Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

acetaminophen 650 mg Supp [CQCH]

Facility

$0.42

Service Code	NDC 713016512
Hospital Charge Code	105907681
Hospital Revenue Code	257
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Aetna of AZ Medicare	$0.12
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.16
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.29
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.25
Rate for Payer: Health Net of AZ Medicare	$0.12
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.34
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [CQCH]

Facility

$0.99

Service Code	NDC 68084039665
Hospital Charge Code	105908090
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Aetna of AZ Medicare	$0.28
Rate for Payer: Allwell Medicare	$0.16
Rate for Payer: Amerigroup Medicare	$0.16
Rate for Payer: APIPA Medicare/Medicaid	$0.37
Rate for Payer: AZCH Complete Medicare	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.67
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of AZ Commercial	$0.64
Rate for Payer: Copperpoint Commercial	$0.25
Rate for Payer: Health Net of AZ Commercial	$0.59
Rate for Payer: Health Net of AZ Medicare	$0.28
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Self Pay Self Pay	$0.79
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.18

acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [CQCH]

Facility

$0.99

Service Code	NDC 68084039665
Hospital Charge Code	105908090
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Cash Price	$0.79
Rate for Payer: Self Pay Self Pay	$0.79

acetaminophen-HYDROcodone 325 mg-5 mg Tab [CQCH]

Facility

$0.33

Service Code	NDC 406012362
Hospital Charge Code	105908680
Hospital Revenue Code	251
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

acetaminophen-HYDROcodone 325 mg-5 mg Tab [CQCH]

Facility

$0.33

Service Code	NDC 406012362
Hospital Charge Code	105908680
Hospital Revenue Code	251
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

Acetaminophen Level

Facility

$286.00

Service Code	CPT 80329
Hospital Charge Code	857776
Hospital Revenue Code	301
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Aetna of AZ Medicare	$80.08
Rate for Payer: Allwell Medicare	$45.76
Rate for Payer: Amerigroup Medicare	$45.76
Rate for Payer: APIPA Medicare/Medicaid	$106.82
Rate for Payer: AZCH Complete Medicare	$45.76
Rate for Payer: Banner UC Health Medicare	$45.76
Rate for Payer: Bisbee Police All Plans	$74.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$194.48
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cigna of AZ Commercial	$185.90
Rate for Payer: Copperpoint Commercial	$70.78
Rate for Payer: Health Net of AZ Commercial	$171.60
Rate for Payer: Health Net of AZ Medicare	$80.08
Rate for Payer: Humana of AZ Medicare	$45.76
Rate for Payer: Self Pay Self Pay	$228.80
Rate for Payer: TriWest Medicare	$45.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$166.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.48

Acetaminophen Level

Facility

$286.00

Service Code	CPT 80329
Hospital Charge Code	857776
Hospital Revenue Code	301
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Bisbee Police All Plans	$74.36
Rate for Payer: Cash Price	$228.80
Rate for Payer: Self Pay Self Pay	$228.80

acetaminophen-oxyCODONE 325 mg-5 mg Tab [CQCH]

Facility

$0.22

Service Code	NDC 406051262
Hospital Charge Code	105908747
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.17
Rate for Payer: Self Pay Self Pay	$0.18

acetaminophen-oxyCODONE 325 mg-5 mg Tab [CQCH]

Facility

$0.22

Service Code	NDC 406051262
Hospital Charge Code	105908747
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
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	$0.08
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	$0.15
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.13
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

Acetone Ql

Facility

$151.00

Service Code	CPT 82575
Hospital Charge Code	857781
Hospital Revenue Code	301
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Cash Price	$120.80
Rate for Payer: Self Pay Self Pay	$120.80

Acetone Ql

Facility

$151.00

Service Code	CPT 82575
Hospital Charge Code	857781
Hospital Revenue Code	301
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Aetna of AZ Medicare	$42.28
Rate for Payer: Allwell Medicare	$24.16
Rate for Payer: Amerigroup Medicare	$24.16
Rate for Payer: APIPA Medicare/Medicaid	$56.40
Rate for Payer: AZCH Complete Medicare	$24.16
Rate for Payer: Banner UC Health Medicare	$24.16
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$102.68
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Copperpoint Commercial	$37.37
Rate for Payer: Health Net of AZ Commercial	$90.60
Rate for Payer: Health Net of AZ Medicare	$42.28
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Self Pay Self Pay	$120.80
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.18

Acetylcholine Receptor Ab, All LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	10864412
Hospital Revenue Code	300
Min. Negotiated Rate	$84.48
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Aetna of AZ Medicare	$147.84
Rate for Payer: Allwell Medicare	$84.48
Rate for Payer: Amerigroup Medicare	$84.48
Rate for Payer: APIPA Medicare/Medicaid	$197.21
Rate for Payer: AZCH Complete Medicare	$84.48
Rate for Payer: Banner UC Health Medicare	$84.48
Rate for Payer: Bisbee Police All Plans	$137.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$359.04
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cigna of AZ Commercial	$343.20
Rate for Payer: Copperpoint Commercial	$130.68
Rate for Payer: Health Net of AZ Commercial	$316.80
Rate for Payer: Health Net of AZ Medicare	$147.84
Rate for Payer: Humana of AZ Medicare	$84.48
Rate for Payer: Self Pay Self Pay	$422.40
Rate for Payer: TriWest Medicare	$84.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$307.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$95.04

Acetylcholine Receptor Ab, All LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	10864412
Hospital Revenue Code	300
Min. Negotiated Rate	$137.28
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Bisbee Police All Plans	$137.28
Rate for Payer: Cash Price	$422.40
Rate for Payer: Self Pay Self Pay	$422.40

Acetylcholine Receptor Antibodies, Complete Profile LC

Facility

$92.00

Service Code	CPT 86041
Hospital Charge Code	27460346
Hospital Revenue Code	305
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Cash Price	$73.60
Rate for Payer: Self Pay Self Pay	$73.60

Acetylcholine Receptor Antibodies, Complete Profile LC

Facility

$92.00

Service Code	CPT 86041
Hospital Charge Code	27460346
Hospital Revenue Code	305
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Aetna of AZ Medicare	$25.76
Rate for Payer: Allwell Medicare	$14.72
Rate for Payer: Amerigroup Medicare	$14.72
Rate for Payer: APIPA Medicare/Medicaid	$34.36
Rate for Payer: AZCH Complete Medicare	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.56
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$59.80
Rate for Payer: Copperpoint Commercial	$22.77
Rate for Payer: Health Net of AZ Commercial	$55.20
Rate for Payer: Health Net of AZ Medicare	$25.76
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Self Pay Self Pay	$73.60
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.56

Acetylcholine Receptor Complete Profile AB LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	22945558
Hospital Revenue Code	301
Min. Negotiated Rate	$84.48
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Aetna of AZ Medicare	$147.84
Rate for Payer: Allwell Medicare	$84.48
Rate for Payer: Amerigroup Medicare	$84.48
Rate for Payer: APIPA Medicare/Medicaid	$197.21
Rate for Payer: AZCH Complete Medicare	$84.48
Rate for Payer: Banner UC Health Medicare	$84.48
Rate for Payer: Bisbee Police All Plans	$137.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$359.04
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cigna of AZ Commercial	$343.20
Rate for Payer: Copperpoint Commercial	$130.68
Rate for Payer: Health Net of AZ Commercial	$316.80
Rate for Payer: Health Net of AZ Medicare	$147.84
Rate for Payer: Humana of AZ Medicare	$84.48
Rate for Payer: Self Pay Self Pay	$422.40
Rate for Payer: TriWest Medicare	$84.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$307.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$95.04

Acetylcholine Receptor Complete Profile AB LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	22945558
Hospital Revenue Code	301
Min. Negotiated Rate	$137.28
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Bisbee Police All Plans	$137.28
Rate for Payer: Cash Price	$422.40
Rate for Payer: Self Pay Self Pay	$422.40

acetylcysteine 20% Inh Sol 4 mL [CQCH]

Facility

$0.96

Service Code	HCPCS J7604
Hospital Charge Code	105909114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of AZ Commercial	$0.86
Rate for Payer: Aetna of AZ Medicare	$0.27
Rate for Payer: Allwell Medicare	$0.15
Rate for Payer: Amerigroup Medicare	$0.15
Rate for Payer: APIPA Medicare/Medicaid	$0.36
Rate for Payer: AZCH Complete Medicare	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Bisbee Police All Plans	$0.25
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.65
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of AZ Commercial	$0.62
Rate for Payer: Copperpoint Commercial	$0.24
Rate for Payer: Health Net of AZ Commercial	$0.58
Rate for Payer: Health Net of AZ Medicare	$0.27
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Self Pay Self Pay	$0.77
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.17

acetylcysteine 20% Inh Sol 4 mL [CQCH]

Facility

$0.96

Service Code	HCPCS J7604
Hospital Charge Code	105909114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of AZ Commercial	$0.86
Rate for Payer: Bisbee Police All Plans	$0.25
Rate for Payer: Cash Price	$0.77
Rate for Payer: Self Pay Self Pay	$0.77

acetylcysteine 6 gm/ 30 mL IV Sol [CQCH]

Facility

$1.51

Service Code	HCPCS J0132
Hospital Charge Code	105909039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Aetna of AZ Medicare	$0.42
Rate for Payer: Allwell Medicare	$0.24
Rate for Payer: Amerigroup Medicare	$0.24
Rate for Payer: APIPA Medicare/Medicaid	$0.56
Rate for Payer: AZCH Complete Medicare	$0.24
Rate for Payer: Banner UC Health Medicare	$0.24
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.03
Rate for Payer: Cash Price	$1.21
Rate for Payer: Cigna of AZ Commercial	$0.98
Rate for Payer: Copperpoint Commercial	$0.37
Rate for Payer: Health Net of AZ Commercial	$0.91
Rate for Payer: Health Net of AZ Medicare	$0.42
Rate for Payer: Humana of AZ Medicare	$0.24
Rate for Payer: Self Pay Self Pay	$1.21
Rate for Payer: TriWest Medicare	$0.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.27

acetylcysteine 6 gm/ 30 mL IV Sol [CQCH]

Facility

$1.51

Service Code	HCPCS J0132
Hospital Charge Code	105909039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Cash Price	$1.21
Rate for Payer: Self Pay Self Pay	$1.21

AChR Binding Abs LC

Facility

$510.00

Service Code	CPT 83519
Hospital Charge Code	6738702
Hospital Revenue Code	301
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna of AZ Commercial	$459.00
Rate for Payer: Aetna of AZ Medicare	$142.80
Rate for Payer: Allwell Medicare	$81.60
Rate for Payer: Amerigroup Medicare	$81.60
Rate for Payer: APIPA Medicare/Medicaid	$190.49
Rate for Payer: AZCH Complete Medicare	$81.60
Rate for Payer: Banner UC Health Medicare	$81.60
Rate for Payer: Bisbee Police All Plans	$132.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$346.80
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cigna of AZ Commercial	$331.50
Rate for Payer: Copperpoint Commercial	$126.22
Rate for Payer: Health Net of AZ Commercial	$306.00
Rate for Payer: Health Net of AZ Medicare	$142.80
Rate for Payer: Humana of AZ Medicare	$81.60
Rate for Payer: Self Pay Self Pay	$408.00
Rate for Payer: TriWest Medicare	$81.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$297.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$91.80

AChR Binding Abs LC

Facility

$510.00

Service Code	CPT 83519
Hospital Charge Code	6738702
Hospital Revenue Code	301
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna of AZ Commercial	$459.00
Rate for Payer: Bisbee Police All Plans	$132.60
Rate for Payer: Cash Price	$408.00
Rate for Payer: Self Pay Self Pay	$408.00

ACTH, Plasma LC

Facility

$458.00

Service Code	CPT 82024
Hospital Charge Code	1905879
Hospital Revenue Code	301
Min. Negotiated Rate	$73.28
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna of AZ Commercial	$412.20
Rate for Payer: Aetna of AZ Medicare	$128.24
Rate for Payer: Allwell Medicare	$73.28
Rate for Payer: Amerigroup Medicare	$73.28
Rate for Payer: APIPA Medicare/Medicaid	$171.06
Rate for Payer: AZCH Complete Medicare	$73.28
Rate for Payer: Banner UC Health Medicare	$73.28
Rate for Payer: Bisbee Police All Plans	$119.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$311.44
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cigna of AZ Commercial	$297.70
Rate for Payer: Copperpoint Commercial	$113.36
Rate for Payer: Health Net of AZ Commercial	$274.80
Rate for Payer: Health Net of AZ Medicare	$128.24
Rate for Payer: Humana of AZ Medicare	$73.28
Rate for Payer: Self Pay Self Pay	$366.40
Rate for Payer: TriWest Medicare	$73.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$267.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$82.44

ACTH, Plasma LC

Facility

$458.00

Service Code	CPT 82024
Hospital Charge Code	1905879
Hospital Revenue Code	301
Min. Negotiated Rate	$119.08
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna of AZ Commercial	$412.20
Rate for Payer: Bisbee Police All Plans	$119.08
Rate for Payer: Cash Price	$366.40
Rate for Payer: Self Pay Self Pay	$366.40

Know your out-of-pocket cost for care.

All Charges