Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

INTRAOP CYTO PATH CONSULT 2

Facility

$147.00

Service Code	CPT 88334
Hospital Charge Code	22545740
Hospital Revenue Code	310
Min. Negotiated Rate	$23.28
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Arizona Complete Health Allwell	$23.52
Rate for Payer: Banner UC Health Medicare	$23.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$99.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.16
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cigna of AZ Commercial	$95.55
Rate for Payer: Devoted Health Medicare	$26.46
Rate for Payer: Humana of AZ Medicare	$23.52
Rate for Payer: Southwest Service Administrators UFCW	$99.96
Rate for Payer: TriWest Medicare	$23.52
Rate for Payer: United Healthcare Commercial	$84.08
Rate for Payer: United Healthcare Medicare	$23.52
Rate for Payer: Veterans Affairs TRICARE	$23.28

INTRAOP CYTO PATH CONSULT 2

Facility

$147.00

Service Code	CPT 88334
Hospital Charge Code	22545740
Hospital Revenue Code	310
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Cash Price	$117.60

INTRAUTERINE COPPER CONTRACEPTIVE

Facility

$1,182.00

Service Code	HCPCS J7300
Hospital Charge Code	22758889
Min. Negotiated Rate	$1,063.80
Max. Negotiated Rate	$1,063.80
Rate for Payer: Aetna of AZ Commercial	$1,063.80
Rate for Payer: Cash Price	$945.60

INTRAUTERINE COPPER CONTRACEPTIVE

Facility

$1,182.00

Service Code	HCPCS J7300
Hospital Charge Code	22758889
Min. Negotiated Rate	$187.23
Max. Negotiated Rate	$1,063.80
Rate for Payer: Aetna of AZ Commercial	$1,063.80
Rate for Payer: Arizona Complete Health Allwell	$189.12
Rate for Payer: Banner UC Health Medicare	$189.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$803.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$189.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$189.12
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cigna of AZ Commercial	$827.40
Rate for Payer: Devoted Health Medicare	$212.76
Rate for Payer: Humana of AZ Medicare	$189.12
Rate for Payer: Southwest Service Administrators UFCW	$803.76
Rate for Payer: TriWest Medicare	$189.12
Rate for Payer: United Healthcare Commercial	$676.10
Rate for Payer: United Healthcare Medicare	$189.12
Rate for Payer: Veterans Affairs TRICARE	$187.23

INTRAVENOUS ADMINISTRATI

Facility

$187.00

Service Code	CPT 96374
Hospital Charge Code	22247979
Hospital Revenue Code	260
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$168.30
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Cash Price	$149.60

INTRAVENOUS ADMINISTRATI

Facility

$187.00

Service Code	CPT 96374
Hospital Charge Code	22247979
Hospital Revenue Code	260
Min. Negotiated Rate	$29.62
Max. Negotiated Rate	$329.11
Rate for Payer: Aetna of AZ Commercial	$168.30
Rate for Payer: Arizona Complete Health Allwell	$29.92
Rate for Payer: Banner UC Health Medicare	$29.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$127.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.92
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cigna of AZ Commercial	$130.90
Rate for Payer: Devoted Health Medicare	$33.66
Rate for Payer: Humana of AZ Medicare	$29.92
Rate for Payer: Seven Corners Travel Insurance	$329.11
Rate for Payer: Southwest Service Administrators UFCW	$127.16
Rate for Payer: TriWest Medicare	$29.92
Rate for Payer: United Healthcare Commercial	$106.96
Rate for Payer: United Healthcare Medicare	$29.92
Rate for Payer: Veterans Affairs TRICARE	$29.62

INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$3,373.00

Service Code	CPT 96366
Hospital Revenue Code	490
Min. Negotiated Rate	$72.46
Max. Negotiated Rate	$3,373.00
Rate for Payer: Seven Corners Travel Insurance	$72.46
Rate for Payer: United Healthcare Commercial	$3,373.00

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

Facility

$3,373.00

Service Code	CPT 96365
Hospital Revenue Code	490
Min. Negotiated Rate	$329.11
Max. Negotiated Rate	$3,373.00
Rate for Payer: Seven Corners Travel Insurance	$329.11
Rate for Payer: United Healthcare Commercial	$3,373.00

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

Facility

$3,373.00

Service Code	CPT 96365
Hospital Revenue Code	360
Min. Negotiated Rate	$329.11
Max. Negotiated Rate	$3,373.00
Rate for Payer: Seven Corners Travel Insurance	$329.11
Rate for Payer: United Healthcare Commercial	$3,373.00

Intrinsic Factor Abs LC

Facility

$179.00

Service Code	CPT 86340
Hospital Charge Code	2769559
Hospital Revenue Code	301
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Arizona Complete Health Allwell	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$121.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.64
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$116.35
Rate for Payer: Devoted Health Medicare	$32.22
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Seven Corners Travel Insurance	$21.87
Rate for Payer: Southwest Service Administrators UFCW	$121.72
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: United Healthcare Commercial	$102.39
Rate for Payer: United Healthcare Medicare	$28.64
Rate for Payer: Veterans Affairs TRICARE	$28.35

Intrinsic Factor Abs LC

Facility

$179.00

Service Code	CPT 86340
Hospital Charge Code	2769559
Hospital Revenue Code	301
Min. Negotiated Rate	$161.10
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Cash Price	$143.20

INTROCAN SAFETY DEEP ACCESS IV CATH 18G

Facility

$41.37

Hospital Charge Code	27685139
Hospital Revenue Code	270
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna of AZ Commercial	$37.23
Rate for Payer: Cash Price	$33.10

INTROCAN SAFETY DEEP ACCESS IV CATH 18G

Facility

$41.37

Hospital Charge Code	27685139
Hospital Revenue Code	270
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna of AZ Commercial	$37.23
Rate for Payer: Arizona Complete Health Allwell	$6.62
Rate for Payer: Banner UC Health Medicare	$6.62
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$28.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.62
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.62
Rate for Payer: Cash Price	$33.10
Rate for Payer: Cigna of AZ Commercial	$28.96
Rate for Payer: Devoted Health Medicare	$7.45
Rate for Payer: Humana of AZ Medicare	$6.62
Rate for Payer: Southwest Service Administrators UFCW	$28.13
Rate for Payer: TriWest Medicare	$6.62
Rate for Payer: United Healthcare Commercial	$23.66
Rate for Payer: United Healthcare Medicare	$6.62
Rate for Payer: Veterans Affairs TRICARE	$6.55

INTRODUCER NEEDLE SET 12CM 18G

Facility

$180.00

Hospital Charge Code	22354314
Hospital Revenue Code	270
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Cash Price	$144.00

INTRODUCER NEEDLE SET 12CM 18G

Facility

$180.00

Hospital Charge Code	22354314
Hospital Revenue Code	270
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Arizona Complete Health Allwell	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$122.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Devoted Health Medicare	$32.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Southwest Service Administrators UFCW	$122.40
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: United Healthcare Commercial	$102.96
Rate for Payer: United Healthcare Medicare	$28.80
Rate for Payer: Veterans Affairs TRICARE	$28.51

INTRODUCER NEEDLE SET 20CM 18G

Facility

$180.00

Hospital Charge Code	22354315
Hospital Revenue Code	270
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Cash Price	$144.00

INTRODUCER NEEDLE SET 20CM 18G

Facility

$180.00

Hospital Charge Code	22354315
Hospital Revenue Code	270
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Arizona Complete Health Allwell	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$122.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Devoted Health Medicare	$32.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Southwest Service Administrators UFCW	$122.40
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: United Healthcare Commercial	$102.96
Rate for Payer: United Healthcare Medicare	$28.80
Rate for Payer: Veterans Affairs TRICARE	$28.51

INTUBATE

Facility

$1,547.00

Service Code	CPT 31500
Hospital Charge Code	1886875
Hospital Revenue Code	410
Min. Negotiated Rate	$245.04
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna of AZ Commercial	$1,392.30
Rate for Payer: Arizona Complete Health Allwell	$247.52
Rate for Payer: Banner UC Health Medicare	$247.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,051.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$247.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$247.52
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Cigna of AZ Commercial	$1,082.90
Rate for Payer: Devoted Health Medicare	$278.46
Rate for Payer: Humana of AZ Medicare	$247.52
Rate for Payer: Seven Corners Travel Insurance	$366.47
Rate for Payer: Southwest Service Administrators UFCW	$1,051.96
Rate for Payer: TriWest Medicare	$247.52
Rate for Payer: United Healthcare Commercial	$884.88
Rate for Payer: United Healthcare Medicare	$247.52
Rate for Payer: United Healthcare New Mexico Commercial	$293.93
Rate for Payer: Veterans Affairs TRICARE	$245.04

INTUBATE

Facility

$1,547.00

Service Code	CPT 31500
Hospital Charge Code	1886875
Hospital Revenue Code	410
Min. Negotiated Rate	$1,392.30
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna of AZ Commercial	$1,392.30
Rate for Payer: Cash Price	$1,237.60

Ionized Calcium Level

Facility

$177.00

Service Code	CPT 82330
Hospital Charge Code	9077417
Hospital Revenue Code	301
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$19.84
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

Ionized Calcium Level

Facility

$177.00

Service Code	CPT 82330
Hospital Charge Code	9077417
Hospital Revenue Code	301
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

IPRATROPIUM 0.002

Facility

$34.00

Service Code	HCPCS J7644
Hospital Charge Code	1170092
Hospital Revenue Code	521
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Cash Price	$27.20

IPRATROPIUM 0.002

Facility

$34.00

Service Code	HCPCS J7644
Hospital Charge Code	1170092
Hospital Revenue Code	521
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.44
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$23.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39

ipratropium 0.02% Inh Sol 2.5 mL [CQCH]

Facility

$0.07

Service Code	HCPCS J7644
Hospital Charge Code	105927008
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.04
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

ipratropium 0.02% Inh Sol 2.5 mL [CQCH]

Facility

$0.07

Service Code	HCPCS J7644
Hospital Charge Code	105927008
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Cash Price	$0.05

Know your out-of-pocket cost for care.

All Charges