Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

cefOXitin 2 gm Inj [CQCH]

Facility

$5.41

Service Code	HCPCS J0694
Hospital Charge Code	105915066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$4.87
Rate for Payer: Aetna of AZ Commercial	$4.87
Rate for Payer: Aetna of AZ Medicare	$1.51
Rate for Payer: Allwell Medicare	$0.87
Rate for Payer: Amerigroup Medicare	$0.87
Rate for Payer: APIPA Medicare/Medicaid	$2.02
Rate for Payer: AZCH Complete Medicare	$0.87
Rate for Payer: Banner UC Health Medicare	$0.87
Rate for Payer: Bisbee Police All Plans	$1.41
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.68
Rate for Payer: Cash Price	$4.33
Rate for Payer: Cigna of AZ Commercial	$3.52
Rate for Payer: Copperpoint Commercial	$1.34
Rate for Payer: Health Net of AZ Commercial	$3.25
Rate for Payer: Health Net of AZ Medicare	$1.51
Rate for Payer: Humana of AZ Medicare	$0.87
Rate for Payer: Self Pay Self Pay	$4.33
Rate for Payer: TriWest Medicare	$0.87
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.97

cefTAZidime 1 gm REC[CQCH]

Facility

$2.97

Service Code	HCPCS J0713
Hospital Charge Code	141532362
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna of AZ Commercial	$2.67
Rate for Payer: Aetna of AZ Medicare	$0.83
Rate for Payer: Allwell Medicare	$0.48
Rate for Payer: Amerigroup Medicare	$0.48
Rate for Payer: APIPA Medicare/Medicaid	$1.11
Rate for Payer: AZCH Complete Medicare	$0.48
Rate for Payer: Banner UC Health Medicare	$0.48
Rate for Payer: Bisbee Police All Plans	$0.77
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.02
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cigna of AZ Commercial	$1.93
Rate for Payer: Copperpoint Commercial	$0.74
Rate for Payer: Health Net of AZ Commercial	$1.78
Rate for Payer: Health Net of AZ Medicare	$0.83
Rate for Payer: Humana of AZ Medicare	$0.48
Rate for Payer: Self Pay Self Pay	$2.38
Rate for Payer: TriWest Medicare	$0.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.53

cefTAZidime 1 gm REC[CQCH]

Facility

$2.97

Service Code	HCPCS J0713
Hospital Charge Code	141532362
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna of AZ Commercial	$2.67
Rate for Payer: Bisbee Police All Plans	$0.77
Rate for Payer: Cash Price	$2.38
Rate for Payer: Self Pay Self Pay	$2.38

cefTRIAXone 1 gm Inj [CQCH]

Facility

$2.77

Service Code	HCPCS J0696
Hospital Charge Code	105915652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$2.49
Rate for Payer: Aetna of AZ Commercial	$2.49
Rate for Payer: Aetna of AZ Medicare	$0.78
Rate for Payer: Allwell Medicare	$0.44
Rate for Payer: Amerigroup Medicare	$0.44
Rate for Payer: APIPA Medicare/Medicaid	$1.03
Rate for Payer: AZCH Complete Medicare	$0.44
Rate for Payer: Banner UC Health Medicare	$0.44
Rate for Payer: Bisbee Police All Plans	$0.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.88
Rate for Payer: Cash Price	$2.21
Rate for Payer: Cigna of AZ Commercial	$1.80
Rate for Payer: Copperpoint Commercial	$0.69
Rate for Payer: Health Net of AZ Commercial	$1.66
Rate for Payer: Health Net of AZ Medicare	$0.78
Rate for Payer: Humana of AZ Medicare	$0.44
Rate for Payer: Self Pay Self Pay	$2.22
Rate for Payer: TriWest Medicare	$0.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.50

cefTRIAXone 1 gm Inj [CQCH]

Facility

$2.77

Service Code	HCPCS J0696
Hospital Charge Code	105915652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$2.49
Rate for Payer: Aetna of AZ Commercial	$2.49
Rate for Payer: Bisbee Police All Plans	$0.72
Rate for Payer: Cash Price	$2.21
Rate for Payer: Self Pay Self Pay	$2.22

cefTRIAXone 2 gm Inj [CQCH]

Facility

$2.13

Service Code	HCPCS J0696
Hospital Charge Code	105915506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of AZ Commercial	$1.92
Rate for Payer: Bisbee Police All Plans	$0.55
Rate for Payer: Cash Price	$1.70
Rate for Payer: Self Pay Self Pay	$1.70

cefTRIAXone 2 gm Inj [CQCH]

Facility

$2.13

Service Code	HCPCS J0696
Hospital Charge Code	105915506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of AZ Commercial	$1.92
Rate for Payer: Aetna of AZ Medicare	$0.60
Rate for Payer: Allwell Medicare	$0.34
Rate for Payer: Amerigroup Medicare	$0.34
Rate for Payer: APIPA Medicare/Medicaid	$0.80
Rate for Payer: AZCH Complete Medicare	$0.34
Rate for Payer: Banner UC Health Medicare	$0.34
Rate for Payer: Bisbee Police All Plans	$0.55
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.45
Rate for Payer: Cash Price	$1.70
Rate for Payer: Cigna of AZ Commercial	$1.38
Rate for Payer: Copperpoint Commercial	$0.53
Rate for Payer: Health Net of AZ Commercial	$1.28
Rate for Payer: Health Net of AZ Medicare	$0.60
Rate for Payer: Humana of AZ Medicare	$0.34
Rate for Payer: Self Pay Self Pay	$1.70
Rate for Payer: TriWest Medicare	$0.34
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.38

cefTRIAXone 500 mg Inj [CQCH]

Facility

$0.92

Service Code	HCPCS J0696
Hospital Charge Code	105915433
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of AZ Commercial	$0.83
Rate for Payer: Aetna of AZ Medicare	$0.26
Rate for Payer: Allwell Medicare	$0.15
Rate for Payer: Amerigroup Medicare	$0.15
Rate for Payer: APIPA Medicare/Medicaid	$0.34
Rate for Payer: AZCH Complete Medicare	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Bisbee Police All Plans	$0.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.63
Rate for Payer: Cash Price	$0.74
Rate for Payer: Cigna of AZ Commercial	$0.60
Rate for Payer: Copperpoint Commercial	$0.23
Rate for Payer: Health Net of AZ Commercial	$0.55
Rate for Payer: Health Net of AZ Medicare	$0.26
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Self Pay Self Pay	$0.74
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.17

cefTRIAXone 500 mg Inj [CQCH]

Facility

$0.92

Service Code	HCPCS J0696
Hospital Charge Code	105915433
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of AZ Commercial	$0.83
Rate for Payer: Bisbee Police All Plans	$0.24
Rate for Payer: Cash Price	$0.74
Rate for Payer: Self Pay Self Pay	$0.74

cefTRIAXone INJ : 1 GM VIAL

Facility

$35.00

Hospital Charge Code	22331184
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Aetna of AZ Medicare	$9.80
Rate for Payer: Allwell Medicare	$5.60
Rate for Payer: Amerigroup Medicare	$5.60
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.60
Rate for Payer: Banner UC Health Medicare	$5.60
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$22.75
Rate for Payer: Copperpoint Commercial	$8.66
Rate for Payer: Health Net of AZ Commercial	$21.00
Rate for Payer: Health Net of AZ Medicare	$9.80
Rate for Payer: Humana of AZ Medicare	$5.60
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

cefTRIAXone INJ : 1 GM VIAL

Facility

$35.00

Hospital Charge Code	22331184
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Cash Price	$28.00
Rate for Payer: Self Pay Self Pay	$28.00

cefuroxime 250 mg Tab [CQCH]

Facility

$1.65

Service Code	NDC 16714040002
Hospital Charge Code	105915725
Hospital Revenue Code	251
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of AZ Commercial	$1.49
Rate for Payer: Bisbee Police All Plans	$0.43
Rate for Payer: Cash Price	$1.32
Rate for Payer: Self Pay Self Pay	$1.32

cefuroxime 250 mg Tab [CQCH]

Facility

$1.65

Service Code	NDC 16714040002
Hospital Charge Code	105915725
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of AZ Commercial	$1.49
Rate for Payer: Aetna of AZ Medicare	$0.46
Rate for Payer: Allwell Medicare	$0.26
Rate for Payer: Amerigroup Medicare	$0.26
Rate for Payer: APIPA Medicare/Medicaid	$0.62
Rate for Payer: AZCH Complete Medicare	$0.26
Rate for Payer: Banner UC Health Medicare	$0.26
Rate for Payer: Bisbee Police All Plans	$0.43
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.12
Rate for Payer: Cash Price	$1.32
Rate for Payer: Cigna of AZ Commercial	$1.07
Rate for Payer: Copperpoint Commercial	$0.41
Rate for Payer: Health Net of AZ Commercial	$0.99
Rate for Payer: Health Net of AZ Medicare	$0.46
Rate for Payer: Humana of AZ Medicare	$0.26
Rate for Payer: Self Pay Self Pay	$1.32
Rate for Payer: TriWest Medicare	$0.26
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.30

celecoxib 100 mg Cap [CQCH]

Facility

$0.84

Service Code	NDC 904650261
Hospital Charge Code	105915790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Aetna of AZ Medicare	$0.24
Rate for Payer: Allwell Medicare	$0.13
Rate for Payer: Amerigroup Medicare	$0.13
Rate for Payer: APIPA Medicare/Medicaid	$0.31
Rate for Payer: AZCH Complete Medicare	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.57
Rate for Payer: Cash Price	$0.67
Rate for Payer: Cigna of AZ Commercial	$0.55
Rate for Payer: Copperpoint Commercial	$0.21
Rate for Payer: Health Net of AZ Commercial	$0.50
Rate for Payer: Health Net of AZ Medicare	$0.24
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Self Pay Self Pay	$0.67
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

celecoxib 100 mg Cap [CQCH]

Facility

$0.84

Service Code	NDC 904650261
Hospital Charge Code	105915790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Cash Price	$0.67
Rate for Payer: Self Pay Self Pay	$0.67

Celiac Disease Comprehensive LC

Facility

$148.00

Service Code	CPT 82784
Hospital Charge Code	10864418
Hospital Revenue Code	301
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

Celiac Disease Comprehensive LC

Facility

$148.00

Service Code	CPT 82784
Hospital Charge Code	10864418
Hospital Revenue Code	301
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Aetna of AZ Medicare	$41.44
Rate for Payer: Allwell Medicare	$23.68
Rate for Payer: Amerigroup Medicare	$23.68
Rate for Payer: APIPA Medicare/Medicaid	$55.28
Rate for Payer: AZCH Complete Medicare	$23.68
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.64
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$96.20
Rate for Payer: Copperpoint Commercial	$36.63
Rate for Payer: Health Net of AZ Commercial	$88.80
Rate for Payer: Health Net of AZ Medicare	$41.44
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Self Pay Self Pay	$118.40
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.64

Celiac Disease II LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	22311182
Hospital Revenue Code	301
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Cash Price	$91.20
Rate for Payer: Self Pay Self Pay	$91.20

Celiac Disease II LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	22311182
Hospital Revenue Code	301
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Medicare	$31.92
Rate for Payer: Allwell Medicare	$18.24
Rate for Payer: Amerigroup Medicare	$18.24
Rate for Payer: APIPA Medicare/Medicaid	$42.58
Rate for Payer: AZCH Complete Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$77.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Copperpoint Commercial	$28.21
Rate for Payer: Health Net of AZ Commercial	$68.40
Rate for Payer: Health Net of AZ Medicare	$31.92
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Self Pay Self Pay	$91.20
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$66.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.52

Cell Ct, Synovial w/o Crystals LC

Facility

$100.00

Service Code	CPT 89051
Hospital Charge Code	22587724
Hospital Revenue Code	309
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Aetna of AZ Medicare	$28.00
Rate for Payer: Allwell Medicare	$16.00
Rate for Payer: Amerigroup Medicare	$16.00
Rate for Payer: APIPA Medicare/Medicaid	$37.35
Rate for Payer: AZCH Complete Medicare	$16.00
Rate for Payer: Banner UC Health Medicare	$16.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna of AZ Commercial	$65.00
Rate for Payer: Copperpoint Commercial	$24.75
Rate for Payer: Health Net of AZ Commercial	$60.00
Rate for Payer: Health Net of AZ Medicare	$28.00
Rate for Payer: Humana of AZ Medicare	$16.00
Rate for Payer: Self Pay Self Pay	$80.00
Rate for Payer: TriWest Medicare	$16.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.00

Cell Ct, Synovial w/o Crystals LC

Facility

$100.00

Service Code	CPT 89051
Hospital Charge Code	22587724
Hospital Revenue Code	309
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Self Pay Self Pay	$80.00

Cellulitis And Other Skin Infections

Facility

$12,128.61

Service Code	APR-DRG 3834
Hospital Charge Code	APRDRG3832
Min. Negotiated Rate	$12,128.61
Max. Negotiated Rate	$12,128.61
Rate for Payer: AHCCCS Medicaid	$12,128.61
Rate for Payer: Allwell Medicaid	$12,128.61
Rate for Payer: AZCH Complete Medicaid	$12,128.61
Rate for Payer: Banner UC Health Medicaid	$12,128.61
Rate for Payer: Mercy Care Medicaid	$12,128.61

Cellulitis And Other Skin Infections

Facility

$3,991.67

Service Code	APR-DRG 3832
Hospital Charge Code	APRDRG3834
Min. Negotiated Rate	$3,991.67
Max. Negotiated Rate	$3,991.67
Rate for Payer: AHCCCS Medicaid	$3,991.67
Rate for Payer: Allwell Medicaid	$3,991.67
Rate for Payer: AZCH Complete Medicaid	$3,991.67
Rate for Payer: Banner UC Health Medicaid	$3,991.67
Rate for Payer: Mercy Care Medicaid	$3,991.67

Cellulitis And Other Skin Infections

Facility

$6,029.94

Service Code	APR-DRG 3833
Hospital Charge Code	APRDRG3834
Min. Negotiated Rate	$6,029.94
Max. Negotiated Rate	$6,029.94
Rate for Payer: AHCCCS Medicaid	$6,029.94
Rate for Payer: Allwell Medicaid	$6,029.94
Rate for Payer: AZCH Complete Medicaid	$6,029.94
Rate for Payer: Banner UC Health Medicaid	$6,029.94
Rate for Payer: Mercy Care Medicaid	$6,029.94

Cellulitis And Other Skin Infections

Facility

$3,010.41

Service Code	APR-DRG 3831
Hospital Charge Code	APRDRG3832
Min. Negotiated Rate	$3,010.41
Max. Negotiated Rate	$3,010.41
Rate for Payer: AHCCCS Medicaid	$3,010.41
Rate for Payer: Allwell Medicaid	$3,010.41
Rate for Payer: AZCH Complete Medicaid	$3,010.41
Rate for Payer: Banner UC Health Medicaid	$3,010.41
Rate for Payer: Mercy Care Medicaid	$3,010.41

Know your out-of-pocket cost for care.

All Charges