Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

FISTULA PLUG COOK

Facility

$2,854.00

Hospital Charge Code	22921514
Hospital Revenue Code	272
Min. Negotiated Rate	$456.64
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Aetna of AZ Medicare	$799.12
Rate for Payer: Allwell Medicare	$456.64
Rate for Payer: Amerigroup Medicare	$456.64
Rate for Payer: APIPA Medicare/Medicaid	$1,065.97
Rate for Payer: AZCH Complete Medicare	$456.64
Rate for Payer: Banner UC Health Medicare	$456.64
Rate for Payer: Bisbee Police All Plans	$742.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,940.72
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Cigna of AZ Commercial	$1,997.80
Rate for Payer: Copperpoint Commercial	$706.37
Rate for Payer: Health Net of AZ Commercial	$1,712.40
Rate for Payer: Health Net of AZ Medicare	$799.12
Rate for Payer: Humana of AZ Medicare	$456.64
Rate for Payer: Self Pay Self Pay	$2,283.20
Rate for Payer: TriWest Medicare	$456.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,663.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$513.72

FIT

Facility

$106.00

Service Code	CPT G0328 QW
Hospital Charge Code	22068803
Hospital Revenue Code	301
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$16.96
Rate for Payer: Amerigroup Medicare	$16.96
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$68.90
Rate for Payer: Copperpoint Commercial	$26.23
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

FIT

Facility

$106.00

Service Code	CPT G0328 QW
Hospital Charge Code	22068803
Hospital Revenue Code	301
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

flecainide 100 mg Tab [CQCH]

Facility

$0.67

Service Code	NDC 50268032115
Hospital Charge Code	112812246
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of AZ Commercial	$0.60
Rate for Payer: Bisbee Police All Plans	$0.17
Rate for Payer: Cash Price	$0.53
Rate for Payer: Self Pay Self Pay	$0.54

flecainide 100 mg Tab [CQCH]

Facility

$0.67

Service Code	NDC 50268032115
Hospital Charge Code	112812246
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.60
Rate for Payer: Aetna of AZ Commercial	$0.60
Rate for Payer: Aetna of AZ Medicare	$0.19
Rate for Payer: Allwell Medicare	$0.11
Rate for Payer: Amerigroup Medicare	$0.11
Rate for Payer: APIPA Medicare/Medicaid	$0.25
Rate for Payer: AZCH Complete Medicare	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Bisbee Police All Plans	$0.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.46
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cigna of AZ Commercial	$0.44
Rate for Payer: Copperpoint Commercial	$0.17
Rate for Payer: Health Net of AZ Commercial	$0.40
Rate for Payer: Health Net of AZ Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Self Pay Self Pay	$0.54
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.12

Fleets Saline Enema 133 mL [CQCH]

Facility

$0.99

Service Code	NDC 132020140
Hospital Charge Code	105941046
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Aetna of AZ Medicare	$0.28
Rate for Payer: Allwell Medicare	$0.16
Rate for Payer: Amerigroup Medicare	$0.16
Rate for Payer: APIPA Medicare/Medicaid	$0.37
Rate for Payer: AZCH Complete Medicare	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.67
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of AZ Commercial	$0.64
Rate for Payer: Copperpoint Commercial	$0.25
Rate for Payer: Health Net of AZ Commercial	$0.59
Rate for Payer: Health Net of AZ Medicare	$0.28
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Self Pay Self Pay	$0.79
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.18

Fleets Saline Enema 133 mL [CQCH]

Facility

$0.99

Service Code	NDC 132020140
Hospital Charge Code	105941046
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Cash Price	$0.79
Rate for Payer: Self Pay Self Pay	$0.79

FLEXIBLE SIGMOIDOSCOPY

Facility

$482.00

Hospital Charge Code	1184683
Hospital Revenue Code	750
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Aetna of AZ Medicare	$134.96
Rate for Payer: Allwell Medicare	$77.12
Rate for Payer: Amerigroup Medicare	$77.12
Rate for Payer: APIPA Medicare/Medicaid	$180.03
Rate for Payer: AZCH Complete Medicare	$77.12
Rate for Payer: Banner UC Health Medicare	$77.12
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$327.76
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$337.40
Rate for Payer: Copperpoint Commercial	$119.30
Rate for Payer: Health Net of AZ Commercial	$289.20
Rate for Payer: Health Net of AZ Medicare	$134.96
Rate for Payer: Humana of AZ Medicare	$77.12
Rate for Payer: Self Pay Self Pay	$385.60
Rate for Payer: TriWest Medicare	$77.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.76

FLEXIBLE SIGMOIDOSCOPY

Facility

$482.00

Hospital Charge Code	1184683
Hospital Revenue Code	750
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Cash Price	$385.60
Rate for Payer: Self Pay Self Pay	$385.60

FLEXIVA PULSE ID 550

Facility

$3,162.25

Hospital Charge Code	27844713
Hospital Revenue Code	270
Min. Negotiated Rate	$505.96
Max. Negotiated Rate	$2,846.03
Rate for Payer: Aetna of AZ Commercial	$2,846.03
Rate for Payer: Aetna of AZ Medicare	$885.43
Rate for Payer: Allwell Medicare	$505.96
Rate for Payer: Amerigroup Medicare	$505.96
Rate for Payer: APIPA Medicare/Medicaid	$1,181.10
Rate for Payer: AZCH Complete Medicare	$505.96
Rate for Payer: Banner UC Health Medicare	$505.96
Rate for Payer: Bisbee Police All Plans	$822.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,150.33
Rate for Payer: Cash Price	$2,529.80
Rate for Payer: Cigna of AZ Commercial	$2,213.57
Rate for Payer: Copperpoint Commercial	$782.66
Rate for Payer: Health Net of AZ Commercial	$1,897.35
Rate for Payer: Health Net of AZ Medicare	$885.43
Rate for Payer: Humana of AZ Medicare	$505.96
Rate for Payer: Self Pay Self Pay	$2,529.80
Rate for Payer: TriWest Medicare	$505.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,843.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$569.21

FLEXIVA PULSE ID 550

Facility

$3,162.25

Hospital Charge Code	27844713
Hospital Revenue Code	270
Min. Negotiated Rate	$822.18
Max. Negotiated Rate	$2,846.03
Rate for Payer: Aetna of AZ Commercial	$2,846.03
Rate for Payer: Bisbee Police All Plans	$822.18
Rate for Payer: Cash Price	$2,529.80
Rate for Payer: Self Pay Self Pay	$2,529.80

florastor 250mg cap [CQCH]

Facility

$0.53

Service Code	NDC 66825000201
Hospital Charge Code	108083252
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.48
Rate for Payer: Aetna of AZ Commercial	$0.48
Rate for Payer: Aetna of AZ Medicare	$0.15
Rate for Payer: Allwell Medicare	$0.08
Rate for Payer: Amerigroup Medicare	$0.08
Rate for Payer: APIPA Medicare/Medicaid	$0.20
Rate for Payer: AZCH Complete Medicare	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Bisbee Police All Plans	$0.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.36
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of AZ Commercial	$0.34
Rate for Payer: Copperpoint Commercial	$0.13
Rate for Payer: Health Net of AZ Commercial	$0.32
Rate for Payer: Health Net of AZ Medicare	$0.15
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Self Pay Self Pay	$0.42
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.10

florastor 250mg cap [CQCH]

Facility

$0.53

Service Code	NDC 66825000201
Hospital Charge Code	108083252
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.48
Rate for Payer: Aetna of AZ Commercial	$0.48
Rate for Payer: Bisbee Police All Plans	$0.14
Rate for Payer: Cash Price	$0.42
Rate for Payer: Self Pay Self Pay	$0.42

fluconazole 100 mg Tab [CQCH]

Facility

$1.57

Service Code	NDC 68084072801
Hospital Charge Code	105922853
Hospital Revenue Code	251
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of AZ Commercial	$1.41
Rate for Payer: Bisbee Police All Plans	$0.41
Rate for Payer: Cash Price	$1.26
Rate for Payer: Self Pay Self Pay	$1.26

fluconazole 100 mg Tab [CQCH]

Facility

$1.57

Service Code	NDC 68084072801
Hospital Charge Code	105922853
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna of AZ Commercial	$1.41
Rate for Payer: Aetna of AZ Medicare	$0.44
Rate for Payer: Allwell Medicare	$0.25
Rate for Payer: Amerigroup Medicare	$0.25
Rate for Payer: APIPA Medicare/Medicaid	$0.59
Rate for Payer: AZCH Complete Medicare	$0.25
Rate for Payer: Banner UC Health Medicare	$0.25
Rate for Payer: Bisbee Police All Plans	$0.41
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.07
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cigna of AZ Commercial	$1.02
Rate for Payer: Copperpoint Commercial	$0.39
Rate for Payer: Health Net of AZ Commercial	$0.94
Rate for Payer: Health Net of AZ Medicare	$0.44
Rate for Payer: Humana of AZ Medicare	$0.25
Rate for Payer: Self Pay Self Pay	$1.26
Rate for Payer: TriWest Medicare	$0.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.28

fludrocortisone 0.1 mg Tab [CQCH]

Facility

$0.77

Service Code	NDC 50268033015
Hospital Charge Code	105922918
Hospital Revenue Code	251
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Cash Price	$0.62
Rate for Payer: Self Pay Self Pay	$0.62

fludrocortisone 0.1 mg Tab [CQCH]

Facility

$0.77

Service Code	NDC 50268033015
Hospital Charge Code	105922918
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Aetna of AZ Medicare	$0.22
Rate for Payer: Allwell Medicare	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.29
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.52
Rate for Payer: Cash Price	$0.62
Rate for Payer: Cigna of AZ Commercial	$0.50
Rate for Payer: Copperpoint Commercial	$0.19
Rate for Payer: Health Net of AZ Commercial	$0.46
Rate for Payer: Health Net of AZ Medicare	$0.22
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Self Pay Self Pay	$0.62
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.14

FLUENT DISPOSABLE PACK

Facility

$990.00

Hospital Charge Code	27448974
Hospital Revenue Code	270
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$891.00
Rate for Payer: Aetna of AZ Commercial	$891.00
Rate for Payer: Aetna of AZ Medicare	$277.20
Rate for Payer: Allwell Medicare	$158.40
Rate for Payer: Amerigroup Medicare	$158.40
Rate for Payer: APIPA Medicare/Medicaid	$369.76
Rate for Payer: AZCH Complete Medicare	$158.40
Rate for Payer: Banner UC Health Medicare	$158.40
Rate for Payer: Bisbee Police All Plans	$257.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$673.20
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cigna of AZ Commercial	$693.00
Rate for Payer: Copperpoint Commercial	$245.03
Rate for Payer: Health Net of AZ Commercial	$594.00
Rate for Payer: Health Net of AZ Medicare	$277.20
Rate for Payer: Humana of AZ Medicare	$158.40
Rate for Payer: Self Pay Self Pay	$792.00
Rate for Payer: TriWest Medicare	$158.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$577.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$178.20

FLUENT DISPOSABLE PACK

Facility

$990.00

Hospital Charge Code	27448974
Hospital Revenue Code	270
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$891.00
Rate for Payer: Aetna of AZ Commercial	$891.00
Rate for Payer: Bisbee Police All Plans	$257.40
Rate for Payer: Cash Price	$792.00
Rate for Payer: Self Pay Self Pay	$792.00

FLUID TRAP

Facility

$325.00

Hospital Charge Code	27770816
Hospital Revenue Code	270
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna of AZ Commercial	$292.50
Rate for Payer: Aetna of AZ Medicare	$91.00
Rate for Payer: Allwell Medicare	$52.00
Rate for Payer: Amerigroup Medicare	$52.00
Rate for Payer: APIPA Medicare/Medicaid	$121.39
Rate for Payer: AZCH Complete Medicare	$52.00
Rate for Payer: Banner UC Health Medicare	$52.00
Rate for Payer: Bisbee Police All Plans	$84.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$221.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cigna of AZ Commercial	$227.50
Rate for Payer: Copperpoint Commercial	$80.44
Rate for Payer: Health Net of AZ Commercial	$195.00
Rate for Payer: Health Net of AZ Medicare	$91.00
Rate for Payer: Humana of AZ Medicare	$52.00
Rate for Payer: Self Pay Self Pay	$260.00
Rate for Payer: TriWest Medicare	$52.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$189.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.50

FLUID TRAP

Facility

$325.00

Hospital Charge Code	27770816
Hospital Revenue Code	270
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna of AZ Commercial	$292.50
Rate for Payer: Bisbee Police All Plans	$84.50
Rate for Payer: Cash Price	$260.00
Rate for Payer: Self Pay Self Pay	$260.00

flumazenil 0.5 mg/5 mL IV Sol [CQCH]

Facility

$0.61

Service Code	NDC 63323042405
Hospital Charge Code	105922998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of AZ Commercial	$0.55
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.49
Rate for Payer: Self Pay Self Pay	$0.49

flumazenil 0.5 mg/5 mL IV Sol [CQCH]

Facility

$0.61

Service Code	NDC 63323042405
Hospital Charge Code	105922998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna of AZ Commercial	$0.55
Rate for Payer: Aetna of AZ Medicare	$0.17
Rate for Payer: Allwell Medicare	$0.10
Rate for Payer: Amerigroup Medicare	$0.10
Rate for Payer: APIPA Medicare/Medicaid	$0.23
Rate for Payer: AZCH Complete Medicare	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.41
Rate for Payer: Cash Price	$0.49
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Copperpoint Commercial	$0.15
Rate for Payer: Health Net of AZ Commercial	$0.37
Rate for Payer: Health Net of AZ Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Self Pay Self Pay	$0.49
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

fluorescein 1 mg ophthalmic Test strip [CQCH]

Facility

$0.93

Service Code	NDC 17238090011
Hospital Charge Code	105923065
Hospital Revenue Code	251
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of AZ Commercial	$0.84
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

fluorescein 1 mg ophthalmic Test strip [CQCH]

Facility

$0.93

Service Code	NDC 17238090011
Hospital Charge Code	105923065
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of AZ Commercial	$0.84
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	$0.35
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	$0.56
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

Know your out-of-pocket cost for care.

All Charges