Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Diabetes

Facility

$5,568.41

Service Code	APR-DRG 4203
Hospital Charge Code	APRDRG4203
Min. Negotiated Rate	$5,568.41
Max. Negotiated Rate	$5,568.41
Rate for Payer: AHCCCS Medicaid	$5,568.41
Rate for Payer: Allwell Medicaid	$5,568.41
Rate for Payer: AZCH Complete Medicaid	$5,568.41
Rate for Payer: Banner UC Health Medicaid	$5,568.41
Rate for Payer: Mercy Care Medicaid	$5,568.41

Diabetes

Facility

$3,647.98

Service Code	APR-DRG 4202
Hospital Charge Code	APRDRG4201
Min. Negotiated Rate	$3,647.98
Max. Negotiated Rate	$3,647.98
Rate for Payer: AHCCCS Medicaid	$3,647.98
Rate for Payer: Allwell Medicaid	$3,647.98
Rate for Payer: AZCH Complete Medicaid	$3,647.98
Rate for Payer: Banner UC Health Medicaid	$3,647.98
Rate for Payer: Mercy Care Medicaid	$3,647.98

Diabetes

Facility

$5,568.41

Service Code	APR-DRG 4203
Hospital Charge Code	APRDRG4202
Min. Negotiated Rate	$5,568.41
Max. Negotiated Rate	$5,568.41
Rate for Payer: AHCCCS Medicaid	$5,568.41
Rate for Payer: Allwell Medicaid	$5,568.41
Rate for Payer: AZCH Complete Medicaid	$5,568.41
Rate for Payer: Banner UC Health Medicaid	$5,568.41
Rate for Payer: Mercy Care Medicaid	$5,568.41

Diabetes

Facility

$3,647.98

Service Code	APR-DRG 4202
Hospital Charge Code	APRDRG4203
Min. Negotiated Rate	$3,647.98
Max. Negotiated Rate	$3,647.98
Rate for Payer: AHCCCS Medicaid	$3,647.98
Rate for Payer: Allwell Medicaid	$3,647.98
Rate for Payer: AZCH Complete Medicaid	$3,647.98
Rate for Payer: Banner UC Health Medicaid	$3,647.98
Rate for Payer: Mercy Care Medicaid	$3,647.98

Diabetes

Facility

$3,025.14

Service Code	APR-DRG 4201
Hospital Charge Code	APRDRG4203
Min. Negotiated Rate	$3,025.14
Max. Negotiated Rate	$3,025.14
Rate for Payer: AHCCCS Medicaid	$3,025.14
Rate for Payer: Allwell Medicaid	$3,025.14
Rate for Payer: AZCH Complete Medicaid	$3,025.14
Rate for Payer: Banner UC Health Medicaid	$3,025.14
Rate for Payer: Mercy Care Medicaid	$3,025.14

Diabetes

Facility

$11,890.83

Service Code	APR-DRG 4204
Hospital Charge Code	APRDRG4204
Min. Negotiated Rate	$11,890.83
Max. Negotiated Rate	$11,890.83
Rate for Payer: AHCCCS Medicaid	$11,890.83
Rate for Payer: Allwell Medicaid	$11,890.83
Rate for Payer: AZCH Complete Medicaid	$11,890.83
Rate for Payer: Banner UC Health Medicaid	$11,890.83
Rate for Payer: Mercy Care Medicaid	$11,890.83

Diabetes

Facility

$11,890.83

Service Code	APR-DRG 4204
Hospital Charge Code	APRDRG4203
Min. Negotiated Rate	$11,890.83
Max. Negotiated Rate	$11,890.83
Rate for Payer: AHCCCS Medicaid	$11,890.83
Rate for Payer: Allwell Medicaid	$11,890.83
Rate for Payer: AZCH Complete Medicaid	$11,890.83
Rate for Payer: Banner UC Health Medicaid	$11,890.83
Rate for Payer: Mercy Care Medicaid	$11,890.83

Diabetes

Facility

$3,025.14

Service Code	APR-DRG 4201
Hospital Charge Code	APRDRG4204
Min. Negotiated Rate	$3,025.14
Max. Negotiated Rate	$3,025.14
Rate for Payer: AHCCCS Medicaid	$3,025.14
Rate for Payer: Allwell Medicaid	$3,025.14
Rate for Payer: AZCH Complete Medicaid	$3,025.14
Rate for Payer: Banner UC Health Medicaid	$3,025.14
Rate for Payer: Mercy Care Medicaid	$3,025.14

Diabetes

Facility

$11,890.83

Service Code	APR-DRG 4204
Hospital Charge Code	APRDRG4201
Min. Negotiated Rate	$11,890.83
Max. Negotiated Rate	$11,890.83
Rate for Payer: AHCCCS Medicaid	$11,890.83
Rate for Payer: Allwell Medicaid	$11,890.83
Rate for Payer: AZCH Complete Medicaid	$11,890.83
Rate for Payer: Banner UC Health Medicaid	$11,890.83
Rate for Payer: Mercy Care Medicaid	$11,890.83

diazePAM 10mg Inj Sol [CQCH]

Facility

$11.07

Service Code	HCPCS J3360
Hospital Charge Code	105918623
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$9.96
Rate for Payer: Aetna of AZ Commercial	$9.96
Rate for Payer: Bisbee Police All Plans	$2.88
Rate for Payer: Cash Price	$8.85
Rate for Payer: Self Pay Self Pay	$8.86

diazePAM 10mg Inj Sol [CQCH]

Facility

$11.07

Service Code	HCPCS J3360
Hospital Charge Code	105918623
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$9.96
Rate for Payer: Aetna of AZ Commercial	$9.96
Rate for Payer: Aetna of AZ Medicare	$3.10
Rate for Payer: Allwell Medicare	$1.77
Rate for Payer: Amerigroup Medicare	$1.77
Rate for Payer: APIPA Medicare/Medicaid	$4.13
Rate for Payer: AZCH Complete Medicare	$1.77
Rate for Payer: Banner UC Health Medicare	$1.77
Rate for Payer: Bisbee Police All Plans	$2.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.53
Rate for Payer: Cash Price	$8.85
Rate for Payer: Cigna of AZ Commercial	$7.20
Rate for Payer: Copperpoint Commercial	$2.74
Rate for Payer: Health Net of AZ Commercial	$6.64
Rate for Payer: Health Net of AZ Medicare	$3.10
Rate for Payer: Humana of AZ Medicare	$1.77
Rate for Payer: Self Pay Self Pay	$8.86
Rate for Payer: TriWest Medicare	$1.77
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.99

diazePAM 2.5 mg Rectal Gel Kit[CQCH]

Facility

$91.25

Service Code	NDC 66490065020
Hospital Charge Code	136170892
Hospital Revenue Code	251
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$82.12
Rate for Payer: Aetna of AZ Commercial	$82.12
Rate for Payer: Aetna of AZ Medicare	$25.55
Rate for Payer: Allwell Medicare	$14.60
Rate for Payer: Amerigroup Medicare	$14.60
Rate for Payer: APIPA Medicare/Medicaid	$34.08
Rate for Payer: AZCH Complete Medicare	$14.60
Rate for Payer: Banner UC Health Medicare	$14.60
Rate for Payer: Bisbee Police All Plans	$23.73
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.05
Rate for Payer: Cash Price	$73.00
Rate for Payer: Cigna of AZ Commercial	$59.31
Rate for Payer: Copperpoint Commercial	$22.58
Rate for Payer: Health Net of AZ Commercial	$54.75
Rate for Payer: Health Net of AZ Medicare	$25.55
Rate for Payer: Humana of AZ Medicare	$14.60
Rate for Payer: Self Pay Self Pay	$73.00
Rate for Payer: TriWest Medicare	$14.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.43

diazePAM 2.5 mg Rectal Gel Kit[CQCH]

Facility

$91.25

Service Code	NDC 66490065020
Hospital Charge Code	136170892
Hospital Revenue Code	251
Min. Negotiated Rate	$23.73
Max. Negotiated Rate	$82.12
Rate for Payer: Aetna of AZ Commercial	$82.12
Rate for Payer: Bisbee Police All Plans	$23.73
Rate for Payer: Cash Price	$73.00
Rate for Payer: Self Pay Self Pay	$73.00

diazePAM 5 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 51079028520
Hospital Charge Code	105918698
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: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

diazePAM 5 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 51079028520
Hospital Charge Code	105918698
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	$0.01
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	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.03
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.04
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

diclofenac topical 1% Gel[CQCH]

Facility

$0.17

Service Code	NDC 67815202
Hospital Charge Code	139707016
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.14

diclofenac topical 1% Gel[CQCH]

Facility

$0.17

Service Code	NDC 67815202
Hospital Charge Code	139707016
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Aetna of AZ Medicare	$0.05
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.12
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.11
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

dicyclomine 10 mg Cap [CQCH]

Facility

$0.48

Service Code	NDC 60687036901
Hospital Charge Code	105918834
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of AZ Commercial	$0.43
Rate for Payer: Aetna of AZ Medicare	$0.13
Rate for Payer: Allwell Medicare	$0.08
Rate for Payer: Amerigroup Medicare	$0.08
Rate for Payer: APIPA Medicare/Medicaid	$0.18
Rate for Payer: AZCH Complete Medicare	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.33
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of AZ Commercial	$0.31
Rate for Payer: Copperpoint Commercial	$0.12
Rate for Payer: Health Net of AZ Commercial	$0.29
Rate for Payer: Health Net of AZ Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Self Pay Self Pay	$0.38
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.09

dicyclomine 10 mg Cap [CQCH]

Facility

$0.48

Service Code	NDC 60687036901
Hospital Charge Code	105918834
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of AZ Commercial	$0.43
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Cash Price	$0.38
Rate for Payer: Self Pay Self Pay	$0.38

dicyclomine 20 mg Inj Sol [CQCH]

Facility

$34.46

Service Code	HCPCS J0500
Hospital Charge Code	105918763
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$31.01
Rate for Payer: Aetna of AZ Commercial	$31.01
Rate for Payer: Aetna of AZ Medicare	$9.65
Rate for Payer: Allwell Medicare	$5.51
Rate for Payer: Amerigroup Medicare	$5.51
Rate for Payer: APIPA Medicare/Medicaid	$12.87
Rate for Payer: AZCH Complete Medicare	$5.51
Rate for Payer: Banner UC Health Medicare	$5.51
Rate for Payer: Bisbee Police All Plans	$8.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.43
Rate for Payer: Cash Price	$27.57
Rate for Payer: Cigna of AZ Commercial	$22.40
Rate for Payer: Copperpoint Commercial	$8.53
Rate for Payer: Health Net of AZ Commercial	$20.68
Rate for Payer: Health Net of AZ Medicare	$9.65
Rate for Payer: Humana of AZ Medicare	$5.51
Rate for Payer: Self Pay Self Pay	$27.57
Rate for Payer: TriWest Medicare	$5.51
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.20

dicyclomine 20 mg Inj Sol [CQCH]

Facility

$34.46

Service Code	HCPCS J0500
Hospital Charge Code	105918763
Hospital Revenue Code	250
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$31.01
Rate for Payer: Aetna of AZ Commercial	$31.01
Rate for Payer: Bisbee Police All Plans	$8.96
Rate for Payer: Cash Price	$27.57
Rate for Payer: Self Pay Self Pay	$27.57

Digestive Malignancy

Facility

$8,453.27

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$8,453.27
Max. Negotiated Rate	$8,453.27
Rate for Payer: AHCCCS Medicaid	$8,453.27
Rate for Payer: Allwell Medicaid	$8,453.27
Rate for Payer: AZCH Complete Medicaid	$8,453.27
Rate for Payer: Banner UC Health Medicaid	$8,453.27
Rate for Payer: Mercy Care Medicaid	$8,453.27

Digestive Malignancy

Facility

$5,198.78

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$5,198.78
Max. Negotiated Rate	$5,198.78
Rate for Payer: AHCCCS Medicaid	$5,198.78
Rate for Payer: Allwell Medicaid	$5,198.78
Rate for Payer: AZCH Complete Medicaid	$5,198.78
Rate for Payer: Banner UC Health Medicaid	$5,198.78
Rate for Payer: Mercy Care Medicaid	$5,198.78

Digestive Malignancy

Facility

$15,754.85

Service Code	APR-DRG 2404
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$15,754.85
Max. Negotiated Rate	$15,754.85
Rate for Payer: AHCCCS Medicaid	$15,754.85
Rate for Payer: Allwell Medicaid	$15,754.85
Rate for Payer: AZCH Complete Medicaid	$15,754.85
Rate for Payer: Banner UC Health Medicaid	$15,754.85
Rate for Payer: Mercy Care Medicaid	$15,754.85

Digestive Malignancy

Facility

$5,986.45

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG2404
Min. Negotiated Rate	$5,986.45
Max. Negotiated Rate	$5,986.45
Rate for Payer: AHCCCS Medicaid	$5,986.45
Rate for Payer: Allwell Medicaid	$5,986.45
Rate for Payer: AZCH Complete Medicaid	$5,986.45
Rate for Payer: Banner UC Health Medicaid	$5,986.45
Rate for Payer: Mercy Care Medicaid	$5,986.45

Know your out-of-pocket cost for care.

All Charges