Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CIT AC 24HR

Facility

$344.00

Service Code	CPT 82507
Hospital Charge Code	22481467
Hospital Revenue Code	301
Min. Negotiated Rate	$27.80
Max. Negotiated Rate	$309.60
Rate for Payer: Aetna of AZ Commercial	$309.60
Rate for Payer: Aetna of AZ Medicare	$96.32
Rate for Payer: AHCCCS Medicaid	$27.80
Rate for Payer: Allwell Medicaid	$27.80
Rate for Payer: Allwell Medicare	$51.60
Rate for Payer: Amerigroup Medicare	$51.60
Rate for Payer: APIPA Medicare/Medicaid	$128.48
Rate for Payer: AZCH Complete Medicaid	$27.80
Rate for Payer: AZCH Complete Medicare	$51.60
Rate for Payer: Banner UC Health Medicaid	$27.80
Rate for Payer: Banner UC Health Medicare	$51.60
Rate for Payer: Bisbee Police All Plans	$89.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$233.92
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cigna of AZ Commercial	$223.60
Rate for Payer: Copperpoint Commercial	$85.14
Rate for Payer: Health Net of AZ Commercial	$206.40
Rate for Payer: Health Net of AZ Medicare	$96.32
Rate for Payer: Humana of AZ Medicare	$51.60
Rate for Payer: Mercy Care Medicaid	$27.80
Rate for Payer: Self Pay Self Pay	$275.20
Rate for Payer: TriWest Medicare	$51.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$200.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.92

citalopram 20 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904608561
Hospital Charge Code	105916535
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

citalopram 20 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904608561
Hospital Charge Code	105916535
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: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Citric Acid (Citrate), Urine LC

Facility

$129.00

Service Code	CPT 82507
Hospital Charge Code	2029186
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Aetna of AZ Medicare	$36.12
Rate for Payer: AHCCCS Medicaid	$27.80
Rate for Payer: Allwell Medicaid	$27.80
Rate for Payer: Allwell Medicare	$19.35
Rate for Payer: Amerigroup Medicare	$19.35
Rate for Payer: APIPA Medicare/Medicaid	$48.18
Rate for Payer: AZCH Complete Medicaid	$27.80
Rate for Payer: AZCH Complete Medicare	$19.35
Rate for Payer: Banner UC Health Medicaid	$27.80
Rate for Payer: Banner UC Health Medicare	$19.35
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.72
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Copperpoint Commercial	$31.93
Rate for Payer: Health Net of AZ Commercial	$77.40
Rate for Payer: Health Net of AZ Medicare	$36.12
Rate for Payer: Humana of AZ Medicare	$19.35
Rate for Payer: Mercy Care Medicaid	$27.80
Rate for Payer: Self Pay Self Pay	$103.20
Rate for Payer: TriWest Medicare	$19.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.22

Citric Acid (Citrate), Urine LC

Facility

$129.00

Service Code	CPT 82507
Hospital Charge Code	2029186
Hospital Revenue Code	302
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Cash Price	$103.20
Rate for Payer: Self Pay Self Pay	$103.20

citric acid-sodium citrate Oral Sol 30 mL UD [CQCH]

Facility

$0.02

Service Code	NDC 121059530
Hospital Charge Code	105916602
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

citric acid-sodium citrate Oral Sol 30 mL UD [CQCH]

Facility

$0.02

Service Code	NDC 121059530
Hospital Charge Code	105916602
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

CK ISOENZYMES

Facility

$168.00

Service Code	CPT 82552
Hospital Charge Code	22481468
Hospital Revenue Code	301
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Cash Price	$134.40
Rate for Payer: Self Pay Self Pay	$134.40

CK ISOENZYMES

Facility

$168.00

Service Code	CPT 82552
Hospital Charge Code	22481468
Hospital Revenue Code	301
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Aetna of AZ Medicare	$47.04
Rate for Payer: AHCCCS Medicaid	$13.39
Rate for Payer: Allwell Medicaid	$13.39
Rate for Payer: Allwell Medicare	$25.20
Rate for Payer: Amerigroup Medicare	$25.20
Rate for Payer: APIPA Medicare/Medicaid	$62.75
Rate for Payer: AZCH Complete Medicaid	$13.39
Rate for Payer: AZCH Complete Medicare	$25.20
Rate for Payer: Banner UC Health Medicaid	$13.39
Rate for Payer: Banner UC Health Medicare	$25.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$114.24
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$109.20
Rate for Payer: Copperpoint Commercial	$41.58
Rate for Payer: Health Net of AZ Commercial	$100.80
Rate for Payer: Health Net of AZ Medicare	$47.04
Rate for Payer: Humana of AZ Medicare	$25.20
Rate for Payer: Mercy Care Medicaid	$13.39
Rate for Payer: Self Pay Self Pay	$134.40
Rate for Payer: TriWest Medicare	$25.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$97.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.24

CK-MB

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	9091368
Hospital Revenue Code	301
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Cash Price	$256.80
Rate for Payer: Self Pay Self Pay	$256.80

CK-MB

Facility

$321.00

Service Code	CPT 82553
Hospital Charge Code	9091368
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Aetna of AZ Medicare	$89.88
Rate for Payer: AHCCCS Medicaid	$11.55
Rate for Payer: Allwell Medicaid	$11.55
Rate for Payer: Allwell Medicare	$48.15
Rate for Payer: Amerigroup Medicare	$48.15
Rate for Payer: APIPA Medicare/Medicaid	$119.89
Rate for Payer: AZCH Complete Medicaid	$11.55
Rate for Payer: AZCH Complete Medicare	$48.15
Rate for Payer: Banner UC Health Medicaid	$11.55
Rate for Payer: Banner UC Health Medicare	$48.15
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$218.28
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$208.65
Rate for Payer: Copperpoint Commercial	$79.45
Rate for Payer: Health Net of AZ Commercial	$192.60
Rate for Payer: Health Net of AZ Medicare	$89.88
Rate for Payer: Humana of AZ Medicare	$48.15
Rate for Payer: Mercy Care Medicaid	$11.55
Rate for Payer: Self Pay Self Pay	$256.80
Rate for Payer: TriWest Medicare	$48.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$187.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.78

CKMB

Facility

$337.00

Service Code	CPT 82553
Hospital Charge Code	22481469
Hospital Revenue Code	301
Min. Negotiated Rate	$87.62
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Bisbee Police All Plans	$87.62
Rate for Payer: Cash Price	$269.60
Rate for Payer: Self Pay Self Pay	$269.60

CKMB

Facility

$337.00

Service Code	CPT 82553
Hospital Charge Code	22481469
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$303.30
Rate for Payer: Aetna of AZ Commercial	$303.30
Rate for Payer: Aetna of AZ Medicare	$94.36
Rate for Payer: AHCCCS Medicaid	$11.55
Rate for Payer: Allwell Medicaid	$11.55
Rate for Payer: Allwell Medicare	$50.55
Rate for Payer: Amerigroup Medicare	$50.55
Rate for Payer: APIPA Medicare/Medicaid	$125.87
Rate for Payer: AZCH Complete Medicaid	$11.55
Rate for Payer: AZCH Complete Medicare	$50.55
Rate for Payer: Banner UC Health Medicaid	$11.55
Rate for Payer: Banner UC Health Medicare	$50.55
Rate for Payer: Bisbee Police All Plans	$87.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$229.16
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cigna of AZ Commercial	$219.05
Rate for Payer: Copperpoint Commercial	$83.41
Rate for Payer: Health Net of AZ Commercial	$202.20
Rate for Payer: Health Net of AZ Medicare	$94.36
Rate for Payer: Humana of AZ Medicare	$50.55
Rate for Payer: Mercy Care Medicaid	$11.55
Rate for Payer: Self Pay Self Pay	$269.60
Rate for Payer: TriWest Medicare	$50.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$196.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.66

CK, Total+Isoenzymes, Serum LC

Facility

$82.00

Service Code	CPT 82550
Hospital Charge Code	2087571
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

CK, Total+Isoenzymes, Serum LC

Facility

$82.00

Service Code	CPT 82550
Hospital Charge Code	2087571
Hospital Revenue Code	301
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: AHCCCS Medicaid	$6.51
Rate for Payer: Allwell Medicaid	$6.51
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicaid	$6.51
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicaid	$6.51
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$53.30
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Mercy Care Medicaid	$6.51
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

CLEANER WOUND BIOLEX 6OZ

Facility

$46.00

Hospital Charge Code	27567551
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

CLEANER WOUND BIOLEX 6OZ

Facility

$48.00

Hospital Charge Code	22355158
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CLEANER WOUND BIOLEX 6OZ

Facility

$48.00

Hospital Charge Code	22355158
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CLEANER WOUND BIOLEX 6OZ

Facility

$46.00

Hospital Charge Code	27567551
Hospital Revenue Code	270
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$6.90
Rate for Payer: Amerigroup Medicare	$6.90
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$6.90
Rate for Payer: Banner UC Health Medicare	$6.90
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$6.90
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$6.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0954
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$19,327.78

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$19,327.78
Max. Negotiated Rate	$19,327.78
Rate for Payer: AHCCCS Medicaid	$19,327.78
Rate for Payer: Allwell Medicaid	$19,327.78
Rate for Payer: AZCH Complete Medicaid	$19,327.78
Rate for Payer: Banner UC Health Medicaid	$19,327.78
Rate for Payer: Mercy Care Medicaid	$19,327.78

Cleft Lip And Palate Repair

Facility

$5,099.18

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,099.18
Max. Negotiated Rate	$5,099.18
Rate for Payer: AHCCCS Medicaid	$5,099.18
Rate for Payer: Allwell Medicaid	$5,099.18
Rate for Payer: AZCH Complete Medicaid	$5,099.18
Rate for Payer: Banner UC Health Medicaid	$5,099.18
Rate for Payer: Mercy Care Medicaid	$5,099.18

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0951
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0953
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Cleft Lip And Palate Repair

Facility

$5,557.89

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG0952
Min. Negotiated Rate	$5,557.89
Max. Negotiated Rate	$5,557.89
Rate for Payer: AHCCCS Medicaid	$5,557.89
Rate for Payer: Allwell Medicaid	$5,557.89
Rate for Payer: AZCH Complete Medicaid	$5,557.89
Rate for Payer: Banner UC Health Medicaid	$5,557.89
Rate for Payer: Mercy Care Medicaid	$5,557.89

Know your out-of-pocket cost for care.

All Charges