Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ALBUMIN 24 HOUR URINE + TOTAL VOLUME

Facility

$130.00

Service Code	CPT 82043
Hospital Charge Code	23294369
Hospital Revenue Code	301
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

albumin human 5% Sol[CQCH]

Facility

$0.16

Service Code	HCPCS P9045
Hospital Charge Code	195848457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Cash Price	$0.12

albumin human 5% Sol[CQCH]

Facility

$0.16

Service Code	HCPCS P9045
Hospital Charge Code	195848457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$76.97
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	$0.12
Rate for Payer: Cash Price	$0.12
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: Seven Corners Travel Insurance	$76.97
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

Albumin Level

Facility

$62.00

Service Code	CPT 82040
Hospital Charge Code	633634
Hospital Revenue Code	301
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Seven Corners Travel Insurance	$7.18
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

Albumin Level

Facility

$62.00

Service Code	CPT 82040
Hospital Charge Code	633634
Hospital Revenue Code	301
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

albuterol 0.083% Inh Sol 3 mL [CQCH]

Facility

$0.06

Service Code	HCPCS J7609
Hospital Charge Code	105909534
Hospital Revenue Code	250
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

albuterol 0.083% Inh Sol 3 mL [CQCH]

Facility

$0.06

Service Code	HCPCS J7609
Hospital Charge Code	105909534
Hospital Revenue Code	250
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

albuterol 0.5% Inh Sol 0.5 mL [CQCH]

Facility

$0.68

Service Code	HCPCS J7609
Hospital Charge Code	105909609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of AZ Commercial	$0.61
Rate for Payer: Cash Price	$0.54

albuterol 0.5% Inh Sol 0.5 mL [CQCH]

Facility

$0.68

Service Code	HCPCS J7609
Hospital Charge Code	105909609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of AZ Commercial	$0.61
Rate for Payer: Arizona Complete Health Allwell	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.46
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.11
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.11
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of AZ Commercial	$0.44
Rate for Payer: Devoted Health Medicare	$0.12
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Southwest Service Administrators UFCW	$0.46
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: United Healthcare Commercial	$0.39
Rate for Payer: United Healthcare Medicare	$0.11
Rate for Payer: Veterans Affairs TRICARE	$0.11

albuterol-ipratropium Inh Sol 3 mL [CQCH]

Facility

$0.18

Service Code	HCPCS J7609
Hospital Charge Code	105909698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
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	$0.12
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	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.12
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.10
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

albuterol-ipratropium Inh Sol 3 mL [CQCH]

Facility

$0.18

Service Code	HCPCS J7609
Hospital Charge Code	105909698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Cash Price	$0.15

albuterol MDI-90 mcg/inh 8 gm [CQCH]

Facility

$60.34

Service Code	NDC 59310057922
Hospital Charge Code	105909469
Hospital Revenue Code	251
Min. Negotiated Rate	$54.31
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna of AZ Commercial	$54.31
Rate for Payer: Cash Price	$48.27

albuterol MDI-90 mcg/inh 8 gm [CQCH]

Facility

$60.34

Service Code	NDC 59310057922
Hospital Charge Code	105909469
Hospital Revenue Code	251
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$54.31
Rate for Payer: Aetna of AZ Commercial	$54.31
Rate for Payer: Arizona Complete Health Allwell	$9.65
Rate for Payer: Banner UC Health Medicare	$9.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$41.03
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.65
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.65
Rate for Payer: Cash Price	$48.27
Rate for Payer: Cigna of AZ Commercial	$39.22
Rate for Payer: Devoted Health Medicare	$10.86
Rate for Payer: Humana of AZ Medicare	$9.65
Rate for Payer: Southwest Service Administrators UFCW	$41.03
Rate for Payer: TriWest Medicare	$9.65
Rate for Payer: United Healthcare Commercial	$34.51
Rate for Payer: United Healthcare Medicare	$9.65
Rate for Payer: Veterans Affairs TRICARE	$9.56

Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 m

Facility

$34.00

Service Code	HCPCS J7620
Hospital Charge Code	1781519
Hospital Revenue Code	521
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Arizona Complete Health Allwell	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.44
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$23.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Humana of AZ Medicare	$5.44
Rate for Payer: Southwest Service Administrators UFCW	$23.12
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: United Healthcare Commercial	$19.45
Rate for Payer: United Healthcare Medicare	$5.44
Rate for Payer: Veterans Affairs TRICARE	$5.39

Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 m

Facility

$34.00

Service Code	HCPCS J7620
Hospital Charge Code	1781519
Hospital Revenue Code	521
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Cash Price	$27.20

Alcohol Abuse And Dependence

Facility

$3,457.90

Service Code	APR-DRG 7752
Hospital Charge Code	APRDRG7751
Min. Negotiated Rate	$3,457.90
Max. Negotiated Rate	$3,457.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,457.90
Rate for Payer: Mercy Care Medicaid	$3,457.90
Rate for Payer: NaphCare Correctional Healthcare	$3,457.90

Alcohol Abuse And Dependence

Facility

$15,554.25

Service Code	APR-DRG 7754
Hospital Charge Code	APRDRG7754
Min. Negotiated Rate	$15,554.25
Max. Negotiated Rate	$15,554.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,554.25
Rate for Payer: Mercy Care Medicaid	$15,554.25
Rate for Payer: NaphCare Correctional Healthcare	$15,554.25

Alcohol Abuse And Dependence

Facility

$3,457.90

Service Code	APR-DRG 7752
Hospital Charge Code	APRDRG7753
Min. Negotiated Rate	$3,457.90
Max. Negotiated Rate	$3,457.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,457.90
Rate for Payer: Mercy Care Medicaid	$3,457.90
Rate for Payer: NaphCare Correctional Healthcare	$3,457.90

Alcohol Abuse And Dependence

Facility

$3,457.90

Service Code	APR-DRG 7752
Hospital Charge Code	APRDRG7754
Min. Negotiated Rate	$3,457.90
Max. Negotiated Rate	$3,457.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,457.90
Rate for Payer: Mercy Care Medicaid	$3,457.90
Rate for Payer: NaphCare Correctional Healthcare	$3,457.90

Alcohol Abuse And Dependence

Facility

$6,181.44

Service Code	APR-DRG 7753
Hospital Charge Code	APRDRG7753
Min. Negotiated Rate	$6,181.44
Max. Negotiated Rate	$6,181.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,181.44
Rate for Payer: Mercy Care Medicaid	$6,181.44
Rate for Payer: NaphCare Correctional Healthcare	$6,181.44

Alcohol Abuse And Dependence

Facility

$15,554.25

Service Code	APR-DRG 7754
Hospital Charge Code	APRDRG7753
Min. Negotiated Rate	$15,554.25
Max. Negotiated Rate	$15,554.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,554.25
Rate for Payer: Mercy Care Medicaid	$15,554.25
Rate for Payer: NaphCare Correctional Healthcare	$15,554.25

Alcohol Abuse And Dependence

Facility

$6,181.44

Service Code	APR-DRG 7753
Hospital Charge Code	APRDRG7751
Min. Negotiated Rate	$6,181.44
Max. Negotiated Rate	$6,181.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,181.44
Rate for Payer: Mercy Care Medicaid	$6,181.44
Rate for Payer: NaphCare Correctional Healthcare	$6,181.44

Alcohol Abuse And Dependence

Facility

$6,181.44

Service Code	APR-DRG 7753
Hospital Charge Code	APRDRG7752
Min. Negotiated Rate	$6,181.44
Max. Negotiated Rate	$6,181.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,181.44
Rate for Payer: Mercy Care Medicaid	$6,181.44
Rate for Payer: NaphCare Correctional Healthcare	$6,181.44

Alcohol Abuse And Dependence

Facility

$2,454.20

Service Code	APR-DRG 7751
Hospital Charge Code	APRDRG7752
Min. Negotiated Rate	$2,454.20
Max. Negotiated Rate	$2,454.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,454.20
Rate for Payer: Mercy Care Medicaid	$2,454.20
Rate for Payer: NaphCare Correctional Healthcare	$2,454.20

Alcohol Abuse And Dependence

Facility

$15,554.25

Service Code	APR-DRG 7754
Hospital Charge Code	APRDRG7752
Min. Negotiated Rate	$15,554.25
Max. Negotiated Rate	$15,554.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,554.25
Rate for Payer: Mercy Care Medicaid	$15,554.25
Rate for Payer: NaphCare Correctional Healthcare	$15,554.25

Know your out-of-pocket cost for care.

All Charges