Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Methylprednisolone 40 MG inj

Facility

$25.00

Service Code	HCPCS J1030
Hospital Charge Code	1167797
Hospital Revenue Code	521
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Arizona Complete Health Allwell	$4.00
Rate for Payer: Banner UC Health Medicare	$4.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cigna of AZ Commercial	$17.50
Rate for Payer: Devoted Health Medicare	$4.50
Rate for Payer: Humana of AZ Medicare	$4.00
Rate for Payer: Southwest Service Administrators UFCW	$17.00
Rate for Payer: TriWest Medicare	$4.00
Rate for Payer: United Healthcare Commercial	$14.30
Rate for Payer: United Healthcare Medicare	$4.00
Rate for Payer: Veterans Affairs TRICARE	$3.96

methylPREDNISolone 40 mg Inj PF [CQCH]

Facility

$4.52

Service Code	HCPCS J2920
Hospital Charge Code	105963075
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$4.07
Rate for Payer: Aetna of AZ Commercial	$4.07
Rate for Payer: Arizona Complete Health Allwell	$0.72
Rate for Payer: Banner UC Health Medicare	$0.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.07
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.72
Rate for Payer: Cash Price	$3.62
Rate for Payer: Cigna of AZ Commercial	$2.94
Rate for Payer: Devoted Health Medicare	$0.81
Rate for Payer: Humana of AZ Medicare	$0.72
Rate for Payer: Southwest Service Administrators UFCW	$3.07
Rate for Payer: TriWest Medicare	$0.72
Rate for Payer: United Healthcare Commercial	$2.59
Rate for Payer: United Healthcare Medicare	$0.72
Rate for Payer: Veterans Affairs TRICARE	$0.72

methylPREDNISolone 40 mg Inj PF [CQCH]

Facility

$4.52

Service Code	HCPCS J2920
Hospital Charge Code	105963075
Hospital Revenue Code	250
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Aetna of AZ Commercial	$4.07
Rate for Payer: Cash Price	$3.62

Methylprednisolone Acetate 40 mg Injection

Facility

$29.00

Service Code	HCPCS J1020
Hospital Charge Code	2997565
Hospital Revenue Code	521
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

Methylprednisolone Acetate 40 mg Injection

Facility

$29.00

Service Code	HCPCS J1020
Hospital Charge Code	2997565
Hospital Revenue Code	521
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

Methylprednisolone injection

Facility

$34.00

Service Code	HCPCS J2930
Hospital Charge Code	1240720
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

Methylprednisolone injection

Facility

$34.00

Service Code	HCPCS J2930
Hospital Charge Code	1240720
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

Methylprednisolone Injection 80 mg Charge

Facility

$47.00

Service Code	HCPCS J1040
Hospital Charge Code	667830
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

Methylprednisolone Injection 80 mg Charge

Facility

$47.00

Service Code	HCPCS J1040
Hospital Charge Code	667830
Hospital Revenue Code	521
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
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: 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: 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

metoclopramide 10 mg/ Inj Sol [CQCH]

Facility

$1.07

Service Code	HCPCS J2765
Hospital Charge Code	105931644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of AZ Commercial	$0.96
Rate for Payer: Cash Price	$0.85

metoclopramide 10 mg/ Inj Sol [CQCH]

Facility

$1.07

Service Code	HCPCS J2765
Hospital Charge Code	105931644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of AZ Commercial	$0.96
Rate for Payer: Arizona Complete Health Allwell	$0.17
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.73
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.17
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.17
Rate for Payer: Cash Price	$0.85
Rate for Payer: Cigna of AZ Commercial	$0.70
Rate for Payer: Devoted Health Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Southwest Service Administrators UFCW	$0.73
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: United Healthcare Commercial	$0.61
Rate for Payer: United Healthcare Medicare	$0.17
Rate for Payer: Veterans Affairs TRICARE	$0.17

metoclopramide 10 mg Tab [CQCH]

Facility

$0.12

Service Code	NDC 51079088820
Hospital Charge Code	105931579
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of AZ Commercial	$0.11
Rate for Payer: Cash Price	$0.10

metoclopramide 10 mg Tab [CQCH]

Facility

$0.12

Service Code	NDC 51079088820
Hospital Charge Code	105931579
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of AZ Commercial	$0.11
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	$0.08
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	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.08
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.07
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

metoclopramide 5 mg/5 mL UD oral Syr [CQCH]

Facility

$0.01

Service Code	NDC 62559011016
Hospital Charge Code	108074697
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

metoclopramide 5 mg/5 mL UD oral Syr [CQCH]

Facility

$0.01

Service Code	NDC 62559011016
Hospital Charge Code	108074697
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

metolazone 5 mg Tab [CQCH]

Facility

$2.75

Service Code	NDC 51079002420
Hospital Charge Code	105931715
Hospital Revenue Code	251
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of AZ Commercial	$2.48
Rate for Payer: Arizona Complete Health Allwell	$0.44
Rate for Payer: Banner UC Health Medicare	$0.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.87
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.44
Rate for Payer: Cash Price	$2.20
Rate for Payer: Cigna of AZ Commercial	$1.79
Rate for Payer: Devoted Health Medicare	$0.50
Rate for Payer: Humana of AZ Medicare	$0.44
Rate for Payer: Southwest Service Administrators UFCW	$1.87
Rate for Payer: TriWest Medicare	$0.44
Rate for Payer: United Healthcare Commercial	$1.57
Rate for Payer: United Healthcare Medicare	$0.44
Rate for Payer: Veterans Affairs TRICARE	$0.44

metolazone 5 mg Tab [CQCH]

Facility

$2.75

Service Code	NDC 51079002420
Hospital Charge Code	105931715
Hospital Revenue Code	251
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of AZ Commercial	$2.48
Rate for Payer: Cash Price	$2.20

metoprolol 5 mg/ 5 mL Inj Sol [CQCH]

Facility

$0.14

Service Code	NDC 409177805
Hospital Charge Code	105931847
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
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	$0.10
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	$0.11
Rate for Payer: Cigna of AZ Commercial	$0.09
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.08
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

metoprolol 5 mg/ 5 mL Inj Sol [CQCH]

Facility

$0.14

Service Code	NDC 409177805
Hospital Charge Code	105931847
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Cash Price	$0.11

metoprolol succinate 50 mg ER Tab [CQCH]

Facility

$0.93

Service Code	NDC 904632361
Hospital Charge Code	105931780
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of AZ Commercial	$0.84
Rate for Payer: Arizona Complete Health Allwell	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.63
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.15
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.15
Rate for Payer: Cash Price	$0.74
Rate for Payer: Cigna of AZ Commercial	$0.60
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Southwest Service Administrators UFCW	$0.63
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: United Healthcare Commercial	$0.53
Rate for Payer: United Healthcare Medicare	$0.15
Rate for Payer: Veterans Affairs TRICARE	$0.15

metoprolol succinate 50 mg ER Tab [CQCH]

Facility

$0.93

Service Code	NDC 904632361
Hospital Charge Code	105931780
Hospital Revenue Code	251
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of AZ Commercial	$0.84
Rate for Payer: Cash Price	$0.74

metoprolol tartrate 25 mg Tab [CQCH]

Facility

$0.10

Service Code	NDC 51079025520
Hospital Charge Code	105931963
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of AZ Commercial	$0.09
Rate for Payer: Cash Price	$0.08

metoprolol tartrate 25 mg Tab [CQCH]

Facility

$0.10

Service Code	NDC 51079025520
Hospital Charge Code	105931963
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of AZ Commercial	$0.09
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	$0.08
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

metroNIDAZOLE 500 mg Premix IVPB Sol [CQCH]

Facility

$0.02

Service Code	NDC 409781124
Hospital Charge Code	105932101
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Cash Price	$0.01

metroNIDAZOLE 500 mg Premix IVPB Sol [CQCH]

Facility

$0.02

Service Code	NDC 409781124
Hospital Charge Code	105932101
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
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

Know your out-of-pocket cost for care.

All Charges