Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Occult Blood, Gastric

Facility

$126.00

Service Code	CPT 82271
Hospital Charge Code	22146128
Hospital Revenue Code	301
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Aetna of AZ Medicare	$35.28
Rate for Payer: Allwell Medicare	$20.16
Rate for Payer: Amerigroup Medicare	$20.16
Rate for Payer: APIPA Medicare/Medicaid	$47.06
Rate for Payer: AZCH Complete Medicare	$20.16
Rate for Payer: Banner UC Health Medicare	$20.16
Rate for Payer: Bisbee Police All Plans	$32.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$85.68
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna of AZ Commercial	$81.90
Rate for Payer: Copperpoint Commercial	$31.18
Rate for Payer: Health Net of AZ Commercial	$75.60
Rate for Payer: Health Net of AZ Medicare	$35.28
Rate for Payer: Humana of AZ Medicare	$20.16
Rate for Payer: Self Pay Self Pay	$100.80
Rate for Payer: TriWest Medicare	$20.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$73.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.68

Occult Blood Stool 1-3

Facility

$89.00

Service Code	CPT 82270
Hospital Charge Code	22283360
Hospital Revenue Code	301
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Aetna of AZ Medicare	$24.92
Rate for Payer: Allwell Medicare	$14.24
Rate for Payer: Amerigroup Medicare	$14.24
Rate for Payer: APIPA Medicare/Medicaid	$33.24
Rate for Payer: AZCH Complete Medicare	$14.24
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$60.52
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$57.85
Rate for Payer: Copperpoint Commercial	$22.03
Rate for Payer: Health Net of AZ Commercial	$53.40
Rate for Payer: Health Net of AZ Medicare	$24.92
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Self Pay Self Pay	$71.20
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.02

Occult Blood Stool 1-3

Facility

$89.00

Service Code	CPT 82270
Hospital Charge Code	22283360
Hospital Revenue Code	301
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Cash Price	$71.20
Rate for Payer: Self Pay Self Pay	$71.20

ocrelizumab 300 mg/10 mL Sol[CQCH]

Facility

$1,877.56

Service Code	HCPCS J2350
Hospital Charge Code	215329113
Hospital Revenue Code	250
Min. Negotiated Rate	$300.41
Max. Negotiated Rate	$1,689.80
Rate for Payer: Aetna of AZ Commercial	$1,689.80
Rate for Payer: Aetna of AZ Medicare	$525.72
Rate for Payer: Allwell Medicare	$300.41
Rate for Payer: Amerigroup Medicare	$300.41
Rate for Payer: APIPA Medicare/Medicaid	$701.27
Rate for Payer: AZCH Complete Medicare	$300.41
Rate for Payer: Banner UC Health Medicare	$300.41
Rate for Payer: Bisbee Police All Plans	$488.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,276.74
Rate for Payer: Cash Price	$1,502.05
Rate for Payer: Cigna of AZ Commercial	$1,220.41
Rate for Payer: Copperpoint Commercial	$464.70
Rate for Payer: Health Net of AZ Commercial	$1,126.54
Rate for Payer: Health Net of AZ Medicare	$525.72
Rate for Payer: Humana of AZ Medicare	$300.41
Rate for Payer: Self Pay Self Pay	$1,502.05
Rate for Payer: TriWest Medicare	$300.41
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,094.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$337.96

ocrelizumab 300 mg/10 mL Sol[CQCH]

Facility

$1,877.56

Service Code	HCPCS J2350
Hospital Charge Code	215329113
Hospital Revenue Code	250
Min. Negotiated Rate	$488.17
Max. Negotiated Rate	$1,689.80
Rate for Payer: Aetna of AZ Commercial	$1,689.80
Rate for Payer: Bisbee Police All Plans	$488.17
Rate for Payer: Cash Price	$1,502.05
Rate for Payer: Self Pay Self Pay	$1,502.05

octreotide 100 mcg/mL Inj Sol [CQCH]

Facility

$2.75

Service Code	HCPCS J2354
Hospital Charge Code	105934605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of AZ Commercial	$2.48
Rate for Payer: Bisbee Police All Plans	$0.72
Rate for Payer: Cash Price	$2.20
Rate for Payer: Self Pay Self Pay	$2.20

octreotide 100 mcg/mL Inj Sol [CQCH]

Facility

$2.75

Service Code	HCPCS J2354
Hospital Charge Code	105934605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna of AZ Commercial	$2.48
Rate for Payer: Aetna of AZ Medicare	$0.77
Rate for Payer: Allwell Medicare	$0.44
Rate for Payer: Amerigroup Medicare	$0.44
Rate for Payer: APIPA Medicare/Medicaid	$1.03
Rate for Payer: AZCH Complete Medicare	$0.44
Rate for Payer: Banner UC Health Medicare	$0.44
Rate for Payer: Bisbee Police All Plans	$0.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.87
Rate for Payer: Cash Price	$2.20
Rate for Payer: Cigna of AZ Commercial	$1.79
Rate for Payer: Copperpoint Commercial	$0.68
Rate for Payer: Health Net of AZ Commercial	$1.65
Rate for Payer: Health Net of AZ Medicare	$0.77
Rate for Payer: Humana of AZ Medicare	$0.44
Rate for Payer: Self Pay Self Pay	$2.20
Rate for Payer: TriWest Medicare	$0.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.50

octreotide 200 mcg/mL Sol [CQCH]

Facility

$4.41

Service Code	HCPCS J2354
Hospital Charge Code	206194616
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$3.97
Rate for Payer: Aetna of AZ Commercial	$3.97
Rate for Payer: Bisbee Police All Plans	$1.15
Rate for Payer: Cash Price	$3.53
Rate for Payer: Self Pay Self Pay	$3.53

octreotide 200 mcg/mL Sol [CQCH]

Facility

$4.41

Service Code	HCPCS J2354
Hospital Charge Code	206194616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$3.97
Rate for Payer: Aetna of AZ Commercial	$3.97
Rate for Payer: Aetna of AZ Medicare	$1.23
Rate for Payer: Allwell Medicare	$0.71
Rate for Payer: Amerigroup Medicare	$0.71
Rate for Payer: APIPA Medicare/Medicaid	$1.65
Rate for Payer: AZCH Complete Medicare	$0.71
Rate for Payer: Banner UC Health Medicare	$0.71
Rate for Payer: Bisbee Police All Plans	$1.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.00
Rate for Payer: Cash Price	$3.53
Rate for Payer: Cigna of AZ Commercial	$2.87
Rate for Payer: Copperpoint Commercial	$1.09
Rate for Payer: Health Net of AZ Commercial	$2.65
Rate for Payer: Health Net of AZ Medicare	$1.23
Rate for Payer: Humana of AZ Medicare	$0.71
Rate for Payer: Self Pay Self Pay	$3.53
Rate for Payer: TriWest Medicare	$0.71
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.79

OLANZapine 10 mg Injection[CQCH]

Facility

$20.93

Service Code	NDC 781910572
Hospital Charge Code	168103443
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$18.84
Rate for Payer: Aetna of AZ Commercial	$18.84
Rate for Payer: Bisbee Police All Plans	$5.44
Rate for Payer: Cash Price	$16.74
Rate for Payer: Self Pay Self Pay	$16.74

OLANZapine 10 mg Injection[CQCH]

Facility

$20.93

Service Code	NDC 781910572
Hospital Charge Code	168103443
Hospital Revenue Code	250
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$18.84
Rate for Payer: Aetna of AZ Commercial	$18.84
Rate for Payer: Aetna of AZ Medicare	$5.86
Rate for Payer: Allwell Medicare	$3.35
Rate for Payer: Amerigroup Medicare	$3.35
Rate for Payer: APIPA Medicare/Medicaid	$7.82
Rate for Payer: AZCH Complete Medicare	$3.35
Rate for Payer: Banner UC Health Medicare	$3.35
Rate for Payer: Bisbee Police All Plans	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.23
Rate for Payer: Cash Price	$16.74
Rate for Payer: Cigna of AZ Commercial	$13.60
Rate for Payer: Copperpoint Commercial	$5.18
Rate for Payer: Health Net of AZ Commercial	$12.56
Rate for Payer: Health Net of AZ Medicare	$5.86
Rate for Payer: Humana of AZ Medicare	$3.35
Rate for Payer: Self Pay Self Pay	$16.74
Rate for Payer: TriWest Medicare	$3.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.77

OLANZapine 5 mg Tab [CQCH]

Facility

$0.36

Service Code	NDC 60505311100
Hospital Charge Code	105969103
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.29
Rate for Payer: Self Pay Self Pay	$0.29

OLANZapine 5 mg Tab [CQCH]

Facility

$0.36

Service Code	NDC 60505311100
Hospital Charge Code	105969103
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.24
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.22
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.29
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

OLYMPUS SHOCKPULSE PROBE

Facility

$1,988.00

Hospital Charge Code	22619416
Hospital Revenue Code	272
Min. Negotiated Rate	$318.08
Max. Negotiated Rate	$1,789.20
Rate for Payer: Aetna of AZ Commercial	$1,789.20
Rate for Payer: Aetna of AZ Medicare	$556.64
Rate for Payer: Allwell Medicare	$318.08
Rate for Payer: Amerigroup Medicare	$318.08
Rate for Payer: APIPA Medicare/Medicaid	$742.52
Rate for Payer: AZCH Complete Medicare	$318.08
Rate for Payer: Banner UC Health Medicare	$318.08
Rate for Payer: Bisbee Police All Plans	$516.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,351.84
Rate for Payer: Cash Price	$1,590.40
Rate for Payer: Cigna of AZ Commercial	$1,391.60
Rate for Payer: Copperpoint Commercial	$492.03
Rate for Payer: Health Net of AZ Commercial	$1,192.80
Rate for Payer: Health Net of AZ Medicare	$556.64
Rate for Payer: Humana of AZ Medicare	$318.08
Rate for Payer: Self Pay Self Pay	$1,590.40
Rate for Payer: TriWest Medicare	$318.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,159.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$357.84

OLYMPUS SHOCKPULSE PROBE

Facility

$1,988.00

Hospital Charge Code	22619416
Hospital Revenue Code	272
Min. Negotiated Rate	$516.88
Max. Negotiated Rate	$1,789.20
Rate for Payer: Aetna of AZ Commercial	$1,789.20
Rate for Payer: Bisbee Police All Plans	$516.88
Rate for Payer: Cash Price	$1,590.40
Rate for Payer: Self Pay Self Pay	$1,590.40

OMNI JUG

Facility

$95.00

Hospital Charge Code	22354804
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Aetna of AZ Medicare	$26.60
Rate for Payer: Allwell Medicare	$15.20
Rate for Payer: Amerigroup Medicare	$15.20
Rate for Payer: APIPA Medicare/Medicaid	$35.48
Rate for Payer: AZCH Complete Medicare	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$64.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Copperpoint Commercial	$23.51
Rate for Payer: Health Net of AZ Commercial	$57.00
Rate for Payer: Health Net of AZ Medicare	$26.60
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Self Pay Self Pay	$76.00
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.10

OMNI JUG

Facility

$95.00

Hospital Charge Code	22354804
Hospital Revenue Code	270
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Cash Price	$76.00
Rate for Payer: Self Pay Self Pay	$76.00

ondansetron 2 mg/mL Sol[CQCH]

Facility

$0.19

Service Code	HCPCS J2405
Hospital Charge Code	169831043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
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	$0.13
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.05
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	$0.15
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

ondansetron 2 mg/mL Sol[CQCH]

Facility

$0.19

Service Code	HCPCS J2405
Hospital Charge Code	169831043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.15

ondansetron 4 mg Dis Tab [CQCH]

Facility

$0.23

Service Code	HCPCS Q0162
Hospital Charge Code	105934883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of AZ Commercial	$0.21
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.19
Rate for Payer: Self Pay Self Pay	$0.18

ondansetron 4 mg Dis Tab [CQCH]

Facility

$0.23

Service Code	HCPCS Q0162
Hospital Charge Code	105934883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of AZ Commercial	$0.21
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.09
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.16
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.15
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.14
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: AHCCCS Medicaid	$17,671.77
Rate for Payer: Allwell Medicaid	$17,671.77
Rate for Payer: AZCH Complete Medicaid	$17,671.77
Rate for Payer: Banner UC Health Medicaid	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: AHCCCS Medicaid	$17,671.77
Rate for Payer: Allwell Medicaid	$17,671.77
Rate for Payer: AZCH Complete Medicaid	$17,671.77
Rate for Payer: Banner UC Health Medicaid	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: AHCCCS Medicaid	$13,508.96
Rate for Payer: Allwell Medicaid	$13,508.96
Rate for Payer: AZCH Complete Medicaid	$13,508.96
Rate for Payer: Banner UC Health Medicaid	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: AHCCCS Medicaid	$13,508.96
Rate for Payer: Allwell Medicaid	$13,508.96
Rate for Payer: AZCH Complete Medicaid	$13,508.96
Rate for Payer: Banner UC Health Medicaid	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96

Know your out-of-pocket cost for care.

All Charges