy Profile LC

Facility

$1,062.00

Service Code	CPT 86003
Hospital Charge Code	22201915
Hospital Revenue Code	302
Min. Negotiated Rate	$955.80
Max. Negotiated Rate	$955.80
Rate for Payer: Aetna of AZ Commercial	$955.80
Rate for Payer: Cash Price	$849.60

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3142
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07
Rate for Payer: NaphCare Correctional Healthcare	$7,850.07

Foot And Toe Procedures

Facility

$21,326.77

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$21,326.77
Max. Negotiated Rate	$21,326.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,326.77
Rate for Payer: Mercy Care Medicaid	$21,326.77
Rate for Payer: NaphCare Correctional Healthcare	$21,326.77

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3141
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07
Rate for Payer: NaphCare Correctional Healthcare	$7,850.07

Foot And Toe Procedures

Facility

$7,268.61

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$7,268.61
Max. Negotiated Rate	$7,268.61
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,268.61
Rate for Payer: Mercy Care Medicaid	$7,268.61
Rate for Payer: NaphCare Correctional Healthcare	$7,268.61

Foot And Toe Procedures

Facility

$11,056.87

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG3144
Min. Negotiated Rate	$11,056.87
Max. Negotiated Rate	$11,056.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,056.87
Rate for Payer: Mercy Care Medicaid	$11,056.87
Rate for Payer: NaphCare Correctional Healthcare	$11,056.87

Foot And Toe Procedures

Facility

$7,850.07

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG3143
Min. Negotiated Rate	$7,850.07
Max. Negotiated Rate	$7,850.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,850.07
Rate for Payer: Mercy Care Medicaid	$7,850.07
Rate for Payer: NaphCare Correctional Healthcare	$7,850.07

Know your out-of-pocket cost for care.

All Charges