Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MESH 3D MAX LEFT EXTRA LARGE

Facility

$1,103.00

Hospital Charge Code	27750234
Hospital Revenue Code	270
Min. Negotiated Rate	$176.48
Max. Negotiated Rate	$992.70
Rate for Payer: Aetna of AZ Commercial	$992.70
Rate for Payer: Aetna of AZ Medicare	$308.84
Rate for Payer: Allwell Medicare	$176.48
Rate for Payer: Amerigroup Medicare	$176.48
Rate for Payer: APIPA Medicare/Medicaid	$411.97
Rate for Payer: AZCH Complete Medicare	$176.48
Rate for Payer: Banner UC Health Medicare	$176.48
Rate for Payer: Bisbee Police All Plans	$286.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$750.04
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cigna of AZ Commercial	$772.10
Rate for Payer: Copperpoint Commercial	$272.99
Rate for Payer: Health Net of AZ Commercial	$661.80
Rate for Payer: Health Net of AZ Medicare	$308.84
Rate for Payer: Humana of AZ Medicare	$176.48
Rate for Payer: Self Pay Self Pay	$882.40
Rate for Payer: TriWest Medicare	$176.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$643.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$198.54

MESH ONLAY PATCH SURGIMESH T613-8S

Facility

$861.00

Hospital Charge Code	22714383
Hospital Revenue Code	272
Min. Negotiated Rate	$223.86
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Bisbee Police All Plans	$223.86
Rate for Payer: Cash Price	$688.80
Rate for Payer: Self Pay Self Pay	$688.80

MESH ONLAY PATCH SURGIMESH T613-8S

Facility

$861.00

Hospital Charge Code	22714383
Hospital Revenue Code	272
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Aetna of AZ Medicare	$241.08
Rate for Payer: Allwell Medicare	$137.76
Rate for Payer: Amerigroup Medicare	$137.76
Rate for Payer: APIPA Medicare/Medicaid	$321.58
Rate for Payer: AZCH Complete Medicare	$137.76
Rate for Payer: Banner UC Health Medicare	$137.76
Rate for Payer: Bisbee Police All Plans	$223.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$585.48
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cigna of AZ Commercial	$602.70
Rate for Payer: Copperpoint Commercial	$213.10
Rate for Payer: Health Net of AZ Commercial	$516.60
Rate for Payer: Health Net of AZ Medicare	$241.08
Rate for Payer: Humana of AZ Medicare	$137.76
Rate for Payer: Self Pay Self Pay	$688.80
Rate for Payer: TriWest Medicare	$137.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$501.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$154.98

MESH TINTRA C15

Facility

$2,280.00

Hospital Charge Code	22354769
Hospital Revenue Code	270
Min. Negotiated Rate	$364.80
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna of AZ Commercial	$2,052.00
Rate for Payer: Aetna of AZ Medicare	$638.40
Rate for Payer: Allwell Medicare	$364.80
Rate for Payer: Amerigroup Medicare	$364.80
Rate for Payer: APIPA Medicare/Medicaid	$851.58
Rate for Payer: AZCH Complete Medicare	$364.80
Rate for Payer: Banner UC Health Medicare	$364.80
Rate for Payer: Bisbee Police All Plans	$592.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,550.40
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Cigna of AZ Commercial	$1,596.00
Rate for Payer: Copperpoint Commercial	$564.30
Rate for Payer: Health Net of AZ Commercial	$1,368.00
Rate for Payer: Health Net of AZ Medicare	$638.40
Rate for Payer: Humana of AZ Medicare	$364.80
Rate for Payer: Self Pay Self Pay	$1,824.00
Rate for Payer: TriWest Medicare	$364.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,329.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$410.40

MESH TINTRA C15

Facility

$2,280.00

Hospital Charge Code	22354769
Hospital Revenue Code	270
Min. Negotiated Rate	$592.80
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna of AZ Commercial	$2,052.00
Rate for Payer: Bisbee Police All Plans	$592.80
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Self Pay Self Pay	$1,824.00

Metanephrines, Frac., Pl. Free LC

Facility

$388.00

Service Code	CPT 83835
Hospital Charge Code	2029237
Hospital Revenue Code	301
Min. Negotiated Rate	$62.08
Max. Negotiated Rate	$349.20
Rate for Payer: Aetna of AZ Commercial	$349.20
Rate for Payer: Aetna of AZ Medicare	$108.64
Rate for Payer: Allwell Medicare	$62.08
Rate for Payer: Amerigroup Medicare	$62.08
Rate for Payer: APIPA Medicare/Medicaid	$144.92
Rate for Payer: AZCH Complete Medicare	$62.08
Rate for Payer: Banner UC Health Medicare	$62.08
Rate for Payer: Bisbee Police All Plans	$100.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$263.84
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cigna of AZ Commercial	$252.20
Rate for Payer: Copperpoint Commercial	$96.03
Rate for Payer: Health Net of AZ Commercial	$232.80
Rate for Payer: Health Net of AZ Medicare	$108.64
Rate for Payer: Humana of AZ Medicare	$62.08
Rate for Payer: Self Pay Self Pay	$310.40
Rate for Payer: TriWest Medicare	$62.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$226.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$69.84

Metanephrines, Frac., Pl. Free LC

Facility

$388.00

Service Code	CPT 83835
Hospital Charge Code	2029237
Hospital Revenue Code	301
Min. Negotiated Rate	$100.88
Max. Negotiated Rate	$349.20
Rate for Payer: Aetna of AZ Commercial	$349.20
Rate for Payer: Bisbee Police All Plans	$100.88
Rate for Payer: Cash Price	$310.40
Rate for Payer: Self Pay Self Pay	$310.40

Metanephrines, Frac, Qn, 24-Hr LC

Facility

$370.00

Service Code	CPT 83835
Hospital Charge Code	1909517
Hospital Revenue Code	301
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Aetna of AZ Medicare	$103.60
Rate for Payer: Allwell Medicare	$59.20
Rate for Payer: Amerigroup Medicare	$59.20
Rate for Payer: APIPA Medicare/Medicaid	$138.19
Rate for Payer: AZCH Complete Medicare	$59.20
Rate for Payer: Banner UC Health Medicare	$59.20
Rate for Payer: Bisbee Police All Plans	$96.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$251.60
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cigna of AZ Commercial	$240.50
Rate for Payer: Copperpoint Commercial	$91.58
Rate for Payer: Health Net of AZ Commercial	$222.00
Rate for Payer: Health Net of AZ Medicare	$103.60
Rate for Payer: Humana of AZ Medicare	$59.20
Rate for Payer: Self Pay Self Pay	$296.00
Rate for Payer: TriWest Medicare	$59.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$215.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$66.60

Metanephrines, Frac, Qn, 24-Hr LC

Facility

$370.00

Service Code	CPT 83835
Hospital Charge Code	1909517
Hospital Revenue Code	301
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Bisbee Police All Plans	$96.20
Rate for Payer: Cash Price	$296.00
Rate for Payer: Self Pay Self Pay	$296.00

METER PEAK FLOW ADULT

Facility

$75.00

Hospital Charge Code	22354322
Hospital Revenue Code	270
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Aetna of AZ Medicare	$21.00
Rate for Payer: Allwell Medicare	$12.00
Rate for Payer: Amerigroup Medicare	$12.00
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicare	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Copperpoint Commercial	$18.56
Rate for Payer: Health Net of AZ Commercial	$45.00
Rate for Payer: Health Net of AZ Medicare	$21.00
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

METER PEAK FLOW ADULT

Facility

$75.00

Hospital Charge Code	22354322
Hospital Revenue Code	270
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Cash Price	$60.00
Rate for Payer: Self Pay Self Pay	$60.00

metFORMIN 500 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904668961
Hospital Charge Code	105931108
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: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
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	$0.04
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

metFORMIN 500 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904668961
Hospital Charge Code	105931108
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.05

metFORMIN 850 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 60687014301
Hospital Charge Code	105931041
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.09
Rate for Payer: Self Pay Self Pay	$0.09

metFORMIN 850 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 60687014301
Hospital Charge Code	105931041
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
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	$0.07
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

methocarbamol 500 mg Tab UD[CQCH]

Facility

$0.18

Service Code	NDC 63739099110
Hospital Charge Code	241829846
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.15
Rate for Payer: Self Pay Self Pay	$0.14

methocarbamol 500 mg Tab UD[CQCH]

Facility

$0.18

Service Code	NDC 63739099110
Hospital Charge Code	241829846
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
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	$0.07
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	$0.12
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.11
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

methohexital 500 mg IV Inj [CQCH]

Facility

$51.28

Service Code	NDC 42023010501
Hospital Charge Code	105931179
Hospital Revenue Code	251
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna of AZ Commercial	$46.15
Rate for Payer: Bisbee Police All Plans	$13.33
Rate for Payer: Cash Price	$41.02
Rate for Payer: Self Pay Self Pay	$41.02

methohexital 500 mg IV Inj [CQCH]

Facility

$51.28

Service Code	NDC 42023010501
Hospital Charge Code	105931179
Hospital Revenue Code	251
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna of AZ Commercial	$46.15
Rate for Payer: Aetna of AZ Medicare	$14.36
Rate for Payer: Allwell Medicare	$8.20
Rate for Payer: Amerigroup Medicare	$8.20
Rate for Payer: APIPA Medicare/Medicaid	$19.15
Rate for Payer: AZCH Complete Medicare	$8.20
Rate for Payer: Banner UC Health Medicare	$8.20
Rate for Payer: Bisbee Police All Plans	$13.33
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.87
Rate for Payer: Cash Price	$41.02
Rate for Payer: Cigna of AZ Commercial	$33.33
Rate for Payer: Copperpoint Commercial	$12.69
Rate for Payer: Health Net of AZ Commercial	$30.77
Rate for Payer: Health Net of AZ Medicare	$14.36
Rate for Payer: Humana of AZ Medicare	$8.20
Rate for Payer: Self Pay Self Pay	$41.02
Rate for Payer: TriWest Medicare	$8.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.23

methylene blue 5 mg/mL Sol 10 mL vial [CQCH]

Facility

$16.19

Service Code	NDC 517037405
Hospital Charge Code	116777202
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna of AZ Commercial	$14.57
Rate for Payer: Aetna of AZ Medicare	$4.53
Rate for Payer: Allwell Medicare	$2.59
Rate for Payer: Amerigroup Medicare	$2.59
Rate for Payer: APIPA Medicare/Medicaid	$6.05
Rate for Payer: AZCH Complete Medicare	$2.59
Rate for Payer: Banner UC Health Medicare	$2.59
Rate for Payer: Bisbee Police All Plans	$4.21
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$11.01
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cigna of AZ Commercial	$10.52
Rate for Payer: Copperpoint Commercial	$4.01
Rate for Payer: Health Net of AZ Commercial	$9.71
Rate for Payer: Health Net of AZ Medicare	$4.53
Rate for Payer: Humana of AZ Medicare	$2.59
Rate for Payer: Self Pay Self Pay	$12.95
Rate for Payer: TriWest Medicare	$2.59
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.91

methylene blue 5 mg/mL Sol 10 mL vial [CQCH]

Facility

$16.19

Service Code	NDC 517037405
Hospital Charge Code	116777202
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna of AZ Commercial	$14.57
Rate for Payer: Bisbee Police All Plans	$4.21
Rate for Payer: Cash Price	$12.95
Rate for Payer: Self Pay Self Pay	$12.95

methylergonovine 0.2 mg/mL Inj Sol [CQCH]

Facility

$5.81

Service Code	HCPCS J2210
Hospital Charge Code	105931380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna of AZ Commercial	$5.23
Rate for Payer: Aetna of AZ Medicare	$1.63
Rate for Payer: Allwell Medicare	$0.93
Rate for Payer: Amerigroup Medicare	$0.93
Rate for Payer: APIPA Medicare/Medicaid	$2.17
Rate for Payer: AZCH Complete Medicare	$0.93
Rate for Payer: Banner UC Health Medicare	$0.93
Rate for Payer: Bisbee Police All Plans	$1.51
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.95
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cigna of AZ Commercial	$3.78
Rate for Payer: Copperpoint Commercial	$1.44
Rate for Payer: Health Net of AZ Commercial	$3.49
Rate for Payer: Health Net of AZ Medicare	$1.63
Rate for Payer: Humana of AZ Medicare	$0.93
Rate for Payer: Self Pay Self Pay	$4.65
Rate for Payer: TriWest Medicare	$0.93
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.05

methylergonovine 0.2 mg/mL Inj Sol [CQCH]

Facility

$5.81

Service Code	HCPCS J2210
Hospital Charge Code	105931380
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna of AZ Commercial	$5.23
Rate for Payer: Bisbee Police All Plans	$1.51
Rate for Payer: Cash Price	$4.65
Rate for Payer: Self Pay Self Pay	$4.65

Methylmalonic Acid, Serum LC

Facility

$382.00

Service Code	CPT 83921
Hospital Charge Code	2029210
Hospital Revenue Code	301
Min. Negotiated Rate	$99.32
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Bisbee Police All Plans	$99.32
Rate for Payer: Cash Price	$305.60
Rate for Payer: Self Pay Self Pay	$305.60

Methylmalonic Acid, Serum LC

Facility

$382.00

Service Code	CPT 83921
Hospital Charge Code	2029210
Hospital Revenue Code	301
Min. Negotiated Rate	$61.12
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Aetna of AZ Medicare	$106.96
Rate for Payer: Allwell Medicare	$61.12
Rate for Payer: Amerigroup Medicare	$61.12
Rate for Payer: APIPA Medicare/Medicaid	$142.68
Rate for Payer: AZCH Complete Medicare	$61.12
Rate for Payer: Banner UC Health Medicare	$61.12
Rate for Payer: Bisbee Police All Plans	$99.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$259.76
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cigna of AZ Commercial	$248.30
Rate for Payer: Copperpoint Commercial	$94.55
Rate for Payer: Health Net of AZ Commercial	$229.20
Rate for Payer: Health Net of AZ Medicare	$106.96
Rate for Payer: Humana of AZ Medicare	$61.12
Rate for Payer: Self Pay Self Pay	$305.60
Rate for Payer: TriWest Medicare	$61.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$222.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.76

Know your out-of-pocket cost for care.

All Charges