Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

$28,128.24

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$28,128.24
Max. Negotiated Rate	$28,128.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,128.24
Rate for Payer: Mercy Care Medicaid	$28,128.24
Rate for Payer: NaphCare Correctional Healthcare	$28,128.24

Lysis of adhesions

Facility

$5,933.00

Service Code	CPT 44005
Hospital Charge Code	27267811
Hospital Revenue Code	360
Min. Negotiated Rate	$5,339.70
Max. Negotiated Rate	$5,339.70
Rate for Payer: Aetna of AZ Commercial	$5,339.70
Rate for Payer: Cash Price	$4,746.40

Lysis of adhesions

Facility

$5,933.00

Service Code	CPT 44005
Hospital Charge Code	27267811
Hospital Revenue Code	360
Min. Negotiated Rate	$939.79
Max. Negotiated Rate	$5,339.70
Rate for Payer: Aetna of AZ Commercial	$5,339.70
Rate for Payer: Arizona Complete Health Allwell	$949.28
Rate for Payer: Banner UC Health Medicare	$949.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,034.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$949.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$949.28
Rate for Payer: Cash Price	$4,746.40
Rate for Payer: Cash Price	$4,746.40
Rate for Payer: Cigna of AZ Commercial	$2,966.50
Rate for Payer: Devoted Health Medicare	$1,067.94
Rate for Payer: Humana of AZ Medicare	$949.28
Rate for Payer: Southwest Service Administrators UFCW	$4,034.44
Rate for Payer: TriWest Medicare	$949.28
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$949.28
Rate for Payer: Veterans Affairs TRICARE	$939.79

M005-IgE Candida albicans LC

Facility

$64.00

Service Code	CPT 86003
Hospital Charge Code	22311199
Hospital Revenue Code	302
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$57.60
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	$41.60
Rate for Payer: Devoted Health Medicare	$11.52
Rate for Payer: Humana of AZ Medicare	$10.24
Rate for Payer: Seven Corners Travel Insurance	$7.57
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

M005-IgE Candida albicans LC

Facility

$64.00

Service Code	CPT 86003
Hospital Charge Code	22311199
Hospital Revenue Code	302
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

Maalox 200 mg-200 mg-20 mg/5 mL Sus UD[CQCH]

Facility

$0.19

Service Code	NDC 57237031631
Hospital Charge Code	239216300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
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	$0.13
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	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.13
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

Maalox 200 mg-200 mg-20 mg/5 mL Sus UD[CQCH]

Facility

$0.19

Service Code	NDC 57237031631
Hospital Charge Code	239216300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Cash Price	$0.15

Maalox-plus XS 30 mL UD [CQCH]

Facility

$0.01

Service Code	NDC 121176230
Hospital Charge Code	105930075
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

Maalox-plus XS 30 mL UD [CQCH]

Facility

$0.01

Service Code	NDC 121176230
Hospital Charge Code	105930075
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

Magnesium Level

Facility

$80.00

Service Code	CPT 83735
Hospital Charge Code	633781
Hospital Revenue Code	301
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Cash Price	$64.00

Magnesium Level

Facility

$80.00

Service Code	CPT 83735
Hospital Charge Code	633781
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Arizona Complete Health Allwell	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$54.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Devoted Health Medicare	$14.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Seven Corners Travel Insurance	$9.71
Rate for Payer: Southwest Service Administrators UFCW	$54.40
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: United Healthcare Commercial	$45.76
Rate for Payer: United Healthcare Medicare	$12.80
Rate for Payer: Veterans Affairs TRICARE	$12.67

magnesium oxide 400 mg Tab [CQCH]

Facility

$0.07

Service Code	NDC 10006070028
Hospital Charge Code	105930142
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

magnesium oxide 400 mg Tab [CQCH]

Facility

$0.07

Service Code	NDC 10006070028
Hospital Charge Code	105930142
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

MAGNESIUM RBC

Facility

$104.00

Service Code	CPT 82570
Hospital Charge Code	22481492
Hospital Revenue Code	301
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Cash Price	$83.20

MAGNESIUM RBC

Facility

$104.00

Service Code	CPT 82570
Hospital Charge Code	22481492
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Arizona Complete Health Allwell	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$70.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.64
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$67.60
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$70.72
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: United Healthcare Commercial	$59.49
Rate for Payer: United Healthcare Medicare	$16.64
Rate for Payer: Veterans Affairs TRICARE	$16.47

Magnesium, RBC LC

Facility

$172.00

Service Code	CPT 83735
Hospital Charge Code	22311200
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.52
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Seven Corners Travel Insurance	$9.71
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: Veterans Affairs TRICARE	$27.24

Magnesium, RBC LC

Facility

$172.00

Service Code	CPT 83735
Hospital Charge Code	22311200
Hospital Revenue Code	301
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

magnesium sulfate 1 gm/100 ml Sol[CQCH]

Facility

$0.03

Service Code	HCPCS J3475
Hospital Charge Code	169584435
Hospital Revenue Code	250
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

magnesium sulfate 1 gm/100 ml Sol[CQCH]

Facility

$0.03

Service Code	HCPCS J3475
Hospital Charge Code	169584435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Cash Price	$0.03

magnesium sulfate 1 gm/2 mL inj Sol [CQCH]

Facility

$0.27

Service Code	HCPCS J3475
Hospital Charge Code	105930353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Cash Price	$0.22

magnesium sulfate 1 gm/2 mL inj Sol [CQCH]

Facility

$0.27

Service Code	HCPCS J3475
Hospital Charge Code	105930353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of AZ Commercial	$0.18
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.15
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

magnesium sulfate 20 gm/ 500 mL IV Sol [CQCH]

Facility

$0.01

Service Code	HCPCS J3475
Hospital Charge Code	105930207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

magnesium sulfate 20 gm/ 500 mL IV Sol [CQCH]

Facility

$0.01

Service Code	HCPCS J3475
Hospital Charge Code	105930207
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

Major Abdominal Vascular Procedures

Facility

$25,119.24

Service Code	APR-DRG 1693
Hospital Charge Code	APRDRG1694
Min. Negotiated Rate	$25,119.24
Max. Negotiated Rate	$25,119.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$25,119.24
Rate for Payer: Mercy Care Medicaid	$25,119.24
Rate for Payer: NaphCare Correctional Healthcare	$25,119.24

Major Abdominal Vascular Procedures

Facility

$17,101.53

Service Code	APR-DRG 1691
Hospital Charge Code	APRDRG1691
Min. Negotiated Rate	$17,101.53
Max. Negotiated Rate	$17,101.53
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,101.53
Rate for Payer: Mercy Care Medicaid	$17,101.53
Rate for Payer: NaphCare Correctional Healthcare	$17,101.53

Know your out-of-pocket cost for care.

All Charges