Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

haloperidol 1 mg Tab [CQCH]

Facility

$0.46

Service Code	NDC 51079073420
Hospital Charge Code	105925162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Cash Price	$0.36
Rate for Payer: Self Pay Self Pay	$0.37

haloperidol 1 mg Tab [CQCH]

Facility

$0.46

Service Code	NDC 51079073420
Hospital Charge Code	105925162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Aetna of AZ Medicare	$0.13
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.17
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.31
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.30
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.28
Rate for Payer: Health Net of AZ Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.37
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

haloperidol 5 mg/mL Inj Sol [CQCH]

Facility

$0.63

Service Code	HCPCS J1630
Hospital Charge Code	105925093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.64
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Aetna of AZ Medicare	$0.18
Rate for Payer: AHCCCS Medicaid	$1.64
Rate for Payer: Allwell Medicaid	$1.64
Rate for Payer: Allwell Medicare	$0.09
Rate for Payer: Amerigroup Medicare	$0.09
Rate for Payer: APIPA Medicare/Medicaid	$0.24
Rate for Payer: AZCH Complete Medicaid	$1.64
Rate for Payer: AZCH Complete Medicare	$0.09
Rate for Payer: Banner UC Health Medicaid	$1.64
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.43
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.41
Rate for Payer: Copperpoint Commercial	$0.16
Rate for Payer: Health Net of AZ Commercial	$0.38
Rate for Payer: Health Net of AZ Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Mercy Care Medicaid	$1.64
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

haloperidol 5 mg/mL Inj Sol [CQCH]

Facility

$0.63

Service Code	HCPCS J1630
Hospital Charge Code	105925093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.50
Rate for Payer: Self Pay Self Pay	$0.50

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$23,327.16
Max. Negotiated Rate	$23,327.16
Rate for Payer: AHCCCS Medicaid	$23,327.16
Rate for Payer: Allwell Medicaid	$23,327.16
Rate for Payer: AZCH Complete Medicaid	$23,327.16
Rate for Payer: Banner UC Health Medicaid	$23,327.16
Rate for Payer: Mercy Care Medicaid	$23,327.16

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$23,327.16
Max. Negotiated Rate	$23,327.16
Rate for Payer: AHCCCS Medicaid	$23,327.16
Rate for Payer: Allwell Medicaid	$23,327.16
Rate for Payer: AZCH Complete Medicaid	$23,327.16
Rate for Payer: Banner UC Health Medicaid	$23,327.16
Rate for Payer: Mercy Care Medicaid	$23,327.16

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3164
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3162
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$5,813.20

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG3163
Min. Negotiated Rate	$5,813.20
Max. Negotiated Rate	$5,813.20
Rate for Payer: AHCCCS Medicaid	$5,813.20
Rate for Payer: Allwell Medicaid	$5,813.20
Rate for Payer: AZCH Complete Medicaid	$5,813.20
Rate for Payer: Banner UC Health Medicaid	$5,813.20
Rate for Payer: Mercy Care Medicaid	$5,813.20

Hand And Wrist Procedures

Facility

$7,741.35

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG3163
Min. Negotiated Rate	$7,741.35
Max. Negotiated Rate	$7,741.35
Rate for Payer: AHCCCS Medicaid	$7,741.35
Rate for Payer: Allwell Medicaid	$7,741.35
Rate for Payer: AZCH Complete Medicaid	$7,741.35
Rate for Payer: Banner UC Health Medicaid	$7,741.35
Rate for Payer: Mercy Care Medicaid	$7,741.35

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$23,327.16
Max. Negotiated Rate	$23,327.16
Rate for Payer: AHCCCS Medicaid	$23,327.16
Rate for Payer: Allwell Medicaid	$23,327.16
Rate for Payer: AZCH Complete Medicaid	$23,327.16
Rate for Payer: Banner UC Health Medicaid	$23,327.16
Rate for Payer: Mercy Care Medicaid	$23,327.16

Hand And Wrist Procedures

Facility

$23,327.16

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG3163
Min. Negotiated Rate	$23,327.16
Max. Negotiated Rate	$23,327.16
Rate for Payer: AHCCCS Medicaid	$23,327.16
Rate for Payer: Allwell Medicaid	$23,327.16
Rate for Payer: AZCH Complete Medicaid	$23,327.16
Rate for Payer: Banner UC Health Medicaid	$23,327.16
Rate for Payer: Mercy Care Medicaid	$23,327.16

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3163
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

Hand And Wrist Procedures

Facility

$12,369.19

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG3161
Min. Negotiated Rate	$12,369.19
Max. Negotiated Rate	$12,369.19
Rate for Payer: AHCCCS Medicaid	$12,369.19
Rate for Payer: Allwell Medicaid	$12,369.19
Rate for Payer: AZCH Complete Medicaid	$12,369.19
Rate for Payer: Banner UC Health Medicaid	$12,369.19
Rate for Payer: Mercy Care Medicaid	$12,369.19

HAPTOGLOBIN

Facility

$205.00

Service Code	CPT 83010
Hospital Charge Code	22481476
Hospital Revenue Code	301
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Cash Price	$164.00
Rate for Payer: Self Pay Self Pay	$164.00

HAPTOGLOBIN

Facility

$205.00

Service Code	CPT 83010
Hospital Charge Code	22481476
Hospital Revenue Code	301
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Aetna of AZ Medicare	$57.40
Rate for Payer: AHCCCS Medicaid	$12.58
Rate for Payer: Allwell Medicaid	$12.58
Rate for Payer: Allwell Medicare	$30.75
Rate for Payer: Amerigroup Medicare	$30.75
Rate for Payer: APIPA Medicare/Medicaid	$76.57
Rate for Payer: AZCH Complete Medicaid	$12.58
Rate for Payer: AZCH Complete Medicare	$30.75
Rate for Payer: Banner UC Health Medicaid	$12.58
Rate for Payer: Banner UC Health Medicare	$30.75
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$139.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cigna of AZ Commercial	$133.25
Rate for Payer: Copperpoint Commercial	$50.74
Rate for Payer: Health Net of AZ Commercial	$123.00
Rate for Payer: Health Net of AZ Medicare	$57.40
Rate for Payer: Humana of AZ Medicare	$30.75
Rate for Payer: Mercy Care Medicaid	$12.58
Rate for Payer: Self Pay Self Pay	$164.00
Rate for Payer: TriWest Medicare	$30.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$119.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.90

Haptoglobin LC

Facility

$205.00

Service Code	CPT 83010
Hospital Charge Code	1906874
Hospital Revenue Code	301
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Aetna of AZ Medicare	$57.40
Rate for Payer: AHCCCS Medicaid	$12.58
Rate for Payer: Allwell Medicaid	$12.58
Rate for Payer: Allwell Medicare	$30.75
Rate for Payer: Amerigroup Medicare	$30.75
Rate for Payer: APIPA Medicare/Medicaid	$76.57
Rate for Payer: AZCH Complete Medicaid	$12.58
Rate for Payer: AZCH Complete Medicare	$30.75
Rate for Payer: Banner UC Health Medicaid	$12.58
Rate for Payer: Banner UC Health Medicare	$30.75
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$139.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cigna of AZ Commercial	$133.25
Rate for Payer: Copperpoint Commercial	$50.74
Rate for Payer: Health Net of AZ Commercial	$123.00
Rate for Payer: Health Net of AZ Medicare	$57.40
Rate for Payer: Humana of AZ Medicare	$30.75
Rate for Payer: Mercy Care Medicaid	$12.58
Rate for Payer: Self Pay Self Pay	$164.00
Rate for Payer: TriWest Medicare	$30.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$119.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.90

Haptoglobin LC

Facility

$205.00

Service Code	CPT 83010
Hospital Charge Code	1906874
Hospital Revenue Code	301
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Cash Price	$164.00
Rate for Payer: Self Pay Self Pay	$164.00

.HBsAg Confirmation LC

Facility

$309.00

Service Code	CPT 87340
Hospital Charge Code	1285756
Hospital Revenue Code	306
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Aetna of AZ Medicare	$86.52
Rate for Payer: AHCCCS Medicaid	$10.33
Rate for Payer: Allwell Medicaid	$10.33
Rate for Payer: Allwell Medicare	$46.35
Rate for Payer: Amerigroup Medicare	$46.35
Rate for Payer: APIPA Medicare/Medicaid	$115.41
Rate for Payer: AZCH Complete Medicaid	$10.33
Rate for Payer: AZCH Complete Medicare	$46.35
Rate for Payer: Banner UC Health Medicaid	$10.33
Rate for Payer: Banner UC Health Medicare	$46.35
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.12
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cigna of AZ Commercial	$200.85
Rate for Payer: Copperpoint Commercial	$76.48
Rate for Payer: Health Net of AZ Commercial	$185.40
Rate for Payer: Health Net of AZ Medicare	$86.52
Rate for Payer: Humana of AZ Medicare	$46.35
Rate for Payer: Mercy Care Medicaid	$10.33
Rate for Payer: Self Pay Self Pay	$247.20
Rate for Payer: TriWest Medicare	$46.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$180.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.62

Know your out-of-pocket cost for care.

All Charges