Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

fluorescein-proparacaine ophthalmic 0.25%-0.5% Sol[CQCH]

Facility

$7.37

Service Code	NDC 54799050721
Hospital Charge Code	134270412
Hospital Revenue Code	251
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna of AZ Commercial	$6.63
Rate for Payer: Bisbee Police All Plans	$1.92
Rate for Payer: Cash Price	$5.90
Rate for Payer: Self Pay Self Pay	$5.90

fluorescein-proparacaine ophthalmic 0.25%-0.5% Sol[CQCH]

Facility

$7.37

Service Code	NDC 54799050721
Hospital Charge Code	134270412
Hospital Revenue Code	251
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna of AZ Commercial	$6.63
Rate for Payer: Aetna of AZ Medicare	$2.06
Rate for Payer: Allwell Medicare	$1.18
Rate for Payer: Amerigroup Medicare	$1.18
Rate for Payer: APIPA Medicare/Medicaid	$2.75
Rate for Payer: AZCH Complete Medicare	$1.18
Rate for Payer: Banner UC Health Medicare	$1.18
Rate for Payer: Bisbee Police All Plans	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.01
Rate for Payer: Cash Price	$5.90
Rate for Payer: Cigna of AZ Commercial	$4.79
Rate for Payer: Copperpoint Commercial	$1.82
Rate for Payer: Health Net of AZ Commercial	$4.42
Rate for Payer: Health Net of AZ Medicare	$2.06
Rate for Payer: Humana of AZ Medicare	$1.18
Rate for Payer: Self Pay Self Pay	$5.90
Rate for Payer: TriWest Medicare	$1.18
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.33

.FLUOR FOR NONINFECT AB (CELIAC COMP)

Facility

$698.00

Service Code	CPT 86255
Hospital Charge Code	22481445
Hospital Revenue Code	301
Min. Negotiated Rate	$111.68
Max. Negotiated Rate	$628.20
Rate for Payer: Aetna of AZ Commercial	$628.20
Rate for Payer: Aetna of AZ Medicare	$195.44
Rate for Payer: Allwell Medicare	$111.68
Rate for Payer: Amerigroup Medicare	$111.68
Rate for Payer: APIPA Medicare/Medicaid	$260.70
Rate for Payer: AZCH Complete Medicare	$111.68
Rate for Payer: Banner UC Health Medicare	$111.68
Rate for Payer: Bisbee Police All Plans	$181.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$474.64
Rate for Payer: Cash Price	$558.40
Rate for Payer: Cigna of AZ Commercial	$453.70
Rate for Payer: Copperpoint Commercial	$172.75
Rate for Payer: Health Net of AZ Commercial	$418.80
Rate for Payer: Health Net of AZ Medicare	$195.44
Rate for Payer: Humana of AZ Medicare	$111.68
Rate for Payer: Self Pay Self Pay	$558.40
Rate for Payer: TriWest Medicare	$111.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$406.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$125.64

.FLUOR FOR NONINFECT AB (CELIAC COMP)

Facility

$698.00

Service Code	CPT 86255
Hospital Charge Code	22481445
Hospital Revenue Code	301
Min. Negotiated Rate	$181.48
Max. Negotiated Rate	$628.20
Rate for Payer: Aetna of AZ Commercial	$628.20
Rate for Payer: Bisbee Police All Plans	$181.48
Rate for Payer: Cash Price	$558.40
Rate for Payer: Self Pay Self Pay	$558.40

FLUOR NONINFECT AGENT AB TITER

Facility

$733.00

Service Code	CPT 86256
Hospital Charge Code	22481474
Hospital Revenue Code	302
Min. Negotiated Rate	$117.28
Max. Negotiated Rate	$659.70
Rate for Payer: Aetna of AZ Commercial	$659.70
Rate for Payer: Aetna of AZ Medicare	$205.24
Rate for Payer: Allwell Medicare	$117.28
Rate for Payer: Amerigroup Medicare	$117.28
Rate for Payer: APIPA Medicare/Medicaid	$273.78
Rate for Payer: AZCH Complete Medicare	$117.28
Rate for Payer: Banner UC Health Medicare	$117.28
Rate for Payer: Bisbee Police All Plans	$190.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$498.44
Rate for Payer: Cash Price	$586.40
Rate for Payer: Cigna of AZ Commercial	$476.45
Rate for Payer: Copperpoint Commercial	$181.42
Rate for Payer: Health Net of AZ Commercial	$439.80
Rate for Payer: Health Net of AZ Medicare	$205.24
Rate for Payer: Humana of AZ Medicare	$117.28
Rate for Payer: Self Pay Self Pay	$586.40
Rate for Payer: TriWest Medicare	$117.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$427.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$131.94

FLUOR NONINFECT AGENT AB TITER

Facility

$733.00

Service Code	CPT 86256
Hospital Charge Code	22481474
Hospital Revenue Code	302
Min. Negotiated Rate	$190.58
Max. Negotiated Rate	$659.70
Rate for Payer: Aetna of AZ Commercial	$659.70
Rate for Payer: Bisbee Police All Plans	$190.58
Rate for Payer: Cash Price	$586.40
Rate for Payer: Self Pay Self Pay	$586.40

Fluoroscopy Stage I

Facility

$535.00

Service Code	CPT 77003
Hospital Charge Code	27267838
Hospital Revenue Code	360
Min. Negotiated Rate	$85.60
Max. Negotiated Rate	$481.50
Rate for Payer: Aetna of AZ Commercial	$481.50
Rate for Payer: Aetna of AZ Medicare	$149.80
Rate for Payer: Allwell Medicare	$85.60
Rate for Payer: Amerigroup Medicare	$85.60
Rate for Payer: APIPA Medicare/Medicaid	$199.82
Rate for Payer: AZCH Complete Medicare	$85.60
Rate for Payer: Banner UC Health Medicare	$85.60
Rate for Payer: Bisbee Police All Plans	$139.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$363.80
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cigna of AZ Commercial	$267.50
Rate for Payer: Copperpoint Commercial	$132.41
Rate for Payer: Health Net of AZ Commercial	$321.00
Rate for Payer: Health Net of AZ Medicare	$149.80
Rate for Payer: Humana of AZ Medicare	$85.60
Rate for Payer: Self Pay Self Pay	$428.00
Rate for Payer: TriWest Medicare	$85.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$311.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$96.30

Fluoroscopy Stage I

Facility

$535.00

Service Code	CPT 77003
Hospital Charge Code	27267838
Hospital Revenue Code	360
Min. Negotiated Rate	$139.10
Max. Negotiated Rate	$481.50
Rate for Payer: Aetna of AZ Commercial	$481.50
Rate for Payer: Bisbee Police All Plans	$139.10
Rate for Payer: Cash Price	$428.00
Rate for Payer: Self Pay Self Pay	$428.00

FLUoxetine 20 mg Cap [CQCH]

Facility

$0.09

Service Code	NDC 904578561
Hospital Charge Code	105923130
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
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	$0.06
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.06
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.07
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

FLUoxetine 20 mg Cap [CQCH]

Facility

$0.09

Service Code	NDC 904578561
Hospital Charge Code	105923130
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.07

fluticasone 110 mcg/inh Inh Aer w/adapter 12 gm [CQCH]

Facility

$223.16

Service Code	NDC 173071920
Hospital Charge Code	105923197
Hospital Revenue Code	251
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$200.84
Rate for Payer: Aetna of AZ Commercial	$200.84
Rate for Payer: Bisbee Police All Plans	$58.02
Rate for Payer: Cash Price	$178.53
Rate for Payer: Self Pay Self Pay	$178.53

fluticasone 110 mcg/inh Inh Aer w/adapter 12 gm [CQCH]

Facility

$223.16

Service Code	NDC 173071920
Hospital Charge Code	105923197
Hospital Revenue Code	251
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$200.84
Rate for Payer: Aetna of AZ Commercial	$200.84
Rate for Payer: Aetna of AZ Medicare	$62.48
Rate for Payer: Allwell Medicare	$35.71
Rate for Payer: Amerigroup Medicare	$35.71
Rate for Payer: APIPA Medicare/Medicaid	$83.35
Rate for Payer: AZCH Complete Medicare	$35.71
Rate for Payer: Banner UC Health Medicare	$35.71
Rate for Payer: Bisbee Police All Plans	$58.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$151.75
Rate for Payer: Cash Price	$178.53
Rate for Payer: Cigna of AZ Commercial	$145.05
Rate for Payer: Copperpoint Commercial	$55.23
Rate for Payer: Health Net of AZ Commercial	$133.90
Rate for Payer: Health Net of AZ Medicare	$62.48
Rate for Payer: Humana of AZ Medicare	$35.71
Rate for Payer: Self Pay Self Pay	$178.53
Rate for Payer: TriWest Medicare	$35.71
Rate for Payer: UnitedHealth Group of AZ Commercial	$130.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.17

fluticasone Nasal 0.05 mg/inh Spray [CQCH]

Facility

$7.42

Service Code	NDC 54327099
Hospital Charge Code	105949746
Hospital Revenue Code	251
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$6.68
Rate for Payer: Aetna of AZ Commercial	$6.68
Rate for Payer: Aetna of AZ Medicare	$2.08
Rate for Payer: Allwell Medicare	$1.19
Rate for Payer: Amerigroup Medicare	$1.19
Rate for Payer: APIPA Medicare/Medicaid	$2.77
Rate for Payer: AZCH Complete Medicare	$1.19
Rate for Payer: Banner UC Health Medicare	$1.19
Rate for Payer: Bisbee Police All Plans	$1.93
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.05
Rate for Payer: Cash Price	$5.94
Rate for Payer: Cigna of AZ Commercial	$4.82
Rate for Payer: Copperpoint Commercial	$1.84
Rate for Payer: Health Net of AZ Commercial	$4.45
Rate for Payer: Health Net of AZ Medicare	$2.08
Rate for Payer: Humana of AZ Medicare	$1.19
Rate for Payer: Self Pay Self Pay	$5.94
Rate for Payer: TriWest Medicare	$1.19
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.34

fluticasone Nasal 0.05 mg/inh Spray [CQCH]

Facility

$7.42

Service Code	NDC 54327099
Hospital Charge Code	105949746
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$6.68
Rate for Payer: Aetna of AZ Commercial	$6.68
Rate for Payer: Bisbee Police All Plans	$1.93
Rate for Payer: Cash Price	$5.94
Rate for Payer: Self Pay Self Pay	$5.94

Folate Level

Facility

$172.00

Service Code	CPT 82746
Hospital Charge Code	633729
Hospital Revenue Code	301
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

Folate Level

Facility

$172.00

Service Code	CPT 82746
Hospital Charge Code	633729
Hospital Revenue Code	301
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: Allwell Medicare	$27.52
Rate for Payer: Amerigroup Medicare	$27.52
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

.Folate Note LC

Facility

$259.00

Service Code	CPT 82747
Hospital Charge Code	22311145
Hospital Revenue Code	306
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Cash Price	$207.20
Rate for Payer: Self Pay Self Pay	$207.20

.Folate Note LC

Facility

$259.00

Service Code	CPT 82747
Hospital Charge Code	22311145
Hospital Revenue Code	306
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Aetna of AZ Medicare	$72.52
Rate for Payer: Allwell Medicare	$41.44
Rate for Payer: Amerigroup Medicare	$41.44
Rate for Payer: APIPA Medicare/Medicaid	$96.74
Rate for Payer: AZCH Complete Medicare	$41.44
Rate for Payer: Banner UC Health Medicare	$41.44
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$176.12
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$168.35
Rate for Payer: Copperpoint Commercial	$64.10
Rate for Payer: Health Net of AZ Commercial	$155.40
Rate for Payer: Health Net of AZ Medicare	$72.52
Rate for Payer: Humana of AZ Medicare	$41.44
Rate for Payer: Self Pay Self Pay	$207.20
Rate for Payer: TriWest Medicare	$41.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$151.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.62

Folate, RBC LC

Facility

$246.00

Service Code	CPT 82747
Hospital Charge Code	1906862
Hospital Revenue Code	301
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Cash Price	$196.80
Rate for Payer: Self Pay Self Pay	$196.80

Folate, RBC LC

Facility

$246.00

Service Code	CPT 82747
Hospital Charge Code	1906862
Hospital Revenue Code	301
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna of AZ Commercial	$221.40
Rate for Payer: Aetna of AZ Medicare	$68.88
Rate for Payer: Allwell Medicare	$39.36
Rate for Payer: Amerigroup Medicare	$39.36
Rate for Payer: APIPA Medicare/Medicaid	$91.88
Rate for Payer: AZCH Complete Medicare	$39.36
Rate for Payer: Banner UC Health Medicare	$39.36
Rate for Payer: Bisbee Police All Plans	$63.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$167.28
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cigna of AZ Commercial	$159.90
Rate for Payer: Copperpoint Commercial	$60.88
Rate for Payer: Health Net of AZ Commercial	$147.60
Rate for Payer: Health Net of AZ Medicare	$68.88
Rate for Payer: Humana of AZ Medicare	$39.36
Rate for Payer: Self Pay Self Pay	$196.80
Rate for Payer: TriWest Medicare	$39.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$143.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.28

FOLEY CATH 30CC 20FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796435
Hospital Revenue Code	270
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Aetna of AZ Medicare	$26.87
Rate for Payer: Allwell Medicare	$15.35
Rate for Payer: Amerigroup Medicare	$15.35
Rate for Payer: APIPA Medicare/Medicaid	$35.84
Rate for Payer: AZCH Complete Medicare	$15.35
Rate for Payer: Banner UC Health Medicare	$15.35
Rate for Payer: Bisbee Police All Plans	$24.95
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.25
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cigna of AZ Commercial	$67.17
Rate for Payer: Copperpoint Commercial	$23.75
Rate for Payer: Health Net of AZ Commercial	$57.57
Rate for Payer: Health Net of AZ Medicare	$26.87
Rate for Payer: Humana of AZ Medicare	$15.35
Rate for Payer: Self Pay Self Pay	$76.76
Rate for Payer: TriWest Medicare	$15.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.27

FOLEY CATH 30CC 20FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796435
Hospital Revenue Code	270
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Bisbee Police All Plans	$24.95
Rate for Payer: Cash Price	$76.76
Rate for Payer: Self Pay Self Pay	$76.76

FOLEY CATH 30CC 24FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796433
Hospital Revenue Code	270
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Bisbee Police All Plans	$24.95
Rate for Payer: Cash Price	$76.76
Rate for Payer: Self Pay Self Pay	$76.76

FOLEY CATH 30CC 24FR 3 WAY

Facility

$95.95

Hospital Charge Code	27796433
Hospital Revenue Code	270
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$86.36
Rate for Payer: Aetna of AZ Commercial	$86.36
Rate for Payer: Aetna of AZ Medicare	$26.87
Rate for Payer: Allwell Medicare	$15.35
Rate for Payer: Amerigroup Medicare	$15.35
Rate for Payer: APIPA Medicare/Medicaid	$35.84
Rate for Payer: AZCH Complete Medicare	$15.35
Rate for Payer: Banner UC Health Medicare	$15.35
Rate for Payer: Bisbee Police All Plans	$24.95
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.25
Rate for Payer: Cash Price	$76.76
Rate for Payer: Cigna of AZ Commercial	$67.17
Rate for Payer: Copperpoint Commercial	$23.75
Rate for Payer: Health Net of AZ Commercial	$57.57
Rate for Payer: Health Net of AZ Medicare	$26.87
Rate for Payer: Humana of AZ Medicare	$15.35
Rate for Payer: Self Pay Self Pay	$76.76
Rate for Payer: TriWest Medicare	$15.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.27

folic acid 1 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 62584089701
Hospital Charge Code	105923258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.09
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

Know your out-of-pocket cost for care.

All Charges