Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Quadrivalent Preservative Free Influenza Vaccine 6-35mos

Facility

$49.00

Service Code	CPT 90685
Hospital Charge Code	17541377
Hospital Revenue Code	636
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Arizona Complete Health Allwell	$7.84
Rate for Payer: Banner UC Health Medicare	$7.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$33.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.84
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$34.30
Rate for Payer: Devoted Health Medicare	$8.82
Rate for Payer: Humana of AZ Medicare	$7.84
Rate for Payer: Southwest Service Administrators UFCW	$33.32
Rate for Payer: TriWest Medicare	$7.84
Rate for Payer: United Healthcare Commercial	$28.03
Rate for Payer: United Healthcare Medicare	$7.84
Rate for Payer: United Healthcare New Mexico Commercial	$9.31
Rate for Payer: Veterans Affairs TRICARE	$7.76

QUANTA LITHO 800 MICRON PROPRIETARY LASER FIBER RFID

Facility

$2,550.00

Hospital Charge Code	27887274
Hospital Revenue Code	270
Min. Negotiated Rate	$2,295.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna of AZ Commercial	$2,295.00
Rate for Payer: Cash Price	$2,040.00

QUANTA LITHO 800 MICRON PROPRIETARY LASER FIBER RFID

Facility

$2,550.00

Hospital Charge Code	27887274
Hospital Revenue Code	270
Min. Negotiated Rate	$403.92
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna of AZ Commercial	$2,295.00
Rate for Payer: Arizona Complete Health Allwell	$408.00
Rate for Payer: Banner UC Health Medicare	$408.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,734.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$408.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$408.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Cigna of AZ Commercial	$1,785.00
Rate for Payer: Devoted Health Medicare	$459.00
Rate for Payer: Humana of AZ Medicare	$408.00
Rate for Payer: Southwest Service Administrators UFCW	$1,734.00
Rate for Payer: TriWest Medicare	$408.00
Rate for Payer: United Healthcare Commercial	$1,458.60
Rate for Payer: United Healthcare Medicare	$408.00
Rate for Payer: Veterans Affairs TRICARE	$403.92

QuantiFERONÂ®-TB Gold Plus (Client Incubated) LC

Facility

$150.00

Service Code	CPT 86480
Hospital Charge Code	23385510
Hospital Revenue Code	302
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Cash Price	$120.00

QuantiFERONÂ®-TB Gold Plus (Client Incubated) LC

Facility

$150.00

Service Code	CPT 86480
Hospital Charge Code	23385510
Hospital Revenue Code	302
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Arizona Complete Health Allwell	$24.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cigna of AZ Commercial	$97.50
Rate for Payer: Devoted Health Medicare	$27.00
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Seven Corners Travel Insurance	$89.87
Rate for Payer: Southwest Service Administrators UFCW	$102.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: United Healthcare Commercial	$85.80
Rate for Payer: United Healthcare Medicare	$24.00
Rate for Payer: Veterans Affairs TRICARE	$23.76

QuantiFERON Client Incubated LC

Facility

$732.00

Service Code	CPT 86480
Hospital Charge Code	6781827
Hospital Revenue Code	302
Min. Negotiated Rate	$658.80
Max. Negotiated Rate	$658.80
Rate for Payer: Aetna of AZ Commercial	$658.80
Rate for Payer: Cash Price	$585.60

QuantiFERON Client Incubated LC

Facility

$732.00

Service Code	CPT 86480
Hospital Charge Code	6781827
Hospital Revenue Code	302
Min. Negotiated Rate	$89.87
Max. Negotiated Rate	$658.80
Rate for Payer: Aetna of AZ Commercial	$658.80
Rate for Payer: Arizona Complete Health Allwell	$117.12
Rate for Payer: Banner UC Health Medicare	$117.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$497.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$117.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$117.12
Rate for Payer: Cash Price	$585.60
Rate for Payer: Cash Price	$585.60
Rate for Payer: Cigna of AZ Commercial	$475.80
Rate for Payer: Devoted Health Medicare	$131.76
Rate for Payer: Humana of AZ Medicare	$117.12
Rate for Payer: Seven Corners Travel Insurance	$89.87
Rate for Payer: Southwest Service Administrators UFCW	$497.76
Rate for Payer: TriWest Medicare	$117.12
Rate for Payer: United Healthcare Commercial	$418.70
Rate for Payer: United Healthcare Medicare	$117.12
Rate for Payer: Veterans Affairs TRICARE	$115.95

QuantiFERON TB Gold (In Tube) LC

Facility

$144.00

Service Code	CPT 86480
Hospital Charge Code	2087648
Hospital Revenue Code	302
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: Cash Price	$115.20
Rate for Payer: Cigna of AZ Commercial	$93.60
Rate for Payer: Devoted Health Medicare	$25.92
Rate for Payer: Humana of AZ Medicare	$23.04
Rate for Payer: Seven Corners Travel Insurance	$89.87
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

QuantiFERON TB Gold (In Tube) LC

Facility

$144.00

Service Code	CPT 86480
Hospital Charge Code	2087648
Hospital Revenue Code	302
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

QUANT LIPOPR

Facility

$426.00

Service Code	CPT 83704
Hospital Charge Code	22481501
Hospital Revenue Code	301
Min. Negotiated Rate	$49.58
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Arizona Complete Health Allwell	$68.16
Rate for Payer: Banner UC Health Medicare	$68.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$289.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$68.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$68.16
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cigna of AZ Commercial	$276.90
Rate for Payer: Devoted Health Medicare	$76.68
Rate for Payer: Humana of AZ Medicare	$68.16
Rate for Payer: Seven Corners Travel Insurance	$49.58
Rate for Payer: Southwest Service Administrators UFCW	$289.68
Rate for Payer: TriWest Medicare	$68.16
Rate for Payer: United Healthcare Commercial	$243.67
Rate for Payer: United Healthcare Medicare	$68.16
Rate for Payer: Veterans Affairs TRICARE	$67.48

QUANT LIPOPR

Facility

$426.00

Service Code	CPT 83704
Hospital Charge Code	22481501
Hospital Revenue Code	301
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Cash Price	$340.80

QUEtiapine 100 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 63739066510
Hospital Charge Code	105938895
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	$0.33

QUEtiapine 100 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 63739066510
Hospital Charge Code	105938895
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	$0.33
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

QUEtiapine 25 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 16714045201
Hospital Charge Code	105938962
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

QUEtiapine 25 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 16714045201
Hospital Charge Code	105938962
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Cash Price	$0.03

QUICK CARE URINALYSIS DIPSTICK

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	22422559
Hospital Revenue Code	307
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Arizona Complete Health Allwell	$4.32
Rate for Payer: Banner UC Health Medicare	$4.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$18.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.32
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$17.55
Rate for Payer: Devoted Health Medicare	$4.86
Rate for Payer: Humana of AZ Medicare	$4.32
Rate for Payer: Seven Corners Travel Insurance	$5.05
Rate for Payer: Southwest Service Administrators UFCW	$18.36
Rate for Payer: TriWest Medicare	$4.32
Rate for Payer: United Healthcare Commercial	$15.44
Rate for Payer: United Healthcare Medicare	$4.32
Rate for Payer: Veterans Affairs TRICARE	$4.28

QUICK CARE URINALYSIS DIPSTICK

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	22422559
Hospital Revenue Code	307
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Cash Price	$21.60

QUICKCLIP PRO 230XM

Facility

$676.00

Hospital Charge Code	27443862
Hospital Revenue Code	270
Min. Negotiated Rate	$107.08
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Arizona Complete Health Allwell	$108.16
Rate for Payer: Banner UC Health Medicare	$108.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$459.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$108.16
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cigna of AZ Commercial	$473.20
Rate for Payer: Devoted Health Medicare	$121.68
Rate for Payer: Humana of AZ Medicare	$108.16
Rate for Payer: Southwest Service Administrators UFCW	$459.68
Rate for Payer: TriWest Medicare	$108.16
Rate for Payer: United Healthcare Commercial	$386.67
Rate for Payer: United Healthcare Medicare	$108.16
Rate for Payer: Veterans Affairs TRICARE	$107.08

QUICKCLIP PRO 230XM

Facility

$676.00

Hospital Charge Code	27443862
Hospital Revenue Code	270
Min. Negotiated Rate	$608.40
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Cash Price	$540.80

QUICKSNAP 2MM X8MM SCREW

Facility

$3,032.00

Hospital Charge Code	27555211
Hospital Revenue Code	270
Min. Negotiated Rate	$480.27
Max. Negotiated Rate	$2,728.80
Rate for Payer: Aetna of AZ Commercial	$2,728.80
Rate for Payer: Arizona Complete Health Allwell	$485.12
Rate for Payer: Banner UC Health Medicare	$485.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,061.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$485.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$485.12
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cigna of AZ Commercial	$2,122.40
Rate for Payer: Devoted Health Medicare	$545.76
Rate for Payer: Humana of AZ Medicare	$485.12
Rate for Payer: Southwest Service Administrators UFCW	$2,061.76
Rate for Payer: TriWest Medicare	$485.12
Rate for Payer: United Healthcare Commercial	$1,734.30
Rate for Payer: United Healthcare Medicare	$485.12
Rate for Payer: Veterans Affairs TRICARE	$480.27

QUICKSNAP 2MM X8MM SCREW

Facility

$3,032.00

Hospital Charge Code	27555211
Hospital Revenue Code	270
Min. Negotiated Rate	$2,728.80
Max. Negotiated Rate	$2,728.80
Rate for Payer: Aetna of AZ Commercial	$2,728.80
Rate for Payer: Cash Price	$2,425.60

quinapril 10 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 65862061890
Hospital Charge Code	105939029
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

quinapril 10 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 65862061890
Hospital Charge Code	105939029
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

QWIX DRILL AO 2IN SIA 2MM X L65MM

Facility

$935.00

Hospital Charge Code	27341817
Hospital Revenue Code	270
Min. Negotiated Rate	$148.10
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Arizona Complete Health Allwell	$149.60
Rate for Payer: Banner UC Health Medicare	$149.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$635.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$149.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$149.60
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cigna of AZ Commercial	$654.50
Rate for Payer: Devoted Health Medicare	$168.30
Rate for Payer: Humana of AZ Medicare	$149.60
Rate for Payer: Southwest Service Administrators UFCW	$635.80
Rate for Payer: TriWest Medicare	$149.60
Rate for Payer: United Healthcare Commercial	$534.82
Rate for Payer: United Healthcare Medicare	$149.60
Rate for Payer: Veterans Affairs TRICARE	$148.10

QWIX DRILL AO 2IN SIA 2MM X L65MM

Facility

$935.00

Hospital Charge Code	27341817
Hospital Revenue Code	270
Min. Negotiated Rate	$841.50
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Cash Price	$748.00

Know your out-of-pocket cost for care.

All Charges