Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

HYDROmorphone 2 mg Tab UD [CQCH]

Facility

$0.16

Service Code	NDC 42858030125
Hospital Charge Code	205505588
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
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	$0.11
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
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	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

HYDROmorphone 2 mg Tab UD [CQCH]

Facility

$0.16

Service Code	NDC 42858030125
Hospital Charge Code	205505588
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.13

hydroxocobalamin 5 g REC [CQCH]

Facility

$750.00

Service Code	NDC 11704037001
Hospital Charge Code	105926041
Hospital Revenue Code	251
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of AZ Commercial	$675.00
Rate for Payer: Bisbee Police All Plans	$195.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Self Pay Self Pay	$600.00

hydroxocobalamin 5 g REC [CQCH]

Facility

$750.00

Service Code	NDC 11704037001
Hospital Charge Code	105926041
Hospital Revenue Code	251
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna of AZ Commercial	$675.00
Rate for Payer: Aetna of AZ Medicare	$210.00
Rate for Payer: Allwell Medicare	$120.00
Rate for Payer: Amerigroup Medicare	$120.00
Rate for Payer: APIPA Medicare/Medicaid	$280.12
Rate for Payer: AZCH Complete Medicare	$120.00
Rate for Payer: Banner UC Health Medicare	$120.00
Rate for Payer: Bisbee Police All Plans	$195.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$510.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cigna of AZ Commercial	$487.50
Rate for Payer: Copperpoint Commercial	$185.62
Rate for Payer: Health Net of AZ Commercial	$450.00
Rate for Payer: Health Net of AZ Medicare	$210.00
Rate for Payer: Humana of AZ Medicare	$120.00
Rate for Payer: Self Pay Self Pay	$600.00
Rate for Payer: TriWest Medicare	$120.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$437.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$135.00

hydroxychloroquine 200 mg Tab [CQCH]

Facility

$1.26

Service Code	NDC 16714075301
Hospital Charge Code	105926121
Hospital Revenue Code	251
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$1.13
Rate for Payer: Aetna of AZ Commercial	$1.13
Rate for Payer: Aetna of AZ Medicare	$0.35
Rate for Payer: Allwell Medicare	$0.20
Rate for Payer: Amerigroup Medicare	$0.20
Rate for Payer: APIPA Medicare/Medicaid	$0.47
Rate for Payer: AZCH Complete Medicare	$0.20
Rate for Payer: Banner UC Health Medicare	$0.20
Rate for Payer: Bisbee Police All Plans	$0.33
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.86
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cigna of AZ Commercial	$0.82
Rate for Payer: Copperpoint Commercial	$0.31
Rate for Payer: Health Net of AZ Commercial	$0.76
Rate for Payer: Health Net of AZ Medicare	$0.35
Rate for Payer: Humana of AZ Medicare	$0.20
Rate for Payer: Self Pay Self Pay	$1.01
Rate for Payer: TriWest Medicare	$0.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.23

hydroxychloroquine 200 mg Tab [CQCH]

Facility

$1.26

Service Code	NDC 16714075301
Hospital Charge Code	105926121
Hospital Revenue Code	251
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.13
Rate for Payer: Aetna of AZ Commercial	$1.13
Rate for Payer: Bisbee Police All Plans	$0.33
Rate for Payer: Cash Price	$1.00
Rate for Payer: Self Pay Self Pay	$1.01

hydrOXYzine HCL 25 mg inj Sol [CQCH]

Facility

$3.21

Service Code	HCPCS J3410
Hospital Charge Code	108073338
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna of AZ Commercial	$2.89
Rate for Payer: Aetna of AZ Medicare	$0.90
Rate for Payer: Allwell Medicare	$0.51
Rate for Payer: Amerigroup Medicare	$0.51
Rate for Payer: APIPA Medicare/Medicaid	$1.20
Rate for Payer: AZCH Complete Medicare	$0.51
Rate for Payer: Banner UC Health Medicare	$0.51
Rate for Payer: Bisbee Police All Plans	$0.83
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.18
Rate for Payer: Cash Price	$2.57
Rate for Payer: Cigna of AZ Commercial	$2.09
Rate for Payer: Copperpoint Commercial	$0.79
Rate for Payer: Health Net of AZ Commercial	$1.93
Rate for Payer: Health Net of AZ Medicare	$0.90
Rate for Payer: Humana of AZ Medicare	$0.51
Rate for Payer: Self Pay Self Pay	$2.57
Rate for Payer: TriWest Medicare	$0.51
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.58

hydrOXYzine HCL 25 mg inj Sol [CQCH]

Facility

$3.21

Service Code	HCPCS J3410
Hospital Charge Code	108073338
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna of AZ Commercial	$2.89
Rate for Payer: Bisbee Police All Plans	$0.83
Rate for Payer: Cash Price	$2.57
Rate for Payer: Self Pay Self Pay	$2.57

hydrOXYzine pamoate 25 mg Cap UD [CQCH]

Facility

$0.38

Service Code	HCPCS Q0177
Hospital Charge Code	176182687
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of AZ Commercial	$0.34
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.14
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.26
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of AZ Commercial	$0.25
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.23
Rate for Payer: Health Net of AZ Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.30
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

hydrOXYzine pamoate 25 mg Cap UD [CQCH]

Facility

$0.38

Service Code	HCPCS Q0177
Hospital Charge Code	176182687
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.34
Rate for Payer: Aetna of AZ Commercial	$0.34
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Cash Price	$0.30
Rate for Payer: Self Pay Self Pay	$0.30

hyoscyamine 0.125 mg Dis tab [CQCH}

Facility

$0.20

Service Code	NDC 42192033801
Hospital Charge Code	112802907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.16

hyoscyamine 0.125 mg Dis tab [CQCH}

Facility

$0.20

Service Code	NDC 42192033801
Hospital Charge Code	112802907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.14
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.12
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.16
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$32.00

Service Code	CPT 86331
Hospital Charge Code	23298035
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Cash Price	$25.60
Rate for Payer: Self Pay Self Pay	$25.60

HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$32.00

Service Code	CPT 86331
Hospital Charge Code	23298035
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Aetna of AZ Medicare	$8.96
Rate for Payer: Allwell Medicare	$5.12
Rate for Payer: Amerigroup Medicare	$5.12
Rate for Payer: APIPA Medicare/Medicaid	$11.95
Rate for Payer: AZCH Complete Medicare	$5.12
Rate for Payer: Banner UC Health Medicare	$5.12
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21.76
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$20.80
Rate for Payer: Copperpoint Commercial	$7.92
Rate for Payer: Health Net of AZ Commercial	$19.20
Rate for Payer: Health Net of AZ Medicare	$8.96
Rate for Payer: Humana of AZ Medicare	$5.12
Rate for Payer: Self Pay Self Pay	$25.60
Rate for Payer: TriWest Medicare	$5.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$18.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.76

HYPERSENSITIVITY PNEUMONITIS PROFILE

Facility

$418.00

Service Code	CPT 86631
Hospital Charge Code	23298036
Hospital Revenue Code	301
Min. Negotiated Rate	$108.68
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Bisbee Police All Plans	$108.68
Rate for Payer: Cash Price	$334.40
Rate for Payer: Self Pay Self Pay	$334.40

HYPERSENSITIVITY PNEUMONITIS PROFILE

Facility

$418.00

Service Code	CPT 86631
Hospital Charge Code	23298036
Hospital Revenue Code	301
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$376.20
Rate for Payer: Aetna of AZ Commercial	$376.20
Rate for Payer: Aetna of AZ Medicare	$117.04
Rate for Payer: Allwell Medicare	$66.88
Rate for Payer: Amerigroup Medicare	$66.88
Rate for Payer: APIPA Medicare/Medicaid	$156.12
Rate for Payer: AZCH Complete Medicare	$66.88
Rate for Payer: Banner UC Health Medicare	$66.88
Rate for Payer: Bisbee Police All Plans	$108.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$284.24
Rate for Payer: Cash Price	$334.40
Rate for Payer: Cigna of AZ Commercial	$271.70
Rate for Payer: Copperpoint Commercial	$103.45
Rate for Payer: Health Net of AZ Commercial	$250.80
Rate for Payer: Health Net of AZ Medicare	$117.04
Rate for Payer: Humana of AZ Medicare	$66.88
Rate for Payer: Self Pay Self Pay	$334.40
Rate for Payer: TriWest Medicare	$66.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$243.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.24

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1993
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: AHCCCS Medicaid	$9,200.97
Rate for Payer: Allwell Medicaid	$9,200.97
Rate for Payer: AZCH Complete Medicaid	$9,200.97
Rate for Payer: Banner UC Health Medicaid	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: AHCCCS Medicaid	$3,474.03
Rate for Payer: Allwell Medicaid	$3,474.03
Rate for Payer: AZCH Complete Medicaid	$3,474.03
Rate for Payer: Banner UC Health Medicaid	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: AHCCCS Medicaid	$9,200.97
Rate for Payer: Allwell Medicaid	$9,200.97
Rate for Payer: AZCH Complete Medicaid	$9,200.97
Rate for Payer: Banner UC Health Medicaid	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1993
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: AHCCCS Medicaid	$3,474.03
Rate for Payer: Allwell Medicaid	$3,474.03
Rate for Payer: AZCH Complete Medicaid	$3,474.03
Rate for Payer: Banner UC Health Medicaid	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1991
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: AHCCCS Medicaid	$3,474.03
Rate for Payer: Allwell Medicaid	$3,474.03
Rate for Payer: AZCH Complete Medicaid	$3,474.03
Rate for Payer: Banner UC Health Medicaid	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03

Hypertension

Facility

$9,200.97

Service Code	APR-DRG 1994
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$9,200.97
Max. Negotiated Rate	$9,200.97
Rate for Payer: AHCCCS Medicaid	$9,200.97
Rate for Payer: Allwell Medicaid	$9,200.97
Rate for Payer: AZCH Complete Medicaid	$9,200.97
Rate for Payer: Banner UC Health Medicaid	$9,200.97
Rate for Payer: Mercy Care Medicaid	$9,200.97

Hypertension

Facility

$4,081.45

Service Code	APR-DRG 1992
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$4,081.45
Max. Negotiated Rate	$4,081.45
Rate for Payer: AHCCCS Medicaid	$4,081.45
Rate for Payer: Allwell Medicaid	$4,081.45
Rate for Payer: AZCH Complete Medicaid	$4,081.45
Rate for Payer: Banner UC Health Medicaid	$4,081.45
Rate for Payer: Mercy Care Medicaid	$4,081.45

Hypertension

Facility

$5,703.08

Service Code	APR-DRG 1993
Hospital Charge Code	APRDRG1994
Min. Negotiated Rate	$5,703.08
Max. Negotiated Rate	$5,703.08
Rate for Payer: AHCCCS Medicaid	$5,703.08
Rate for Payer: Allwell Medicaid	$5,703.08
Rate for Payer: AZCH Complete Medicaid	$5,703.08
Rate for Payer: Banner UC Health Medicaid	$5,703.08
Rate for Payer: Mercy Care Medicaid	$5,703.08

Hypertension

Facility

$3,474.03

Service Code	APR-DRG 1991
Hospital Charge Code	APRDRG1992
Min. Negotiated Rate	$3,474.03
Max. Negotiated Rate	$3,474.03
Rate for Payer: AHCCCS Medicaid	$3,474.03
Rate for Payer: Allwell Medicaid	$3,474.03
Rate for Payer: AZCH Complete Medicaid	$3,474.03
Rate for Payer: Banner UC Health Medicaid	$3,474.03
Rate for Payer: Mercy Care Medicaid	$3,474.03

Know your out-of-pocket cost for care.

All Charges