Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Vitamin B12

Facility

$108.00

Service Code	CPT 82607
Hospital Charge Code	22050695
Hospital Revenue Code	301
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Cash Price	$86.40
Rate for Payer: Self Pay Self Pay	$86.40

Vitamin B12/Folate Panel

Facility

$180.00

Service Code	CPT 82607
Hospital Charge Code	20183520
Hospital Revenue Code	301
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$28.80
Rate for Payer: Amerigroup Medicare	$28.80
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$117.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

Vitamin B12/Folate Panel

Facility

$180.00

Service Code	CPT 82607
Hospital Charge Code	20183520
Hospital Revenue Code	301
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

Vitamin B12 Level

Facility

$179.00

Service Code	CPT 82607
Hospital Charge Code	633871
Hospital Revenue Code	301
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Cash Price	$143.20
Rate for Payer: Self Pay Self Pay	$143.20

Vitamin B12 Level

Facility

$179.00

Service Code	CPT 82607
Hospital Charge Code	633871
Hospital Revenue Code	301
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Aetna of AZ Medicare	$50.12
Rate for Payer: Allwell Medicare	$28.64
Rate for Payer: Amerigroup Medicare	$28.64
Rate for Payer: APIPA Medicare/Medicaid	$66.86
Rate for Payer: AZCH Complete Medicare	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$121.72
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$116.35
Rate for Payer: Copperpoint Commercial	$44.30
Rate for Payer: Health Net of AZ Commercial	$107.40
Rate for Payer: Health Net of AZ Medicare	$50.12
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Self Pay Self Pay	$143.20
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.22

Vitamin B12 Level

Facility

$108.00

Service Code	CPT 82607
Hospital Charge Code	21254686
Hospital Revenue Code	301
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Aetna of AZ Medicare	$30.24
Rate for Payer: Allwell Medicare	$17.28
Rate for Payer: Amerigroup Medicare	$17.28
Rate for Payer: APIPA Medicare/Medicaid	$40.34
Rate for Payer: AZCH Complete Medicare	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$73.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$70.20
Rate for Payer: Copperpoint Commercial	$26.73
Rate for Payer: Health Net of AZ Commercial	$64.80
Rate for Payer: Health Net of AZ Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Self Pay Self Pay	$86.40
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.44

Vitamin B12 Level

Facility

$108.00

Service Code	CPT 82607
Hospital Charge Code	21254686
Hospital Revenue Code	301
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Cash Price	$86.40
Rate for Payer: Self Pay Self Pay	$86.40

Vitamin B1 (Thiamine) Whl Blood LC

Facility

$345.00

Service Code	CPT 84425
Hospital Charge Code	6781596
Hospital Revenue Code	301
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna of AZ Commercial	$310.50
Rate for Payer: Bisbee Police All Plans	$89.70
Rate for Payer: Cash Price	$276.00
Rate for Payer: Self Pay Self Pay	$276.00

Vitamin B1 (Thiamine) Whl Blood LC

Facility

$345.00

Service Code	CPT 84425
Hospital Charge Code	6781596
Hospital Revenue Code	301
Min. Negotiated Rate	$55.20
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna of AZ Commercial	$310.50
Rate for Payer: Aetna of AZ Medicare	$96.60
Rate for Payer: Allwell Medicare	$55.20
Rate for Payer: Amerigroup Medicare	$55.20
Rate for Payer: APIPA Medicare/Medicaid	$128.86
Rate for Payer: AZCH Complete Medicare	$55.20
Rate for Payer: Banner UC Health Medicare	$55.20
Rate for Payer: Bisbee Police All Plans	$89.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$234.60
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cigna of AZ Commercial	$224.25
Rate for Payer: Copperpoint Commercial	$85.39
Rate for Payer: Health Net of AZ Commercial	$207.00
Rate for Payer: Health Net of AZ Medicare	$96.60
Rate for Payer: Humana of AZ Medicare	$55.20
Rate for Payer: Self Pay Self Pay	$276.00
Rate for Payer: TriWest Medicare	$55.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$201.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$62.10

Vitamin B2 Whole Blood LC

Facility

$342.00

Service Code	CPT 84252
Hospital Charge Code	6780835
Hospital Revenue Code	301
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of AZ Commercial	$307.80
Rate for Payer: Bisbee Police All Plans	$88.92
Rate for Payer: Cash Price	$273.60
Rate for Payer: Self Pay Self Pay	$273.60

Vitamin B2 Whole Blood LC

Facility

$342.00

Service Code	CPT 84252
Hospital Charge Code	6780835
Hospital Revenue Code	301
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of AZ Commercial	$307.80
Rate for Payer: Aetna of AZ Medicare	$95.76
Rate for Payer: Allwell Medicare	$54.72
Rate for Payer: Amerigroup Medicare	$54.72
Rate for Payer: APIPA Medicare/Medicaid	$127.74
Rate for Payer: AZCH Complete Medicare	$54.72
Rate for Payer: Banner UC Health Medicare	$54.72
Rate for Payer: Bisbee Police All Plans	$88.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$232.56
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cigna of AZ Commercial	$222.30
Rate for Payer: Copperpoint Commercial	$84.64
Rate for Payer: Health Net of AZ Commercial	$205.20
Rate for Payer: Health Net of AZ Medicare	$95.76
Rate for Payer: Humana of AZ Medicare	$54.72
Rate for Payer: Self Pay Self Pay	$273.60
Rate for Payer: TriWest Medicare	$54.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$199.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.56

Vitamin B3 (Niacin+Metabolite) LC

Facility

$708.00

Service Code	CPT 82542
Hospital Charge Code	6781648
Hospital Revenue Code	301
Min. Negotiated Rate	$184.08
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Bisbee Police All Plans	$184.08
Rate for Payer: Cash Price	$566.40
Rate for Payer: Self Pay Self Pay	$566.40

Vitamin B3 (Niacin+Metabolite) LC

Facility

$708.00

Service Code	CPT 82542
Hospital Charge Code	6781648
Hospital Revenue Code	301
Min. Negotiated Rate	$113.28
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Aetna of AZ Medicare	$198.24
Rate for Payer: Allwell Medicare	$113.28
Rate for Payer: Amerigroup Medicare	$113.28
Rate for Payer: APIPA Medicare/Medicaid	$264.44
Rate for Payer: AZCH Complete Medicare	$113.28
Rate for Payer: Banner UC Health Medicare	$113.28
Rate for Payer: Bisbee Police All Plans	$184.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$481.44
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cigna of AZ Commercial	$460.20
Rate for Payer: Copperpoint Commercial	$175.23
Rate for Payer: Health Net of AZ Commercial	$424.80
Rate for Payer: Health Net of AZ Medicare	$198.24
Rate for Payer: Humana of AZ Medicare	$113.28
Rate for Payer: Self Pay Self Pay	$566.40
Rate for Payer: TriWest Medicare	$113.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$412.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$127.44

Vitamin B6 LC

Facility

$579.00

Service Code	CPT 84207
Hospital Charge Code	1909644
Hospital Revenue Code	301
Min. Negotiated Rate	$150.54
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Bisbee Police All Plans	$150.54
Rate for Payer: Cash Price	$463.20
Rate for Payer: Self Pay Self Pay	$463.20

Vitamin B6 LC

Facility

$579.00

Service Code	CPT 84207
Hospital Charge Code	1909644
Hospital Revenue Code	301
Min. Negotiated Rate	$92.64
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Aetna of AZ Medicare	$162.12
Rate for Payer: Allwell Medicare	$92.64
Rate for Payer: Amerigroup Medicare	$92.64
Rate for Payer: APIPA Medicare/Medicaid	$216.26
Rate for Payer: AZCH Complete Medicare	$92.64
Rate for Payer: Banner UC Health Medicare	$92.64
Rate for Payer: Bisbee Police All Plans	$150.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$393.72
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cigna of AZ Commercial	$376.35
Rate for Payer: Copperpoint Commercial	$143.30
Rate for Payer: Health Net of AZ Commercial	$347.40
Rate for Payer: Health Net of AZ Medicare	$162.12
Rate for Payer: Humana of AZ Medicare	$92.64
Rate for Payer: Self Pay Self Pay	$463.20
Rate for Payer: TriWest Medicare	$92.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$337.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.22

Vitamin D, 25-Hydroxy LC

Facility

$292.00

Service Code	CPT 82306
Hospital Charge Code	1285623
Hospital Revenue Code	301
Min. Negotiated Rate	$75.92
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Bisbee Police All Plans	$75.92
Rate for Payer: Cash Price	$233.60
Rate for Payer: Self Pay Self Pay	$233.60

Vitamin D, 25-Hydroxy LC

Facility

$292.00

Service Code	CPT 82306
Hospital Charge Code	1285623
Hospital Revenue Code	301
Min. Negotiated Rate	$46.72
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Aetna of AZ Medicare	$81.76
Rate for Payer: Allwell Medicare	$46.72
Rate for Payer: Amerigroup Medicare	$46.72
Rate for Payer: APIPA Medicare/Medicaid	$109.06
Rate for Payer: AZCH Complete Medicare	$46.72
Rate for Payer: Banner UC Health Medicare	$46.72
Rate for Payer: Bisbee Police All Plans	$75.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$198.56
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cigna of AZ Commercial	$189.80
Rate for Payer: Copperpoint Commercial	$72.27
Rate for Payer: Health Net of AZ Commercial	$175.20
Rate for Payer: Health Net of AZ Medicare	$81.76
Rate for Payer: Humana of AZ Medicare	$46.72
Rate for Payer: Self Pay Self Pay	$233.60
Rate for Payer: TriWest Medicare	$46.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$170.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.56

Vitamin D 25 Hydroxy Level

Facility

$352.00

Service Code	CPT 82306
Hospital Charge Code	633872
Hospital Revenue Code	301
Min. Negotiated Rate	$56.32
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Aetna of AZ Medicare	$98.56
Rate for Payer: Allwell Medicare	$56.32
Rate for Payer: Amerigroup Medicare	$56.32
Rate for Payer: APIPA Medicare/Medicaid	$131.47
Rate for Payer: AZCH Complete Medicare	$56.32
Rate for Payer: Banner UC Health Medicare	$56.32
Rate for Payer: Bisbee Police All Plans	$91.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$239.36
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cigna of AZ Commercial	$228.80
Rate for Payer: Copperpoint Commercial	$87.12
Rate for Payer: Health Net of AZ Commercial	$211.20
Rate for Payer: Health Net of AZ Medicare	$98.56
Rate for Payer: Humana of AZ Medicare	$56.32
Rate for Payer: Self Pay Self Pay	$281.60
Rate for Payer: TriWest Medicare	$56.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$205.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$63.36

Vitamin D 25 Hydroxy Level

Facility

$352.00

Service Code	CPT 82306
Hospital Charge Code	633872
Hospital Revenue Code	301
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Bisbee Police All Plans	$91.52
Rate for Payer: Cash Price	$281.60
Rate for Payer: Self Pay Self Pay	$281.60

Vitamin D3 1000 International Unit Tab UD [CQCH]

Facility

$0.04

Service Code	NDC 20555003300
Hospital Charge Code	107994658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.03

Vitamin D3 1000 International Unit Tab UD [CQCH]

Facility

$0.04

Service Code	NDC 20555003300
Hospital Charge Code	107994658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Vitamin D3 400 intl units Tab [CQCH]

Facility

$0.02

Service Code	NDC 43292055881
Hospital Charge Code	105916255
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

Vitamin D3 400 intl units Tab [CQCH]

Facility

$0.02

Service Code	NDC 43292055881
Hospital Charge Code	105916255
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

vitamin E 400 units Cap [CQCH]

Facility

$0.16

Service Code	NDC 904027460
Hospital Charge Code	105945267
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.13

vitamin E 400 units Cap [CQCH]

Facility

$0.16

Service Code	NDC 904027460
Hospital Charge Code	105945267
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: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.11
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

Know your out-of-pocket cost for care.

All Charges