Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

$10,013.89

Service Code	APR-DRG 1711
Hospital Charge Code	APRDRG1714
Min. Negotiated Rate	$10,013.89
Max. Negotiated Rate	$10,013.89
Rate for Payer: AHCCCS Medicaid	$10,013.89
Rate for Payer: Allwell Medicaid	$10,013.89
Rate for Payer: AZCH Complete Medicaid	$10,013.89
Rate for Payer: Banner UC Health Medicaid	$10,013.89
Rate for Payer: Mercy Care Medicaid	$10,013.89

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

$15,065.37

Service Code	APR-DRG 1713
Hospital Charge Code	APRDRG1713
Min. Negotiated Rate	$15,065.37
Max. Negotiated Rate	$15,065.37
Rate for Payer: AHCCCS Medicaid	$15,065.37
Rate for Payer: Allwell Medicaid	$15,065.37
Rate for Payer: AZCH Complete Medicaid	$15,065.37
Rate for Payer: Banner UC Health Medicaid	$15,065.37
Rate for Payer: Mercy Care Medicaid	$15,065.37

PESSARY, NON-RUBBER ANY TYPE

Facility

$296.00

Service Code	CPT A4562
Hospital Charge Code	22951059
Hospital Revenue Code	278
Min. Negotiated Rate	$47.36
Max. Negotiated Rate	$266.40
Rate for Payer: Aetna of AZ Commercial	$266.40
Rate for Payer: Aetna of AZ Medicare	$82.88
Rate for Payer: Allwell Medicare	$47.36
Rate for Payer: Amerigroup Medicare	$47.36
Rate for Payer: APIPA Medicare/Medicaid	$110.56
Rate for Payer: AZCH Complete Medicare	$47.36
Rate for Payer: Banner UC Health Medicare	$47.36
Rate for Payer: Bisbee Police All Plans	$76.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$201.28
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cigna of AZ Commercial	$148.00
Rate for Payer: Copperpoint Commercial	$73.26
Rate for Payer: Health Net of AZ Commercial	$177.60
Rate for Payer: Health Net of AZ Medicare	$82.88
Rate for Payer: Humana of AZ Medicare	$47.36
Rate for Payer: Self Pay Self Pay	$236.80
Rate for Payer: TriWest Medicare	$47.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$172.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.28

PESSARY, NON-RUBBER ANY TYPE

Facility

$296.00

Service Code	CPT A4562
Hospital Charge Code	22951059
Hospital Revenue Code	278
Min. Negotiated Rate	$76.96
Max. Negotiated Rate	$266.40
Rate for Payer: Aetna of AZ Commercial	$266.40
Rate for Payer: Bisbee Police All Plans	$76.96
Rate for Payer: Cash Price	$236.80
Rate for Payer: Self Pay Self Pay	$236.80

PFT Pre Post

Facility

$898.00

Service Code	CPT 94060
Hospital Charge Code	15513379
Hospital Revenue Code	460
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Aetna of AZ Medicare	$251.44
Rate for Payer: AHCCCS Medicaid	$191.73
Rate for Payer: Allwell Medicaid	$191.73
Rate for Payer: Allwell Medicare	$143.68
Rate for Payer: Amerigroup Medicare	$143.68
Rate for Payer: APIPA Medicare/Medicaid	$335.40
Rate for Payer: AZCH Complete Medicaid	$191.73
Rate for Payer: AZCH Complete Medicare	$143.68
Rate for Payer: Banner UC Health Medicaid	$191.73
Rate for Payer: Banner UC Health Medicare	$143.68
Rate for Payer: Bisbee Police All Plans	$233.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$610.64
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cigna of AZ Commercial	$628.60
Rate for Payer: Copperpoint Commercial	$222.25
Rate for Payer: Health Net of AZ Commercial	$538.80
Rate for Payer: Health Net of AZ Medicare	$251.44
Rate for Payer: Humana of AZ Medicare	$143.68
Rate for Payer: Mercy Care Medicaid	$191.73
Rate for Payer: Self Pay Self Pay	$718.40
Rate for Payer: TriWest Medicare	$143.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$523.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$161.64

PFT Pre Post

Facility

$898.00

Service Code	CPT 94060
Hospital Charge Code	15513379
Hospital Revenue Code	460
Min. Negotiated Rate	$233.48
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Bisbee Police All Plans	$233.48
Rate for Payer: Cash Price	$718.40
Rate for Payer: Self Pay Self Pay	$718.40

PHALANGECTOMY TOE EACH TOE

Facility

$1,365.00

Service Code	CPT 28150
Hospital Charge Code	24043335
Hospital Revenue Code	360
Min. Negotiated Rate	$354.90
Max. Negotiated Rate	$1,228.50
Rate for Payer: Aetna of AZ Commercial	$1,228.50
Rate for Payer: Bisbee Police All Plans	$354.90
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Self Pay Self Pay	$1,092.00

PHALANGECTOMY TOE EACH TOE

Facility

$1,365.00

Service Code	CPT 28150
Hospital Charge Code	24043335
Hospital Revenue Code	360
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,228.50
Rate for Payer: Aetna of AZ Medicare	$382.20
Rate for Payer: AHCCCS Medicaid	$2,052.04
Rate for Payer: Allwell Medicaid	$2,052.04
Rate for Payer: Allwell Medicare	$218.40
Rate for Payer: Amerigroup Medicare	$218.40
Rate for Payer: APIPA Medicare/Medicaid	$509.83
Rate for Payer: AZCH Complete Medicaid	$2,052.04
Rate for Payer: AZCH Complete Medicare	$218.40
Rate for Payer: Banner UC Health Medicaid	$2,052.04
Rate for Payer: Banner UC Health Medicare	$218.40
Rate for Payer: Bisbee Police All Plans	$354.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$928.20
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cigna of AZ Commercial	$682.50
Rate for Payer: Copperpoint Commercial	$337.84
Rate for Payer: Health Net of AZ Commercial	$819.00
Rate for Payer: Health Net of AZ Medicare	$382.20
Rate for Payer: Humana of AZ Medicare	$218.40
Rate for Payer: Mercy Care Medicaid	$2,052.04
Rate for Payer: Self Pay Self Pay	$1,092.00
Rate for Payer: TriWest Medicare	$218.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$245.70

phenazopyridine 200 mg Tab[CQCH]

Facility

$0.34

Service Code	NDC 65162068210
Hospital Charge Code	219324821
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of AZ Commercial	$0.31
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.13
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	$0.23
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of AZ Commercial	$0.22
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	$0.10
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.27
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

phenazopyridine 200 mg Tab[CQCH]

Facility

$0.34

Service Code	NDC 65162068210
Hospital Charge Code	219324821
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of AZ Commercial	$0.31
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.27
Rate for Payer: Self Pay Self Pay	$0.27

PHENobarbital 130 mg/1 mL Inj Sol [CQCH]

Facility

$50.21

Service Code	HCPCS J2560
Hospital Charge Code	105936151
Hospital Revenue Code	250
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$45.19
Rate for Payer: Aetna of AZ Commercial	$45.19
Rate for Payer: Aetna of AZ Medicare	$14.06
Rate for Payer: Allwell Medicare	$8.03
Rate for Payer: Amerigroup Medicare	$8.03
Rate for Payer: APIPA Medicare/Medicaid	$18.75
Rate for Payer: AZCH Complete Medicare	$8.03
Rate for Payer: Banner UC Health Medicare	$8.03
Rate for Payer: Bisbee Police All Plans	$13.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.14
Rate for Payer: Cash Price	$40.17
Rate for Payer: Cigna of AZ Commercial	$32.64
Rate for Payer: Copperpoint Commercial	$12.43
Rate for Payer: Health Net of AZ Commercial	$30.13
Rate for Payer: Health Net of AZ Medicare	$14.06
Rate for Payer: Humana of AZ Medicare	$8.03
Rate for Payer: Self Pay Self Pay	$40.17
Rate for Payer: TriWest Medicare	$8.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.04

PHENobarbital 130 mg/1 mL Inj Sol [CQCH]

Facility

$50.21

Service Code	HCPCS J2560
Hospital Charge Code	105936151
Hospital Revenue Code	250
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$45.19
Rate for Payer: Aetna of AZ Commercial	$45.19
Rate for Payer: Bisbee Police All Plans	$13.05
Rate for Payer: Cash Price	$40.17
Rate for Payer: Self Pay Self Pay	$40.17

PHENobarbital 32.4 mg Tab [CQCH]

Facility

$0.27

Service Code	NDC 904657561
Hospital Charge Code	105936220
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	$0.21
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

PHENobarbital 32.4 mg Tab [CQCH]

Facility

$0.27

Service Code	NDC 904657561
Hospital Charge Code	105936220
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	$0.21
Rate for Payer: Self Pay Self Pay	$0.22

PHENobarbital 65 mg/mL Sol[CQCH]

Facility

$19.35

Service Code	HCPCS J2560
Hospital Charge Code	121708919
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$17.41
Rate for Payer: Aetna of AZ Commercial	$17.41
Rate for Payer: Bisbee Police All Plans	$5.03
Rate for Payer: Cash Price	$15.48
Rate for Payer: Self Pay Self Pay	$15.48

PHENobarbital 65 mg/mL Sol[CQCH]

Facility

$19.35

Service Code	HCPCS J2560
Hospital Charge Code	121708919
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$17.41
Rate for Payer: Aetna of AZ Commercial	$17.41
Rate for Payer: Aetna of AZ Medicare	$5.42
Rate for Payer: Allwell Medicare	$3.10
Rate for Payer: Amerigroup Medicare	$3.10
Rate for Payer: APIPA Medicare/Medicaid	$7.23
Rate for Payer: AZCH Complete Medicare	$3.10
Rate for Payer: Banner UC Health Medicare	$3.10
Rate for Payer: Bisbee Police All Plans	$5.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.16
Rate for Payer: Cash Price	$15.48
Rate for Payer: Cigna of AZ Commercial	$12.58
Rate for Payer: Copperpoint Commercial	$4.79
Rate for Payer: Health Net of AZ Commercial	$11.61
Rate for Payer: Health Net of AZ Medicare	$5.42
Rate for Payer: Humana of AZ Medicare	$3.10
Rate for Payer: Self Pay Self Pay	$15.48
Rate for Payer: TriWest Medicare	$3.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.48

Phenobarbital, Serum LC

Facility

$206.00

Service Code	CPT 80184
Hospital Charge Code	1285609
Hospital Revenue Code	301
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Aetna of AZ Medicare	$57.68
Rate for Payer: Allwell Medicare	$32.96
Rate for Payer: Amerigroup Medicare	$32.96
Rate for Payer: APIPA Medicare/Medicaid	$76.94
Rate for Payer: AZCH Complete Medicare	$32.96
Rate for Payer: Banner UC Health Medicare	$32.96
Rate for Payer: Bisbee Police All Plans	$53.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$140.08
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cigna of AZ Commercial	$133.90
Rate for Payer: Copperpoint Commercial	$50.98
Rate for Payer: Health Net of AZ Commercial	$123.60
Rate for Payer: Health Net of AZ Medicare	$57.68
Rate for Payer: Humana of AZ Medicare	$32.96
Rate for Payer: Self Pay Self Pay	$164.80
Rate for Payer: TriWest Medicare	$32.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$120.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.08

Phenobarbital, Serum LC

Facility

$206.00

Service Code	CPT 80184
Hospital Charge Code	1285609
Hospital Revenue Code	301
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Bisbee Police All Plans	$53.56
Rate for Payer: Cash Price	$164.80
Rate for Payer: Self Pay Self Pay	$164.80

phenylephrine 10 mg/ 1 mL Inj Sol [CQCH]

Facility

$3.68

Service Code	HCPCS J2370
Hospital Charge Code	105936354
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna of AZ Commercial	$3.31
Rate for Payer: Bisbee Police All Plans	$0.96
Rate for Payer: Cash Price	$2.95
Rate for Payer: Self Pay Self Pay	$2.94

phenylephrine 10 mg/ 1 mL Inj Sol [CQCH]

Facility

$3.68

Service Code	HCPCS J2370
Hospital Charge Code	105936354
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna of AZ Commercial	$3.31
Rate for Payer: Aetna of AZ Medicare	$1.03
Rate for Payer: Allwell Medicare	$0.59
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: APIPA Medicare/Medicaid	$1.37
Rate for Payer: AZCH Complete Medicare	$0.59
Rate for Payer: Banner UC Health Medicare	$0.59
Rate for Payer: Bisbee Police All Plans	$0.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.50
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cigna of AZ Commercial	$2.39
Rate for Payer: Copperpoint Commercial	$0.91
Rate for Payer: Health Net of AZ Commercial	$2.21
Rate for Payer: Health Net of AZ Medicare	$1.03
Rate for Payer: Humana of AZ Medicare	$0.59
Rate for Payer: Self Pay Self Pay	$2.94
Rate for Payer: TriWest Medicare	$0.59
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.66

phenylephrine nasal 0.25% Sol 15 mL [CQCH]

Facility

$0.21

Service Code	NDC 24134803
Hospital Charge Code	105936423
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
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	$0.08
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	$0.17
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	$0.03
Rate for Payer: Self Pay Self Pay	$0.17
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

phenylephrine nasal 0.25% Sol 15 mL [CQCH]

Facility

$0.21

Service Code	NDC 24134803
Hospital Charge Code	105936423
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.17
Rate for Payer: Self Pay Self Pay	$0.17

phenylephrine nasal 1% spray 15 mL [CQCH]

Facility

$0.23

Service Code	NDC 24135202
Hospital Charge Code	105936488
Hospital Revenue Code	251
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	$0.18
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

phenylephrine nasal 1% spray 15 mL [CQCH]

Facility

$0.23

Service Code	NDC 24135202
Hospital Charge Code	105936488
Hospital Revenue Code	251
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	$0.18
Rate for Payer: Self Pay Self Pay	$0.18

phenytoin 100 mg ER Cap [CQCH]

Facility

$0.52

Service Code	NDC 68084037601
Hospital Charge Code	105936628
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of AZ Commercial	$0.47
Rate for Payer: Bisbee Police All Plans	$0.14
Rate for Payer: Cash Price	$0.41
Rate for Payer: Self Pay Self Pay	$0.42

Know your out-of-pocket cost for care.

All Charges