Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

OXYGEN SETUP

Facility

$135.00

Hospital Charge Code	7229383
Hospital Revenue Code	270
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Arizona Complete Health Allwell	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$91.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$21.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$21.60
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$94.50
Rate for Payer: Devoted Health Medicare	$24.30
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Southwest Service Administrators UFCW	$91.80
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: United Healthcare Commercial	$77.22
Rate for Payer: United Healthcare Medicare	$21.60
Rate for Payer: Veterans Affairs TRICARE	$21.38

OXYGEN TREATMENT HOOD

Facility

$554.00

Hospital Charge Code	24153387
Min. Negotiated Rate	$498.60
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna of AZ Commercial	$498.60
Rate for Payer: Cash Price	$443.20

OXYGEN TREATMENT HOOD

Facility

$554.00

Hospital Charge Code	24153387
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna of AZ Commercial	$498.60
Rate for Payer: Arizona Complete Health Allwell	$88.64
Rate for Payer: Banner UC Health Medicare	$88.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$376.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$88.64
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cigna of AZ Commercial	$387.80
Rate for Payer: Devoted Health Medicare	$99.72
Rate for Payer: Humana of AZ Medicare	$88.64
Rate for Payer: Southwest Service Administrators UFCW	$376.72
Rate for Payer: TriWest Medicare	$88.64
Rate for Payer: United Healthcare Commercial	$316.89
Rate for Payer: United Healthcare Medicare	$88.64
Rate for Payer: Veterans Affairs TRICARE	$87.75

OXYMASK ADULT UNIVERSAL

Facility

$24.00

Hospital Charge Code	23801599
Hospital Revenue Code	272
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Arizona Complete Health Allwell	$3.84
Rate for Payer: Banner UC Health Medicare	$3.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$16.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.84
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Devoted Health Medicare	$4.32
Rate for Payer: Humana of AZ Medicare	$3.84
Rate for Payer: Southwest Service Administrators UFCW	$16.32
Rate for Payer: TriWest Medicare	$3.84
Rate for Payer: United Healthcare Commercial	$13.73
Rate for Payer: United Healthcare Medicare	$3.84
Rate for Payer: Veterans Affairs TRICARE	$3.80

OXYMASK ADULT UNIVERSAL

Facility

$24.00

Hospital Charge Code	23801599
Hospital Revenue Code	272
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Cash Price	$19.20

oxymetazoline Nasal 0.05% Spry [CQCH]

Facility

$0.27

Service Code	NDC 904571135
Hospital Charge Code	105935609
Hospital Revenue Code	251
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

oxymetazoline Nasal 0.05% Spry [CQCH]

Facility

$0.27

Service Code	NDC 904571135
Hospital Charge Code	105935609
Hospital Revenue Code	251
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

oxytocin 10 units/ 1 mL Inj Sol [CQCH]

Facility

$1.43

Service Code	HCPCS J2590
Hospital Charge Code	105935674
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.29
Rate for Payer: Aetna of AZ Commercial	$1.29
Rate for Payer: Arizona Complete Health Allwell	$0.23
Rate for Payer: Banner UC Health Medicare	$0.23
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.23
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.23
Rate for Payer: Cash Price	$1.14
Rate for Payer: Cigna of AZ Commercial	$0.93
Rate for Payer: Devoted Health Medicare	$0.26
Rate for Payer: Humana of AZ Medicare	$0.23
Rate for Payer: Southwest Service Administrators UFCW	$0.97
Rate for Payer: TriWest Medicare	$0.23
Rate for Payer: United Healthcare Commercial	$0.82
Rate for Payer: United Healthcare Medicare	$0.23
Rate for Payer: Veterans Affairs TRICARE	$0.23

oxytocin 10 units/ 1 mL Inj Sol [CQCH]

Facility

$1.43

Service Code	HCPCS J2590
Hospital Charge Code	105935674
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Aetna of AZ Commercial	$1.29
Rate for Payer: Cash Price	$1.14

PACKING NASAL 5.5 RHINO

Facility

$144.00

Hospital Charge Code	22354976
Hospital Revenue Code	270
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Cash Price	$115.20

PACKING NASAL 5.5 RHINO

Facility

$144.00

Hospital Charge Code	22354976
Hospital Revenue Code	270
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Arizona Complete Health Allwell	$23.04
Rate for Payer: Banner UC Health Medicare	$23.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.04
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna of AZ Commercial	$100.80
Rate for Payer: Devoted Health Medicare	$25.92
Rate for Payer: Humana of AZ Medicare	$23.04
Rate for Payer: Southwest Service Administrators UFCW	$97.92
Rate for Payer: TriWest Medicare	$23.04
Rate for Payer: United Healthcare Commercial	$82.37
Rate for Payer: United Healthcare Medicare	$23.04
Rate for Payer: Veterans Affairs TRICARE	$22.81

PACKING NASAL 7.5 RHINO

Facility

$159.00

Hospital Charge Code	22354977
Hospital Revenue Code	270
Min. Negotiated Rate	$25.19
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Arizona Complete Health Allwell	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$108.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.44
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$111.30
Rate for Payer: Devoted Health Medicare	$28.62
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Southwest Service Administrators UFCW	$108.12
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: United Healthcare Commercial	$90.95
Rate for Payer: United Healthcare Medicare	$25.44
Rate for Payer: Veterans Affairs TRICARE	$25.19

PACKING NASAL 7.5 RHINO

Facility

$159.00

Hospital Charge Code	22354977
Hospital Revenue Code	270
Min. Negotiated Rate	$143.10
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Cash Price	$127.20

PACK ORTHO 5 HIP

Facility

$158.00

Hospital Charge Code	22926426
Hospital Revenue Code	272
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Arizona Complete Health Allwell	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$107.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.28
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$110.60
Rate for Payer: Devoted Health Medicare	$28.44
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Southwest Service Administrators UFCW	$107.44
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: United Healthcare Commercial	$90.38
Rate for Payer: United Healthcare Medicare	$25.28
Rate for Payer: Veterans Affairs TRICARE	$25.03

PACK ORTHO 5 HIP

Facility

$158.00

Hospital Charge Code	22926426
Hospital Revenue Code	272
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Cash Price	$126.40

PADDED GAIT BELT LG

Facility

$289.00

Hospital Charge Code	27445198
Hospital Revenue Code	270
Min. Negotiated Rate	$45.78
Max. Negotiated Rate	$260.10
Rate for Payer: Aetna of AZ Commercial	$260.10
Rate for Payer: Arizona Complete Health Allwell	$46.24
Rate for Payer: Banner UC Health Medicare	$46.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$196.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$46.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$46.24
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cigna of AZ Commercial	$202.30
Rate for Payer: Devoted Health Medicare	$52.02
Rate for Payer: Humana of AZ Medicare	$46.24
Rate for Payer: Southwest Service Administrators UFCW	$196.52
Rate for Payer: TriWest Medicare	$46.24
Rate for Payer: United Healthcare Commercial	$165.31
Rate for Payer: United Healthcare Medicare	$46.24
Rate for Payer: Veterans Affairs TRICARE	$45.78

PADDED GAIT BELT LG

Facility

$289.00

Hospital Charge Code	27445198
Hospital Revenue Code	270
Min. Negotiated Rate	$260.10
Max. Negotiated Rate	$260.10
Rate for Payer: Aetna of AZ Commercial	$260.10
Rate for Payer: Cash Price	$231.20

PADDED GAIT BELT MED

Facility

$279.00

Hospital Charge Code	27446678
Hospital Revenue Code	270
Min. Negotiated Rate	$251.10
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Cash Price	$223.20

PADDED GAIT BELT MED

Facility

$279.00

Hospital Charge Code	27446678
Hospital Revenue Code	270
Min. Negotiated Rate	$44.19
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Arizona Complete Health Allwell	$44.64
Rate for Payer: Banner UC Health Medicare	$44.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$189.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.64
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna of AZ Commercial	$195.30
Rate for Payer: Devoted Health Medicare	$50.22
Rate for Payer: Humana of AZ Medicare	$44.64
Rate for Payer: Southwest Service Administrators UFCW	$189.72
Rate for Payer: TriWest Medicare	$44.64
Rate for Payer: United Healthcare Commercial	$159.59
Rate for Payer: United Healthcare Medicare	$44.64
Rate for Payer: Veterans Affairs TRICARE	$44.19

PADDED GAIT BELT SM

Facility

$216.00

Hospital Charge Code	27446677
Hospital Revenue Code	270
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Cash Price	$172.80

PADDED GAIT BELT SM

Facility

$216.00

Hospital Charge Code	27446677
Hospital Revenue Code	270
Min. Negotiated Rate	$34.21
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Arizona Complete Health Allwell	$34.56
Rate for Payer: Banner UC Health Medicare	$34.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$146.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.56
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna of AZ Commercial	$151.20
Rate for Payer: Devoted Health Medicare	$38.88
Rate for Payer: Humana of AZ Medicare	$34.56
Rate for Payer: Southwest Service Administrators UFCW	$146.88
Rate for Payer: TriWest Medicare	$34.56
Rate for Payer: United Healthcare Commercial	$123.55
Rate for Payer: United Healthcare Medicare	$34.56
Rate for Payer: Veterans Affairs TRICARE	$34.21

PAD GROUNDING (BOVIE) CONMED

Facility

$18.00

Hospital Charge Code	22355702
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Arizona Complete Health Allwell	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.88
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Devoted Health Medicare	$3.24
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Southwest Service Administrators UFCW	$12.24
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: United Healthcare Commercial	$10.30
Rate for Payer: United Healthcare Medicare	$2.88
Rate for Payer: Veterans Affairs TRICARE	$2.85

PAD GROUNDING (BOVIE) CONMED

Facility

$18.00

Hospital Charge Code	22355702
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Cash Price	$14.40

Pain Management drug screen

Facility

$155.00

Service Code	CPT 80305 QW
Hospital Charge Code	1491676
Hospital Revenue Code	301
Min. Negotiated Rate	$18.27
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.80
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$100.75
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Seven Corners Travel Insurance	$18.27
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: Veterans Affairs TRICARE	$24.55

Pain Management drug screen

Facility

$155.00

Service Code	CPT 80305 QW
Hospital Charge Code	1491676
Hospital Revenue Code	301
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

Know your out-of-pocket cost for care.

All Charges