Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ascorbic acid 500 mg Tab [CQCH]

Facility

$0.02

Service Code	NDC 904052380
Hospital Charge Code	105911388
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	$0.01

ascorbic acid 500 mg Tab [CQCH]

Facility

$0.02

Service Code	NDC 904052380
Hospital Charge Code	105911388
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	$0.01
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

ASCORBIC ACID (VITAMIN C), BLOOD

Facility

$41.00

Service Code	CPT 82180
Hospital Charge Code	23603251
Hospital Revenue Code	301
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

ASCORBIC ACID (VITAMIN C), BLOOD

Facility

$41.00

Service Code	CPT 82180
Hospital Charge Code	23603251
Hospital Revenue Code	301
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Seven Corners Travel Insurance	$14.34
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

Aspartate Aminotransferase

Facility

$124.00

Service Code	CPT 84450
Hospital Charge Code	633633
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: Veterans Affairs TRICARE	$19.64

Aspartate Aminotransferase

Facility

$124.00

Service Code	CPT 84450
Hospital Charge Code	633633
Hospital Revenue Code	301
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Cash Price	$99.20

Aspergillus Antibodies, Quantitative LC

Facility

$403.00

Service Code	CPT 86606
Hospital Charge Code	12689406
Hospital Revenue Code	302
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$362.70
Rate for Payer: Aetna of AZ Commercial	$362.70
Rate for Payer: Arizona Complete Health Allwell	$64.48
Rate for Payer: Banner UC Health Medicare	$64.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$274.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$64.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$64.48
Rate for Payer: Cash Price	$322.40
Rate for Payer: Cash Price	$322.40
Rate for Payer: Cigna of AZ Commercial	$261.95
Rate for Payer: Devoted Health Medicare	$72.54
Rate for Payer: Humana of AZ Medicare	$64.48
Rate for Payer: Seven Corners Travel Insurance	$21.82
Rate for Payer: Southwest Service Administrators UFCW	$274.04
Rate for Payer: TriWest Medicare	$64.48
Rate for Payer: United Healthcare Commercial	$230.52
Rate for Payer: United Healthcare Medicare	$64.48
Rate for Payer: Veterans Affairs TRICARE	$63.84

Aspergillus Antibodies, Quantitative LC

Facility

$403.00

Service Code	CPT 86606
Hospital Charge Code	12689406
Hospital Revenue Code	302
Min. Negotiated Rate	$362.70
Max. Negotiated Rate	$362.70
Rate for Payer: Aetna of AZ Commercial	$362.70
Rate for Payer: Cash Price	$322.40

ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION

Facility

$267.00

Service Code	CPT 20612
Hospital Charge Code	24049291
Hospital Revenue Code	360
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Arizona Complete Health Allwell	$42.72
Rate for Payer: Banner UC Health Medicare	$23.14
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$181.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$25.10
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.72
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cigna of AZ Commercial	$133.50
Rate for Payer: Devoted Health Medicare	$48.06
Rate for Payer: Humana of AZ Medicare	$42.72
Rate for Payer: Mercy Care Medicaid	$25.10
Rate for Payer: NaphCare Correctional Healthcare	$23.14
Rate for Payer: Seven Corners Travel Insurance	$474.93
Rate for Payer: Southwest Service Administrators UFCW	$181.56
Rate for Payer: TriWest Medicare	$42.72
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$42.72
Rate for Payer: Veterans Affairs TRICARE	$42.29

ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION

Facility

$267.00

Service Code	CPT 20612
Hospital Charge Code	24049291
Hospital Revenue Code	360
Min. Negotiated Rate	$240.30
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Cash Price	$213.60

aspirin 300 mg Supp [CQCH]

Facility

$0.27

Service Code	NDC 574703412
Hospital Charge Code	105911455
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of AZ Commercial	$0.18
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.15
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

aspirin 300 mg Supp [CQCH]

Facility

$0.27

Service Code	NDC 574703412
Hospital Charge Code	105911455
Hospital Revenue Code	251
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Cash Price	$0.22

aspirin 325 mg Oral EC Tab [CQCH]

Facility

$0.01

Service Code	NDC 63739052301
Hospital Charge Code	105911703
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
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	$0.01
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

aspirin 325 mg Oral EC Tab [CQCH]

Facility

$0.01

Service Code	NDC 63739052301
Hospital Charge Code	105911703
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

aspirin 325 mg Tab [CQCH]

Facility

$0.01

Service Code	NDC 66553000101
Hospital Charge Code	105911642
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
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	$0.01
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

aspirin 325 mg Tab [CQCH]

Facility

$0.01

Service Code	NDC 66553000101
Hospital Charge Code	105911642
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

aspirin 81 mg Chew Tab [CQCH]

Facility

$0.01

Service Code	NDC 904679480
Hospital Charge Code	105911581
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

aspirin 81 mg Chew Tab [CQCH]

Facility

$0.01

Service Code	NDC 904679480
Hospital Charge Code	105911581
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
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	$0.01
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

aspirin 81 mg Oral EC Tab [CQCH]

Facility

$0.03

Service Code	NDC 904770418
Hospital Charge Code	105911516
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
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	$0.02
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	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

aspirin 81 mg Oral EC Tab [CQCH]

Facility

$0.03

Service Code	NDC 904770418
Hospital Charge Code	105911516
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Cash Price	$0.03

ASSESSMENT INITIAL EA

Facility

$39.00

Service Code	CPT 96127
Hospital Charge Code	2478917
Hospital Revenue Code	521
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Cash Price	$31.20

ASSESSMENT INITIAL EA

Facility

$39.00

Service Code	CPT 96127
Hospital Charge Code	2478917
Hospital Revenue Code	521
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$57.80
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Arizona Complete Health Allwell	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.24
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Devoted Health Medicare	$7.02
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Seven Corners Travel Insurance	$57.80
Rate for Payer: Southwest Service Administrators UFCW	$26.52
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: United Healthcare Commercial	$22.31
Rate for Payer: United Healthcare Medicare	$6.24
Rate for Payer: Veterans Affairs TRICARE	$6.18

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80
Rate for Payer: NaphCare Correctional Healthcare	$9,015.80

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35
Rate for Payer: NaphCare Correctional Healthcare	$3,985.35

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80
Rate for Payer: NaphCare Correctional Healthcare	$9,015.80

Know your out-of-pocket cost for care.

All Charges