Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Oxcarbazepine (Trileptal), LC

Facility

$234.00

Service Code	CPT 80299
Hospital Charge Code	1285602
Hospital Revenue Code	301
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna of AZ Commercial	$210.60
Rate for Payer: Aetna of AZ Medicare	$65.52
Rate for Payer: Allwell Medicare	$37.44
Rate for Payer: Amerigroup Medicare	$37.44
Rate for Payer: APIPA Medicare/Medicaid	$87.40
Rate for Payer: AZCH Complete Medicare	$37.44
Rate for Payer: Banner UC Health Medicare	$37.44
Rate for Payer: Bisbee Police All Plans	$60.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$159.12
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna of AZ Commercial	$152.10
Rate for Payer: Copperpoint Commercial	$57.91
Rate for Payer: Health Net of AZ Commercial	$140.40
Rate for Payer: Health Net of AZ Medicare	$65.52
Rate for Payer: Humana of AZ Medicare	$37.44
Rate for Payer: Self Pay Self Pay	$187.20
Rate for Payer: TriWest Medicare	$37.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$136.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.12

OXIMAX

Facility

$56.00

Hospital Charge Code	24157864
Hospital Revenue Code	270
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of AZ Commercial	$50.40
Rate for Payer: Bisbee Police All Plans	$14.56
Rate for Payer: Cash Price	$44.80
Rate for Payer: Self Pay Self Pay	$44.80

OXIMAX

Facility

$56.00

Hospital Charge Code	24157864
Hospital Revenue Code	270
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of AZ Commercial	$50.40
Rate for Payer: Aetna of AZ Medicare	$15.68
Rate for Payer: Allwell Medicare	$8.96
Rate for Payer: Amerigroup Medicare	$8.96
Rate for Payer: APIPA Medicare/Medicaid	$20.92
Rate for Payer: AZCH Complete Medicare	$8.96
Rate for Payer: Banner UC Health Medicare	$8.96
Rate for Payer: Bisbee Police All Plans	$14.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.08
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cigna of AZ Commercial	$39.20
Rate for Payer: Copperpoint Commercial	$13.86
Rate for Payer: Health Net of AZ Commercial	$33.60
Rate for Payer: Health Net of AZ Medicare	$15.68
Rate for Payer: Humana of AZ Medicare	$8.96
Rate for Payer: Self Pay Self Pay	$44.80
Rate for Payer: TriWest Medicare	$8.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.08

oxybutynin 5 mg Tab [CQCH]

Facility

$0.59

Service Code	NDC 904282161
Hospital Charge Code	105935217
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of AZ Commercial	$0.53
Rate for Payer: Aetna of AZ Medicare	$0.17
Rate for Payer: Allwell Medicare	$0.09
Rate for Payer: Amerigroup Medicare	$0.09
Rate for Payer: APIPA Medicare/Medicaid	$0.22
Rate for Payer: AZCH Complete Medicare	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Bisbee Police All Plans	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.40
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of AZ Commercial	$0.38
Rate for Payer: Copperpoint Commercial	$0.15
Rate for Payer: Health Net of AZ Commercial	$0.35
Rate for Payer: Health Net of AZ Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Self Pay Self Pay	$0.47
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

oxybutynin 5 mg Tab [CQCH]

Facility

$0.59

Service Code	NDC 904282161
Hospital Charge Code	105935217
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of AZ Commercial	$0.53
Rate for Payer: Bisbee Police All Plans	$0.15
Rate for Payer: Cash Price	$0.47
Rate for Payer: Self Pay Self Pay	$0.47

Oxycodone

Facility

$254.00

Service Code	CPT 80365
Hospital Charge Code	23090937
Hospital Revenue Code	301
Min. Negotiated Rate	$40.64
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of AZ Commercial	$228.60
Rate for Payer: Aetna of AZ Medicare	$71.12
Rate for Payer: Allwell Medicare	$40.64
Rate for Payer: Amerigroup Medicare	$40.64
Rate for Payer: APIPA Medicare/Medicaid	$94.87
Rate for Payer: AZCH Complete Medicare	$40.64
Rate for Payer: Banner UC Health Medicare	$40.64
Rate for Payer: Bisbee Police All Plans	$66.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$172.72
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cigna of AZ Commercial	$165.10
Rate for Payer: Copperpoint Commercial	$62.87
Rate for Payer: Health Net of AZ Commercial	$152.40
Rate for Payer: Health Net of AZ Medicare	$71.12
Rate for Payer: Humana of AZ Medicare	$40.64
Rate for Payer: Self Pay Self Pay	$203.20
Rate for Payer: TriWest Medicare	$40.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.72

Oxycodone

Facility

$254.00

Service Code	CPT 80365
Hospital Charge Code	23090937
Hospital Revenue Code	301
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of AZ Commercial	$228.60
Rate for Payer: Bisbee Police All Plans	$66.04
Rate for Payer: Cash Price	$203.20
Rate for Payer: Self Pay Self Pay	$203.20

oxyCODONE 10 mg ER Tab [CQCH]

Facility

$3.31

Service Code	NDC 59011041020
Hospital Charge Code	105935475
Hospital Revenue Code	251
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna of AZ Commercial	$2.98
Rate for Payer: Aetna of AZ Medicare	$0.93
Rate for Payer: Allwell Medicare	$0.53
Rate for Payer: Amerigroup Medicare	$0.53
Rate for Payer: APIPA Medicare/Medicaid	$1.24
Rate for Payer: AZCH Complete Medicare	$0.53
Rate for Payer: Banner UC Health Medicare	$0.53
Rate for Payer: Bisbee Police All Plans	$0.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.25
Rate for Payer: Cash Price	$2.65
Rate for Payer: Cigna of AZ Commercial	$2.15
Rate for Payer: Copperpoint Commercial	$0.82
Rate for Payer: Health Net of AZ Commercial	$1.99
Rate for Payer: Health Net of AZ Medicare	$0.93
Rate for Payer: Humana of AZ Medicare	$0.53
Rate for Payer: Self Pay Self Pay	$2.65
Rate for Payer: TriWest Medicare	$0.53
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.60

oxyCODONE 10 mg ER Tab [CQCH]

Facility

$3.31

Service Code	NDC 59011041020
Hospital Charge Code	105935475
Hospital Revenue Code	251
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna of AZ Commercial	$2.98
Rate for Payer: Bisbee Police All Plans	$0.86
Rate for Payer: Cash Price	$2.65
Rate for Payer: Self Pay Self Pay	$2.65

oxyCODONE 15 mg Tab [CQCH]

Facility

$0.40

Service Code	NDC 904674361
Hospital Charge Code	105935410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of AZ Commercial	$0.36
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.15
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.27
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of AZ Commercial	$0.26
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.24
Rate for Payer: Health Net of AZ Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.32
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

oxyCODONE 15 mg Tab [CQCH]

Facility

$0.40

Service Code	NDC 904674361
Hospital Charge Code	105935410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna of AZ Commercial	$0.36
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Cash Price	$0.32
Rate for Payer: Self Pay Self Pay	$0.32

oxyCODONE 5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 42858000110
Hospital Charge Code	105935278
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Aetna of AZ Medicare	$0.06
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	$0.14
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.12
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.16
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

oxyCODONE 5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 42858000110
Hospital Charge Code	105935278
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.16

OXYGEN DAILY

Facility

$358.00

Hospital Charge Code	1886880
Hospital Revenue Code	270
Min. Negotiated Rate	$57.28
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of AZ Commercial	$322.20
Rate for Payer: Aetna of AZ Medicare	$100.24
Rate for Payer: Allwell Medicare	$57.28
Rate for Payer: Amerigroup Medicare	$57.28
Rate for Payer: APIPA Medicare/Medicaid	$133.71
Rate for Payer: AZCH Complete Medicare	$57.28
Rate for Payer: Banner UC Health Medicare	$57.28
Rate for Payer: Bisbee Police All Plans	$93.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$243.44
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cigna of AZ Commercial	$250.60
Rate for Payer: Copperpoint Commercial	$88.61
Rate for Payer: Health Net of AZ Commercial	$214.80
Rate for Payer: Health Net of AZ Medicare	$100.24
Rate for Payer: Humana of AZ Medicare	$57.28
Rate for Payer: Self Pay Self Pay	$286.40
Rate for Payer: TriWest Medicare	$57.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$208.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.44

OXYGEN DAILY

Facility

$358.00

Hospital Charge Code	1886880
Hospital Revenue Code	270
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of AZ Commercial	$322.20
Rate for Payer: Bisbee Police All Plans	$93.08
Rate for Payer: Cash Price	$286.40
Rate for Payer: Self Pay Self Pay	$286.40

Oxygen per hour

Facility

$39.00

Service Code	CPT 94644
Hospital Charge Code	1558431
Hospital Revenue Code	460
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

Oxygen per hour

Facility

$39.00

Service Code	CPT 94644
Hospital Charge Code	1558431
Hospital Revenue Code	460
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: Allwell Medicare	$6.24
Rate for Payer: Amerigroup Medicare	$6.24
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicare	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

OXYGEN SETUP

Facility

$135.00

Hospital Charge Code	7229383
Hospital Revenue Code	270
Min. Negotiated Rate	$21.60
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	$21.60
Rate for Payer: Amerigroup Medicare	$21.60
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicare	$21.60
Rate for Payer: Banner UC Health Medicare	$21.60
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	$21.60
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$21.60
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	$3.84
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	$3.84
Rate for Payer: Amerigroup Medicare	$3.84
Rate for Payer: APIPA Medicare/Medicaid	$8.96
Rate for Payer: AZCH Complete Medicare	$3.84
Rate for Payer: Banner UC Health Medicare	$3.84
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	$3.84
Rate for Payer: Self Pay Self Pay	$19.20
Rate for Payer: TriWest Medicare	$3.84
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	$0.04
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

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

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	$0.23
Max. Negotiated Rate	$1.29
Rate for Payer: Aetna of AZ Commercial	$1.29
Rate for Payer: Aetna of AZ Medicare	$0.40
Rate for Payer: Allwell Medicare	$0.23
Rate for Payer: Amerigroup Medicare	$0.23
Rate for Payer: APIPA Medicare/Medicaid	$0.53
Rate for Payer: AZCH Complete Medicare	$0.23
Rate for Payer: Banner UC Health Medicare	$0.23
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: 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	$0.23
Rate for Payer: Self Pay Self Pay	$1.14
Rate for Payer: TriWest Medicare	$0.23
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.26

Know your out-of-pocket cost for care.

All Charges