Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

midodrine 5 mg Tab [CQCH]

Facility

$0.94

Service Code	NDC 51079045320
Hospital Charge Code	105932438
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna of AZ Commercial	$0.85
Rate for Payer: Arizona Complete Health Allwell	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.15
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.15
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cigna of AZ Commercial	$0.61
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Southwest Service Administrators UFCW	$0.64
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: United Healthcare Commercial	$0.54
Rate for Payer: United Healthcare Medicare	$0.15
Rate for Payer: Veterans Affairs TRICARE	$0.15

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: Blue Cross Blue Shield of Arizona Health Choice	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97
Rate for Payer: NaphCare Correctional Healthcare	$10,856.97

Migraine And Other Headaches

Facility

$5,772.52

Service Code	APR-DRG 0543
Hospital Charge Code	APRDRG0543
Min. Negotiated Rate	$5,772.52
Max. Negotiated Rate	$5,772.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52
Rate for Payer: NaphCare Correctional Healthcare	$5,772.52

Migraine And Other Headaches

Facility

$3,981.85

Service Code	APR-DRG 0541
Hospital Charge Code	APRDRG0541
Min. Negotiated Rate	$3,981.85
Max. Negotiated Rate	$3,981.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85
Rate for Payer: NaphCare Correctional Healthcare	$3,981.85

Migraine And Other Headaches

Facility

$4,679.74

Service Code	APR-DRG 0542
Hospital Charge Code	APRDRG0543
Min. Negotiated Rate	$4,679.74
Max. Negotiated Rate	$4,679.74
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74
Rate for Payer: NaphCare Correctional Healthcare	$4,679.74

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: Blue Cross Blue Shield of Arizona Health Choice	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52
Rate for Payer: NaphCare Correctional Healthcare	$5,772.52

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: Blue Cross Blue Shield of Arizona Health Choice	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85
Rate for Payer: NaphCare Correctional Healthcare	$3,981.85

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: Blue Cross Blue Shield of Arizona Health Choice	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$5,772.52
Rate for Payer: Mercy Care Medicaid	$5,772.52
Rate for Payer: NaphCare Correctional Healthcare	$5,772.52

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: Blue Cross Blue Shield of Arizona Health Choice	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97
Rate for Payer: NaphCare Correctional Healthcare	$10,856.97

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: Blue Cross Blue Shield of Arizona Health Choice	$10,856.97
Rate for Payer: Mercy Care Medicaid	$10,856.97
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$3,981.85
Rate for Payer: Mercy Care Medicaid	$3,981.85
Rate for Payer: NaphCare Correctional Healthcare	$3,981.85

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: Blue Cross Blue Shield of Arizona Health Choice	$4,679.74
Rate for Payer: Mercy Care Medicaid	$4,679.74
Rate for Payer: NaphCare Correctional Healthcare	$4,679.74

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: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.04
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

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	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Cash Price	$0.06

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	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of AZ Commercial	$1.40
Rate for Payer: Cash Price	$1.25

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	$0.25
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of AZ Commercial	$1.40
Rate for Payer: Arizona Complete Health Allwell	$0.25
Rate for Payer: Banner UC Health Medicare	$0.25
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.06
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.25
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.25
Rate for Payer: Cash Price	$1.25
Rate for Payer: Cigna of AZ Commercial	$1.01
Rate for Payer: Devoted Health Medicare	$0.28
Rate for Payer: Humana of AZ Medicare	$0.25
Rate for Payer: Southwest Service Administrators UFCW	$1.06
Rate for Payer: TriWest Medicare	$0.25
Rate for Payer: United Healthcare Commercial	$0.89
Rate for Payer: United Healthcare Medicare	$0.25
Rate for Payer: Veterans Affairs TRICARE	$0.25

mineral oil lubricant 10mL [CQCH]

Facility

$1.05

Service Code	NDC 63323025410
Hospital Charge Code	112812835
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of AZ Commercial	$0.95
Rate for Payer: Arizona Complete Health Allwell	$0.17
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.71
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.17
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.17
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cigna of AZ Commercial	$0.68
Rate for Payer: Devoted Health Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Southwest Service Administrators UFCW	$0.71
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: United Healthcare Commercial	$0.60
Rate for Payer: United Healthcare Medicare	$0.17
Rate for Payer: Veterans Affairs TRICARE	$0.17

mineral oil lubricant 10mL [CQCH]

Facility

$1.05

Service Code	NDC 63323025410
Hospital Charge Code	112812835
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna of AZ Commercial	$0.95
Rate for Payer: Cash Price	$0.84

Minimum Inhibitory Concentration

Facility

$145.00

Service Code	CPT 87077
Hospital Charge Code	294946
Hospital Revenue Code	306
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of AZ Commercial	$130.50
Rate for Payer: Cash Price	$116.00

Minimum Inhibitory Concentration

Facility

$145.00

Service Code	CPT 87077
Hospital Charge Code	294946
Hospital Revenue Code	306
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna of AZ Commercial	$130.50
Rate for Payer: Arizona Complete Health Allwell	$23.20
Rate for Payer: Banner UC Health Medicare	$23.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$98.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.20
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: Devoted Health Medicare	$26.10
Rate for Payer: Humana of AZ Medicare	$23.20
Rate for Payer: Seven Corners Travel Insurance	$11.72
Rate for Payer: Southwest Service Administrators UFCW	$98.60
Rate for Payer: TriWest Medicare	$23.20
Rate for Payer: United Healthcare Commercial	$82.94
Rate for Payer: United Healthcare Medicare	$23.20
Rate for Payer: Veterans Affairs TRICARE	$22.97

Know your out-of-pocket cost for care.

All Charges