Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

predniSONE 1 mg Tab [CQCH]

Facility

$0.16

Service Code	HCPCS J7510
Hospital Charge Code	105937861
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	$0.13

predniSONE 1 mg Tab [CQCH]

Facility

$0.16

Service Code	HCPCS J7510
Hospital Charge Code	105937861
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
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	$0.11
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	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.11
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.09
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

predniSONE 20 mg Tab [CQCH]

Facility

$0.13

Service Code	HCPCS J7510
Hospital Charge Code	105937930
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

predniSONE 20 mg Tab [CQCH]

Facility

$0.13

Service Code	HCPCS J7510
Hospital Charge Code	105937930
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

predniSONE 5 mg Tab [CQCH]

Facility

$0.14

Service Code	HCPCS J7510
Hospital Charge Code	105937719
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

predniSONE 5 mg Tab [CQCH]

Facility

$0.14

Service Code	HCPCS J7510
Hospital Charge Code	105937719
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

pregabalin 50 mg oral cap [CQCH]

Facility

$0.41

Service Code	NDC 904699261
Hospital Charge Code	105937999
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Arizona Complete Health Allwell	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.07
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.28
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.23
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.06

pregabalin 50 mg oral cap [CQCH]

Facility

$0.41

Service Code	NDC 904699261
Hospital Charge Code	105937999
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Cash Price	$0.32

PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)

Facility

$114.00

Service Code	CPT 84163
Hospital Charge Code	23296930
Hospital Revenue Code	301
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Arizona Complete Health Allwell	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$77.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.24
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Devoted Health Medicare	$20.52
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Seven Corners Travel Insurance	$21.82
Rate for Payer: Southwest Service Administrators UFCW	$77.52
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: United Healthcare Commercial	$65.21
Rate for Payer: United Healthcare Medicare	$18.24
Rate for Payer: Veterans Affairs TRICARE	$18.06

PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)

Facility

$114.00

Service Code	CPT 84163
Hospital Charge Code	23296930
Hospital Revenue Code	301
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Cash Price	$91.20

PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)

Facility

$109.00

Service Code	CPT 84163
Hospital Charge Code	23294372
Hospital Revenue Code	301
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Cash Price	$87.20

PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)

Facility

$109.00

Service Code	CPT 84163
Hospital Charge Code	23294372
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Arizona Complete Health Allwell	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$74.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.44
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$70.85
Rate for Payer: Devoted Health Medicare	$19.62
Rate for Payer: Humana of AZ Medicare	$17.44
Rate for Payer: Seven Corners Travel Insurance	$21.82
Rate for Payer: Southwest Service Administrators UFCW	$74.12
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: United Healthcare Commercial	$62.35
Rate for Payer: United Healthcare Medicare	$17.44
Rate for Payer: Veterans Affairs TRICARE	$17.27

Pregnancy Test Serum 1

Facility

$15.00

Service Code	CPT 84703
Hospital Charge Code	9579719
Hospital Revenue Code	301
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Arizona Complete Health Allwell	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$10.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of AZ Commercial	$9.75
Rate for Payer: Devoted Health Medicare	$2.70
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Seven Corners Travel Insurance	$10.90
Rate for Payer: Southwest Service Administrators UFCW	$10.20
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: United Healthcare Commercial	$8.58
Rate for Payer: United Healthcare Medicare	$2.40
Rate for Payer: Veterans Affairs TRICARE	$2.38

Pregnancy Test Serum 1

Facility

$15.00

Service Code	CPT 84703
Hospital Charge Code	9579719
Hospital Revenue Code	301
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Cash Price	$12.00

Pregnancy Test Urine 1

Facility

$212.00

Service Code	CPT 81025
Hospital Charge Code	9579720
Hospital Revenue Code	300
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Arizona Complete Health Allwell	$24.16
Rate for Payer: Arizona Complete Health Allwell	$33.92
Rate for Payer: Banner UC Health Medicare	$24.16
Rate for Payer: Banner UC Health Medicare	$33.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$144.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$33.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.92
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$137.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Devoted Health Medicare	$38.16
Rate for Payer: Devoted Health Medicare	$27.18
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Humana of AZ Medicare	$33.92
Rate for Payer: Seven Corners Travel Insurance	$12.48
Rate for Payer: Seven Corners Travel Insurance	$12.48
Rate for Payer: Southwest Service Administrators UFCW	$102.68
Rate for Payer: Southwest Service Administrators UFCW	$144.16
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: TriWest Medicare	$33.92
Rate for Payer: United Healthcare Commercial	$121.26
Rate for Payer: United Healthcare Commercial	$86.37
Rate for Payer: United Healthcare Medicare	$24.16
Rate for Payer: United Healthcare Medicare	$33.92
Rate for Payer: Veterans Affairs TRICARE	$33.58
Rate for Payer: Veterans Affairs TRICARE	$23.92

Pregnancy Test Urine 1

Facility

$151.00

Service Code	CPT 81025
Hospital Charge Code	9579720
Hospital Revenue Code	300
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$169.60

PREMATURITY WITH MAJOR PROBLEMS

Facility

$52,459.09

Service Code	MSDRG 791
Min. Negotiated Rate	$52,459.09
Max. Negotiated Rate	$52,459.09
Rate for Payer: Seven Corners Travel Insurance	$52,459.09

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$31,653.80

Service Code	MSDRG 792
Min. Negotiated Rate	$31,653.80
Max. Negotiated Rate	$31,653.80
Rate for Payer: Seven Corners Travel Insurance	$31,653.80

PRESS PATCH

Facility

$38.00

Hospital Charge Code	22355154
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Cash Price	$30.40

PRESS PATCH

Facility

$38.00

Hospital Charge Code	22355154
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Arizona Complete Health Allwell	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.08
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Devoted Health Medicare	$6.84
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Southwest Service Administrators UFCW	$25.84
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: United Healthcare Commercial	$21.74
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: Veterans Affairs TRICARE	$6.02

Preventive Medicine 12-17 years Established - 99394

Facility

$379.00

Service Code	CPT 99394
Hospital Charge Code	631694
Hospital Revenue Code	521
Min. Negotiated Rate	$341.10
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Cash Price	$303.20

Preventive Medicine 12-17 years Established - 99394

Facility

$379.00

Service Code	CPT 99394
Hospital Charge Code	631694
Hospital Revenue Code	521
Min. Negotiated Rate	$27.21
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Arizona Complete Health Allwell	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$257.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27.21
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.64
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$265.30
Rate for Payer: Devoted Health Medicare	$68.22
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Mercy Care Medicaid	$27.21
Rate for Payer: NaphCare Correctional Healthcare	$27.21
Rate for Payer: Southwest Service Administrators UFCW	$257.72
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: United Healthcare Commercial	$216.79
Rate for Payer: United Healthcare Medicare	$60.64
Rate for Payer: Veterans Affairs TRICARE	$60.03

Preventive Medicine 12-17 years New - 99384

Facility

$525.00

Service Code	CPT 99384
Hospital Charge Code	631695
Hospital Revenue Code	521
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Cash Price	$420.00

Preventive Medicine 12-17 years New - 99384

Facility

$525.00

Service Code	CPT 99384
Hospital Charge Code	631695
Hospital Revenue Code	521
Min. Negotiated Rate	$31.01
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna of AZ Commercial	$472.50
Rate for Payer: Arizona Complete Health Allwell	$84.00
Rate for Payer: Banner UC Health Medicare	$84.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$357.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$31.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cigna of AZ Commercial	$367.50
Rate for Payer: Devoted Health Medicare	$94.50
Rate for Payer: Humana of AZ Medicare	$84.00
Rate for Payer: Mercy Care Medicaid	$31.01
Rate for Payer: NaphCare Correctional Healthcare	$31.01
Rate for Payer: Southwest Service Administrators UFCW	$357.00
Rate for Payer: TriWest Medicare	$84.00
Rate for Payer: United Healthcare Commercial	$300.30
Rate for Payer: United Healthcare Medicare	$84.00
Rate for Payer: Veterans Affairs TRICARE	$83.16

Preventive Medicine 1-4 years Established - 99392

Facility

$342.00

Service Code	CPT 99392
Hospital Charge Code	631692
Hospital Revenue Code	521
Min. Negotiated Rate	$307.80
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of AZ Commercial	$307.80
Rate for Payer: Cash Price	$273.60

Know your out-of-pocket cost for care.

All Charges