Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Metanephrines, Frac., Pl. Free LC

Facility

$388.00

Service Code	CPT 83835
Hospital Charge Code	2029237
Hospital Revenue Code	301
Min. Negotiated Rate	$349.20
Max. Negotiated Rate	$349.20
Rate for Payer: Aetna of AZ Commercial	$349.20
Rate for Payer: Cash Price	$310.40

Metanephrines, Frac., Pl. Free LC

Facility

$388.00

Service Code	CPT 83835
Hospital Charge Code	2029237
Hospital Revenue Code	301
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$349.20
Rate for Payer: Aetna of AZ Commercial	$349.20
Rate for Payer: Arizona Complete Health Allwell	$62.08
Rate for Payer: Banner UC Health Medicare	$62.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$263.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$62.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$62.08
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cigna of AZ Commercial	$252.20
Rate for Payer: Devoted Health Medicare	$69.84
Rate for Payer: Humana of AZ Medicare	$62.08
Rate for Payer: Seven Corners Travel Insurance	$24.56
Rate for Payer: Southwest Service Administrators UFCW	$263.84
Rate for Payer: TriWest Medicare	$62.08
Rate for Payer: United Healthcare Commercial	$221.94
Rate for Payer: United Healthcare Medicare	$62.08
Rate for Payer: Veterans Affairs TRICARE	$61.46

Metanephrines, Frac, Qn, 24-Hr LC

Facility

$370.00

Service Code	CPT 83835
Hospital Charge Code	1909517
Hospital Revenue Code	301
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Arizona Complete Health Allwell	$59.20
Rate for Payer: Banner UC Health Medicare	$59.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$251.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$59.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$59.20
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cigna of AZ Commercial	$240.50
Rate for Payer: Devoted Health Medicare	$66.60
Rate for Payer: Humana of AZ Medicare	$59.20
Rate for Payer: Seven Corners Travel Insurance	$24.56
Rate for Payer: Southwest Service Administrators UFCW	$251.60
Rate for Payer: TriWest Medicare	$59.20
Rate for Payer: United Healthcare Commercial	$211.64
Rate for Payer: United Healthcare Medicare	$59.20
Rate for Payer: Veterans Affairs TRICARE	$58.61

Metanephrines, Frac, Qn, 24-Hr LC

Facility

$370.00

Service Code	CPT 83835
Hospital Charge Code	1909517
Hospital Revenue Code	301
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Cash Price	$296.00

METER PEAK FLOW ADULT

Facility

$75.00

Hospital Charge Code	22354322
Hospital Revenue Code	270
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Cash Price	$60.00

METER PEAK FLOW ADULT

Facility

$75.00

Hospital Charge Code	22354322
Hospital Revenue Code	270
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Arizona Complete Health Allwell	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Devoted Health Medicare	$13.50
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Southwest Service Administrators UFCW	$51.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: United Healthcare Commercial	$42.90
Rate for Payer: United Healthcare Medicare	$12.00
Rate for Payer: Veterans Affairs TRICARE	$11.88

metFORMIN 500 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904668961
Hospital Charge Code	105931108
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
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	$0.04
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	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.03
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

metFORMIN 500 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904668961
Hospital Charge Code	105931108
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Cash Price	$0.04

metFORMIN 850 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 60687014301
Hospital Charge Code	105931041
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
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	$0.07
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	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.07
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.06
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

metFORMIN 850 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 60687014301
Hospital Charge Code	105931041
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Cash Price	$0.09

methocarbamol 500 mg Tab UD[CQCH]

Facility

$0.18

Service Code	NDC 63739099110
Hospital Charge Code	241829846
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Cash Price	$0.15

methocarbamol 500 mg Tab UD[CQCH]

Facility

$0.18

Service Code	NDC 63739099110
Hospital Charge Code	241829846
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
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	$0.12
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	$0.12
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.10
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

methohexital 500 mg IV Inj [CQCH]

Facility

$51.28

Service Code	NDC 42023010501
Hospital Charge Code	105931179
Hospital Revenue Code	251
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna of AZ Commercial	$46.15
Rate for Payer: Cash Price	$41.02

methohexital 500 mg IV Inj [CQCH]

Facility

$51.28

Service Code	NDC 42023010501
Hospital Charge Code	105931179
Hospital Revenue Code	251
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna of AZ Commercial	$46.15
Rate for Payer: Arizona Complete Health Allwell	$8.20
Rate for Payer: Banner UC Health Medicare	$8.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$34.87
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.20
Rate for Payer: Cash Price	$41.02
Rate for Payer: Cigna of AZ Commercial	$33.33
Rate for Payer: Devoted Health Medicare	$9.23
Rate for Payer: Humana of AZ Medicare	$8.20
Rate for Payer: Southwest Service Administrators UFCW	$34.87
Rate for Payer: TriWest Medicare	$8.20
Rate for Payer: United Healthcare Commercial	$29.33
Rate for Payer: United Healthcare Medicare	$8.20
Rate for Payer: Veterans Affairs TRICARE	$8.12

methylene blue 5 mg/mL Sol 10 mL vial [CQCH]

Facility

$16.19

Service Code	NDC 517037405
Hospital Charge Code	116777202
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna of AZ Commercial	$14.57
Rate for Payer: Arizona Complete Health Allwell	$2.59
Rate for Payer: Banner UC Health Medicare	$2.59
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$11.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.59
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.59
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cigna of AZ Commercial	$10.52
Rate for Payer: Devoted Health Medicare	$2.91
Rate for Payer: Humana of AZ Medicare	$2.59
Rate for Payer: Southwest Service Administrators UFCW	$11.01
Rate for Payer: TriWest Medicare	$2.59
Rate for Payer: United Healthcare Commercial	$9.26
Rate for Payer: United Healthcare Medicare	$2.59
Rate for Payer: Veterans Affairs TRICARE	$2.56

methylene blue 5 mg/mL Sol 10 mL vial [CQCH]

Facility

$16.19

Service Code	NDC 517037405
Hospital Charge Code	116777202
Hospital Revenue Code	250
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna of AZ Commercial	$14.57
Rate for Payer: Cash Price	$12.95

methylergonovine 0.2 mg/mL Inj Sol [CQCH]

Facility

$5.81

Service Code	HCPCS J2210
Hospital Charge Code	105931380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna of AZ Commercial	$5.23
Rate for Payer: Arizona Complete Health Allwell	$0.93
Rate for Payer: Banner UC Health Medicare	$0.93
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.95
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.93
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.93
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cigna of AZ Commercial	$3.78
Rate for Payer: Devoted Health Medicare	$1.05
Rate for Payer: Humana of AZ Medicare	$0.93
Rate for Payer: Southwest Service Administrators UFCW	$3.95
Rate for Payer: TriWest Medicare	$0.93
Rate for Payer: United Healthcare Commercial	$3.32
Rate for Payer: United Healthcare Medicare	$0.93
Rate for Payer: Veterans Affairs TRICARE	$0.92

methylergonovine 0.2 mg/mL Inj Sol [CQCH]

Facility

$5.81

Service Code	HCPCS J2210
Hospital Charge Code	105931380
Hospital Revenue Code	250
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna of AZ Commercial	$5.23
Rate for Payer: Cash Price	$4.65

Methylmalonic Acid, Serum LC

Facility

$382.00

Service Code	CPT 83921
Hospital Charge Code	2029210
Hospital Revenue Code	301
Min. Negotiated Rate	$343.80
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Cash Price	$305.60

Methylmalonic Acid, Serum LC

Facility

$382.00

Service Code	CPT 83921
Hospital Charge Code	2029210
Hospital Revenue Code	301
Min. Negotiated Rate	$30.75
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Arizona Complete Health Allwell	$61.12
Rate for Payer: Banner UC Health Medicare	$61.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$259.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$61.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$61.12
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cigna of AZ Commercial	$248.30
Rate for Payer: Devoted Health Medicare	$68.76
Rate for Payer: Humana of AZ Medicare	$61.12
Rate for Payer: Seven Corners Travel Insurance	$30.75
Rate for Payer: Southwest Service Administrators UFCW	$259.76
Rate for Payer: TriWest Medicare	$61.12
Rate for Payer: United Healthcare Commercial	$218.50
Rate for Payer: United Healthcare Medicare	$61.12
Rate for Payer: Veterans Affairs TRICARE	$60.51

methylPREDNISolone 125 mg Inj PF [CQCH]

Facility

$7.21

Service Code	HCPCS J2930
Hospital Charge Code	105955507
Hospital Revenue Code	250
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Aetna of AZ Commercial	$6.49
Rate for Payer: Cash Price	$5.77

methylPREDNISolone 125 mg Inj PF [CQCH]

Facility

$7.21

Service Code	HCPCS J2930
Hospital Charge Code	105955507
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$6.49
Rate for Payer: Aetna of AZ Commercial	$6.49
Rate for Payer: Arizona Complete Health Allwell	$1.15
Rate for Payer: Banner UC Health Medicare	$1.15
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.90
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.15
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.15
Rate for Payer: Cash Price	$5.77
Rate for Payer: Cigna of AZ Commercial	$4.69
Rate for Payer: Devoted Health Medicare	$1.30
Rate for Payer: Humana of AZ Medicare	$1.15
Rate for Payer: Southwest Service Administrators UFCW	$4.90
Rate for Payer: TriWest Medicare	$1.15
Rate for Payer: United Healthcare Commercial	$4.12
Rate for Payer: United Healthcare Medicare	$1.15
Rate for Payer: Veterans Affairs TRICARE	$1.14

methylPREDNISolone 1 gm Inj [CQCH]

Facility

$22.30

Service Code	HCPCS J2930
Hospital Charge Code	105931449
Hospital Revenue Code	250
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$20.07
Rate for Payer: Aetna of AZ Commercial	$20.07
Rate for Payer: Cash Price	$17.84

methylPREDNISolone 1 gm Inj [CQCH]

Facility

$22.30

Service Code	HCPCS J2930
Hospital Charge Code	105931449
Hospital Revenue Code	250
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$20.07
Rate for Payer: Aetna of AZ Commercial	$20.07
Rate for Payer: Arizona Complete Health Allwell	$3.57
Rate for Payer: Banner UC Health Medicare	$3.57
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$15.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.57
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.57
Rate for Payer: Cash Price	$17.84
Rate for Payer: Cigna of AZ Commercial	$14.49
Rate for Payer: Devoted Health Medicare	$4.01
Rate for Payer: Humana of AZ Medicare	$3.57
Rate for Payer: Southwest Service Administrators UFCW	$15.16
Rate for Payer: TriWest Medicare	$3.57
Rate for Payer: United Healthcare Commercial	$12.76
Rate for Payer: United Healthcare Medicare	$3.57
Rate for Payer: Veterans Affairs TRICARE	$3.53

Methylprednisolone 40 MG inj

Facility

$25.00

Service Code	HCPCS J1030
Hospital Charge Code	1167797
Hospital Revenue Code	521
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Cash Price	$20.00

Know your out-of-pocket cost for care.

All Charges