Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

OVERFLOW PROTECTION BACTERIAL FILTER

Facility

$85.06

Hospital Charge Code	27839757
Hospital Revenue Code	270
Min. Negotiated Rate	$13.47
Max. Negotiated Rate	$76.55
Rate for Payer: Aetna of AZ Commercial	$76.55
Rate for Payer: Arizona Complete Health Allwell	$13.61
Rate for Payer: Banner UC Health Medicare	$13.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.61
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.61
Rate for Payer: Cash Price	$68.05
Rate for Payer: Cigna of AZ Commercial	$59.54
Rate for Payer: Devoted Health Medicare	$15.31
Rate for Payer: Humana of AZ Medicare	$13.61
Rate for Payer: Southwest Service Administrators UFCW	$57.84
Rate for Payer: TriWest Medicare	$13.61
Rate for Payer: United Healthcare Commercial	$48.65
Rate for Payer: United Healthcare Medicare	$13.61
Rate for Payer: Veterans Affairs TRICARE	$13.47

OVERFLOW PROTECTION BACTERIAL FILTER

Facility

$85.06

Hospital Charge Code	27839757
Hospital Revenue Code	270
Min. Negotiated Rate	$76.55
Max. Negotiated Rate	$76.55
Rate for Payer: Aetna of AZ Commercial	$76.55
Rate for Payer: Cash Price	$68.05

Oxalate, Quant, 24-Hour Urine LC

Facility

$172.00

Service Code	CPT 83945
Hospital Charge Code	2029209
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

Oxalate, Quant, 24-Hour Urine LC

Facility

$172.00

Service Code	CPT 83945
Hospital Charge Code	2029209
Hospital Revenue Code	301
Min. Negotiated Rate	$20.95
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	$20.95
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

OXcarbazepine 600 mg Tab [CQCH]

Facility

$0.94

Service Code	NDC 50268068115
Hospital Charge Code	110527678
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna of AZ Commercial	$0.85
Rate for Payer: Cash Price	$0.75

OXcarbazepine 600 mg Tab [CQCH]

Facility

$0.94

Service Code	NDC 50268068115
Hospital Charge Code	110527678
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna of AZ Commercial	$0.85
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	$0.64
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	$0.75
Rate for Payer: Cigna of AZ Commercial	$0.61
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Southwest Service Administrators UFCW	$0.64
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: United Healthcare Commercial	$0.54
Rate for Payer: United Healthcare Medicare	$0.15
Rate for Payer: Veterans Affairs TRICARE	$0.15

Oxcarbazepine (Trileptal), LC

Facility

$234.00

Service Code	CPT 80299
Hospital Charge Code	1285602
Hospital Revenue Code	301
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna of AZ Commercial	$210.60
Rate for Payer: Cash Price	$187.20

Oxcarbazepine (Trileptal), LC

Facility

$234.00

Service Code	CPT 80299
Hospital Charge Code	1285602
Hospital Revenue Code	301
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna of AZ Commercial	$210.60
Rate for Payer: Arizona Complete Health Allwell	$37.44
Rate for Payer: Banner UC Health Medicare	$37.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$159.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.44
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna of AZ Commercial	$152.10
Rate for Payer: Devoted Health Medicare	$42.12
Rate for Payer: Humana of AZ Medicare	$37.44
Rate for Payer: Seven Corners Travel Insurance	$27.03
Rate for Payer: Southwest Service Administrators UFCW	$159.12
Rate for Payer: TriWest Medicare	$37.44
Rate for Payer: United Healthcare Commercial	$133.85
Rate for Payer: United Healthcare Medicare	$37.44
Rate for Payer: Veterans Affairs TRICARE	$37.07

OXIMAX

Facility

$56.00

Hospital Charge Code	24157864
Hospital Revenue Code	270
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of AZ Commercial	$50.40
Rate for Payer: Arizona Complete Health Allwell	$8.96
Rate for Payer: Banner UC Health Medicare	$8.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$38.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.96
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cigna of AZ Commercial	$39.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Humana of AZ Medicare	$8.96
Rate for Payer: Southwest Service Administrators UFCW	$38.08
Rate for Payer: TriWest Medicare	$8.96
Rate for Payer: United Healthcare Commercial	$32.03
Rate for Payer: United Healthcare Medicare	$8.96
Rate for Payer: Veterans Affairs TRICARE	$8.87

OXIMAX

Facility

$56.00

Hospital Charge Code	24157864
Hospital Revenue Code	270
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of AZ Commercial	$50.40
Rate for Payer: Cash Price	$44.80

oxybutynin 5 mg Tab [CQCH]

Facility

$0.59

Service Code	NDC 904282161
Hospital Charge Code	105935217
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

oxybutynin 5 mg Tab [CQCH]

Facility

$0.59

Service Code	NDC 904282161
Hospital Charge Code	105935217
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

Oxycodone

Facility

$254.00

Service Code	CPT 80365
Hospital Charge Code	23090937
Hospital Revenue Code	301
Min. Negotiated Rate	$228.60
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of AZ Commercial	$228.60
Rate for Payer: Cash Price	$203.20

Oxycodone

Facility

$254.00

Service Code	CPT 80365
Hospital Charge Code	23090937
Hospital Revenue Code	301
Min. Negotiated Rate	$40.23
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of AZ Commercial	$228.60
Rate for Payer: Arizona Complete Health Allwell	$40.64
Rate for Payer: Banner UC Health Medicare	$40.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$172.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.64
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cigna of AZ Commercial	$165.10
Rate for Payer: Devoted Health Medicare	$45.72
Rate for Payer: Humana of AZ Medicare	$40.64
Rate for Payer: Southwest Service Administrators UFCW	$172.72
Rate for Payer: TriWest Medicare	$40.64
Rate for Payer: United Healthcare Commercial	$145.29
Rate for Payer: United Healthcare Medicare	$40.64
Rate for Payer: Veterans Affairs TRICARE	$40.23

oxyCODONE 10 mg ER Tab [CQCH]

Facility

$3.31

Service Code	NDC 59011041020
Hospital Charge Code	105935475
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna of AZ Commercial	$2.98
Rate for Payer: Cash Price	$2.65

oxyCODONE 10 mg ER Tab [CQCH]

Facility

$3.31

Service Code	NDC 59011041020
Hospital Charge Code	105935475
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna of AZ Commercial	$2.98
Rate for Payer: Arizona Complete Health Allwell	$0.53
Rate for Payer: Banner UC Health Medicare	$0.53
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.53
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.53
Rate for Payer: Cash Price	$2.65
Rate for Payer: Cigna of AZ Commercial	$2.15
Rate for Payer: Devoted Health Medicare	$0.60
Rate for Payer: Humana of AZ Medicare	$0.53
Rate for Payer: Southwest Service Administrators UFCW	$2.25
Rate for Payer: TriWest Medicare	$0.53
Rate for Payer: United Healthcare Commercial	$1.89
Rate for Payer: United Healthcare Medicare	$0.53
Rate for Payer: Veterans Affairs TRICARE	$0.52

oxyCODONE 15 mg Tab [CQCH]

Facility

$0.40

Service Code	NDC 904674361
Hospital Charge Code	105935410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of AZ Commercial	$0.36
Rate for Payer: Cash Price	$0.32

oxyCODONE 15 mg Tab [CQCH]

Facility

$0.40

Service Code	NDC 904674361
Hospital Charge Code	105935410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of AZ Commercial	$0.36
Rate for Payer: Arizona Complete Health Allwell	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.27
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.06
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.06
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of AZ Commercial	$0.26
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Southwest Service Administrators UFCW	$0.27
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: United Healthcare Commercial	$0.23
Rate for Payer: United Healthcare Medicare	$0.06
Rate for Payer: Veterans Affairs TRICARE	$0.06

oxyCODONE 5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 42858000110
Hospital Charge Code	105935278
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
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	$0.14
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	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.14
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

oxyCODONE 5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 42858000110
Hospital Charge Code	105935278
Hospital Revenue Code	251
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Cash Price	$0.16

OXYGEN DAILY

Facility

$358.00

Hospital Charge Code	1886880
Hospital Revenue Code	270
Min. Negotiated Rate	$322.20
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of AZ Commercial	$322.20
Rate for Payer: Cash Price	$286.40

OXYGEN DAILY

Facility

$358.00

Hospital Charge Code	1886880
Hospital Revenue Code	270
Min. Negotiated Rate	$56.71
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of AZ Commercial	$322.20
Rate for Payer: Arizona Complete Health Allwell	$57.28
Rate for Payer: Banner UC Health Medicare	$57.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$243.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$57.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$57.28
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cigna of AZ Commercial	$250.60
Rate for Payer: Devoted Health Medicare	$64.44
Rate for Payer: Humana of AZ Medicare	$57.28
Rate for Payer: Southwest Service Administrators UFCW	$243.44
Rate for Payer: TriWest Medicare	$57.28
Rate for Payer: United Healthcare Commercial	$204.78
Rate for Payer: United Healthcare Medicare	$57.28
Rate for Payer: Veterans Affairs TRICARE	$56.71

Oxygen per hour

Facility

$39.00

Service Code	CPT 94644
Hospital Charge Code	1558431
Hospital Revenue Code	460
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$205.86
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Arizona Complete Health Allwell	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.24
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Devoted Health Medicare	$7.02
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$26.52
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: United Healthcare Commercial	$22.31
Rate for Payer: United Healthcare Medicare	$6.24
Rate for Payer: United Healthcare New Mexico Commercial	$7.41
Rate for Payer: Veterans Affairs TRICARE	$6.18

Oxygen per hour

Facility

$39.00

Service Code	CPT 94644
Hospital Charge Code	1558431
Hospital Revenue Code	460
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Cash Price	$31.20

OXYGEN SETUP

Facility

$135.00

Hospital Charge Code	7229383
Hospital Revenue Code	270
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Cash Price	$108.00

Know your out-of-pocket cost for care.

All Charges