Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PRESS PATCH

Facility

$38.00

Hospital Charge Code	22355154
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Aetna of AZ Medicare	$10.64
Rate for Payer: Allwell Medicare	$5.70
Rate for Payer: Amerigroup Medicare	$5.70
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$5.70
Rate for Payer: Banner UC Health Medicare	$5.70
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.84
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Copperpoint Commercial	$9.40
Rate for Payer: Health Net of AZ Commercial	$22.80
Rate for Payer: Health Net of AZ Medicare	$10.64
Rate for Payer: Humana of AZ Medicare	$5.70
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$5.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

PRESS PATCH

Facility

$38.00

Hospital Charge Code	22355154
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

primidone 50 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 603537121
Hospital Charge Code	105938066
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

primidone 50 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 603537121
Hospital Charge Code	105938066
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Primidone (Mysoline), Serum LC

Facility

$319.00

Service Code	CPT 80188
Hospital Charge Code	1285610
Hospital Revenue Code	301
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$287.10
Rate for Payer: Aetna of AZ Commercial	$287.10
Rate for Payer: Bisbee Police All Plans	$82.94
Rate for Payer: Cash Price	$255.20
Rate for Payer: Self Pay Self Pay	$255.20

Primidone (Mysoline), Serum LC

Facility

$319.00

Service Code	CPT 80188
Hospital Charge Code	1285610
Hospital Revenue Code	301
Min. Negotiated Rate	$16.59
Max. Negotiated Rate	$287.10
Rate for Payer: Aetna of AZ Commercial	$287.10
Rate for Payer: Aetna of AZ Medicare	$89.32
Rate for Payer: AHCCCS Medicaid	$16.59
Rate for Payer: Allwell Medicaid	$16.59
Rate for Payer: Allwell Medicare	$47.85
Rate for Payer: Amerigroup Medicare	$47.85
Rate for Payer: APIPA Medicare/Medicaid	$119.15
Rate for Payer: AZCH Complete Medicaid	$16.59
Rate for Payer: AZCH Complete Medicare	$47.85
Rate for Payer: Banner UC Health Medicaid	$16.59
Rate for Payer: Banner UC Health Medicare	$47.85
Rate for Payer: Bisbee Police All Plans	$82.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$216.92
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cigna of AZ Commercial	$207.35
Rate for Payer: Copperpoint Commercial	$78.95
Rate for Payer: Health Net of AZ Commercial	$191.40
Rate for Payer: Health Net of AZ Medicare	$89.32
Rate for Payer: Humana of AZ Medicare	$47.85
Rate for Payer: Mercy Care Medicaid	$16.59
Rate for Payer: Self Pay Self Pay	$255.20
Rate for Payer: TriWest Medicare	$47.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$185.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.42

PROBE PULSE OX PED/ADULT NOVAMETRIX

Facility

$101.00

Hospital Charge Code	22355401
Hospital Revenue Code	270
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Bisbee Police All Plans	$26.26
Rate for Payer: Cash Price	$80.80
Rate for Payer: Self Pay Self Pay	$80.80

PROBE PULSE OX PED/ADULT NOVAMETRIX

Facility

$101.00

Hospital Charge Code	22355401
Hospital Revenue Code	270
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Aetna of AZ Medicare	$28.28
Rate for Payer: Allwell Medicare	$15.15
Rate for Payer: Amerigroup Medicare	$15.15
Rate for Payer: APIPA Medicare/Medicaid	$37.72
Rate for Payer: AZCH Complete Medicare	$15.15
Rate for Payer: Banner UC Health Medicare	$15.15
Rate for Payer: Bisbee Police All Plans	$26.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.68
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$70.70
Rate for Payer: Copperpoint Commercial	$25.00
Rate for Payer: Health Net of AZ Commercial	$60.60
Rate for Payer: Health Net of AZ Medicare	$28.28
Rate for Payer: Humana of AZ Medicare	$15.15
Rate for Payer: Self Pay Self Pay	$80.80
Rate for Payer: TriWest Medicare	$15.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.18

proBNP LC

Facility

$130.00

Service Code	CPT 83880
Hospital Charge Code	1285628
Hospital Revenue Code	301
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Aetna of AZ Medicare	$36.40
Rate for Payer: AHCCCS Medicaid	$39.26
Rate for Payer: Allwell Medicaid	$39.26
Rate for Payer: Allwell Medicare	$19.50
Rate for Payer: Amerigroup Medicare	$19.50
Rate for Payer: APIPA Medicare/Medicaid	$48.56
Rate for Payer: AZCH Complete Medicaid	$39.26
Rate for Payer: AZCH Complete Medicare	$19.50
Rate for Payer: Banner UC Health Medicaid	$39.26
Rate for Payer: Banner UC Health Medicare	$19.50
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$88.40
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.18
Rate for Payer: Health Net of AZ Commercial	$78.00
Rate for Payer: Health Net of AZ Medicare	$36.40
Rate for Payer: Humana of AZ Medicare	$19.50
Rate for Payer: Mercy Care Medicaid	$39.26
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$19.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

proBNP LC

Facility

$130.00

Service Code	CPT 83880
Hospital Charge Code	1285628
Hospital Revenue Code	301
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Self Pay Self Pay	$104.00

procainamide 100 mg/mL Sol[CQCH]

Facility

$6.03

Service Code	HCPCS J2690
Hospital Charge Code	135202939
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$5.43
Rate for Payer: Aetna of AZ Commercial	$5.43
Rate for Payer: Bisbee Police All Plans	$1.57
Rate for Payer: Cash Price	$4.82
Rate for Payer: Self Pay Self Pay	$4.82

procainamide 100 mg/mL Sol[CQCH]

Facility

$6.03

Service Code	HCPCS J2690
Hospital Charge Code	135202939
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$181.34
Rate for Payer: Aetna of AZ Commercial	$5.43
Rate for Payer: Aetna of AZ Medicare	$1.69
Rate for Payer: AHCCCS Medicaid	$181.34
Rate for Payer: Allwell Medicaid	$181.34
Rate for Payer: Allwell Medicare	$0.90
Rate for Payer: Amerigroup Medicare	$0.90
Rate for Payer: APIPA Medicare/Medicaid	$2.25
Rate for Payer: AZCH Complete Medicaid	$181.34
Rate for Payer: AZCH Complete Medicare	$0.90
Rate for Payer: Banner UC Health Medicaid	$181.34
Rate for Payer: Banner UC Health Medicare	$0.90
Rate for Payer: Bisbee Police All Plans	$1.57
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.10
Rate for Payer: Cash Price	$4.82
Rate for Payer: Cash Price	$4.82
Rate for Payer: Cigna of AZ Commercial	$3.92
Rate for Payer: Copperpoint Commercial	$1.49
Rate for Payer: Health Net of AZ Commercial	$3.62
Rate for Payer: Health Net of AZ Medicare	$1.69
Rate for Payer: Humana of AZ Medicare	$0.90
Rate for Payer: Mercy Care Medicaid	$181.34
Rate for Payer: Self Pay Self Pay	$4.82
Rate for Payer: TriWest Medicare	$0.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.09

Procedures For Obesity

Facility

$7,285.44

Service Code	APR-DRG 4031
Hospital Charge Code	APRDRG4031
Min. Negotiated Rate	$7,285.44
Max. Negotiated Rate	$7,285.44
Rate for Payer: AHCCCS Medicaid	$7,285.44
Rate for Payer: Allwell Medicaid	$7,285.44
Rate for Payer: AZCH Complete Medicaid	$7,285.44
Rate for Payer: Banner UC Health Medicaid	$7,285.44
Rate for Payer: Mercy Care Medicaid	$7,285.44

Procedures For Obesity

Facility

$8,425.22

Service Code	APR-DRG 4032
Hospital Charge Code	APRDRG4032
Min. Negotiated Rate	$8,425.22
Max. Negotiated Rate	$8,425.22
Rate for Payer: AHCCCS Medicaid	$8,425.22
Rate for Payer: Allwell Medicaid	$8,425.22
Rate for Payer: AZCH Complete Medicaid	$8,425.22
Rate for Payer: Banner UC Health Medicaid	$8,425.22
Rate for Payer: Mercy Care Medicaid	$8,425.22

Procedures For Obesity

Facility

$29,636.25

Service Code	APR-DRG 4034
Hospital Charge Code	APRDRG4033
Min. Negotiated Rate	$29,636.25
Max. Negotiated Rate	$29,636.25
Rate for Payer: AHCCCS Medicaid	$29,636.25
Rate for Payer: Allwell Medicaid	$29,636.25
Rate for Payer: AZCH Complete Medicaid	$29,636.25
Rate for Payer: Banner UC Health Medicaid	$29,636.25
Rate for Payer: Mercy Care Medicaid	$29,636.25

Procedures For Obesity

Facility

$7,285.44

Service Code	APR-DRG 4031
Hospital Charge Code	APRDRG4032
Min. Negotiated Rate	$7,285.44
Max. Negotiated Rate	$7,285.44
Rate for Payer: AHCCCS Medicaid	$7,285.44
Rate for Payer: Allwell Medicaid	$7,285.44
Rate for Payer: AZCH Complete Medicaid	$7,285.44
Rate for Payer: Banner UC Health Medicaid	$7,285.44
Rate for Payer: Mercy Care Medicaid	$7,285.44

Procedures For Obesity

Facility

$13,512.47

Service Code	APR-DRG 4033
Hospital Charge Code	APRDRG4031
Min. Negotiated Rate	$13,512.47
Max. Negotiated Rate	$13,512.47
Rate for Payer: AHCCCS Medicaid	$13,512.47
Rate for Payer: Allwell Medicaid	$13,512.47
Rate for Payer: AZCH Complete Medicaid	$13,512.47
Rate for Payer: Banner UC Health Medicaid	$13,512.47
Rate for Payer: Mercy Care Medicaid	$13,512.47

Procedures For Obesity

Facility

$8,425.22

Service Code	APR-DRG 4032
Hospital Charge Code	APRDRG4031
Min. Negotiated Rate	$8,425.22
Max. Negotiated Rate	$8,425.22
Rate for Payer: AHCCCS Medicaid	$8,425.22
Rate for Payer: Allwell Medicaid	$8,425.22
Rate for Payer: AZCH Complete Medicaid	$8,425.22
Rate for Payer: Banner UC Health Medicaid	$8,425.22
Rate for Payer: Mercy Care Medicaid	$8,425.22

Procedures For Obesity

Facility

$13,512.47

Service Code	APR-DRG 4033
Hospital Charge Code	APRDRG4033
Min. Negotiated Rate	$13,512.47
Max. Negotiated Rate	$13,512.47
Rate for Payer: AHCCCS Medicaid	$13,512.47
Rate for Payer: Allwell Medicaid	$13,512.47
Rate for Payer: AZCH Complete Medicaid	$13,512.47
Rate for Payer: Banner UC Health Medicaid	$13,512.47
Rate for Payer: Mercy Care Medicaid	$13,512.47

Procedures For Obesity

Facility

$29,636.25

Service Code	APR-DRG 4034
Hospital Charge Code	APRDRG4034
Min. Negotiated Rate	$29,636.25
Max. Negotiated Rate	$29,636.25
Rate for Payer: AHCCCS Medicaid	$29,636.25
Rate for Payer: Allwell Medicaid	$29,636.25
Rate for Payer: AZCH Complete Medicaid	$29,636.25
Rate for Payer: Banner UC Health Medicaid	$29,636.25
Rate for Payer: Mercy Care Medicaid	$29,636.25

Procedures For Obesity

Facility

$29,636.25

Service Code	APR-DRG 4034
Hospital Charge Code	APRDRG4031
Min. Negotiated Rate	$29,636.25
Max. Negotiated Rate	$29,636.25
Rate for Payer: AHCCCS Medicaid	$29,636.25
Rate for Payer: Allwell Medicaid	$29,636.25
Rate for Payer: AZCH Complete Medicaid	$29,636.25
Rate for Payer: Banner UC Health Medicaid	$29,636.25
Rate for Payer: Mercy Care Medicaid	$29,636.25

Procedures For Obesity

Facility

$7,285.44

Service Code	APR-DRG 4031
Hospital Charge Code	APRDRG4034
Min. Negotiated Rate	$7,285.44
Max. Negotiated Rate	$7,285.44
Rate for Payer: AHCCCS Medicaid	$7,285.44
Rate for Payer: Allwell Medicaid	$7,285.44
Rate for Payer: AZCH Complete Medicaid	$7,285.44
Rate for Payer: Banner UC Health Medicaid	$7,285.44
Rate for Payer: Mercy Care Medicaid	$7,285.44

Procedures For Obesity

Facility

$8,425.22

Service Code	APR-DRG 4032
Hospital Charge Code	APRDRG4034
Min. Negotiated Rate	$8,425.22
Max. Negotiated Rate	$8,425.22
Rate for Payer: AHCCCS Medicaid	$8,425.22
Rate for Payer: Allwell Medicaid	$8,425.22
Rate for Payer: AZCH Complete Medicaid	$8,425.22
Rate for Payer: Banner UC Health Medicaid	$8,425.22
Rate for Payer: Mercy Care Medicaid	$8,425.22

Procedures For Obesity

Facility

$13,512.47

Service Code	APR-DRG 4033
Hospital Charge Code	APRDRG4034
Min. Negotiated Rate	$13,512.47
Max. Negotiated Rate	$13,512.47
Rate for Payer: AHCCCS Medicaid	$13,512.47
Rate for Payer: Allwell Medicaid	$13,512.47
Rate for Payer: AZCH Complete Medicaid	$13,512.47
Rate for Payer: Banner UC Health Medicaid	$13,512.47
Rate for Payer: Mercy Care Medicaid	$13,512.47

Procedures For Obesity

Facility

$29,636.25

Service Code	APR-DRG 4034
Hospital Charge Code	APRDRG4032
Min. Negotiated Rate	$29,636.25
Max. Negotiated Rate	$29,636.25
Rate for Payer: AHCCCS Medicaid	$29,636.25
Rate for Payer: Allwell Medicaid	$29,636.25
Rate for Payer: AZCH Complete Medicaid	$29,636.25
Rate for Payer: Banner UC Health Medicaid	$29,636.25
Rate for Payer: Mercy Care Medicaid	$29,636.25

Know your out-of-pocket cost for care.

All Charges