Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

morphine 10 mg/5 mL Oral Sol UD [CQCH]

Facility

$0.24

Service Code	NDC 66689003250
Hospital Charge Code	105964301
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.19
Rate for Payer: Self Pay Self Pay	$0.19

morphine 10 mg/mL preservative-free Sol[CQCH]

Facility

$1.94

Service Code	HCPCS J2274
Hospital Charge Code	169360742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna of AZ Commercial	$1.75
Rate for Payer: Aetna of AZ Medicare	$0.54
Rate for Payer: Allwell Medicare	$0.31
Rate for Payer: Amerigroup Medicare	$0.31
Rate for Payer: APIPA Medicare/Medicaid	$0.72
Rate for Payer: AZCH Complete Medicare	$0.31
Rate for Payer: Banner UC Health Medicare	$0.31
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.32
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of AZ Commercial	$1.26
Rate for Payer: Copperpoint Commercial	$0.48
Rate for Payer: Health Net of AZ Commercial	$1.16
Rate for Payer: Health Net of AZ Medicare	$0.54
Rate for Payer: Humana of AZ Medicare	$0.31
Rate for Payer: Self Pay Self Pay	$1.55
Rate for Payer: TriWest Medicare	$0.31
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.35

morphine 10 mg/mL preservative-free Sol[CQCH]

Facility

$1.94

Service Code	HCPCS J2274
Hospital Charge Code	169360742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna of AZ Commercial	$1.75
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Cash Price	$1.55
Rate for Payer: Self Pay Self Pay	$1.55

morphine 15 mg ER Tab [CQCH]

Facility

$0.49

Service Code	NDC 406831562
Hospital Charge Code	105932700
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of AZ Commercial	$0.44
Rate for Payer: Bisbee Police All Plans	$0.13
Rate for Payer: Cash Price	$0.39
Rate for Payer: Self Pay Self Pay	$0.39

morphine 15 mg ER Tab [CQCH]

Facility

$0.49

Service Code	NDC 406831562
Hospital Charge Code	105932700
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of AZ Commercial	$0.44
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	$0.18
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	$0.33
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of AZ Commercial	$0.32
Rate for Payer: Copperpoint Commercial	$0.12
Rate for Payer: Health Net of AZ Commercial	$0.29
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	$0.39
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

morphine 15 mg Tab-IR [CQCH]

Facility

$0.33

Service Code	NDC 832027311
Hospital Charge Code	145868627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Aetna of AZ Medicare	$0.09
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.12
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.22
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of AZ Commercial	$0.21
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.20
Rate for Payer: Health Net of AZ Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.26
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

morphine 15 mg Tab-IR [CQCH]

Facility

$0.33

Service Code	NDC 832027311
Hospital Charge Code	145868627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.27
Rate for Payer: Self Pay Self Pay	$0.26

morphine 2 mg/ 1 mL Inj Soln [CQCH]

Facility

$1.73

Service Code	HCPCS J2270
Hospital Charge Code	105932635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of AZ Commercial	$1.56
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Cash Price	$1.38
Rate for Payer: Self Pay Self Pay	$1.38

morphine 2 mg/ 1 mL Inj Soln [CQCH]

Facility

$1.73

Service Code	HCPCS J2270
Hospital Charge Code	105932635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of AZ Commercial	$1.56
Rate for Payer: Aetna of AZ Medicare	$0.48
Rate for Payer: Allwell Medicare	$0.28
Rate for Payer: Amerigroup Medicare	$0.28
Rate for Payer: APIPA Medicare/Medicaid	$0.65
Rate for Payer: AZCH Complete Medicare	$0.28
Rate for Payer: Banner UC Health Medicare	$0.28
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.18
Rate for Payer: Cash Price	$1.38
Rate for Payer: Cigna of AZ Commercial	$1.12
Rate for Payer: Copperpoint Commercial	$0.43
Rate for Payer: Health Net of AZ Commercial	$1.04
Rate for Payer: Health Net of AZ Medicare	$0.48
Rate for Payer: Humana of AZ Medicare	$0.28
Rate for Payer: Self Pay Self Pay	$1.38
Rate for Payer: TriWest Medicare	$0.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.31

morphine 4 mg/ 1 mL Inj Sol [CQCH]

Facility

$1.68

Service Code	HCPCS J2270
Hospital Charge Code	105932899
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.51
Rate for Payer: Aetna of AZ Commercial	$1.51
Rate for Payer: Aetna of AZ Medicare	$0.47
Rate for Payer: Allwell Medicare	$0.27
Rate for Payer: Amerigroup Medicare	$0.27
Rate for Payer: APIPA Medicare/Medicaid	$0.63
Rate for Payer: AZCH Complete Medicare	$0.27
Rate for Payer: Banner UC Health Medicare	$0.27
Rate for Payer: Bisbee Police All Plans	$0.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.14
Rate for Payer: Cash Price	$1.34
Rate for Payer: Cigna of AZ Commercial	$1.09
Rate for Payer: Copperpoint Commercial	$0.42
Rate for Payer: Health Net of AZ Commercial	$1.01
Rate for Payer: Health Net of AZ Medicare	$0.47
Rate for Payer: Humana of AZ Medicare	$0.27
Rate for Payer: Self Pay Self Pay	$1.34
Rate for Payer: TriWest Medicare	$0.27
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.30

morphine 4 mg/ 1 mL Inj Sol [CQCH]

Facility

$1.68

Service Code	HCPCS J2270
Hospital Charge Code	105932899
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.51
Rate for Payer: Aetna of AZ Commercial	$1.51
Rate for Payer: Bisbee Police All Plans	$0.44
Rate for Payer: Cash Price	$1.34
Rate for Payer: Self Pay Self Pay	$1.34

morphine 5 mg/ 1 mL Inj Sol PF [CQCH]

Facility

$1.84

Service Code	HCPCS J2270
Hospital Charge Code	108648889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Cash Price	$1.47
Rate for Payer: Self Pay Self Pay	$1.47

morphine 5 mg/ 1 mL Inj Sol PF [CQCH]

Facility

$1.84

Service Code	HCPCS J2270
Hospital Charge Code	108648889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Aetna of AZ Medicare	$0.52
Rate for Payer: Allwell Medicare	$0.29
Rate for Payer: Amerigroup Medicare	$0.29
Rate for Payer: APIPA Medicare/Medicaid	$0.69
Rate for Payer: AZCH Complete Medicare	$0.29
Rate for Payer: Banner UC Health Medicare	$0.29
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.25
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna of AZ Commercial	$1.20
Rate for Payer: Copperpoint Commercial	$0.46
Rate for Payer: Health Net of AZ Commercial	$1.10
Rate for Payer: Health Net of AZ Medicare	$0.52
Rate for Payer: Humana of AZ Medicare	$0.29
Rate for Payer: Self Pay Self Pay	$1.47
Rate for Payer: TriWest Medicare	$0.29
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.33

morphine 5 mg/mL Sol

Facility

$31.00

Service Code	CPT J2274
Hospital Charge Code	22282603
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of AZ Commercial	$27.90
Rate for Payer: Aetna of AZ Medicare	$8.68
Rate for Payer: Allwell Medicare	$4.96
Rate for Payer: Amerigroup Medicare	$4.96
Rate for Payer: APIPA Medicare/Medicaid	$11.58
Rate for Payer: AZCH Complete Medicare	$4.96
Rate for Payer: Banner UC Health Medicare	$4.96
Rate for Payer: Bisbee Police All Plans	$8.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21.08
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cigna of AZ Commercial	$20.15
Rate for Payer: Copperpoint Commercial	$7.67
Rate for Payer: Health Net of AZ Commercial	$18.60
Rate for Payer: Health Net of AZ Medicare	$8.68
Rate for Payer: Humana of AZ Medicare	$4.96
Rate for Payer: Self Pay Self Pay	$24.80
Rate for Payer: TriWest Medicare	$4.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$18.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.58

morphine 5 mg/mL Sol

Facility

$31.00

Service Code	CPT J2274
Hospital Charge Code	22282603
Hospital Revenue Code	250
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of AZ Commercial	$27.90
Rate for Payer: Bisbee Police All Plans	$8.06
Rate for Payer: Cash Price	$24.80
Rate for Payer: Self Pay Self Pay	$24.80

MORPHOMETRIC ANALYSIS

Facility

$551.00

Service Code	CPT 88361
Hospital Charge Code	22545726
Hospital Revenue Code	310
Min. Negotiated Rate	$143.26
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Cash Price	$440.80
Rate for Payer: Self Pay Self Pay	$440.80

MORPHOMETRIC ANALYSIS

Facility

$551.00

Service Code	CPT 88361
Hospital Charge Code	22545726
Hospital Revenue Code	310
Min. Negotiated Rate	$88.16
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Aetna of AZ Medicare	$154.28
Rate for Payer: Allwell Medicare	$88.16
Rate for Payer: Amerigroup Medicare	$88.16
Rate for Payer: APIPA Medicare/Medicaid	$205.80
Rate for Payer: AZCH Complete Medicare	$88.16
Rate for Payer: Banner UC Health Medicare	$88.16
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$374.68
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Copperpoint Commercial	$136.37
Rate for Payer: Health Net of AZ Commercial	$330.60
Rate for Payer: Health Net of AZ Medicare	$154.28
Rate for Payer: Humana of AZ Medicare	$88.16
Rate for Payer: Self Pay Self Pay	$440.80
Rate for Payer: TriWest Medicare	$88.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$321.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.18

Most recent hemoglobin A1c > = 8% and < = 9%

Facility

$0.01

Service Code	CPT 3052F
Hospital Charge Code	27389470
Hospital Revenue Code	301
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Most recent hemoglobin A1c > = 8% and < = 9%

Facility

$0.01

Service Code	CPT 3052F
Hospital Charge Code	27389470
Hospital Revenue Code	301
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

MOTORIZED ABSORBABLE 30 TACK TRACKER

Facility

$2,948.10

Hospital Charge Code	28006934
Hospital Revenue Code	270
Min. Negotiated Rate	$471.70
Max. Negotiated Rate	$2,653.29
Rate for Payer: Aetna of AZ Commercial	$2,653.29
Rate for Payer: Aetna of AZ Medicare	$825.47
Rate for Payer: Allwell Medicare	$471.70
Rate for Payer: Amerigroup Medicare	$471.70
Rate for Payer: APIPA Medicare/Medicaid	$1,101.12
Rate for Payer: AZCH Complete Medicare	$471.70
Rate for Payer: Banner UC Health Medicare	$471.70
Rate for Payer: Bisbee Police All Plans	$766.51
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,004.71
Rate for Payer: Cash Price	$2,358.48
Rate for Payer: Cigna of AZ Commercial	$2,063.67
Rate for Payer: Copperpoint Commercial	$729.65
Rate for Payer: Health Net of AZ Commercial	$1,768.86
Rate for Payer: Health Net of AZ Medicare	$825.47
Rate for Payer: Humana of AZ Medicare	$471.70
Rate for Payer: Self Pay Self Pay	$2,358.48
Rate for Payer: TriWest Medicare	$471.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,718.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$530.66

MOTORIZED ABSORBABLE 30 TACK TRACKER

Facility

$2,948.10

Hospital Charge Code	28006934
Hospital Revenue Code	270
Min. Negotiated Rate	$766.51
Max. Negotiated Rate	$2,653.29
Rate for Payer: Aetna of AZ Commercial	$2,653.29
Rate for Payer: Bisbee Police All Plans	$766.51
Rate for Payer: Cash Price	$2,358.48
Rate for Payer: Self Pay Self Pay	$2,358.48

MPL (MPL PROTO-ONCOGENE, THROMBOPOIETIN RECEPTOR) (EG, MYELO

Facility

$751.00

Service Code	CPT 81338
Hospital Charge Code	28010051
Hospital Revenue Code	302
Min. Negotiated Rate	$120.16
Max. Negotiated Rate	$675.90
Rate for Payer: Aetna of AZ Commercial	$675.90
Rate for Payer: Aetna of AZ Medicare	$210.28
Rate for Payer: Allwell Medicare	$120.16
Rate for Payer: Amerigroup Medicare	$120.16
Rate for Payer: APIPA Medicare/Medicaid	$280.50
Rate for Payer: AZCH Complete Medicare	$120.16
Rate for Payer: Banner UC Health Medicare	$120.16
Rate for Payer: Bisbee Police All Plans	$195.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$510.68
Rate for Payer: Cash Price	$600.80
Rate for Payer: Cigna of AZ Commercial	$488.15
Rate for Payer: Copperpoint Commercial	$185.87
Rate for Payer: Health Net of AZ Commercial	$450.60
Rate for Payer: Health Net of AZ Medicare	$210.28
Rate for Payer: Humana of AZ Medicare	$120.16
Rate for Payer: Self Pay Self Pay	$600.80
Rate for Payer: TriWest Medicare	$120.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$437.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$135.18

MPL (MPL PROTO-ONCOGENE, THROMBOPOIETIN RECEPTOR) (EG, MYELO

Facility

$751.00

Service Code	CPT 81338
Hospital Charge Code	28010051
Hospital Revenue Code	302
Min. Negotiated Rate	$195.26
Max. Negotiated Rate	$675.90
Rate for Payer: Aetna of AZ Commercial	$675.90
Rate for Payer: Bisbee Police All Plans	$195.26
Rate for Payer: Cash Price	$600.80
Rate for Payer: Self Pay Self Pay	$600.80

MRA Abdomen w/ Contrast

Facility

$2,233.00

Service Code	CPT 74185
Hospital Charge Code	2214011
Hospital Revenue Code	610
Min. Negotiated Rate	$357.28
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Aetna of AZ Medicare	$625.24
Rate for Payer: Allwell Medicare	$357.28
Rate for Payer: Amerigroup Medicare	$357.28
Rate for Payer: APIPA Medicare/Medicaid	$834.03
Rate for Payer: AZCH Complete Medicare	$357.28
Rate for Payer: Banner UC Health Medicare	$357.28
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,518.44
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cigna of AZ Commercial	$1,563.10
Rate for Payer: Copperpoint Commercial	$552.67
Rate for Payer: Health Net of AZ Commercial	$1,339.80
Rate for Payer: Health Net of AZ Medicare	$625.24
Rate for Payer: Humana of AZ Medicare	$357.28
Rate for Payer: Self Pay Self Pay	$1,786.40
Rate for Payer: TriWest Medicare	$357.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,301.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$401.94

MRA Abdomen w/ Contrast

Facility

$2,233.00

Service Code	CPT 74185
Hospital Charge Code	2214011
Hospital Revenue Code	610
Min. Negotiated Rate	$580.58
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Self Pay Self Pay	$1,786.40

Know your out-of-pocket cost for care.

All Charges