Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Migraine And Other Headaches

Facility

$4,679.74

Service Code	APR-DRG 0542
Hospital Charge Code	APRDRG0544
Min. Negotiated Rate	$4,679.74
Max. Negotiated Rate	$4,679.74
Rate for Payer: AHCCCS Medicaid	$4,679.74
Rate for Payer: Allwell Medicaid	$4,679.74
Rate for Payer: AZCH Complete Medicaid	$4,679.74
Rate for Payer: Banner UC Health Medicaid	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74

Migraine And Other Headaches

Facility

$5,772.52

Service Code	APR-DRG 0543
Hospital Charge Code	APRDRG0541
Min. Negotiated Rate	$5,772.52
Max. Negotiated Rate	$5,772.52
Rate for Payer: AHCCCS Medicaid	$5,772.52
Rate for Payer: Allwell Medicaid	$5,772.52
Rate for Payer: AZCH Complete Medicaid	$5,772.52
Rate for Payer: Banner UC Health Medicaid	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52

Migraine And Other Headaches

Facility

$3,981.85

Service Code	APR-DRG 0541
Hospital Charge Code	APRDRG0542
Min. Negotiated Rate	$3,981.85
Max. Negotiated Rate	$3,981.85
Rate for Payer: AHCCCS Medicaid	$3,981.85
Rate for Payer: Allwell Medicaid	$3,981.85
Rate for Payer: AZCH Complete Medicaid	$3,981.85
Rate for Payer: Banner UC Health Medicaid	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85

Migraine And Other Headaches

Facility

$5,772.52

Service Code	APR-DRG 0543
Hospital Charge Code	APRDRG0542
Min. Negotiated Rate	$5,772.52
Max. Negotiated Rate	$5,772.52
Rate for Payer: AHCCCS Medicaid	$5,772.52
Rate for Payer: Allwell Medicaid	$5,772.52
Rate for Payer: AZCH Complete Medicaid	$5,772.52
Rate for Payer: Banner UC Health Medicaid	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52

Migraine And Other Headaches

Facility

$10,856.97

Service Code	APR-DRG 0544
Hospital Charge Code	APRDRG0541
Min. Negotiated Rate	$10,856.97
Max. Negotiated Rate	$10,856.97
Rate for Payer: AHCCCS Medicaid	$10,856.97
Rate for Payer: Allwell Medicaid	$10,856.97
Rate for Payer: AZCH Complete Medicaid	$10,856.97
Rate for Payer: Banner UC Health Medicaid	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97

Migraine And Other Headaches

Facility

$4,679.74

Service Code	APR-DRG 0542
Hospital Charge Code	APRDRG0541
Min. Negotiated Rate	$4,679.74
Max. Negotiated Rate	$4,679.74
Rate for Payer: AHCCCS Medicaid	$4,679.74
Rate for Payer: Allwell Medicaid	$4,679.74
Rate for Payer: AZCH Complete Medicaid	$4,679.74
Rate for Payer: Banner UC Health Medicaid	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74

Migraine And Other Headaches

Facility

$5,772.52

Service Code	APR-DRG 0543
Hospital Charge Code	APRDRG0544
Min. Negotiated Rate	$5,772.52
Max. Negotiated Rate	$5,772.52
Rate for Payer: AHCCCS Medicaid	$5,772.52
Rate for Payer: Allwell Medicaid	$5,772.52
Rate for Payer: AZCH Complete Medicaid	$5,772.52
Rate for Payer: Banner UC Health Medicaid	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52

Migraine And Other Headaches

Facility

$10,856.97

Service Code	APR-DRG 0544
Hospital Charge Code	APRDRG0544
Min. Negotiated Rate	$10,856.97
Max. Negotiated Rate	$10,856.97
Rate for Payer: AHCCCS Medicaid	$10,856.97
Rate for Payer: Allwell Medicaid	$10,856.97
Rate for Payer: AZCH Complete Medicaid	$10,856.97
Rate for Payer: Banner UC Health Medicaid	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97

Migraine And Other Headaches

Facility

$4,679.74

Service Code	APR-DRG 0542
Hospital Charge Code	APRDRG0542
Min. Negotiated Rate	$4,679.74
Max. Negotiated Rate	$4,679.74
Rate for Payer: AHCCCS Medicaid	$4,679.74
Rate for Payer: Allwell Medicaid	$4,679.74
Rate for Payer: AZCH Complete Medicaid	$4,679.74
Rate for Payer: Banner UC Health Medicaid	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74

Migraine And Other Headaches

Facility

$10,856.97

Service Code	APR-DRG 0544
Hospital Charge Code	APRDRG0543
Min. Negotiated Rate	$10,856.97
Max. Negotiated Rate	$10,856.97
Rate for Payer: AHCCCS Medicaid	$10,856.97
Rate for Payer: Allwell Medicaid	$10,856.97
Rate for Payer: AZCH Complete Medicaid	$10,856.97
Rate for Payer: Banner UC Health Medicaid	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97

Migraine And Other Headaches

Facility

$10,856.97

Service Code	APR-DRG 0544
Hospital Charge Code	APRDRG0542
Min. Negotiated Rate	$10,856.97
Max. Negotiated Rate	$10,856.97
Rate for Payer: AHCCCS Medicaid	$10,856.97
Rate for Payer: Allwell Medicaid	$10,856.97
Rate for Payer: AZCH Complete Medicaid	$10,856.97
Rate for Payer: Banner UC Health Medicaid	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97

Migraine And Other Headaches

Facility

$3,981.85

Service Code	APR-DRG 0541
Hospital Charge Code	APRDRG0544
Min. Negotiated Rate	$3,981.85
Max. Negotiated Rate	$3,981.85
Rate for Payer: AHCCCS Medicaid	$3,981.85
Rate for Payer: Allwell Medicaid	$3,981.85
Rate for Payer: AZCH Complete Medicaid	$3,981.85
Rate for Payer: Banner UC Health Medicaid	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85

Migraine And Other Headaches

Facility

$3,981.85

Service Code	APR-DRG 0541
Hospital Charge Code	APRDRG0543
Min. Negotiated Rate	$3,981.85
Max. Negotiated Rate	$3,981.85
Rate for Payer: AHCCCS Medicaid	$3,981.85
Rate for Payer: Allwell Medicaid	$3,981.85
Rate for Payer: AZCH Complete Medicaid	$3,981.85
Rate for Payer: Banner UC Health Medicaid	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85

milk of magnesia Conc. UD 10 mL [CQCH]

Facility

$0.07

Service Code	NDC 121052710
Hospital Charge Code	108074751
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

milk of magnesia Conc. UD 10 mL [CQCH]

Facility

$0.07

Service Code	NDC 121052710
Hospital Charge Code	108074751
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
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	$0.03
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	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
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	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Mineral oil enema 4.5 ounce [CQCH]

Facility

$1.56

Service Code	NDC 132030140
Hospital Charge Code	105940981
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of AZ Commercial	$1.40
Rate for Payer: Aetna of AZ Medicare	$0.44
Rate for Payer: Allwell Medicare	$0.23
Rate for Payer: Amerigroup Medicare	$0.23
Rate for Payer: APIPA Medicare/Medicaid	$0.58
Rate for Payer: AZCH Complete Medicare	$0.23
Rate for Payer: Banner UC Health Medicare	$0.23
Rate for Payer: Bisbee Police All Plans	$0.41
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.06
Rate for Payer: Cash Price	$1.25
Rate for Payer: Cigna of AZ Commercial	$1.01
Rate for Payer: Copperpoint Commercial	$0.39
Rate for Payer: Health Net of AZ Commercial	$0.94
Rate for Payer: Health Net of AZ Medicare	$0.44
Rate for Payer: Humana of AZ Medicare	$0.23
Rate for Payer: Self Pay Self Pay	$1.25
Rate for Payer: TriWest Medicare	$0.23
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.28

Mineral oil enema 4.5 ounce [CQCH]

Facility

$1.56

Service Code	NDC 132030140
Hospital Charge Code	105940981
Hospital Revenue Code	251
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of AZ Commercial	$1.40
Rate for Payer: Bisbee Police All Plans	$0.41
Rate for Payer: Cash Price	$1.25
Rate for Payer: Self Pay Self Pay	$1.25

mineral oil lubricant 10mL [CQCH]

Facility

$1.05

Service Code	NDC 63323025410
Hospital Charge Code	112812835
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of AZ Commercial	$0.95
Rate for Payer: Aetna of AZ Medicare	$0.29
Rate for Payer: Allwell Medicare	$0.16
Rate for Payer: Amerigroup Medicare	$0.16
Rate for Payer: APIPA Medicare/Medicaid	$0.39
Rate for Payer: AZCH Complete Medicare	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Bisbee Police All Plans	$0.27
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.71
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cigna of AZ Commercial	$0.68
Rate for Payer: Copperpoint Commercial	$0.26
Rate for Payer: Health Net of AZ Commercial	$0.63
Rate for Payer: Health Net of AZ Medicare	$0.29
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Self Pay Self Pay	$0.84
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.19

mineral oil lubricant 10mL [CQCH]

Facility

$1.05

Service Code	NDC 63323025410
Hospital Charge Code	112812835
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of AZ Commercial	$0.95
Rate for Payer: Bisbee Police All Plans	$0.27
Rate for Payer: Cash Price	$0.84
Rate for Payer: Self Pay Self Pay	$0.84

Minimum Inhibitory Concentration

Facility

$145.00

Service Code	CPT 87077
Hospital Charge Code	294946
Hospital Revenue Code	306
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of AZ Commercial	$130.50
Rate for Payer: Bisbee Police All Plans	$37.70
Rate for Payer: Cash Price	$116.00
Rate for Payer: Self Pay Self Pay	$116.00

Minimum Inhibitory Concentration

Facility

$145.00

Service Code	CPT 87077
Hospital Charge Code	294946
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of AZ Commercial	$130.50
Rate for Payer: Aetna of AZ Medicare	$40.60
Rate for Payer: AHCCCS Medicaid	$8.08
Rate for Payer: Allwell Medicaid	$8.08
Rate for Payer: Allwell Medicare	$21.75
Rate for Payer: Amerigroup Medicare	$21.75
Rate for Payer: APIPA Medicare/Medicaid	$54.16
Rate for Payer: AZCH Complete Medicaid	$8.08
Rate for Payer: AZCH Complete Medicare	$21.75
Rate for Payer: Banner UC Health Medicaid	$8.08
Rate for Payer: Banner UC Health Medicare	$21.75
Rate for Payer: Bisbee Police All Plans	$37.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$98.60
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cigna of AZ Commercial	$94.25
Rate for Payer: Copperpoint Commercial	$35.89
Rate for Payer: Health Net of AZ Commercial	$87.00
Rate for Payer: Health Net of AZ Medicare	$40.60
Rate for Payer: Humana of AZ Medicare	$21.75
Rate for Payer: Mercy Care Medicaid	$8.08
Rate for Payer: Self Pay Self Pay	$116.00
Rate for Payer: TriWest Medicare	$21.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$84.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.10

Mini-Neb Initial

Facility

$111.00

Service Code	CPT 94664
Hospital Charge Code	1886941
Hospital Revenue Code	460
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Cash Price	$88.80
Rate for Payer: Self Pay Self Pay	$88.80

Mini-Neb Initial

Facility

$111.00

Service Code	CPT 94664
Hospital Charge Code	1886941
Hospital Revenue Code	460
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$272.42
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Aetna of AZ Medicare	$31.08
Rate for Payer: AHCCCS Medicaid	$272.42
Rate for Payer: Allwell Medicaid	$272.42
Rate for Payer: Allwell Medicare	$16.65
Rate for Payer: Amerigroup Medicare	$16.65
Rate for Payer: APIPA Medicare/Medicaid	$41.46
Rate for Payer: AZCH Complete Medicaid	$272.42
Rate for Payer: AZCH Complete Medicare	$16.65
Rate for Payer: Banner UC Health Medicaid	$272.42
Rate for Payer: Banner UC Health Medicare	$16.65
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$75.48
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cigna of AZ Commercial	$77.70
Rate for Payer: Copperpoint Commercial	$27.47
Rate for Payer: Health Net of AZ Commercial	$66.60
Rate for Payer: Health Net of AZ Medicare	$31.08
Rate for Payer: Humana of AZ Medicare	$16.65
Rate for Payer: Mercy Care Medicaid	$272.42
Rate for Payer: Self Pay Self Pay	$88.80
Rate for Payer: TriWest Medicare	$16.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$64.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.98

Mini-Neb Subsequent

Facility

$154.00

Service Code	CPT 94640
Hospital Charge Code	1886942
Hospital Revenue Code	410
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$138.60
Rate for Payer: Aetna of AZ Commercial	$138.60
Rate for Payer: Bisbee Police All Plans	$40.04
Rate for Payer: Cash Price	$123.20
Rate for Payer: Self Pay Self Pay	$123.20

Mini-Neb Subsequent

Facility

$154.00

Service Code	CPT 94640
Hospital Charge Code	1886942
Hospital Revenue Code	410
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$272.42
Rate for Payer: Aetna of AZ Commercial	$138.60
Rate for Payer: Aetna of AZ Medicare	$43.12
Rate for Payer: AHCCCS Medicaid	$272.42
Rate for Payer: Allwell Medicaid	$272.42
Rate for Payer: Allwell Medicare	$23.10
Rate for Payer: Amerigroup Medicare	$23.10
Rate for Payer: APIPA Medicare/Medicaid	$57.52
Rate for Payer: AZCH Complete Medicaid	$272.42
Rate for Payer: AZCH Complete Medicare	$23.10
Rate for Payer: Banner UC Health Medicaid	$272.42
Rate for Payer: Banner UC Health Medicare	$23.10
Rate for Payer: Bisbee Police All Plans	$40.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$104.72
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cigna of AZ Commercial	$107.80
Rate for Payer: Copperpoint Commercial	$38.12
Rate for Payer: Health Net of AZ Commercial	$92.40
Rate for Payer: Health Net of AZ Medicare	$43.12
Rate for Payer: Humana of AZ Medicare	$23.10
Rate for Payer: Mercy Care Medicaid	$272.42
Rate for Payer: Self Pay Self Pay	$123.20
Rate for Payer: TriWest Medicare	$23.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$89.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.72

Know your out-of-pocket cost for care.

All Charges