Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

hyoscyamine 0.125 mg Dis tab [CQCH}

Facility

$0.20

Service Code	NDC 42192033801
Hospital Charge Code	112802907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.14
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.11
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$32.00

Service Code	CPT 86331
Hospital Charge Code	23298035
Hospital Revenue Code	301
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Arizona Complete Health Allwell	$5.12
Rate for Payer: Banner UC Health Medicare	$5.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$21.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.12
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$20.80
Rate for Payer: Devoted Health Medicare	$5.76
Rate for Payer: Humana of AZ Medicare	$5.12
Rate for Payer: Seven Corners Travel Insurance	$17.37
Rate for Payer: Southwest Service Administrators UFCW	$21.76
Rate for Payer: TriWest Medicare	$5.12
Rate for Payer: United Healthcare Commercial	$18.30
Rate for Payer: United Healthcare Medicare	$5.12
Rate for Payer: Veterans Affairs TRICARE	$5.07

HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$32.00

Service Code	CPT 86331
Hospital Charge Code	23298035
Hospital Revenue Code	301
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Cash Price	$25.60

HYPERSENSITIVITY PNEUMONITIS PROFILE

Facility

$418.00

Service Code	CPT 86631
Hospital Charge Code	23298036
Hospital Revenue Code	301
Min. Negotiated Rate	$376.20
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Cash Price	$334.40

HYPERSENSITIVITY PNEUMONITIS PROFILE

Facility

$418.00

Service Code	CPT 86631
Hospital Charge Code	23298036
Hospital Revenue Code	301
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Arizona Complete Health Allwell	$66.88
Rate for Payer: Banner UC Health Medicare	$66.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$284.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$66.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$66.88
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cigna of AZ Commercial	$271.70
Rate for Payer: Devoted Health Medicare	$75.24
Rate for Payer: Humana of AZ Medicare	$66.88
Rate for Payer: Seven Corners Travel Insurance	$17.14
Rate for Payer: Southwest Service Administrators UFCW	$284.24
Rate for Payer: TriWest Medicare	$66.88
Rate for Payer: United Healthcare Commercial	$239.10
Rate for Payer: United Healthcare Medicare	$66.88
Rate for Payer: Veterans Affairs TRICARE	$66.21

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1991
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03
Rate for Payer: NaphCare Correctional Healthcare	$3,474.03

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97
Rate for Payer: NaphCare Correctional Healthcare	$9,200.97

Hypertension

Facility

$5,703.08

Service Code	APR-DRG 1993
Hospital Charge Code	APRDRG1991
Min. Negotiated Rate	$5,703.08
Max. Negotiated Rate	$5,703.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,703.08
Rate for Payer: Mercy Care Medicaid	$5,703.08
Rate for Payer: NaphCare Correctional Healthcare	$5,703.08

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1993
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97
Rate for Payer: NaphCare Correctional Healthcare	$9,200.97

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03
Rate for Payer: NaphCare Correctional Healthcare	$3,474.03

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1991
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97
Rate for Payer: NaphCare Correctional Healthcare	$9,200.97

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97
Rate for Payer: NaphCare Correctional Healthcare	$9,200.97

Hypertension

Facility

$4,081.45

Service Code	APR-DRG 1992
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$4,081.45
Max. Negotiated Rate	$4,081.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,081.45
Rate for Payer: Mercy Care Medicaid	$4,081.45
Rate for Payer: NaphCare Correctional Healthcare	$4,081.45

Hypertension

Facility

$4,081.45

Service Code	APR-DRG 1992
Hospital Charge Code	APRDRG1993
Min. Negotiated Rate	$4,081.45
Max. Negotiated Rate	$4,081.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,081.45
Rate for Payer: Mercy Care Medicaid	$4,081.45
Rate for Payer: NaphCare Correctional Healthcare	$4,081.45

Hypertension

Facility

$5,703.08

Service Code	APR-DRG 1993
Hospital Charge Code	APRDRG1993
Min. Negotiated Rate	$5,703.08
Max. Negotiated Rate	$5,703.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,703.08
Rate for Payer: Mercy Care Medicaid	$5,703.08
Rate for Payer: NaphCare Correctional Healthcare	$5,703.08

Hypertension

Facility

$5,703.08

Service Code	APR-DRG 1993
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$5,703.08
Max. Negotiated Rate	$5,703.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,703.08
Rate for Payer: Mercy Care Medicaid	$5,703.08
Rate for Payer: NaphCare Correctional Healthcare	$5,703.08

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1993
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03
Rate for Payer: NaphCare Correctional Healthcare	$3,474.03

Hypertension

Facility

$4,081.45

Service Code	APR-DRG 1992
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$4,081.45
Max. Negotiated Rate	$4,081.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,081.45
Rate for Payer: Mercy Care Medicaid	$4,081.45
Rate for Payer: NaphCare Correctional Healthcare	$4,081.45

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03
Rate for Payer: NaphCare Correctional Healthcare	$3,474.03

Hypertension

Facility

$5,703.08

Service Code	APR-DRG 1993
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$5,703.08
Max. Negotiated Rate	$5,703.08
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,703.08
Rate for Payer: Mercy Care Medicaid	$5,703.08
Rate for Payer: NaphCare Correctional Healthcare	$5,703.08

Hypertension

Facility

$4,081.45

Service Code	APR-DRG 1992
Hospital Charge Code	APRDRG1991
Min. Negotiated Rate	$4,081.45
Max. Negotiated Rate	$4,081.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,081.45
Rate for Payer: Mercy Care Medicaid	$4,081.45
Rate for Payer: NaphCare Correctional Healthcare	$4,081.45

HYPERTENSION WITH MCC

Facility

$15,434.15

Service Code	MSDRG 304
Min. Negotiated Rate	$15,434.15
Max. Negotiated Rate	$15,434.15
Rate for Payer: Seven Corners Travel Insurance	$15,434.15

HYPERTENSION WITHOUT MCC

Facility

$9,923.42

Service Code	MSDRG 305
Min. Negotiated Rate	$9,923.42
Max. Negotiated Rate	$9,923.42
Rate for Payer: Seven Corners Travel Insurance	$9,923.42

Hypovolemia And Related Electrolyte Disorders

Facility

$3,302.19

Service Code	APR-DRG 4222
Hospital Charge Code	APRDRG4224
Min. Negotiated Rate	$3,302.19
Max. Negotiated Rate	$3,302.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,302.19
Rate for Payer: Mercy Care Medicaid	$3,302.19
Rate for Payer: NaphCare Correctional Healthcare	$3,302.19

Hypovolemia And Related Electrolyte Disorders

Facility

$3,302.19

Service Code	APR-DRG 4222
Hospital Charge Code	APRDRG4223
Min. Negotiated Rate	$3,302.19
Max. Negotiated Rate	$3,302.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,302.19
Rate for Payer: Mercy Care Medicaid	$3,302.19
Rate for Payer: NaphCare Correctional Healthcare	$3,302.19

Know your out-of-pocket cost for care.

All Charges