Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Vitamin B12 Level

Facility

$179.00

Service Code	CPT 82607
Hospital Charge Code	633871
Hospital Revenue Code	301
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Arizona Complete Health Allwell	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$121.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.64
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$116.35
Rate for Payer: Devoted Health Medicare	$32.22
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Seven Corners Travel Insurance	$21.87
Rate for Payer: Southwest Service Administrators UFCW	$121.72
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: United Healthcare Commercial	$102.39
Rate for Payer: United Healthcare Medicare	$28.64
Rate for Payer: Veterans Affairs TRICARE	$28.35

Vitamin B12 Level

Facility

$108.00

Service Code	CPT 82607
Hospital Charge Code	21254686
Hospital Revenue Code	301
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Arizona Complete Health Allwell	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$73.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.28
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$70.20
Rate for Payer: Devoted Health Medicare	$19.44
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Seven Corners Travel Insurance	$21.87
Rate for Payer: Southwest Service Administrators UFCW	$73.44
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: United Healthcare Commercial	$61.78
Rate for Payer: United Healthcare Medicare	$17.28
Rate for Payer: Veterans Affairs TRICARE	$17.11

Vitamin B12 Level

Facility

$179.00

Service Code	CPT 82607
Hospital Charge Code	633871
Hospital Revenue Code	301
Min. Negotiated Rate	$161.10
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Cash Price	$143.20

Vitamin B1 (Thiamine) Whl Blood LC

Facility

$345.00

Service Code	CPT 84425
Hospital Charge Code	6781596
Hospital Revenue Code	301
Min. Negotiated Rate	$30.78
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna of AZ Commercial	$310.50
Rate for Payer: Arizona Complete Health Allwell	$55.20
Rate for Payer: Banner UC Health Medicare	$55.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$234.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$55.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$55.20
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cigna of AZ Commercial	$224.25
Rate for Payer: Devoted Health Medicare	$62.10
Rate for Payer: Humana of AZ Medicare	$55.20
Rate for Payer: Seven Corners Travel Insurance	$30.78
Rate for Payer: Southwest Service Administrators UFCW	$234.60
Rate for Payer: TriWest Medicare	$55.20
Rate for Payer: United Healthcare Commercial	$197.34
Rate for Payer: United Healthcare Medicare	$55.20
Rate for Payer: Veterans Affairs TRICARE	$54.65

Vitamin B1 (Thiamine) Whl Blood LC

Facility

$345.00

Service Code	CPT 84425
Hospital Charge Code	6781596
Hospital Revenue Code	301
Min. Negotiated Rate	$310.50
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna of AZ Commercial	$310.50
Rate for Payer: Cash Price	$276.00

Vitamin B2 Whole Blood LC

Facility

$342.00

Service Code	CPT 84252
Hospital Charge Code	6780835
Hospital Revenue Code	301
Min. Negotiated Rate	$307.80
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of AZ Commercial	$307.80
Rate for Payer: Cash Price	$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	$29.35
Max. Negotiated Rate	$307.80
Rate for Payer: Aetna of AZ Commercial	$307.80
Rate for Payer: Arizona Complete Health Allwell	$54.72
Rate for Payer: Banner UC Health Medicare	$54.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$232.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$54.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$54.72
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cigna of AZ Commercial	$222.30
Rate for Payer: Devoted Health Medicare	$61.56
Rate for Payer: Humana of AZ Medicare	$54.72
Rate for Payer: Seven Corners Travel Insurance	$29.35
Rate for Payer: Southwest Service Administrators UFCW	$232.56
Rate for Payer: TriWest Medicare	$54.72
Rate for Payer: United Healthcare Commercial	$195.62
Rate for Payer: United Healthcare Medicare	$54.72
Rate for Payer: Veterans Affairs TRICARE	$54.17

Vitamin B3 (Niacin+Metabolite) LC

Facility

$708.00

Service Code	CPT 82542
Hospital Charge Code	6781648
Hospital Revenue Code	301
Min. Negotiated Rate	$34.93
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Arizona Complete Health Allwell	$113.28
Rate for Payer: Banner UC Health Medicare	$113.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$481.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$113.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$113.28
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cigna of AZ Commercial	$460.20
Rate for Payer: Devoted Health Medicare	$127.44
Rate for Payer: Humana of AZ Medicare	$113.28
Rate for Payer: Seven Corners Travel Insurance	$34.93
Rate for Payer: Southwest Service Administrators UFCW	$481.44
Rate for Payer: TriWest Medicare	$113.28
Rate for Payer: United Healthcare Commercial	$404.98
Rate for Payer: United Healthcare Medicare	$113.28
Rate for Payer: Veterans Affairs TRICARE	$112.15

Vitamin B3 (Niacin+Metabolite) LC

Facility

$708.00

Service Code	CPT 82542
Hospital Charge Code	6781648
Hospital Revenue Code	301
Min. Negotiated Rate	$637.20
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Cash Price	$566.40

Vitamin B6 LC

Facility

$579.00

Service Code	CPT 84207
Hospital Charge Code	1909644
Hospital Revenue Code	301
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Arizona Complete Health Allwell	$92.64
Rate for Payer: Banner UC Health Medicare	$92.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$393.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$92.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$92.64
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cigna of AZ Commercial	$376.35
Rate for Payer: Devoted Health Medicare	$104.22
Rate for Payer: Humana of AZ Medicare	$92.64
Rate for Payer: Seven Corners Travel Insurance	$40.74
Rate for Payer: Southwest Service Administrators UFCW	$393.72
Rate for Payer: TriWest Medicare	$92.64
Rate for Payer: United Healthcare Commercial	$331.19
Rate for Payer: United Healthcare Medicare	$92.64
Rate for Payer: Veterans Affairs TRICARE	$91.71

Vitamin B6 LC

Facility

$579.00

Service Code	CPT 84207
Hospital Charge Code	1909644
Hospital Revenue Code	301
Min. Negotiated Rate	$521.10
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Cash Price	$463.20

Vitamin D, 25-Hydroxy LC

Facility

$292.00

Service Code	CPT 82306
Hospital Charge Code	1285623
Hospital Revenue Code	301
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Arizona Complete Health Allwell	$46.72
Rate for Payer: Banner UC Health Medicare	$46.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$198.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$46.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$46.72
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cigna of AZ Commercial	$189.80
Rate for Payer: Devoted Health Medicare	$52.56
Rate for Payer: Humana of AZ Medicare	$46.72
Rate for Payer: Seven Corners Travel Insurance	$42.92
Rate for Payer: Southwest Service Administrators UFCW	$198.56
Rate for Payer: TriWest Medicare	$46.72
Rate for Payer: United Healthcare Commercial	$167.02
Rate for Payer: United Healthcare Medicare	$46.72
Rate for Payer: Veterans Affairs TRICARE	$46.25

Vitamin D, 25-Hydroxy LC

Facility

$292.00

Service Code	CPT 82306
Hospital Charge Code	1285623
Hospital Revenue Code	301
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$262.80
Rate for Payer: Aetna of AZ Commercial	$262.80
Rate for Payer: Cash Price	$233.60

Vitamin D 25 Hydroxy Level

Facility

$352.00

Service Code	CPT 82306
Hospital Charge Code	633872
Hospital Revenue Code	301
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Arizona Complete Health Allwell	$56.32
Rate for Payer: Banner UC Health Medicare	$56.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$239.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$56.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$56.32
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cigna of AZ Commercial	$228.80
Rate for Payer: Devoted Health Medicare	$63.36
Rate for Payer: Humana of AZ Medicare	$56.32
Rate for Payer: Seven Corners Travel Insurance	$42.92
Rate for Payer: Southwest Service Administrators UFCW	$239.36
Rate for Payer: TriWest Medicare	$56.32
Rate for Payer: United Healthcare Commercial	$201.34
Rate for Payer: United Healthcare Medicare	$56.32
Rate for Payer: Veterans Affairs TRICARE	$55.76

Vitamin D 25 Hydroxy Level

Facility

$352.00

Service Code	CPT 82306
Hospital Charge Code	633872
Hospital Revenue Code	301
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Cash Price	$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	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Cash Price	$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: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$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	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Cash Price	$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: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$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	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.11
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.09
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

vitamin E 400 units Cap [CQCH]

Facility

$0.16

Service Code	NDC 904027460
Hospital Charge Code	105945267
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Cash Price	$0.13

Vitamin E, Serum LC

Facility

$221.00

Service Code	CPT 84446
Hospital Charge Code	2029231
Hospital Revenue Code	301
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of AZ Commercial	$198.90
Rate for Payer: Cash Price	$176.80

Vitamin E, Serum LC

Facility

$221.00

Service Code	CPT 84446
Hospital Charge Code	2029231
Hospital Revenue Code	301
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna of AZ Commercial	$198.90
Rate for Payer: Arizona Complete Health Allwell	$35.36
Rate for Payer: Banner UC Health Medicare	$35.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$150.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.36
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cigna of AZ Commercial	$143.65
Rate for Payer: Devoted Health Medicare	$39.78
Rate for Payer: Humana of AZ Medicare	$35.36
Rate for Payer: Seven Corners Travel Insurance	$20.56
Rate for Payer: Southwest Service Administrators UFCW	$150.28
Rate for Payer: TriWest Medicare	$35.36
Rate for Payer: United Healthcare Commercial	$126.41
Rate for Payer: United Healthcare Medicare	$35.36
Rate for Payer: Veterans Affairs TRICARE	$35.01

Vitamin K LC

Facility

$172.00

Service Code	CPT 84597
Hospital Charge Code	6780828
Hospital Revenue Code	305
Min. Negotiated Rate	$19.89
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	$19.89
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

Vitamin K LC

Facility

$172.00

Service Code	CPT 84597
Hospital Charge Code	6780828
Hospital Revenue Code	305
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

Know your out-of-pocket cost for care.

All Charges