Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Vit B12 Unsat Binding Capacity LC

Facility

$195.00

Service Code	CPT 82608
Hospital Charge Code	6738694
Hospital Revenue Code	301
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Arizona Complete Health Allwell	$31.20
Rate for Payer: Banner UC Health Medicare	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$132.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cigna of AZ Commercial	$126.75
Rate for Payer: Devoted Health Medicare	$35.10
Rate for Payer: Humana of AZ Medicare	$31.20
Rate for Payer: Seven Corners Travel Insurance	$20.76
Rate for Payer: Southwest Service Administrators UFCW	$132.60
Rate for Payer: TriWest Medicare	$31.20
Rate for Payer: United Healthcare Commercial	$111.54
Rate for Payer: United Healthcare Medicare	$31.20
Rate for Payer: Veterans Affairs TRICARE	$30.89

Vit B12 Unsat Binding Capacity LC

Facility

$195.00

Service Code	CPT 82608
Hospital Charge Code	6738694
Hospital Revenue Code	301
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Cash Price	$156.00

Voiding pressure studies, intra-abdominal (i.e., rectal, gastric, intraperitoneal) (list separately in addition to code for primary procedure)

Facility

$2,671.00

Service Code	CPT 51797
Hospital Revenue Code	490
Min. Negotiated Rate	$2,671.00
Max. Negotiated Rate	$2,671.00
Rate for Payer: United Healthcare Commercial	$2,671.00

Voiding Pressure Study

Facility

$2,000.00

Service Code	CPT 51728
Hospital Charge Code	27291784
Hospital Revenue Code	360
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna of AZ Commercial	$1,800.00
Rate for Payer: Cash Price	$1,600.00

Voiding Pressure Study

Facility

$2,000.00

Service Code	CPT 51728
Hospital Charge Code	27291784
Hospital Revenue Code	360
Min. Negotiated Rate	$127.64
Max. Negotiated Rate	$3,098.00
Rate for Payer: Aetna of AZ Commercial	$1,800.00
Rate for Payer: Arizona Complete Health Allwell	$320.00
Rate for Payer: Banner UC Health Medicare	$127.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,360.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$320.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$320.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Cash Price	$1,600.00
Rate for Payer: Cigna of AZ Commercial	$1,000.00
Rate for Payer: Devoted Health Medicare	$360.00
Rate for Payer: Humana of AZ Medicare	$320.00
Rate for Payer: NaphCare Correctional Healthcare	$127.64
Rate for Payer: Seven Corners Travel Insurance	$1,078.90
Rate for Payer: Southwest Service Administrators UFCW	$1,360.00
Rate for Payer: TriWest Medicare	$320.00
Rate for Payer: United Healthcare Commercial	$3,098.00
Rate for Payer: United Healthcare Medicare	$320.00
Rate for Payer: Veterans Affairs TRICARE	$316.80

Void Press Intraabdominal

Facility

$1,003.00

Service Code	CPT 51797
Hospital Charge Code	27281884
Hospital Revenue Code	360
Min. Negotiated Rate	$158.88
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$902.70
Rate for Payer: Arizona Complete Health Allwell	$160.48
Rate for Payer: Banner UC Health Medicare	$160.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$682.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$160.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$160.48
Rate for Payer: Cash Price	$802.40
Rate for Payer: Cash Price	$802.40
Rate for Payer: Cigna of AZ Commercial	$501.50
Rate for Payer: Devoted Health Medicare	$180.54
Rate for Payer: Humana of AZ Medicare	$160.48
Rate for Payer: Southwest Service Administrators UFCW	$682.04
Rate for Payer: TriWest Medicare	$160.48
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$160.48
Rate for Payer: Veterans Affairs TRICARE	$158.88

Void Press Intraabdominal

Facility

$1,003.00

Service Code	CPT 51797
Hospital Charge Code	27281884
Hospital Revenue Code	360
Min. Negotiated Rate	$902.70
Max. Negotiated Rate	$902.70
Rate for Payer: Aetna of AZ Commercial	$902.70
Rate for Payer: Cash Price	$802.40

Vulvar Abscess incision and draninga

Facility

$672.00

Service Code	CPT 56405
Hospital Charge Code	27281904
Hospital Revenue Code	360
Min. Negotiated Rate	$604.80
Max. Negotiated Rate	$604.80
Rate for Payer: Aetna of AZ Commercial	$604.80
Rate for Payer: Cash Price	$537.60

Vulvar Abscess incision and draninga

Facility

$672.00

Service Code	CPT 56405
Hospital Charge Code	27281904
Hospital Revenue Code	360
Min. Negotiated Rate	$18.13
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$604.80
Rate for Payer: Arizona Complete Health Allwell	$107.52
Rate for Payer: Banner UC Health Medicare	$48.86
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$456.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$107.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$107.52
Rate for Payer: Cash Price	$537.60
Rate for Payer: Cash Price	$537.60
Rate for Payer: Cash Price	$537.60
Rate for Payer: Cigna of AZ Commercial	$336.00
Rate for Payer: Devoted Health Medicare	$120.96
Rate for Payer: Humana of AZ Medicare	$107.52
Rate for Payer: Mercy Care Medicaid	$18.13
Rate for Payer: NaphCare Correctional Healthcare	$48.86
Rate for Payer: Seven Corners Travel Insurance	$471.50
Rate for Payer: Southwest Service Administrators UFCW	$456.96
Rate for Payer: TriWest Medicare	$107.52
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$107.52
Rate for Payer: Veterans Affairs TRICARE	$106.44

VULVECTOMY SIMPLE; PARTIAL

Facility

$5,008.71

Service Code	CPT 56620
Hospital Revenue Code	360
Min. Negotiated Rate	$1,051.19
Max. Negotiated Rate	$5,008.71
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: United Healthcare Commercial	$4,169.00

vW Antigen LC

Facility

$404.00

Service Code	CPT 85246
Hospital Charge Code	2769552
Hospital Revenue Code	305
Min. Negotiated Rate	$363.60
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Cash Price	$323.20

vW Antigen LC

Facility

$404.00

Service Code	CPT 85246
Hospital Charge Code	2769552
Hospital Revenue Code	305
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Arizona Complete Health Allwell	$64.64
Rate for Payer: Banner UC Health Medicare	$64.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$274.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$64.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$64.64
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cigna of AZ Commercial	$262.60
Rate for Payer: Devoted Health Medicare	$72.72
Rate for Payer: Humana of AZ Medicare	$64.64
Rate for Payer: Seven Corners Travel Insurance	$33.26
Rate for Payer: Southwest Service Administrators UFCW	$274.72
Rate for Payer: TriWest Medicare	$64.64
Rate for Payer: United Healthcare Commercial	$231.09
Rate for Payer: United Healthcare Medicare	$64.64
Rate for Payer: Veterans Affairs TRICARE	$63.99

vWF Activity LC

Facility

$308.00

Service Code	CPT 85245
Hospital Charge Code	2769553
Hospital Revenue Code	305
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Arizona Complete Health Allwell	$49.28
Rate for Payer: Banner UC Health Medicare	$49.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$209.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.28
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cigna of AZ Commercial	$200.20
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Humana of AZ Medicare	$49.28
Rate for Payer: Seven Corners Travel Insurance	$33.26
Rate for Payer: Southwest Service Administrators UFCW	$209.44
Rate for Payer: TriWest Medicare	$49.28
Rate for Payer: United Healthcare Commercial	$176.18
Rate for Payer: United Healthcare Medicare	$49.28
Rate for Payer: Veterans Affairs TRICARE	$48.79

vWF Activity LC

Facility

$308.00

Service Code	CPT 85245
Hospital Charge Code	2769553
Hospital Revenue Code	305
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Cash Price	$246.40

warfarin 1 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 56016975
Hospital Charge Code	105945657
Hospital Revenue Code	251
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

warfarin 1 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 56016975
Hospital Charge Code	105945657
Hospital Revenue Code	251
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

warfarin 2 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 56017075
Hospital Charge Code	105945527
Hospital Revenue Code	251
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

warfarin 2 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 56017075
Hospital Charge Code	105945527
Hospital Revenue Code	251
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

warfarin 3 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 56018875
Hospital Charge Code	105945462
Hospital Revenue Code	251
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

warfarin 3 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 56018875
Hospital Charge Code	105945462
Hospital Revenue Code	251
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

warfarin 5 mg Tab [CQCH]

Facility

$0.38

Service Code	NDC 832121601
Hospital Charge Code	105945397
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of AZ Commercial	$0.34
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	$0.26
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	$0.30
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	$0.26
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

warfarin 5 mg Tab [CQCH]

Facility

$0.38

Service Code	NDC 832121601
Hospital Charge Code	105945397
Hospital Revenue Code	251
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of AZ Commercial	$0.34
Rate for Payer: Cash Price	$0.30

warfarin 7.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 56017375
Hospital Charge Code	105945332
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
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	$0.04
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	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.03
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

warfarin 7.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 56017375
Hospital Charge Code	105945332
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Cash Price	$0.05

WARMER SCOPE BLUE HEAT SINGLE USE

Facility

$99.00

Hospital Charge Code	22354936
Hospital Revenue Code	270
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Arizona Complete Health Allwell	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$67.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.84
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$69.30
Rate for Payer: Devoted Health Medicare	$17.82
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Southwest Service Administrators UFCW	$67.32
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: United Healthcare Commercial	$56.63
Rate for Payer: United Healthcare Medicare	$15.84
Rate for Payer: Veterans Affairs TRICARE	$15.68

Know your out-of-pocket cost for care.

All Charges