Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

acetaminophen 650 mg Supp [CQCH]

Facility

$0.42

Service Code	NDC 713016512
Hospital Charge Code	105907681
Hospital Revenue Code	257
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
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	$0.29
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	$0.34
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.29
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.24
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.07

acetaminophen 650 mg Supp [CQCH]

Facility

$0.42

Service Code	NDC 713016512
Hospital Charge Code	105907681
Hospital Revenue Code	257
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Cash Price	$0.34

acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [CQCH]

Facility

$0.99

Service Code	NDC 68084039665
Hospital Charge Code	105908090
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Arizona Complete Health Allwell	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.67
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.16
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of AZ Commercial	$0.64
Rate for Payer: Devoted Health Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Southwest Service Administrators UFCW	$0.67
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: United Healthcare Commercial	$0.57
Rate for Payer: United Healthcare Medicare	$0.16
Rate for Payer: Veterans Affairs TRICARE	$0.16

acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [CQCH]

Facility

$0.99

Service Code	NDC 68084039665
Hospital Charge Code	105908090
Hospital Revenue Code	251
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Cash Price	$0.79

acetaminophen-HYDROcodone 325 mg-5 mg Tab [CQCH]

Facility

$0.33

Service Code	NDC 406012362
Hospital Charge Code	105908680
Hospital Revenue Code	251
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Cash Price	$0.27

acetaminophen-HYDROcodone 325 mg-5 mg Tab [CQCH]

Facility

$0.33

Service Code	NDC 406012362
Hospital Charge Code	105908680
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
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	$0.27
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	$0.19
Rate for Payer: United Healthcare Medicare	$0.05
Rate for Payer: Veterans Affairs TRICARE	$0.05

Acetaminophen Level

Facility

$286.00

Service Code	CPT 80329
Hospital Charge Code	857776
Hospital Revenue Code	301
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Cash Price	$228.80

Acetaminophen Level

Facility

$286.00

Service Code	CPT 80329
Hospital Charge Code	857776
Hospital Revenue Code	301
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Arizona Complete Health Allwell	$45.76
Rate for Payer: Banner UC Health Medicare	$45.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$194.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.76
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cigna of AZ Commercial	$185.90
Rate for Payer: Devoted Health Medicare	$51.48
Rate for Payer: Humana of AZ Medicare	$45.76
Rate for Payer: Southwest Service Administrators UFCW	$194.48
Rate for Payer: TriWest Medicare	$45.76
Rate for Payer: United Healthcare Commercial	$163.59
Rate for Payer: United Healthcare Medicare	$45.76
Rate for Payer: Veterans Affairs TRICARE	$45.30

acetaminophen-oxyCODONE 325 mg-5 mg Tab [CQCH]

Facility

$0.22

Service Code	NDC 406051262
Hospital Charge Code	105908747
Hospital Revenue Code	251
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Cash Price	$0.17

acetaminophen-oxyCODONE 325 mg-5 mg Tab [CQCH]

Facility

$0.22

Service Code	NDC 406051262
Hospital Charge Code	105908747
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
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	$0.15
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	$0.17
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.15
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.13
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.03

Acetone Ql

Facility

$151.00

Service Code	CPT 82575
Hospital Charge Code	857781
Hospital Revenue Code	301
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Arizona Complete Health Allwell	$24.16
Rate for Payer: Banner UC Health Medicare	$24.16
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: Care1st Health Plan Arizona Medicare	$24.16
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Devoted Health Medicare	$27.18
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Seven Corners Travel Insurance	$13.72
Rate for Payer: Southwest Service Administrators UFCW	$102.68
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: United Healthcare Commercial	$86.37
Rate for Payer: United Healthcare Medicare	$24.16
Rate for Payer: Veterans Affairs TRICARE	$23.92

Acetone Ql

Facility

$151.00

Service Code	CPT 82575
Hospital Charge Code	857781
Hospital Revenue Code	301
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Cash Price	$120.80

Acetylcholine Receptor Ab, All LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	10864412
Hospital Revenue Code	300
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Cash Price	$422.40

Acetylcholine Receptor Ab, All LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	10864412
Hospital Revenue Code	300
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Arizona Complete Health Allwell	$84.48
Rate for Payer: Banner UC Health Medicare	$84.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$359.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.48
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cigna of AZ Commercial	$343.20
Rate for Payer: Devoted Health Medicare	$95.04
Rate for Payer: Humana of AZ Medicare	$84.48
Rate for Payer: Seven Corners Travel Insurance	$26.68
Rate for Payer: Southwest Service Administrators UFCW	$359.04
Rate for Payer: TriWest Medicare	$84.48
Rate for Payer: United Healthcare Commercial	$302.02
Rate for Payer: United Healthcare Medicare	$84.48
Rate for Payer: Veterans Affairs TRICARE	$83.64

Acetylcholine Receptor Antibodies, Complete Profile LC

Facility

$92.00

Service Code	CPT 86041
Hospital Charge Code	27460346
Hospital Revenue Code	305
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Arizona Complete Health Allwell	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$62.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.72
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$59.80
Rate for Payer: Devoted Health Medicare	$16.56
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Seven Corners Travel Insurance	$26.68
Rate for Payer: Southwest Service Administrators UFCW	$62.56
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: United Healthcare Commercial	$52.62
Rate for Payer: United Healthcare Medicare	$14.72
Rate for Payer: Veterans Affairs TRICARE	$14.57

Acetylcholine Receptor Antibodies, Complete Profile LC

Facility

$92.00

Service Code	CPT 86041
Hospital Charge Code	27460346
Hospital Revenue Code	305
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Cash Price	$73.60

Acetylcholine Receptor Complete Profile AB LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	22945558
Hospital Revenue Code	301
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Cash Price	$422.40

Acetylcholine Receptor Complete Profile AB LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	22945558
Hospital Revenue Code	301
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Arizona Complete Health Allwell	$84.48
Rate for Payer: Banner UC Health Medicare	$84.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$359.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$84.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$84.48
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cigna of AZ Commercial	$343.20
Rate for Payer: Devoted Health Medicare	$95.04
Rate for Payer: Humana of AZ Medicare	$84.48
Rate for Payer: Seven Corners Travel Insurance	$26.68
Rate for Payer: Southwest Service Administrators UFCW	$359.04
Rate for Payer: TriWest Medicare	$84.48
Rate for Payer: United Healthcare Commercial	$302.02
Rate for Payer: United Healthcare Medicare	$84.48
Rate for Payer: Veterans Affairs TRICARE	$83.64

acetylcysteine 20% Inh Sol 4 mL [CQCH]

Facility

$0.96

Service Code	HCPCS J7604
Hospital Charge Code	105909114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of AZ Commercial	$0.86
Rate for Payer: Cash Price	$0.77

acetylcysteine 20% Inh Sol 4 mL [CQCH]

Facility

$0.96

Service Code	HCPCS J7604
Hospital Charge Code	105909114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of AZ Commercial	$0.86
Rate for Payer: Arizona Complete Health Allwell	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.65
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.15
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.15
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of AZ Commercial	$0.62
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Southwest Service Administrators UFCW	$0.65
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: United Healthcare Commercial	$0.55
Rate for Payer: United Healthcare Medicare	$0.15
Rate for Payer: Veterans Affairs TRICARE	$0.15

acetylcysteine 6 gm/ 30 mL IV Sol [CQCH]

Facility

$1.51

Service Code	HCPCS J0132
Hospital Charge Code	105909039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Arizona Complete Health Allwell	$0.24
Rate for Payer: Banner UC Health Medicare	$0.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.03
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.24
Rate for Payer: Cash Price	$1.21
Rate for Payer: Cigna of AZ Commercial	$0.98
Rate for Payer: Devoted Health Medicare	$0.27
Rate for Payer: Humana of AZ Medicare	$0.24
Rate for Payer: Southwest Service Administrators UFCW	$1.03
Rate for Payer: TriWest Medicare	$0.24
Rate for Payer: United Healthcare Commercial	$0.86
Rate for Payer: United Healthcare Medicare	$0.24
Rate for Payer: Veterans Affairs TRICARE	$0.24

acetylcysteine 6 gm/ 30 mL IV Sol [CQCH]

Facility

$1.51

Service Code	HCPCS J0132
Hospital Charge Code	105909039
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Cash Price	$1.21

AChR Binding Abs LC

Facility

$510.00

Service Code	CPT 83519
Hospital Charge Code	6738702
Hospital Revenue Code	301
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna of AZ Commercial	$459.00
Rate for Payer: Arizona Complete Health Allwell	$81.60
Rate for Payer: Banner UC Health Medicare	$81.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$346.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$81.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$81.60
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cigna of AZ Commercial	$331.50
Rate for Payer: Devoted Health Medicare	$91.80
Rate for Payer: Humana of AZ Medicare	$81.60
Rate for Payer: Seven Corners Travel Insurance	$26.68
Rate for Payer: Southwest Service Administrators UFCW	$346.80
Rate for Payer: TriWest Medicare	$81.60
Rate for Payer: United Healthcare Commercial	$291.72
Rate for Payer: United Healthcare Medicare	$81.60
Rate for Payer: Veterans Affairs TRICARE	$80.78

AChR Binding Abs LC

Facility

$510.00

Service Code	CPT 83519
Hospital Charge Code	6738702
Hospital Revenue Code	301
Min. Negotiated Rate	$459.00
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna of AZ Commercial	$459.00
Rate for Payer: Cash Price	$408.00

Acid Fast Smear+Culture LC

Facility

$54.00

Service Code	CPT 87116
Hospital Charge Code	22201719
Hospital Revenue Code	306
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Arizona Complete Health Allwell	$8.64
Rate for Payer: Banner UC Health Medicare	$8.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.64
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of AZ Commercial	$35.10
Rate for Payer: Devoted Health Medicare	$9.72
Rate for Payer: Humana of AZ Medicare	$8.64
Rate for Payer: Seven Corners Travel Insurance	$15.66
Rate for Payer: Southwest Service Administrators UFCW	$36.72
Rate for Payer: TriWest Medicare	$8.64
Rate for Payer: United Healthcare Commercial	$30.89
Rate for Payer: United Healthcare Medicare	$8.64
Rate for Payer: Veterans Affairs TRICARE	$8.55

Know your out-of-pocket cost for care.

All Charges