Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

OXYGEN SETUP

Facility

$135.00

Hospital Charge Code	7229383
Hospital Revenue Code	270
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Aetna of AZ Medicare	$37.80
Rate for Payer: Allwell Medicare	$20.25
Rate for Payer: Amerigroup Medicare	$20.25
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicare	$20.25
Rate for Payer: Banner UC Health Medicare	$20.25
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$94.50
Rate for Payer: Copperpoint Commercial	$33.41
Rate for Payer: Health Net of AZ Commercial	$81.00
Rate for Payer: Health Net of AZ Medicare	$37.80
Rate for Payer: Humana of AZ Medicare	$20.25
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$20.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.30

OXYGEN SETUP

Facility

$135.00

Hospital Charge Code	7229383
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Cash Price	$108.00
Rate for Payer: Self Pay Self Pay	$108.00

OXYMASK ADULT UNIVERSAL

Facility

$24.00

Hospital Charge Code	23801599
Hospital Revenue Code	272
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Cash Price	$19.20
Rate for Payer: Self Pay Self Pay	$19.20

OXYMASK ADULT UNIVERSAL

Facility

$24.00

Hospital Charge Code	23801599
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Aetna of AZ Medicare	$6.72
Rate for Payer: Allwell Medicare	$3.60
Rate for Payer: Amerigroup Medicare	$3.60
Rate for Payer: APIPA Medicare/Medicaid	$8.96
Rate for Payer: AZCH Complete Medicare	$3.60
Rate for Payer: Banner UC Health Medicare	$3.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.32
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Copperpoint Commercial	$5.94
Rate for Payer: Health Net of AZ Commercial	$14.40
Rate for Payer: Health Net of AZ Medicare	$6.72
Rate for Payer: Humana of AZ Medicare	$3.60
Rate for Payer: Self Pay Self Pay	$19.20
Rate for Payer: TriWest Medicare	$3.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.32

oxymetazoline Nasal 0.05% Spry [CQCH]

Facility

$0.27

Service Code	NDC 904571135
Hospital Charge Code	105935609
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.22
Rate for Payer: Self Pay Self Pay	$0.22

oxymetazoline Nasal 0.05% Spry [CQCH]

Facility

$0.27

Service Code	NDC 904571135
Hospital Charge Code	105935609
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of AZ Commercial	$0.24
Rate for Payer: Aetna of AZ Medicare	$0.08
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.10
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.18
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of AZ Commercial	$0.18
Rate for Payer: Copperpoint Commercial	$0.07
Rate for Payer: Health Net of AZ Commercial	$0.16
Rate for Payer: Health Net of AZ Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.22
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

oxytocin 10 units/ 1 mL Inj Sol [CQCH]

Facility

$1.43

Service Code	HCPCS J2590
Hospital Charge Code	105935674
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$1.29
Rate for Payer: Aetna of AZ Commercial	$1.29
Rate for Payer: Bisbee Police All Plans	$0.37
Rate for Payer: Cash Price	$1.14
Rate for Payer: Self Pay Self Pay	$1.14

oxytocin 10 units/ 1 mL Inj Sol [CQCH]

Facility

$1.43

Service Code	HCPCS J2590
Hospital Charge Code	105935674
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna of AZ Commercial	$1.29
Rate for Payer: Aetna of AZ Medicare	$0.40
Rate for Payer: AHCCCS Medicaid	$3.06
Rate for Payer: Allwell Medicaid	$3.06
Rate for Payer: Allwell Medicare	$0.21
Rate for Payer: Amerigroup Medicare	$0.21
Rate for Payer: APIPA Medicare/Medicaid	$0.53
Rate for Payer: AZCH Complete Medicaid	$3.06
Rate for Payer: AZCH Complete Medicare	$0.21
Rate for Payer: Banner UC Health Medicaid	$3.06
Rate for Payer: Banner UC Health Medicare	$0.21
Rate for Payer: Bisbee Police All Plans	$0.37
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.97
Rate for Payer: Cash Price	$1.14
Rate for Payer: Cash Price	$1.14
Rate for Payer: Cigna of AZ Commercial	$0.93
Rate for Payer: Copperpoint Commercial	$0.35
Rate for Payer: Health Net of AZ Commercial	$0.86
Rate for Payer: Health Net of AZ Medicare	$0.40
Rate for Payer: Humana of AZ Medicare	$0.21
Rate for Payer: Mercy Care Medicaid	$3.06
Rate for Payer: Self Pay Self Pay	$1.14
Rate for Payer: TriWest Medicare	$0.21
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.26

PACIFIER SOOTHIE

Facility

$21.00

Hospital Charge Code	23734058
Hospital Revenue Code	270
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of AZ Commercial	$18.90
Rate for Payer: Aetna of AZ Medicare	$5.88
Rate for Payer: Allwell Medicare	$3.15
Rate for Payer: Amerigroup Medicare	$3.15
Rate for Payer: APIPA Medicare/Medicaid	$7.84
Rate for Payer: AZCH Complete Medicare	$3.15
Rate for Payer: Banner UC Health Medicare	$3.15
Rate for Payer: Bisbee Police All Plans	$5.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.28
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cigna of AZ Commercial	$14.70
Rate for Payer: Copperpoint Commercial	$5.20
Rate for Payer: Health Net of AZ Commercial	$12.60
Rate for Payer: Health Net of AZ Medicare	$5.88
Rate for Payer: Humana of AZ Medicare	$3.15
Rate for Payer: Self Pay Self Pay	$16.80
Rate for Payer: TriWest Medicare	$3.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.78

PACIFIER SOOTHIE

Facility

$21.00

Hospital Charge Code	23734058
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna of AZ Commercial	$18.90
Rate for Payer: Bisbee Police All Plans	$5.46
Rate for Payer: Cash Price	$16.80
Rate for Payer: Self Pay Self Pay	$16.80

PACK GEL REUSE HOT-COLD

Facility

$16.00

Hospital Charge Code	22355378
Hospital Revenue Code	279
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

PACK GEL REUSE HOT-COLD

Facility

$16.00

Hospital Charge Code	22355378
Hospital Revenue Code	279
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Cash Price	$12.80
Rate for Payer: Self Pay Self Pay	$12.80

PACKING NASAL 5.5 RHINO

Facility

$144.00

Hospital Charge Code	22354976
Hospital Revenue Code	270
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Bisbee Police All Plans	$37.44
Rate for Payer: Cash Price	$115.20
Rate for Payer: Self Pay Self Pay	$115.20

PACKING NASAL 5.5 RHINO

Facility

$144.00

Hospital Charge Code	22354976
Hospital Revenue Code	270
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Aetna of AZ Medicare	$40.32
Rate for Payer: Allwell Medicare	$21.60
Rate for Payer: Amerigroup Medicare	$21.60
Rate for Payer: APIPA Medicare/Medicaid	$53.78
Rate for Payer: AZCH Complete Medicare	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
Rate for Payer: Bisbee Police All Plans	$37.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$97.92
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna of AZ Commercial	$100.80
Rate for Payer: Copperpoint Commercial	$35.64
Rate for Payer: Health Net of AZ Commercial	$86.40
Rate for Payer: Health Net of AZ Medicare	$40.32
Rate for Payer: Humana of AZ Medicare	$21.60
Rate for Payer: Self Pay Self Pay	$115.20
Rate for Payer: TriWest Medicare	$21.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$83.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.92

PACKING NASAL 7.5 RHINO

Facility

$159.00

Hospital Charge Code	22354977
Hospital Revenue Code	270
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

PACKING NASAL 7.5 RHINO

Facility

$159.00

Hospital Charge Code	22354977
Hospital Revenue Code	270
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: Allwell Medicare	$23.85
Rate for Payer: Amerigroup Medicare	$23.85
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$23.85
Rate for Payer: Banner UC Health Medicare	$23.85
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$111.30
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$23.85
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$23.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

PACK OB DRAPE III

Facility

$75.00

Hospital Charge Code	22355354
Hospital Revenue Code	272
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

PACK OB DRAPE III

Facility

$75.00

Hospital Charge Code	22355354
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
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	$11.25
Rate for Payer: Amerigroup Medicare	$11.25
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicare	$11.25
Rate for Payer: Banner UC Health Medicare	$11.25
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	$11.25
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$11.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

PACK ORTHO 5 HIP

Facility

$158.00

Hospital Charge Code	22926426
Hospital Revenue Code	272
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Aetna of AZ Medicare	$44.24
Rate for Payer: Allwell Medicare	$23.70
Rate for Payer: Amerigroup Medicare	$23.70
Rate for Payer: APIPA Medicare/Medicaid	$59.01
Rate for Payer: AZCH Complete Medicare	$23.70
Rate for Payer: Banner UC Health Medicare	$23.70
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$107.44
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$110.60
Rate for Payer: Copperpoint Commercial	$39.10
Rate for Payer: Health Net of AZ Commercial	$94.80
Rate for Payer: Health Net of AZ Medicare	$44.24
Rate for Payer: Humana of AZ Medicare	$23.70
Rate for Payer: Self Pay Self Pay	$126.40
Rate for Payer: TriWest Medicare	$23.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.44

PACK ORTHO 5 HIP

Facility

$158.00

Hospital Charge Code	22926426
Hospital Revenue Code	272
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Cash Price	$126.40
Rate for Payer: Self Pay Self Pay	$126.40

PADDED GAIT BELT LG

Facility

$289.00

Hospital Charge Code	27445198
Hospital Revenue Code	270
Min. Negotiated Rate	$75.14
Max. Negotiated Rate	$260.10
Rate for Payer: Aetna of AZ Commercial	$260.10
Rate for Payer: Bisbee Police All Plans	$75.14
Rate for Payer: Cash Price	$231.20
Rate for Payer: Self Pay Self Pay	$231.20

PADDED GAIT BELT LG

Facility

$289.00

Hospital Charge Code	27445198
Hospital Revenue Code	270
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$260.10
Rate for Payer: Aetna of AZ Commercial	$260.10
Rate for Payer: Aetna of AZ Medicare	$80.92
Rate for Payer: Allwell Medicare	$43.35
Rate for Payer: Amerigroup Medicare	$43.35
Rate for Payer: APIPA Medicare/Medicaid	$107.94
Rate for Payer: AZCH Complete Medicare	$43.35
Rate for Payer: Banner UC Health Medicare	$43.35
Rate for Payer: Bisbee Police All Plans	$75.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$196.52
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cigna of AZ Commercial	$202.30
Rate for Payer: Copperpoint Commercial	$71.53
Rate for Payer: Health Net of AZ Commercial	$173.40
Rate for Payer: Health Net of AZ Medicare	$80.92
Rate for Payer: Humana of AZ Medicare	$43.35
Rate for Payer: Self Pay Self Pay	$231.20
Rate for Payer: TriWest Medicare	$43.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$168.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.02

PADDED GAIT BELT MED

Facility

$279.00

Hospital Charge Code	27446678
Hospital Revenue Code	270
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Bisbee Police All Plans	$72.54
Rate for Payer: Cash Price	$223.20
Rate for Payer: Self Pay Self Pay	$223.20

PADDED GAIT BELT MED

Facility

$279.00

Hospital Charge Code	27446678
Hospital Revenue Code	270
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$251.10
Rate for Payer: Aetna of AZ Commercial	$251.10
Rate for Payer: Aetna of AZ Medicare	$78.12
Rate for Payer: Allwell Medicare	$41.85
Rate for Payer: Amerigroup Medicare	$41.85
Rate for Payer: APIPA Medicare/Medicaid	$104.21
Rate for Payer: AZCH Complete Medicare	$41.85
Rate for Payer: Banner UC Health Medicare	$41.85
Rate for Payer: Bisbee Police All Plans	$72.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$189.72
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna of AZ Commercial	$195.30
Rate for Payer: Copperpoint Commercial	$69.05
Rate for Payer: Health Net of AZ Commercial	$167.40
Rate for Payer: Health Net of AZ Medicare	$78.12
Rate for Payer: Humana of AZ Medicare	$41.85
Rate for Payer: Self Pay Self Pay	$223.20
Rate for Payer: TriWest Medicare	$41.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$162.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.22

PADDED GAIT BELT SM

Facility

$216.00

Hospital Charge Code	27446677
Hospital Revenue Code	270
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Bisbee Police All Plans	$56.16
Rate for Payer: Cash Price	$172.80
Rate for Payer: Self Pay Self Pay	$172.80

Know your out-of-pocket cost for care.

All Charges