Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

medroxyPROGESTERone 2.5 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 555087202
Hospital Charge Code	105930428
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

MEDTRONIC CLERIFY VISUALIZATION SYSTEM

Facility

$715.00

Hospital Charge Code	27392763
Hospital Revenue Code	270
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$643.50
Rate for Payer: APIPA Medicare/Medicaid	$267.05
Rate for Payer: Aetna of AZ Commercial	$643.50
Rate for Payer: Aetna of AZ Medicare	$200.20
Rate for Payer: Allwell Medicare	$107.25
Rate for Payer: Amerigroup Medicare	$107.25
Rate for Payer: AZCH Complete Medicare	$107.25
Rate for Payer: Banner UC Health Medicare	$107.25
Rate for Payer: Bisbee Police All Plans	$185.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$486.20
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cigna of AZ Commercial	$500.50
Rate for Payer: Copperpoint Commercial	$176.96
Rate for Payer: Health Net of AZ Commercial	$429.00
Rate for Payer: Health Net of AZ Medicare	$200.20
Rate for Payer: Humana of AZ Medicare	$107.25
Rate for Payer: Self Pay Self Pay	$572.00
Rate for Payer: TriWest Medicare	$107.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$416.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$128.70

MEDTRONIC CLERIFY VISUALIZATION SYSTEM

Facility

$715.00

Hospital Charge Code	27392763
Hospital Revenue Code	270
Min. Negotiated Rate	$185.90
Max. Negotiated Rate	$643.50
Rate for Payer: Aetna of AZ Commercial	$643.50
Rate for Payer: Bisbee Police All Plans	$185.90
Rate for Payer: Cash Price	$572.00
Rate for Payer: Self Pay Self Pay	$572.00

megestrol 400 mg/10 mL Oral Susp UD [CQCH]

Facility

$0.50

Service Code	NDC 66689002001
Hospital Charge Code	105930493
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of AZ Commercial	$0.45
Rate for Payer: Bisbee Police All Plans	$0.13
Rate for Payer: Cash Price	$0.40
Rate for Payer: Self Pay Self Pay	$0.40

megestrol 400 mg/10 mL Oral Susp UD [CQCH]

Facility

$0.50

Service Code	NDC 66689002001
Hospital Charge Code	105930493
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of AZ Commercial	$0.45
Rate for Payer: Aetna of AZ Medicare	$0.14
Rate for Payer: Allwell Medicare	$0.08
Rate for Payer: Amerigroup Medicare	$0.08
Rate for Payer: APIPA Medicare/Medicaid	$0.19
Rate for Payer: AZCH Complete Medicare	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Bisbee Police All Plans	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.34
Rate for Payer: Cash Price	$0.40
Rate for Payer: Cigna of AZ Commercial	$0.33
Rate for Payer: Copperpoint Commercial	$0.12
Rate for Payer: Health Net of AZ Commercial	$0.30
Rate for Payer: Health Net of AZ Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Self Pay Self Pay	$0.40
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.09

melatonin 3 mg Tab UD [CQCH]

Facility

$0.17

Service Code	NDC 50268052415
Hospital Charge Code	111571064
Hospital Revenue Code	250
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

melatonin 3 mg Tab UD [CQCH]

Facility

$0.17

Service Code	NDC 50268052415
Hospital Charge Code	111571064
Hospital Revenue Code	250
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

memantine 10 mg Tab UD [CQCH]

Facility

$0.30

Service Code	NDC 60687018457
Hospital Charge Code	107742580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of AZ Commercial	$0.27
Rate for Payer: Aetna of AZ Medicare	$0.08
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.11
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.20
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of AZ Commercial	$0.20
Rate for Payer: Copperpoint Commercial	$0.07
Rate for Payer: Health Net of AZ Commercial	$0.18
Rate for Payer: Health Net of AZ Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.24
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

memantine 10 mg Tab UD [CQCH]

Facility

$0.30

Service Code	NDC 60687018457
Hospital Charge Code	107742580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna of AZ Commercial	$0.27
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.24
Rate for Payer: Self Pay Self Pay	$0.24

MEMOFIX DRILL BIT 1.7MM

Facility

$1,505.00

Hospital Charge Code	24127788
Hospital Revenue Code	270
Min. Negotiated Rate	$225.75
Max. Negotiated Rate	$1,354.50
Rate for Payer: Aetna of AZ Commercial	$1,354.50
Rate for Payer: Aetna of AZ Medicare	$421.40
Rate for Payer: Allwell Medicare	$225.75
Rate for Payer: Amerigroup Medicare	$225.75
Rate for Payer: APIPA Medicare/Medicaid	$562.12
Rate for Payer: AZCH Complete Medicare	$225.75
Rate for Payer: Banner UC Health Medicare	$225.75
Rate for Payer: Bisbee Police All Plans	$391.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,023.40
Rate for Payer: Cash Price	$1,204.00
Rate for Payer: Cigna of AZ Commercial	$1,053.50
Rate for Payer: Copperpoint Commercial	$372.49
Rate for Payer: Health Net of AZ Commercial	$903.00
Rate for Payer: Health Net of AZ Medicare	$421.40
Rate for Payer: Humana of AZ Medicare	$225.75
Rate for Payer: Self Pay Self Pay	$1,204.00
Rate for Payer: TriWest Medicare	$225.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$877.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$270.90

MEMOFIX DRILL BIT 1.7MM

Facility

$1,505.00

Hospital Charge Code	24127788
Hospital Revenue Code	270
Min. Negotiated Rate	$391.30
Max. Negotiated Rate	$1,354.50
Rate for Payer: Aetna of AZ Commercial	$1,354.50
Rate for Payer: Bisbee Police All Plans	$391.30
Rate for Payer: Cash Price	$1,204.00
Rate for Payer: Self Pay Self Pay	$1,204.00

MEMOFIX NITINOL STAPLE 10MMX10MMX10MM

Facility

$6,631.00

Hospital Charge Code	24358107
Hospital Revenue Code	270
Min. Negotiated Rate	$994.65
Max. Negotiated Rate	$5,967.90
Rate for Payer: Aetna of AZ Commercial	$5,967.90
Rate for Payer: Aetna of AZ Medicare	$1,856.68
Rate for Payer: Allwell Medicare	$994.65
Rate for Payer: Amerigroup Medicare	$994.65
Rate for Payer: APIPA Medicare/Medicaid	$2,476.68
Rate for Payer: AZCH Complete Medicare	$994.65
Rate for Payer: Banner UC Health Medicare	$994.65
Rate for Payer: Bisbee Police All Plans	$1,724.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,509.08
Rate for Payer: Cash Price	$5,304.80
Rate for Payer: Cigna of AZ Commercial	$4,641.70
Rate for Payer: Copperpoint Commercial	$1,641.17
Rate for Payer: Health Net of AZ Commercial	$3,978.60
Rate for Payer: Health Net of AZ Medicare	$1,856.68
Rate for Payer: Humana of AZ Medicare	$994.65
Rate for Payer: Self Pay Self Pay	$5,304.80
Rate for Payer: TriWest Medicare	$994.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,865.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,193.58

MEMOFIX NITINOL STAPLE 10MMX10MMX10MM

Facility

$6,631.00

Hospital Charge Code	24358107
Hospital Revenue Code	270
Min. Negotiated Rate	$1,724.06
Max. Negotiated Rate	$5,967.90
Rate for Payer: Aetna of AZ Commercial	$5,967.90
Rate for Payer: Bisbee Police All Plans	$1,724.06
Rate for Payer: Cash Price	$5,304.80
Rate for Payer: Self Pay Self Pay	$5,304.80

MEMOFIX NITINOL STAPLE 10MM X 15MM

Facility

$3,315.00

Hospital Charge Code	27341814
Hospital Revenue Code	270
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$2,983.50
Rate for Payer: Aetna of AZ Commercial	$2,983.50
Rate for Payer: Aetna of AZ Medicare	$928.20
Rate for Payer: Allwell Medicare	$497.25
Rate for Payer: Amerigroup Medicare	$497.25
Rate for Payer: APIPA Medicare/Medicaid	$1,238.15
Rate for Payer: AZCH Complete Medicare	$497.25
Rate for Payer: Banner UC Health Medicare	$497.25
Rate for Payer: Bisbee Police All Plans	$861.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,254.20
Rate for Payer: Cash Price	$2,652.00
Rate for Payer: Cigna of AZ Commercial	$2,320.50
Rate for Payer: Copperpoint Commercial	$820.46
Rate for Payer: Health Net of AZ Commercial	$1,989.00
Rate for Payer: Health Net of AZ Medicare	$928.20
Rate for Payer: Humana of AZ Medicare	$497.25
Rate for Payer: Self Pay Self Pay	$2,652.00
Rate for Payer: TriWest Medicare	$497.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,932.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$596.70

MEMOFIX NITINOL STAPLE 10MM X 15MM

Facility

$3,315.00

Hospital Charge Code	27341814
Hospital Revenue Code	270
Min. Negotiated Rate	$861.90
Max. Negotiated Rate	$2,983.50
Rate for Payer: Aetna of AZ Commercial	$2,983.50
Rate for Payer: Bisbee Police All Plans	$861.90
Rate for Payer: Cash Price	$2,652.00
Rate for Payer: Self Pay Self Pay	$2,652.00

MEMOFIX NITINOL STAPLE 12MMX12MMX12MM

Facility

$6,631.00

Hospital Charge Code	24358109
Hospital Revenue Code	270
Min. Negotiated Rate	$1,724.06
Max. Negotiated Rate	$5,967.90
Rate for Payer: Aetna of AZ Commercial	$5,967.90
Rate for Payer: Bisbee Police All Plans	$1,724.06
Rate for Payer: Cash Price	$5,304.80
Rate for Payer: Self Pay Self Pay	$5,304.80

MEMOFIX NITINOL STAPLE 12MMX12MMX12MM

Facility

$6,631.00

Hospital Charge Code	24358109
Hospital Revenue Code	270
Min. Negotiated Rate	$994.65
Max. Negotiated Rate	$5,967.90
Rate for Payer: Aetna of AZ Commercial	$5,967.90
Rate for Payer: Aetna of AZ Medicare	$1,856.68
Rate for Payer: Allwell Medicare	$994.65
Rate for Payer: Amerigroup Medicare	$994.65
Rate for Payer: APIPA Medicare/Medicaid	$2,476.68
Rate for Payer: AZCH Complete Medicare	$994.65
Rate for Payer: Banner UC Health Medicare	$994.65
Rate for Payer: Bisbee Police All Plans	$1,724.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,509.08
Rate for Payer: Cash Price	$5,304.80
Rate for Payer: Cigna of AZ Commercial	$4,641.70
Rate for Payer: Copperpoint Commercial	$1,641.17
Rate for Payer: Health Net of AZ Commercial	$3,978.60
Rate for Payer: Health Net of AZ Medicare	$1,856.68
Rate for Payer: Humana of AZ Medicare	$994.65
Rate for Payer: Self Pay Self Pay	$5,304.80
Rate for Payer: TriWest Medicare	$994.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,865.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,193.58

MEMOFIX NITINO STAPLE 8MMX8MMX8MM

Facility

$3,448.00

Hospital Charge Code	24127792
Hospital Revenue Code	270
Min. Negotiated Rate	$517.20
Max. Negotiated Rate	$3,103.20
Rate for Payer: Aetna of AZ Commercial	$3,103.20
Rate for Payer: Aetna of AZ Medicare	$965.44
Rate for Payer: Allwell Medicare	$517.20
Rate for Payer: Amerigroup Medicare	$517.20
Rate for Payer: APIPA Medicare/Medicaid	$1,287.83
Rate for Payer: AZCH Complete Medicare	$517.20
Rate for Payer: Banner UC Health Medicare	$517.20
Rate for Payer: Bisbee Police All Plans	$896.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,344.64
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Cigna of AZ Commercial	$2,413.60
Rate for Payer: Copperpoint Commercial	$853.38
Rate for Payer: Health Net of AZ Commercial	$2,068.80
Rate for Payer: Health Net of AZ Medicare	$965.44
Rate for Payer: Humana of AZ Medicare	$517.20
Rate for Payer: Self Pay Self Pay	$2,758.40
Rate for Payer: TriWest Medicare	$517.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,010.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$620.64

MEMOFIX NITINO STAPLE 8MMX8MMX8MM

Facility

$3,448.00

Hospital Charge Code	24127792
Hospital Revenue Code	270
Min. Negotiated Rate	$896.48
Max. Negotiated Rate	$3,103.20
Rate for Payer: Aetna of AZ Commercial	$3,103.20
Rate for Payer: Bisbee Police All Plans	$896.48
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Self Pay Self Pay	$2,758.40

MEMOFIX PIN 1.7MM

Facility

$1,048.00

Hospital Charge Code	24127790
Hospital Revenue Code	270
Min. Negotiated Rate	$272.48
Max. Negotiated Rate	$943.20
Rate for Payer: Aetna of AZ Commercial	$943.20
Rate for Payer: Bisbee Police All Plans	$272.48
Rate for Payer: Cash Price	$838.40
Rate for Payer: Self Pay Self Pay	$838.40

MEMOFIX PIN 1.7MM

Facility

$1,048.00

Hospital Charge Code	24127790
Hospital Revenue Code	270
Min. Negotiated Rate	$157.20
Max. Negotiated Rate	$943.20
Rate for Payer: Aetna of AZ Commercial	$943.20
Rate for Payer: Aetna of AZ Medicare	$293.44
Rate for Payer: Allwell Medicare	$157.20
Rate for Payer: Amerigroup Medicare	$157.20
Rate for Payer: APIPA Medicare/Medicaid	$391.43
Rate for Payer: AZCH Complete Medicare	$157.20
Rate for Payer: Banner UC Health Medicare	$157.20
Rate for Payer: Bisbee Police All Plans	$272.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$712.64
Rate for Payer: Cash Price	$838.40
Rate for Payer: Cigna of AZ Commercial	$733.60
Rate for Payer: Copperpoint Commercial	$259.38
Rate for Payer: Health Net of AZ Commercial	$628.80
Rate for Payer: Health Net of AZ Medicare	$293.44
Rate for Payer: Humana of AZ Medicare	$157.20
Rate for Payer: Self Pay Self Pay	$838.40
Rate for Payer: TriWest Medicare	$157.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$610.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$188.64

Menstrual And Other Female Reproductive System Disorders

Facility

$3,737.06

Service Code	APR-DRG 5322
Hospital Charge Code	APRDRG5321
Min. Negotiated Rate	$3,737.06
Max. Negotiated Rate	$3,737.06
Rate for Payer: AHCCCS Medicaid	$3,737.06
Rate for Payer: Allwell Medicaid	$3,737.06
Rate for Payer: AZCH Complete Medicaid	$3,737.06
Rate for Payer: Banner UC Health Medicaid	$3,737.06
Rate for Payer: Mercy Care Medicaid	$3,737.06

Menstrual And Other Female Reproductive System Disorders

Facility

$11,878.91

Service Code	APR-DRG 5324
Hospital Charge Code	APRDRG5324
Min. Negotiated Rate	$11,878.91
Max. Negotiated Rate	$11,878.91
Rate for Payer: AHCCCS Medicaid	$11,878.91
Rate for Payer: Allwell Medicaid	$11,878.91
Rate for Payer: AZCH Complete Medicaid	$11,878.91
Rate for Payer: Banner UC Health Medicaid	$11,878.91
Rate for Payer: Mercy Care Medicaid	$11,878.91

Menstrual And Other Female Reproductive System Disorders

Facility

$3,118.42

Service Code	APR-DRG 5321
Hospital Charge Code	APRDRG5323
Min. Negotiated Rate	$3,118.42
Max. Negotiated Rate	$3,118.42
Rate for Payer: AHCCCS Medicaid	$3,118.42
Rate for Payer: Allwell Medicaid	$3,118.42
Rate for Payer: AZCH Complete Medicaid	$3,118.42
Rate for Payer: Banner UC Health Medicaid	$3,118.42
Rate for Payer: Mercy Care Medicaid	$3,118.42

Menstrual And Other Female Reproductive System Disorders

Facility

$5,450.58

Service Code	APR-DRG 5323
Hospital Charge Code	APRDRG5322
Min. Negotiated Rate	$5,450.58
Max. Negotiated Rate	$5,450.58
Rate for Payer: AHCCCS Medicaid	$5,450.58
Rate for Payer: Allwell Medicaid	$5,450.58
Rate for Payer: AZCH Complete Medicaid	$5,450.58
Rate for Payer: Banner UC Health Medicaid	$5,450.58
Rate for Payer: Mercy Care Medicaid	$5,450.58

Know your out-of-pocket cost for care.

All Charges