Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$18,143.26

Service Code	MSDRG 063
Min. Negotiated Rate	$18,143.26
Max. Negotiated Rate	$18,143.26
Rate for Payer: Seven Corners Travel Insurance	$18,143.26

ISONEB FILTERED NEBULIZER SYSTEM

Facility

$29.00

Hospital Charge Code	23937347
Hospital Revenue Code	270
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Arizona Complete Health Allwell	$4.64
Rate for Payer: Banner UC Health Medicare	$4.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$19.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.64
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$20.30
Rate for Payer: Devoted Health Medicare	$5.22
Rate for Payer: Humana of AZ Medicare	$4.64
Rate for Payer: Southwest Service Administrators UFCW	$19.72
Rate for Payer: TriWest Medicare	$4.64
Rate for Payer: United Healthcare Commercial	$16.59
Rate for Payer: United Healthcare Medicare	$4.64
Rate for Payer: Veterans Affairs TRICARE	$4.59

ISONEB FILTERED NEBULIZER SYSTEM

Facility

$29.00

Hospital Charge Code	23937347
Hospital Revenue Code	270
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Cash Price	$23.20

isosorbide dinitrate 10 mg Tab [CQCH]

Facility

$0.59

Service Code	NDC 68084008201
Hospital Charge Code	105927222
Hospital Revenue Code	251
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of AZ Commercial	$0.53
Rate for Payer: Cash Price	$0.47

isosorbide dinitrate 10 mg Tab [CQCH]

Facility

$0.59

Service Code	NDC 68084008201
Hospital Charge Code	105927222
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of AZ Commercial	$0.53
Rate for Payer: Arizona Complete Health Allwell	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.09
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.09
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of AZ Commercial	$0.38
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Southwest Service Administrators UFCW	$0.40
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: United Healthcare Commercial	$0.34
Rate for Payer: United Healthcare Medicare	$0.09
Rate for Payer: Veterans Affairs TRICARE	$0.09

isosorbide dinitrate 20 mg Tab [CQCH]

Facility

$0.56

Service Code	NDC 143177201
Hospital Charge Code	105927157
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of AZ Commercial	$0.50
Rate for Payer: Cash Price	$0.45

isosorbide dinitrate 20 mg Tab [CQCH]

Facility

$0.56

Service Code	NDC 143177201
Hospital Charge Code	105927157
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of AZ Commercial	$0.50
Rate for Payer: Arizona Complete Health Allwell	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.38
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.09
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.09
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of AZ Commercial	$0.36
Rate for Payer: Devoted Health Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Southwest Service Administrators UFCW	$0.38
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: United Healthcare Commercial	$0.32
Rate for Payer: United Healthcare Medicare	$0.09
Rate for Payer: Veterans Affairs TRICARE	$0.09

isosorbide mononitrate 30 mg ER Tab [CQCH]

Facility

$0.50

Service Code	NDC 68084059101
Hospital Charge Code	105927291
Hospital Revenue Code	251
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of AZ Commercial	$0.45
Rate for Payer: Cash Price	$0.40

isosorbide mononitrate 30 mg ER Tab [CQCH]

Facility

$0.50

Service Code	NDC 68084059101
Hospital Charge Code	105927291
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of AZ Commercial	$0.45
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	$0.34
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	$0.40
Rate for Payer: Cigna of AZ Commercial	$0.33
Rate for Payer: Devoted Health Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Southwest Service Administrators UFCW	$0.34
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: United Healthcare Commercial	$0.29
Rate for Payer: United Healthcare Medicare	$0.08
Rate for Payer: Veterans Affairs TRICARE	$0.08

ISOVUE 300 10 X 100 ML VL

Facility

$114.00

Hospital Charge Code	22354939
Hospital Revenue Code	270
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$79.80
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

ISOVUE 300 10 X 100 ML VL

Facility

$114.00

Hospital Charge Code	22354939
Hospital Revenue Code	270
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

IV CATHETERIZATION

Facility

$97.00

Hospital Charge Code	22282948
Hospital Revenue Code	272
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Cash Price	$77.60

IV CATHETERIZATION

Facility

$97.00

Hospital Charge Code	22282948
Hospital Revenue Code	272
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

IV-D5NS BAG : 1000 ML

Facility

$30.00

Hospital Charge Code	22551066
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Cash Price	$24.00

IV-D5NS BAG : 1000 ML

Facility

$30.00

Hospital Charge Code	22551066
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Arizona Complete Health Allwell	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$20.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Devoted Health Medicare	$5.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Southwest Service Administrators UFCW	$20.40
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: United Healthcare Commercial	$17.16
Rate for Payer: United Healthcare Medicare	$4.80
Rate for Payer: Veterans Affairs TRICARE	$4.75

IV HYDRA ADDITITIONAL HOUR Charge

Facility

$47.00

Service Code	CPT 96361
Hospital Charge Code	859135
Hospital Revenue Code	521
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$72.46
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Seven Corners Travel Insurance	$72.46
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

IV HYDRA ADDITITIONAL HOUR Charge

Facility

$47.00

Service Code	CPT 96361
Hospital Charge Code	859135
Hospital Revenue Code	521
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

IV Hydration 1ST Hour Charge

Facility

$168.00

Service Code	CPT 96360
Hospital Charge Code	859131
Hospital Revenue Code	521
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$329.11
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Arizona Complete Health Allwell	$26.88
Rate for Payer: Banner UC Health Medicare	$26.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.88
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$117.60
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$26.88
Rate for Payer: Seven Corners Travel Insurance	$329.11
Rate for Payer: Southwest Service Administrators UFCW	$114.24
Rate for Payer: TriWest Medicare	$26.88
Rate for Payer: United Healthcare Commercial	$96.10
Rate for Payer: United Healthcare Medicare	$26.88
Rate for Payer: Veterans Affairs TRICARE	$26.61

IV Hydration 1ST Hour Charge

Facility

$168.00

Service Code	CPT 96360
Hospital Charge Code	859131
Hospital Revenue Code	521
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Cash Price	$134.40

IV Infusion Addition Hr

Facility

$64.00

Service Code	CPT 96366
Hospital Charge Code	892857
Hospital Revenue Code	521
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$72.46
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Arizona Complete Health Allwell	$10.24
Rate for Payer: Banner UC Health Medicare	$10.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$43.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.24
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cigna of AZ Commercial	$44.80
Rate for Payer: Devoted Health Medicare	$11.52
Rate for Payer: Humana of AZ Medicare	$10.24
Rate for Payer: Seven Corners Travel Insurance	$72.46
Rate for Payer: Southwest Service Administrators UFCW	$43.52
Rate for Payer: TriWest Medicare	$10.24
Rate for Payer: United Healthcare Commercial	$36.61
Rate for Payer: United Healthcare Medicare	$10.24
Rate for Payer: Veterans Affairs TRICARE	$10.14

IV Infusion Addition Hr

Facility

$64.00

Service Code	CPT 96366
Hospital Charge Code	892857
Hospital Revenue Code	521
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Cash Price	$51.20

IV INFUSION FOR THERAPY

Facility

$200.00

Service Code	CPT 96360
Hospital Charge Code	22247981
Hospital Revenue Code	260
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$329.11
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Arizona Complete Health Allwell	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$136.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$140.00
Rate for Payer: Devoted Health Medicare	$36.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Seven Corners Travel Insurance	$329.11
Rate for Payer: Southwest Service Administrators UFCW	$136.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: United Healthcare Commercial	$114.40
Rate for Payer: United Healthcare Medicare	$32.00
Rate for Payer: Veterans Affairs TRICARE	$31.68

IV INFUSION FOR THERAPY

Facility

$200.00

Service Code	CPT 96360
Hospital Charge Code	22247981
Hospital Revenue Code	260
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Cash Price	$160.00

IV PRIMARY TUBING HOSPIRA

Facility

$62.00

Hospital Charge Code	22355539
Hospital Revenue Code	270
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

IV PRIMARY TUBING HOSPIRA

Facility

$62.00

Hospital Charge Code	22355539
Hospital Revenue Code	270
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

Know your out-of-pocket cost for care.

All Charges