Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

potassium chloride 20 mEq ER Tab [CQCH]

Facility

$0.62

Service Code	NDC 68084036009
Hospital Charge Code	105937370
Hospital Revenue Code	251
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Cash Price	$0.50

Potassium Level

Facility

$71.00

Service Code	CPT 84132
Hospital Charge Code	633616
Hospital Revenue Code	301
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

Potassium Level

Facility

$71.00

Service Code	CPT 84132
Hospital Charge Code	633616
Hospital Revenue Code	301
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$46.15
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Seven Corners Travel Insurance	$6.90
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg REC UD[CQCH]

Facility

$0.32

Service Code	NDC 71351001001
Hospital Charge Code	163314692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of AZ Commercial	$0.29
Rate for Payer: Arizona Complete Health Allwell	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.22
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.05
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.05
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of AZ Commercial	$0.21
Rate for Payer: Devoted Health Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Southwest Service Administrators UFCW	$0.22
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: United Healthcare Commercial	$0.18
Rate for Payer: United Healthcare Medicare	$0.05
Rate for Payer: Veterans Affairs TRICARE	$0.05

potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg REC UD[CQCH]

Facility

$0.32

Service Code	NDC 71351001001
Hospital Charge Code	163314692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of AZ Commercial	$0.29
Rate for Payer: Cash Price	$0.26

Powerpoint SLIM IMPLANTABLE PORT

Facility

$1,650.00

Hospital Charge Code	24325294
Hospital Revenue Code	270
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna of AZ Commercial	$1,485.00
Rate for Payer: Cash Price	$1,320.00

Powerpoint SLIM IMPLANTABLE PORT

Facility

$1,650.00

Hospital Charge Code	24325294
Hospital Revenue Code	270
Min. Negotiated Rate	$261.36
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna of AZ Commercial	$1,485.00
Rate for Payer: Arizona Complete Health Allwell	$264.00
Rate for Payer: Banner UC Health Medicare	$264.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,122.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$264.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$264.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Cigna of AZ Commercial	$1,155.00
Rate for Payer: Devoted Health Medicare	$297.00
Rate for Payer: Humana of AZ Medicare	$264.00
Rate for Payer: Southwest Service Administrators UFCW	$1,122.00
Rate for Payer: TriWest Medicare	$264.00
Rate for Payer: United Healthcare Commercial	$943.80
Rate for Payer: United Healthcare Medicare	$264.00
Rate for Payer: Veterans Affairs TRICARE	$261.36

pramipexole 0.5 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 68462033290
Hospital Charge Code	105937512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
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	$0.09
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	$0.09
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

pramipexole 0.5 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 68462033290
Hospital Charge Code	105937512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Cash Price	$0.10

prazosin 1 mg Cap [CQCH]

Facility

$0.24

Service Code	NDC 378110101
Hospital Charge Code	118000537
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
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	$0.16
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	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.16
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.14
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

prazosin 1 mg Cap [CQCH]

Facility

$0.24

Service Code	NDC 378110101
Hospital Charge Code	118000537
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Cash Price	$0.19

Prealbumin LC

Facility

$203.00

Service Code	CPT 84134
Hospital Charge Code	1905830
Hospital Revenue Code	301
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Arizona Complete Health Allwell	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.48
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$131.95
Rate for Payer: Devoted Health Medicare	$36.54
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Seven Corners Travel Insurance	$21.16
Rate for Payer: Southwest Service Administrators UFCW	$138.04
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: United Healthcare Commercial	$116.12
Rate for Payer: United Healthcare Medicare	$32.48
Rate for Payer: Veterans Affairs TRICARE	$32.16

Prealbumin LC

Facility

$203.00

Service Code	CPT 84134
Hospital Charge Code	1905830
Hospital Revenue Code	301
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Cash Price	$162.40

PRE-ANES EXAM/EVAL

Facility

$186.00

Service Code	CPT 99231 QZ
Hospital Charge Code	22789175
Hospital Revenue Code	370
Min. Negotiated Rate	$29.46
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Arizona Complete Health Allwell	$29.76
Rate for Payer: Banner UC Health Medicare	$29.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$126.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.76
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$120.90
Rate for Payer: Devoted Health Medicare	$33.48
Rate for Payer: Humana of AZ Medicare	$29.76
Rate for Payer: Southwest Service Administrators UFCW	$126.48
Rate for Payer: TriWest Medicare	$29.76
Rate for Payer: United Healthcare Commercial	$106.39
Rate for Payer: United Healthcare Medicare	$29.76
Rate for Payer: Veterans Affairs TRICARE	$29.46

PRE-ANES EXAM/EVAL

Facility

$186.00

Service Code	CPT 99231 QZ
Hospital Charge Code	22789175
Hospital Revenue Code	370
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Cash Price	$148.80

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$18,981.67

Service Code	MSDRG 067
Min. Negotiated Rate	$18,981.67
Max. Negotiated Rate	$18,981.67
Rate for Payer: Seven Corners Travel Insurance	$18,981.67

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$11,308.41

Service Code	MSDRG 068
Min. Negotiated Rate	$11,308.41
Max. Negotiated Rate	$11,308.41
Rate for Payer: Seven Corners Travel Insurance	$11,308.41

PRECISION THIN 9.0 X .38 X .25.0MM

Facility

$135.00

Hospital Charge Code	24185370
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

PRECISION THIN 9.0 X .38 X .25.0MM

Facility

$135.00

Hospital Charge Code	24185370
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

prednisoLONE 15 mg/5 mL Oral Syrup UD [CQCH]

Facility

$0.13

Service Code	HCPCS J7510
Hospital Charge Code	105937577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Cash Price	$0.10

prednisoLONE 15 mg/5 mL Oral Syrup UD [CQCH]

Facility

$0.13

Service Code	HCPCS J7510
Hospital Charge Code	105937577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
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	$0.09
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	$0.09
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

prednisoLONE acetate 1% Ophth Susp [CQCH]

Facility

$8.65

Service Code	NDC 61314063705
Hospital Charge Code	105937654
Hospital Revenue Code	251
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$7.79
Rate for Payer: Aetna of AZ Commercial	$7.79
Rate for Payer: Cash Price	$6.92

prednisoLONE acetate 1% Ophth Susp [CQCH]

Facility

$8.65

Service Code	NDC 61314063705
Hospital Charge Code	105937654
Hospital Revenue Code	251
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$7.79
Rate for Payer: Aetna of AZ Commercial	$7.79
Rate for Payer: Arizona Complete Health Allwell	$1.38
Rate for Payer: Banner UC Health Medicare	$1.38
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.38
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.38
Rate for Payer: Cash Price	$6.92
Rate for Payer: Cigna of AZ Commercial	$5.62
Rate for Payer: Devoted Health Medicare	$1.56
Rate for Payer: Humana of AZ Medicare	$1.38
Rate for Payer: Southwest Service Administrators UFCW	$5.88
Rate for Payer: TriWest Medicare	$1.38
Rate for Payer: United Healthcare Commercial	$4.95
Rate for Payer: United Healthcare Medicare	$1.38
Rate for Payer: Veterans Affairs TRICARE	$1.37

predniSONE 10 mg Tab [CQCH]

Facility

$0.15

Service Code	HCPCS J7510
Hospital Charge Code	105937790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
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	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
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	$0.09
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

predniSONE 10 mg Tab [CQCH]

Facility

$0.15

Service Code	HCPCS J7510
Hospital Charge Code	105937790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Cash Price	$0.12

Know your out-of-pocket cost for care.

All Charges