Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Varicella-Zoster IgM Ab LC

Facility

$276.00

Service Code	CPT 86787
Hospital Charge Code	6780778
Hospital Revenue Code	302
Min. Negotiated Rate	$248.40
Max. Negotiated Rate	$248.40
Rate for Payer: Aetna of AZ Commercial	$248.40
Rate for Payer: Cash Price	$220.80

Varicella-Zoster IgM Ab LC

Facility

$276.00

Service Code	CPT 86787
Hospital Charge Code	6780778
Hospital Revenue Code	302
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$248.40
Rate for Payer: Aetna of AZ Commercial	$248.40
Rate for Payer: Arizona Complete Health Allwell	$44.16
Rate for Payer: Banner UC Health Medicare	$44.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$187.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.16
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cigna of AZ Commercial	$179.40
Rate for Payer: Devoted Health Medicare	$49.68
Rate for Payer: Humana of AZ Medicare	$44.16
Rate for Payer: Seven Corners Travel Insurance	$18.68
Rate for Payer: Southwest Service Administrators UFCW	$187.68
Rate for Payer: TriWest Medicare	$44.16
Rate for Payer: United Healthcare Commercial	$157.87
Rate for Payer: United Healthcare Medicare	$44.16
Rate for Payer: Veterans Affairs TRICARE	$43.72

Varicella-Zoster V Ab, IgG LC

Facility

$290.00

Service Code	CPT 86787
Hospital Charge Code	1905871
Hospital Revenue Code	302
Min. Negotiated Rate	$261.00
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Cash Price	$232.00

Varicella-Zoster V Ab, IgG LC

Facility

$290.00

Service Code	CPT 86787
Hospital Charge Code	1905871
Hospital Revenue Code	302
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Arizona Complete Health Allwell	$46.40
Rate for Payer: Banner UC Health Medicare	$46.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$197.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$46.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$46.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$188.50
Rate for Payer: Devoted Health Medicare	$52.20
Rate for Payer: Humana of AZ Medicare	$46.40
Rate for Payer: Seven Corners Travel Insurance	$18.68
Rate for Payer: Southwest Service Administrators UFCW	$197.20
Rate for Payer: TriWest Medicare	$46.40
Rate for Payer: United Healthcare Commercial	$165.88
Rate for Payer: United Healthcare Medicare	$46.40
Rate for Payer: Veterans Affairs TRICARE	$45.94

VASECTOMY

Facility

$486.00

Service Code	CPT 55250
Hospital Charge Code	23171943
Min. Negotiated Rate	$76.98
Max. Negotiated Rate	$3,234.38
Rate for Payer: Aetna of AZ Commercial	$437.40
Rate for Payer: Arizona Complete Health Allwell	$77.76
Rate for Payer: Banner UC Health Medicare	$77.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$330.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$102.86
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$77.76
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cigna of AZ Commercial	$340.20
Rate for Payer: Devoted Health Medicare	$87.48
Rate for Payer: Humana of AZ Medicare	$77.76
Rate for Payer: Mercy Care Medicaid	$102.86
Rate for Payer: NaphCare Correctional Healthcare	$102.86
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$330.48
Rate for Payer: TriWest Medicare	$77.76
Rate for Payer: United Healthcare Commercial	$277.99
Rate for Payer: United Healthcare Medicare	$77.76
Rate for Payer: Veterans Affairs TRICARE	$76.98

VASECTOMY

Facility

$486.00

Service Code	CPT 55250
Hospital Charge Code	23171943
Min. Negotiated Rate	$437.40
Max. Negotiated Rate	$437.40
Rate for Payer: Aetna of AZ Commercial	$437.40
Rate for Payer: Cash Price	$388.80

VASECTOMY SET

Facility

$201.80

Hospital Charge Code	27748912
Hospital Revenue Code	270
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$181.62
Rate for Payer: Aetna of AZ Commercial	$181.62
Rate for Payer: Arizona Complete Health Allwell	$32.29
Rate for Payer: Banner UC Health Medicare	$32.29
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$137.22
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.29
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.29
Rate for Payer: Cash Price	$161.44
Rate for Payer: Cigna of AZ Commercial	$141.26
Rate for Payer: Devoted Health Medicare	$36.32
Rate for Payer: Humana of AZ Medicare	$32.29
Rate for Payer: Southwest Service Administrators UFCW	$137.22
Rate for Payer: TriWest Medicare	$32.29
Rate for Payer: United Healthcare Commercial	$115.43
Rate for Payer: United Healthcare Medicare	$32.29
Rate for Payer: Veterans Affairs TRICARE	$31.97

VASECTOMY SET

Facility

$201.80

Hospital Charge Code	27748912
Hospital Revenue Code	270
Min. Negotiated Rate	$181.62
Max. Negotiated Rate	$181.62
Rate for Payer: Aetna of AZ Commercial	$181.62
Rate for Payer: Cash Price	$161.44

VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INC

Facility

$1,214.00

Service Code	CPT 55250
Hospital Charge Code	28068477
Hospital Revenue Code	360
Min. Negotiated Rate	$102.86
Max. Negotiated Rate	$4,169.00
Rate for Payer: Aetna of AZ Commercial	$1,092.60
Rate for Payer: Arizona Complete Health Allwell	$194.24
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$825.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$102.86
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$194.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$194.24
Rate for Payer: Cash Price	$971.20
Rate for Payer: Cash Price	$971.20
Rate for Payer: Cash Price	$971.20
Rate for Payer: Cigna of AZ Commercial	$607.00
Rate for Payer: Devoted Health Medicare	$218.52
Rate for Payer: Humana of AZ Medicare	$194.24
Rate for Payer: Mercy Care Medicaid	$102.86
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: Southwest Service Administrators UFCW	$825.52
Rate for Payer: TriWest Medicare	$194.24
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$194.24
Rate for Payer: Veterans Affairs TRICARE	$192.30

VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INC

Facility

$1,214.00

Service Code	CPT 55250
Hospital Charge Code	28068477
Hospital Revenue Code	360
Min. Negotiated Rate	$1,092.60
Max. Negotiated Rate	$1,092.60
Rate for Payer: Aetna of AZ Commercial	$1,092.60
Rate for Payer: Cash Price	$971.20

Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)

Facility

$4,169.00

Service Code	CPT 55250
Hospital Revenue Code	490
Min. Negotiated Rate	$102.86
Max. Negotiated Rate	$4,169.00
Rate for Payer: Banner UC Health Medicare	$690.65
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$102.86
Rate for Payer: Mercy Care Medicaid	$102.86
Rate for Payer: NaphCare Correctional Healthcare	$690.65
Rate for Payer: Seven Corners Travel Insurance	$3,234.38
Rate for Payer: United Healthcare Commercial	$4,169.00

vasopressin 20 units/1 mL Inj Sol [CQCH]

Facility

$183.23

Service Code	NDC 42023016425
Hospital Charge Code	105944809
Hospital Revenue Code	251
Min. Negotiated Rate	$164.91
Max. Negotiated Rate	$164.91
Rate for Payer: Aetna of AZ Commercial	$164.91
Rate for Payer: Cash Price	$146.58

vasopressin 20 units/1 mL Inj Sol [CQCH]

Facility

$183.23

Service Code	NDC 42023016425
Hospital Charge Code	105944809
Hospital Revenue Code	251
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$164.91
Rate for Payer: Aetna of AZ Commercial	$164.91
Rate for Payer: Arizona Complete Health Allwell	$29.32
Rate for Payer: Banner UC Health Medicare	$29.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$124.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.32
Rate for Payer: Cash Price	$146.58
Rate for Payer: Cigna of AZ Commercial	$119.10
Rate for Payer: Devoted Health Medicare	$32.98
Rate for Payer: Humana of AZ Medicare	$29.32
Rate for Payer: Southwest Service Administrators UFCW	$124.60
Rate for Payer: TriWest Medicare	$29.32
Rate for Payer: United Healthcare Commercial	$104.81
Rate for Payer: United Healthcare Medicare	$29.32
Rate for Payer: Veterans Affairs TRICARE	$29.02

VATHIN DISP FLEX URTETEROSCOPE QUANTA

Facility

$3,725.00

Hospital Charge Code	27936382
Hospital Revenue Code	270
Min. Negotiated Rate	$590.04
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna of AZ Commercial	$3,352.50
Rate for Payer: Arizona Complete Health Allwell	$596.00
Rate for Payer: Banner UC Health Medicare	$596.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,533.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$596.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$596.00
Rate for Payer: Cash Price	$2,980.00
Rate for Payer: Cigna of AZ Commercial	$2,607.50
Rate for Payer: Devoted Health Medicare	$670.50
Rate for Payer: Humana of AZ Medicare	$596.00
Rate for Payer: Southwest Service Administrators UFCW	$2,533.00
Rate for Payer: TriWest Medicare	$596.00
Rate for Payer: United Healthcare Commercial	$2,130.70
Rate for Payer: United Healthcare Medicare	$596.00
Rate for Payer: Veterans Affairs TRICARE	$590.04

VATHIN DISP FLEX URTETEROSCOPE QUANTA

Facility

$3,725.00

Hospital Charge Code	27936382
Hospital Revenue Code	270
Min. Negotiated Rate	$3,352.50
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna of AZ Commercial	$3,352.50
Rate for Payer: Cash Price	$2,980.00

vecuronium 10 mg REC PWD [CQCH]

Facility

$4.63

Service Code	NDC 47335093144
Hospital Charge Code	111168336
Hospital Revenue Code	250
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna of AZ Commercial	$4.17
Rate for Payer: Cash Price	$3.70

vecuronium 10 mg REC PWD [CQCH]

Facility

$4.63

Service Code	NDC 47335093144
Hospital Charge Code	111168336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna of AZ Commercial	$4.17
Rate for Payer: Arizona Complete Health Allwell	$0.74
Rate for Payer: Banner UC Health Medicare	$0.74
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.74
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.74
Rate for Payer: Cash Price	$3.70
Rate for Payer: Cigna of AZ Commercial	$3.01
Rate for Payer: Devoted Health Medicare	$0.83
Rate for Payer: Humana of AZ Medicare	$0.74
Rate for Payer: Southwest Service Administrators UFCW	$3.15
Rate for Payer: TriWest Medicare	$0.74
Rate for Payer: United Healthcare Commercial	$2.65
Rate for Payer: United Healthcare Medicare	$0.74
Rate for Payer: Veterans Affairs TRICARE	$0.73

vedolizumab 300 mg REC[CQCH]

Facility

$8,666.58

Service Code	HCPCS J3380
Hospital Charge Code	228424664
Hospital Revenue Code	250
Min. Negotiated Rate	$7,799.92
Max. Negotiated Rate	$7,799.92
Rate for Payer: Aetna of AZ Commercial	$7,799.92
Rate for Payer: Cash Price	$6,933.26

vedolizumab 300 mg REC[CQCH]

Facility

$8,666.58

Service Code	HCPCS J3380
Hospital Charge Code	228424664
Hospital Revenue Code	250
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$7,799.92
Rate for Payer: Aetna of AZ Commercial	$7,799.92
Rate for Payer: Arizona Complete Health Allwell	$1,386.65
Rate for Payer: Banner UC Health Medicare	$1,386.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5,893.27
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,386.65
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,386.65
Rate for Payer: Cash Price	$6,933.26
Rate for Payer: Cash Price	$6,933.26
Rate for Payer: Cigna of AZ Commercial	$5,633.28
Rate for Payer: Devoted Health Medicare	$1,559.98
Rate for Payer: Humana of AZ Medicare	$1,386.65
Rate for Payer: Seven Corners Travel Insurance	$31.35
Rate for Payer: Southwest Service Administrators UFCW	$5,893.27
Rate for Payer: TriWest Medicare	$1,386.65
Rate for Payer: United Healthcare Commercial	$4,957.28
Rate for Payer: United Healthcare Medicare	$1,386.65
Rate for Payer: Veterans Affairs TRICARE	$1,372.79

VEIN LIGATION AND STRIPPING

Facility

$39,514.25

Service Code	MSDRG 263
Min. Negotiated Rate	$39,514.25
Max. Negotiated Rate	$39,514.25
Rate for Payer: Seven Corners Travel Insurance	$39,514.25

venlafaxine 75 mg ER Capsule [CQCH]

Facility

$0.35

Service Code	NDC 904646961
Hospital Charge Code	160253304
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Arizona Complete Health Allwell	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.06
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.06
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Devoted Health Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Southwest Service Administrators UFCW	$0.24
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: United Healthcare Commercial	$0.20
Rate for Payer: United Healthcare Medicare	$0.06
Rate for Payer: Veterans Affairs TRICARE	$0.06

venlafaxine 75 mg ER Capsule [CQCH]

Facility

$0.35

Service Code	NDC 904646961
Hospital Charge Code	160253304
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Cash Price	$0.28

venlafaxine 75 mg Tab IR [CQCH]

Facility

$0.39

Service Code	NDC 68084085601
Hospital Charge Code	105944939
Hospital Revenue Code	251
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of AZ Commercial	$0.35
Rate for Payer: Cash Price	$0.31

venlafaxine 75 mg Tab IR [CQCH]

Facility

$0.39

Service Code	NDC 68084085601
Hospital Charge Code	105944939
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of AZ Commercial	$0.35
Rate for Payer: Arizona Complete Health Allwell	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.27
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.06
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.06
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of AZ Commercial	$0.25
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Southwest Service Administrators UFCW	$0.27
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: United Healthcare Commercial	$0.22
Rate for Payer: United Healthcare Medicare	$0.06
Rate for Payer: Veterans Affairs TRICARE	$0.06

Venous Blood Gas..

Facility

$309.00

Service Code	CPT 82803
Hospital Charge Code	22040456
Hospital Revenue Code	301
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Arizona Complete Health Allwell	$49.44
Rate for Payer: Banner UC Health Medicare	$49.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$210.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.44
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cigna of AZ Commercial	$200.85
Rate for Payer: Devoted Health Medicare	$55.62
Rate for Payer: Humana of AZ Medicare	$49.44
Rate for Payer: Seven Corners Travel Insurance	$37.80
Rate for Payer: Southwest Service Administrators UFCW	$210.12
Rate for Payer: TriWest Medicare	$49.44
Rate for Payer: United Healthcare Commercial	$176.75
Rate for Payer: United Healthcare Medicare	$49.44
Rate for Payer: Veterans Affairs TRICARE	$48.95

Know your out-of-pocket cost for care.

All Charges