Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

THP cephalexin 500 mg Cap [CQCH]

Facility

$0.32

Service Code	NDC 99999999977
Hospital Charge Code	110283528
Hospital Revenue Code	253
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

THP cephalexin oral susp. 250 mg/5 mL (100 mL) [CQCH]

Facility

$12.93

Service Code	NDC 99999999973
Hospital Charge Code	110285053
Hospital Revenue Code	253
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$11.64
Rate for Payer: Aetna of AZ Commercial	$11.64
Rate for Payer: Arizona Complete Health Allwell	$2.07
Rate for Payer: Banner UC Health Medicare	$2.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.79
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.07
Rate for Payer: Cash Price	$10.34
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.33
Rate for Payer: Humana of AZ Medicare	$2.07
Rate for Payer: Southwest Service Administrators UFCW	$8.79
Rate for Payer: TriWest Medicare	$2.07
Rate for Payer: United Healthcare Commercial	$7.40
Rate for Payer: United Healthcare Medicare	$2.07
Rate for Payer: Veterans Affairs TRICARE	$2.05

THP cephalexin oral susp. 250 mg/5 mL (100 mL) [CQCH]

Facility

$12.93

Service Code	NDC 99999999973
Hospital Charge Code	110285053
Hospital Revenue Code	253
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$11.64
Rate for Payer: Aetna of AZ Commercial	$11.64
Rate for Payer: Cash Price	$10.34

THP ciprofloxacin 500 mg Tab [CQCH]

Facility

$0.32

Service Code	NDC 99999999978
Hospital Charge Code	110283248
Hospital Revenue Code	253
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

THP ciprofloxacin 500 mg Tab [CQCH]

Facility

$0.32

Service Code	NDC 99999999978
Hospital Charge Code	110283248
Hospital Revenue Code	253
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

THP ondansetron 4 mg Dis Tab [CQCH]

Facility

$2.48

Service Code	NDC 99999999979
Hospital Charge Code	110283021
Hospital Revenue Code	253
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Aetna of AZ Commercial	$2.23
Rate for Payer: Cash Price	$1.98

THP ondansetron 4 mg Dis Tab [CQCH]

Facility

$2.48

Service Code	NDC 99999999979
Hospital Charge Code	110283021
Hospital Revenue Code	253
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$2.23
Rate for Payer: Aetna of AZ Commercial	$2.23
Rate for Payer: Arizona Complete Health Allwell	$0.40
Rate for Payer: Banner UC Health Medicare	$0.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.40
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cigna of AZ Commercial	$1.61
Rate for Payer: Devoted Health Medicare	$0.45
Rate for Payer: Humana of AZ Medicare	$0.40
Rate for Payer: Southwest Service Administrators UFCW	$1.69
Rate for Payer: TriWest Medicare	$0.40
Rate for Payer: United Healthcare Commercial	$1.42
Rate for Payer: United Healthcare Medicare	$0.40
Rate for Payer: Veterans Affairs TRICARE	$0.39

THP Tramadol 50 mg [CQCH]

Facility

$0.27

Service Code	NDC 99999999981
Hospital Charge Code	141650147
Hospital Revenue Code	253
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
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	$0.18
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	$0.21
Rate for Payer: Cigna of AZ Commercial	$0.18
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.15
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

THP Tramadol 50 mg [CQCH]

Facility

$0.27

Service Code	NDC 99999999981
Hospital Charge Code	141650147
Hospital Revenue Code	253
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Cash Price	$0.21

Throat Culture

Facility

$164.00

Service Code	CPT 87070
Hospital Charge Code	850755
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Arizona Complete Health Allwell	$26.24
Rate for Payer: Banner UC Health Medicare	$26.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$111.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.24
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cigna of AZ Commercial	$106.60
Rate for Payer: Devoted Health Medicare	$29.52
Rate for Payer: Humana of AZ Medicare	$26.24
Rate for Payer: Seven Corners Travel Insurance	$12.50
Rate for Payer: Southwest Service Administrators UFCW	$111.52
Rate for Payer: TriWest Medicare	$26.24
Rate for Payer: United Healthcare Commercial	$93.81
Rate for Payer: United Healthcare Medicare	$26.24
Rate for Payer: Veterans Affairs TRICARE	$25.98

Throat Culture

Facility

$164.00

Service Code	CPT 87070
Hospital Charge Code	850755
Hospital Revenue Code	306
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Cash Price	$131.20

THROMBN CLTG

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	22481506
Hospital Revenue Code	305
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Cash Price	$104.00

THROMBN CLTG

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	22481506
Hospital Revenue Code	305
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Arizona Complete Health Allwell	$20.80
Rate for Payer: Banner UC Health Medicare	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$88.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Devoted Health Medicare	$23.40
Rate for Payer: Humana of AZ Medicare	$20.80
Rate for Payer: Seven Corners Travel Insurance	$8.37
Rate for Payer: Southwest Service Administrators UFCW	$88.40
Rate for Payer: TriWest Medicare	$20.80
Rate for Payer: United Healthcare Commercial	$74.36
Rate for Payer: United Healthcare Medicare	$20.80
Rate for Payer: Veterans Affairs TRICARE	$20.59

THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD

Facility

$47.00

Service Code	CPT 85730
Hospital Charge Code	23090941
Hospital Revenue Code	301
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD

Facility

$47.00

Service Code	CPT 85730
Hospital Charge Code	23090941
Hospital Revenue Code	301
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Seven Corners Travel Insurance	$8.71
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

THYROGLOBULIN

Facility

$80.00

Service Code	CPT 84432
Hospital Charge Code	28008411
Hospital Revenue Code	302
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Cash Price	$64.00

THYROGLOBULIN

Facility

$80.00

Service Code	CPT 84432
Hospital Charge Code	28008411
Hospital Revenue Code	302
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Arizona Complete Health Allwell	$12.80
Rate for Payer: Banner UC Health Medicare	$12.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$54.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Devoted Health Medicare	$14.40
Rate for Payer: Humana of AZ Medicare	$12.80
Rate for Payer: Seven Corners Travel Insurance	$23.29
Rate for Payer: Southwest Service Administrators UFCW	$54.40
Rate for Payer: TriWest Medicare	$12.80
Rate for Payer: United Healthcare Commercial	$45.76
Rate for Payer: United Healthcare Medicare	$12.80
Rate for Payer: Veterans Affairs TRICARE	$12.67

Thyroglobulin Antibody LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	22311207
Hospital Revenue Code	302
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Aetna of AZ Commercial	$261.90
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$232.80

Thyroglobulin Antibody LC

Facility

$291.00

Service Code	CPT 86800
Hospital Charge Code	22311207
Hospital Revenue Code	302
Min. Negotiated Rate	$23.07
Max. Negotiated Rate	$261.90
Rate for Payer: Aetna of AZ Commercial	$261.90
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Arizona Complete Health Allwell	$34.72
Rate for Payer: Arizona Complete Health Allwell	$46.56
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Banner UC Health Medicare	$46.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$197.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$147.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$46.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$46.56
Rate for Payer: Cash Price	$232.80
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$232.80
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$189.15
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Devoted Health Medicare	$52.38
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Humana of AZ Medicare	$46.56
Rate for Payer: Seven Corners Travel Insurance	$23.07
Rate for Payer: Seven Corners Travel Insurance	$23.07
Rate for Payer: Southwest Service Administrators UFCW	$147.56
Rate for Payer: Southwest Service Administrators UFCW	$197.88
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: TriWest Medicare	$46.56
Rate for Payer: United Healthcare Commercial	$166.45
Rate for Payer: United Healthcare Commercial	$124.12
Rate for Payer: United Healthcare Medicare	$34.72
Rate for Payer: United Healthcare Medicare	$46.56
Rate for Payer: Veterans Affairs TRICARE	$46.09
Rate for Payer: Veterans Affairs TRICARE	$34.37

Thyroid Antibodies LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	2087653
Hospital Revenue Code	301
Min. Negotiated Rate	$23.07
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Arizona Complete Health Allwell	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$147.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.72
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Seven Corners Travel Insurance	$23.07
Rate for Payer: Southwest Service Administrators UFCW	$147.56
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: United Healthcare Commercial	$124.12
Rate for Payer: United Healthcare Medicare	$34.72
Rate for Payer: Veterans Affairs TRICARE	$34.37

Thyroid Antibodies LC

Facility

$217.00

Service Code	CPT 86800
Hospital Charge Code	2087653
Hospital Revenue Code	301
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Cash Price	$173.60

Thyroid Cascade Profile LC

Facility

$200.00

Service Code	CPT 84443
Hospital Charge Code	2087654
Hospital Revenue Code	301
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Arizona Complete Health Allwell	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$136.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$130.00
Rate for Payer: Devoted Health Medicare	$36.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Seven Corners Travel Insurance	$24.36
Rate for Payer: Southwest Service Administrators UFCW	$136.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: United Healthcare Commercial	$114.40
Rate for Payer: United Healthcare Medicare	$32.00
Rate for Payer: Veterans Affairs TRICARE	$31.68

Thyroid Cascade Profile LC

Facility

$200.00

Service Code	CPT 84443
Hospital Charge Code	2087654
Hospital Revenue Code	301
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Cash Price	$160.00

Thyroid Disorders

Facility

$13,507.56

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG4272
Min. Negotiated Rate	$13,507.56
Max. Negotiated Rate	$13,507.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,507.56
Rate for Payer: Mercy Care Medicaid	$13,507.56
Rate for Payer: NaphCare Correctional Healthcare	$13,507.56

Thyroid Disorders

Facility

$13,507.56

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG4273
Min. Negotiated Rate	$13,507.56
Max. Negotiated Rate	$13,507.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,507.56
Rate for Payer: Mercy Care Medicaid	$13,507.56
Rate for Payer: NaphCare Correctional Healthcare	$13,507.56

Know your out-of-pocket cost for care.

All Charges