Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Valproic Acid Level

Facility

$239.00

Service Code	CPT 80164
Hospital Charge Code	633867
Hospital Revenue Code	301
Min. Negotiated Rate	$215.10
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Cash Price	$191.20

valsartan 80 mg Tab [CQCH]

Facility

$1.00

Service Code	NDC 60687012801
Hospital Charge Code	105944531
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of AZ Commercial	$0.90
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	$0.68
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	$0.80
Rate for Payer: Cigna of AZ Commercial	$0.65
Rate for Payer: Devoted Health Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Southwest Service Administrators UFCW	$0.68
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

valsartan 80 mg Tab [CQCH]

Facility

$1.00

Service Code	NDC 60687012801
Hospital Charge Code	105944531
Hospital Revenue Code	251
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of AZ Commercial	$0.90
Rate for Payer: Cash Price	$0.80

vancomycin 1000 mg IV Inj [CQCH]

Facility

$2.60

Service Code	HCPCS J3370
Hospital Charge Code	105944736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of AZ Commercial	$2.34
Rate for Payer: Arizona Complete Health Allwell	$0.42
Rate for Payer: Banner UC Health Medicare	$0.42
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.77
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.42
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.42
Rate for Payer: Cash Price	$2.08
Rate for Payer: Cigna of AZ Commercial	$1.69
Rate for Payer: Devoted Health Medicare	$0.47
Rate for Payer: Humana of AZ Medicare	$0.42
Rate for Payer: Southwest Service Administrators UFCW	$1.77
Rate for Payer: TriWest Medicare	$0.42
Rate for Payer: United Healthcare Commercial	$1.49
Rate for Payer: United Healthcare Medicare	$0.42
Rate for Payer: Veterans Affairs TRICARE	$0.41

vancomycin 1000 mg IV Inj [CQCH]

Facility

$2.60

Service Code	HCPCS J3370
Hospital Charge Code	105944736
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Aetna of AZ Commercial	$2.34
Rate for Payer: Cash Price	$2.08

vancomycin 125 mg Cap UD [CQCH]

Facility

$8.37

Service Code	NDC 47781072902
Hospital Charge Code	108082992
Hospital Revenue Code	250
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$7.53
Rate for Payer: Aetna of AZ Commercial	$7.53
Rate for Payer: Cash Price	$6.70

vancomycin 125 mg Cap UD [CQCH]

Facility

$8.37

Service Code	NDC 47781072902
Hospital Charge Code	108082992
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$7.53
Rate for Payer: Aetna of AZ Commercial	$7.53
Rate for Payer: Arizona Complete Health Allwell	$1.34
Rate for Payer: Banner UC Health Medicare	$1.34
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.34
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.34
Rate for Payer: Cash Price	$6.70
Rate for Payer: Cigna of AZ Commercial	$5.44
Rate for Payer: Devoted Health Medicare	$1.51
Rate for Payer: Humana of AZ Medicare	$1.34
Rate for Payer: Southwest Service Administrators UFCW	$5.69
Rate for Payer: TriWest Medicare	$1.34
Rate for Payer: United Healthcare Commercial	$4.79
Rate for Payer: United Healthcare Medicare	$1.34
Rate for Payer: Veterans Affairs TRICARE	$1.33

vancomycin 500 mg IV Inj [CQCH]

Facility

$2.06

Service Code	HCPCS J3370
Hospital Charge Code	105944667
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna of AZ Commercial	$1.85
Rate for Payer: Arizona Complete Health Allwell	$0.33
Rate for Payer: Banner UC Health Medicare	$0.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.33
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.33
Rate for Payer: Cash Price	$1.65
Rate for Payer: Cigna of AZ Commercial	$1.34
Rate for Payer: Devoted Health Medicare	$0.37
Rate for Payer: Humana of AZ Medicare	$0.33
Rate for Payer: Southwest Service Administrators UFCW	$1.40
Rate for Payer: TriWest Medicare	$0.33
Rate for Payer: United Healthcare Commercial	$1.18
Rate for Payer: United Healthcare Medicare	$0.33
Rate for Payer: Veterans Affairs TRICARE	$0.33

vancomycin 500 mg IV Inj [CQCH]

Facility

$2.06

Service Code	HCPCS J3370
Hospital Charge Code	105944667
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna of AZ Commercial	$1.85
Rate for Payer: Cash Price	$1.65

Vancomycin Lvl Peak 1

Facility

$176.00

Service Code	CPT 80202
Hospital Charge Code	9579711
Hospital Revenue Code	301
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Cash Price	$140.80

Vancomycin Lvl Peak 1

Facility

$176.00

Service Code	CPT 80202
Hospital Charge Code	9579711
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Arizona Complete Health Allwell	$28.16
Rate for Payer: Banner UC Health Medicare	$28.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$119.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.16
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cigna of AZ Commercial	$114.40
Rate for Payer: Devoted Health Medicare	$31.68
Rate for Payer: Humana of AZ Medicare	$28.16
Rate for Payer: Seven Corners Travel Insurance	$19.63
Rate for Payer: Southwest Service Administrators UFCW	$119.68
Rate for Payer: TriWest Medicare	$28.16
Rate for Payer: United Healthcare Commercial	$100.67
Rate for Payer: United Healthcare Medicare	$28.16
Rate for Payer: Veterans Affairs TRICARE	$27.88

Vancomycin Lvl Random

Facility

$185.00

Service Code	CPT 80202
Hospital Charge Code	633868
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Arizona Complete Health Allwell	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.60
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$120.25
Rate for Payer: Devoted Health Medicare	$33.30
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Seven Corners Travel Insurance	$19.63
Rate for Payer: Southwest Service Administrators UFCW	$125.80
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: United Healthcare Commercial	$105.82
Rate for Payer: United Healthcare Medicare	$29.60
Rate for Payer: Veterans Affairs TRICARE	$29.30

Vancomycin Lvl Random

Facility

$185.00

Service Code	CPT 80202
Hospital Charge Code	633868
Hospital Revenue Code	301
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Cash Price	$148.00

Vancomycin Lvl Trough 1

Facility

$185.00

Service Code	CPT 80202
Hospital Charge Code	9579712
Hospital Revenue Code	301
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Cash Price	$148.00

Vancomycin Lvl Trough 1

Facility

$185.00

Service Code	CPT 80202
Hospital Charge Code	9579712
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Arizona Complete Health Allwell	$29.60
Rate for Payer: Banner UC Health Medicare	$29.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.60
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$120.25
Rate for Payer: Devoted Health Medicare	$33.30
Rate for Payer: Humana of AZ Medicare	$29.60
Rate for Payer: Seven Corners Travel Insurance	$19.63
Rate for Payer: Southwest Service Administrators UFCW	$125.80
Rate for Payer: TriWest Medicare	$29.60
Rate for Payer: United Healthcare Commercial	$105.82
Rate for Payer: United Healthcare Medicare	$29.60
Rate for Payer: Veterans Affairs TRICARE	$29.30

Vanillylmandelic Acid, 24-Hr U LC

Facility

$172.00

Service Code	CPT 84585
Hospital Charge Code	1909573
Hospital Revenue Code	301
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

Vanillylmandelic Acid, 24-Hr U LC

Facility

$172.00

Service Code	CPT 84585
Hospital Charge Code	1909573
Hospital Revenue Code	301
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.52
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Seven Corners Travel Insurance	$22.48
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: Veterans Affairs TRICARE	$27.24

VAP Cholesterol Profile LC

Facility

$109.00

Service Code	CPT 84478
Hospital Charge Code	1909580
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

VAP Cholesterol Profile LC

Facility

$109.00

Service Code	CPT 84478
Hospital Charge Code	1909580
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
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	$8.32
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

Vapotherm Initial

Facility

$4,256.00

Service Code	CPT 94002
Hospital Charge Code	3882290
Hospital Revenue Code	410
Min. Negotiated Rate	$674.15
Max. Negotiated Rate	$3,830.40
Rate for Payer: Aetna of AZ Commercial	$3,830.40
Rate for Payer: Arizona Complete Health Allwell	$680.96
Rate for Payer: Banner UC Health Medicare	$680.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,894.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$680.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$680.96
Rate for Payer: Cash Price	$3,404.80
Rate for Payer: Cash Price	$3,404.80
Rate for Payer: Cigna of AZ Commercial	$2,979.20
Rate for Payer: Devoted Health Medicare	$766.08
Rate for Payer: Humana of AZ Medicare	$680.96
Rate for Payer: Seven Corners Travel Insurance	$955.88
Rate for Payer: Southwest Service Administrators UFCW	$2,894.08
Rate for Payer: TriWest Medicare	$680.96
Rate for Payer: United Healthcare Commercial	$2,434.43
Rate for Payer: United Healthcare Medicare	$680.96
Rate for Payer: United Healthcare New Mexico Commercial	$808.64
Rate for Payer: Veterans Affairs TRICARE	$674.15

Vapotherm Initial

Facility

$4,256.00

Service Code	CPT 94002
Hospital Charge Code	3882290
Hospital Revenue Code	410
Min. Negotiated Rate	$3,830.40
Max. Negotiated Rate	$3,830.40
Rate for Payer: Aetna of AZ Commercial	$3,830.40
Rate for Payer: Cash Price	$3,404.80

Vapotherm Subsequent

Facility

$2,858.00

Service Code	CPT 94003
Hospital Charge Code	3882291
Hospital Revenue Code	410
Min. Negotiated Rate	$2,572.20
Max. Negotiated Rate	$2,572.20
Rate for Payer: Aetna of AZ Commercial	$2,572.20
Rate for Payer: Cash Price	$2,286.40

Vapotherm Subsequent

Facility

$2,858.00

Service Code	CPT 94003
Hospital Charge Code	3882291
Hospital Revenue Code	410
Min. Negotiated Rate	$452.71
Max. Negotiated Rate	$2,572.20
Rate for Payer: Aetna of AZ Commercial	$2,572.20
Rate for Payer: Arizona Complete Health Allwell	$457.28
Rate for Payer: Banner UC Health Medicare	$457.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,943.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$457.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$457.28
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Cigna of AZ Commercial	$2,000.60
Rate for Payer: Devoted Health Medicare	$514.44
Rate for Payer: Humana of AZ Medicare	$457.28
Rate for Payer: Seven Corners Travel Insurance	$955.88
Rate for Payer: Southwest Service Administrators UFCW	$1,943.44
Rate for Payer: TriWest Medicare	$457.28
Rate for Payer: United Healthcare Commercial	$1,634.78
Rate for Payer: United Healthcare Medicare	$457.28
Rate for Payer: United Healthcare New Mexico Commercial	$543.02
Rate for Payer: Veterans Affairs TRICARE	$452.71

Varicella Virus Vaccine POC

Facility

$362.00

Service Code	CPT 90716
Hospital Charge Code	667686
Hospital Revenue Code	636
Min. Negotiated Rate	$57.34
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Arizona Complete Health Allwell	$57.92
Rate for Payer: Banner UC Health Medicare	$57.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$246.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$57.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$57.92
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cigna of AZ Commercial	$253.40
Rate for Payer: Devoted Health Medicare	$65.16
Rate for Payer: Humana of AZ Medicare	$57.92
Rate for Payer: Southwest Service Administrators UFCW	$246.16
Rate for Payer: TriWest Medicare	$57.92
Rate for Payer: United Healthcare Commercial	$207.06
Rate for Payer: United Healthcare Medicare	$57.92
Rate for Payer: United Healthcare New Mexico Commercial	$68.78
Rate for Payer: Veterans Affairs TRICARE	$57.34

Varicella Virus Vaccine POC

Facility

$362.00

Service Code	CPT 90716
Hospital Charge Code	667686
Hospital Revenue Code	636
Min. Negotiated Rate	$325.80
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Cash Price	$289.60

Know your out-of-pocket cost for care.

All Charges