Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

potassium chloride 10 mEq ER Tab [CQCH]

Facility

$0.42

Service Code	NDC 245531601
Hospital Charge Code	108127557
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.33
Rate for Payer: Self Pay Self Pay	$0.34

potassium chloride 20 mEq ER Tab [CQCH]

Facility

$0.62

Service Code	NDC 68084036009
Hospital Charge Code	105937370
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.50
Rate for Payer: Self Pay Self Pay	$0.50

potassium chloride 20 mEq ER Tab [CQCH]

Facility

$0.62

Service Code	NDC 68084036009
Hospital Charge Code	105937370
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Aetna of AZ Medicare	$0.17
Rate for Payer: Allwell Medicare	$0.10
Rate for Payer: Amerigroup Medicare	$0.10
Rate for Payer: APIPA Medicare/Medicaid	$0.23
Rate for Payer: AZCH Complete Medicare	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.42
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Copperpoint Commercial	$0.15
Rate for Payer: Health Net of AZ Commercial	$0.37
Rate for Payer: Health Net of AZ Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

Potassium Level

Facility

$71.00

Service Code	CPT 84132
Hospital Charge Code	633616
Hospital Revenue Code	301
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$46.15
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

Potassium Level

Facility

$71.00

Service Code	CPT 84132
Hospital Charge Code	633616
Hospital Revenue Code	301
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg REC UD[CQCH]

Facility

$0.32

Service Code	NDC 71351001001
Hospital Charge Code	163314692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of AZ Commercial	$0.29
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	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.22
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of AZ Commercial	$0.21
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.19
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

potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg REC UD[CQCH]

Facility

$0.32

Service Code	NDC 71351001001
Hospital Charge Code	163314692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of AZ Commercial	$0.29
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.26
Rate for Payer: Self Pay Self Pay	$0.26

Powerpoint SLIM IMPLANTABLE PORT

Facility

$1,650.00

Hospital Charge Code	24325294
Hospital Revenue Code	270
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna of AZ Commercial	$1,485.00
Rate for Payer: Bisbee Police All Plans	$429.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Self Pay Self Pay	$1,320.00

Powerpoint SLIM IMPLANTABLE PORT

Facility

$1,650.00

Hospital Charge Code	24325294
Hospital Revenue Code	270
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna of AZ Commercial	$1,485.00
Rate for Payer: Aetna of AZ Medicare	$462.00
Rate for Payer: Allwell Medicare	$264.00
Rate for Payer: Amerigroup Medicare	$264.00
Rate for Payer: APIPA Medicare/Medicaid	$616.27
Rate for Payer: AZCH Complete Medicare	$264.00
Rate for Payer: Banner UC Health Medicare	$264.00
Rate for Payer: Bisbee Police All Plans	$429.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,122.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Cigna of AZ Commercial	$1,155.00
Rate for Payer: Copperpoint Commercial	$408.38
Rate for Payer: Health Net of AZ Commercial	$990.00
Rate for Payer: Health Net of AZ Medicare	$462.00
Rate for Payer: Humana of AZ Medicare	$264.00
Rate for Payer: Self Pay Self Pay	$1,320.00
Rate for Payer: TriWest Medicare	$264.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$961.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$297.00

pramipexole 0.5 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 68462033290
Hospital Charge Code	105937512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.09
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

pramipexole 0.5 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 68462033290
Hospital Charge Code	105937512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.10
Rate for Payer: Self Pay Self Pay	$0.10

prazosin 1 mg Cap [CQCH]

Facility

$0.24

Service Code	NDC 378110101
Hospital Charge Code	118000537
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.19
Rate for Payer: Self Pay Self Pay	$0.19

prazosin 1 mg Cap [CQCH]

Facility

$0.24

Service Code	NDC 378110101
Hospital Charge Code	118000537
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Aetna of AZ Medicare	$0.07
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	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.16
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	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.19
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

Prealbumin LC

Facility

$203.00

Service Code	CPT 84134
Hospital Charge Code	1905830
Hospital Revenue Code	301
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

Prealbumin LC

Facility

$203.00

Service Code	CPT 84134
Hospital Charge Code	1905830
Hospital Revenue Code	301
Min. Negotiated Rate	$32.48
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: Allwell Medicare	$32.48
Rate for Payer: Amerigroup Medicare	$32.48
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicare	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$131.95
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

PRE-ANES EXAM/EVAL

Facility

$186.00

Service Code	CPT 99231 QZ
Hospital Charge Code	22789175
Hospital Revenue Code	370
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Cash Price	$148.80
Rate for Payer: Self Pay Self Pay	$148.80

PRE-ANES EXAM/EVAL

Facility

$186.00

Service Code	CPT 99231 QZ
Hospital Charge Code	22789175
Hospital Revenue Code	370
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: Allwell Medicare	$29.76
Rate for Payer: Amerigroup Medicare	$29.76
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicare	$29.76
Rate for Payer: Banner UC Health Medicare	$29.76
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$120.90
Rate for Payer: Copperpoint Commercial	$46.03
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$29.76
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$29.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

prednisoLONE 15 mg/5 mL Oral Syrup UD [CQCH]

Facility

$0.13

Service Code	HCPCS J7510
Hospital Charge Code	105937577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.09
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

prednisoLONE 15 mg/5 mL Oral Syrup UD [CQCH]

Facility

$0.13

Service Code	HCPCS J7510
Hospital Charge Code	105937577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.10
Rate for Payer: Self Pay Self Pay	$0.10

prednisoLONE acetate 1% Ophth Susp [CQCH]

Facility

$8.65

Service Code	NDC 61314063705
Hospital Charge Code	105937654
Hospital Revenue Code	251
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$7.79
Rate for Payer: Aetna of AZ Commercial	$7.79
Rate for Payer: Bisbee Police All Plans	$2.25
Rate for Payer: Cash Price	$6.92
Rate for Payer: Self Pay Self Pay	$6.92

prednisoLONE acetate 1% Ophth Susp [CQCH]

Facility

$8.65

Service Code	NDC 61314063705
Hospital Charge Code	105937654
Hospital Revenue Code	251
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$7.79
Rate for Payer: Aetna of AZ Commercial	$7.79
Rate for Payer: Aetna of AZ Medicare	$2.42
Rate for Payer: Allwell Medicare	$1.38
Rate for Payer: Amerigroup Medicare	$1.38
Rate for Payer: APIPA Medicare/Medicaid	$3.23
Rate for Payer: AZCH Complete Medicare	$1.38
Rate for Payer: Banner UC Health Medicare	$1.38
Rate for Payer: Bisbee Police All Plans	$2.25
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.88
Rate for Payer: Cash Price	$6.92
Rate for Payer: Cigna of AZ Commercial	$5.62
Rate for Payer: Copperpoint Commercial	$2.14
Rate for Payer: Health Net of AZ Commercial	$5.19
Rate for Payer: Health Net of AZ Medicare	$2.42
Rate for Payer: Humana of AZ Medicare	$1.38
Rate for Payer: Self Pay Self Pay	$6.92
Rate for Payer: TriWest Medicare	$1.38
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.56

predniSONE 10 mg Tab [CQCH]

Facility

$0.15

Service Code	HCPCS J7510
Hospital Charge Code	105937790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.12
Rate for Payer: Self Pay Self Pay	$0.12

predniSONE 10 mg Tab [CQCH]

Facility

$0.15

Service Code	HCPCS J7510
Hospital Charge Code	105937790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.09
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.12
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

predniSONE 1 mg Tab [CQCH]

Facility

$0.16

Service Code	HCPCS J7510
Hospital Charge Code	105937861
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.11
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

predniSONE 1 mg Tab [CQCH]

Facility

$0.16

Service Code	HCPCS J7510
Hospital Charge Code	105937861
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.13

Know your out-of-pocket cost for care.

All Charges