Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

QUANT LIPOPR

Facility

$426.00

Service Code	CPT 83704
Hospital Charge Code	22481501
Hospital Revenue Code	301
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Bisbee Police All Plans	$110.76
Rate for Payer: Cash Price	$340.80
Rate for Payer: Self Pay Self Pay	$340.80

QUEtiapine 100 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 63739066510
Hospital Charge Code	105938895
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.15
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	$0.28
Rate for Payer: Cash Price	$0.33
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	$0.11
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.33
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	$0.07

QUEtiapine 100 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 63739066510
Hospital Charge Code	105938895
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.33
Rate for Payer: Self Pay Self Pay	$0.33

QUEtiapine 25 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 16714045201
Hospital Charge Code	105938962
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

QUEtiapine 25 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 16714045201
Hospital Charge Code	105938962
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.03

QUICK CARE URINALYSIS DIPSTICK

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	22422559
Hospital Revenue Code	307
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Cash Price	$21.60
Rate for Payer: Self Pay Self Pay	$21.60

QUICK CARE URINALYSIS DIPSTICK

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	22422559
Hospital Revenue Code	307
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Aetna of AZ Medicare	$7.56
Rate for Payer: Allwell Medicare	$4.32
Rate for Payer: Amerigroup Medicare	$4.32
Rate for Payer: APIPA Medicare/Medicaid	$10.08
Rate for Payer: AZCH Complete Medicare	$4.32
Rate for Payer: Banner UC Health Medicare	$4.32
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$18.36
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$17.55
Rate for Payer: Copperpoint Commercial	$6.68
Rate for Payer: Health Net of AZ Commercial	$16.20
Rate for Payer: Health Net of AZ Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$4.32
Rate for Payer: Self Pay Self Pay	$21.60
Rate for Payer: TriWest Medicare	$4.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.86

QUICKCLIP PRO 230XM

Facility

$676.00

Hospital Charge Code	27443862
Hospital Revenue Code	270
Min. Negotiated Rate	$175.76
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Bisbee Police All Plans	$175.76
Rate for Payer: Cash Price	$540.80
Rate for Payer: Self Pay Self Pay	$540.80

QUICKCLIP PRO 230XM

Facility

$676.00

Hospital Charge Code	27443862
Hospital Revenue Code	270
Min. Negotiated Rate	$108.16
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Aetna of AZ Medicare	$189.28
Rate for Payer: Allwell Medicare	$108.16
Rate for Payer: Amerigroup Medicare	$108.16
Rate for Payer: APIPA Medicare/Medicaid	$252.49
Rate for Payer: AZCH Complete Medicare	$108.16
Rate for Payer: Banner UC Health Medicare	$108.16
Rate for Payer: Bisbee Police All Plans	$175.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$459.68
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cigna of AZ Commercial	$473.20
Rate for Payer: Copperpoint Commercial	$167.31
Rate for Payer: Health Net of AZ Commercial	$405.60
Rate for Payer: Health Net of AZ Medicare	$189.28
Rate for Payer: Humana of AZ Medicare	$108.16
Rate for Payer: Self Pay Self Pay	$540.80
Rate for Payer: TriWest Medicare	$108.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$394.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$121.68

QUICKSNAP 2MM X8MM SCREW

Facility

$3,032.00

Hospital Charge Code	27555211
Hospital Revenue Code	270
Min. Negotiated Rate	$788.32
Max. Negotiated Rate	$2,728.80
Rate for Payer: Aetna of AZ Commercial	$2,728.80
Rate for Payer: Bisbee Police All Plans	$788.32
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Self Pay Self Pay	$2,425.60

QUICKSNAP 2MM X8MM SCREW

Facility

$3,032.00

Hospital Charge Code	27555211
Hospital Revenue Code	270
Min. Negotiated Rate	$485.12
Max. Negotiated Rate	$2,728.80
Rate for Payer: Aetna of AZ Commercial	$2,728.80
Rate for Payer: Aetna of AZ Medicare	$848.96
Rate for Payer: Allwell Medicare	$485.12
Rate for Payer: Amerigroup Medicare	$485.12
Rate for Payer: APIPA Medicare/Medicaid	$1,132.45
Rate for Payer: AZCH Complete Medicare	$485.12
Rate for Payer: Banner UC Health Medicare	$485.12
Rate for Payer: Bisbee Police All Plans	$788.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,061.76
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cigna of AZ Commercial	$2,122.40
Rate for Payer: Copperpoint Commercial	$750.42
Rate for Payer: Health Net of AZ Commercial	$1,819.20
Rate for Payer: Health Net of AZ Medicare	$848.96
Rate for Payer: Humana of AZ Medicare	$485.12
Rate for Payer: Self Pay Self Pay	$2,425.60
Rate for Payer: TriWest Medicare	$485.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,767.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$545.76

quinapril 10 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 65862061890
Hospital Charge Code	105939029
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

quinapril 10 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 65862061890
Hospital Charge Code	105939029
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

QWIX DRILL AO 2IN SIA 2MM X L65MM

Facility

$935.00

Hospital Charge Code	27341817
Hospital Revenue Code	270
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Aetna of AZ Medicare	$261.80
Rate for Payer: Allwell Medicare	$149.60
Rate for Payer: Amerigroup Medicare	$149.60
Rate for Payer: APIPA Medicare/Medicaid	$349.22
Rate for Payer: AZCH Complete Medicare	$149.60
Rate for Payer: Banner UC Health Medicare	$149.60
Rate for Payer: Bisbee Police All Plans	$243.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$635.80
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cigna of AZ Commercial	$654.50
Rate for Payer: Copperpoint Commercial	$231.41
Rate for Payer: Health Net of AZ Commercial	$561.00
Rate for Payer: Health Net of AZ Medicare	$261.80
Rate for Payer: Humana of AZ Medicare	$149.60
Rate for Payer: Self Pay Self Pay	$748.00
Rate for Payer: TriWest Medicare	$149.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$545.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$168.30

QWIX DRILL AO 2IN SIA 2MM X L65MM

Facility

$935.00

Hospital Charge Code	27341817
Hospital Revenue Code	270
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Bisbee Police All Plans	$243.10
Rate for Payer: Cash Price	$748.00
Rate for Payer: Self Pay Self Pay	$748.00

rabies immune globulin, human 300 units/mL 1 mL Sol[CQCH]

Facility

$646.31

Service Code	NDC 13533031801
Hospital Charge Code	142368685
Hospital Revenue Code	250
Min. Negotiated Rate	$168.04
Max. Negotiated Rate	$581.68
Rate for Payer: Aetna of AZ Commercial	$581.68
Rate for Payer: Bisbee Police All Plans	$168.04
Rate for Payer: Cash Price	$517.05
Rate for Payer: Self Pay Self Pay	$517.05

rabies immune globulin, human 300 units/mL 1 mL Sol[CQCH]

Facility

$646.31

Service Code	NDC 13533031801
Hospital Charge Code	142368685
Hospital Revenue Code	250
Min. Negotiated Rate	$103.41
Max. Negotiated Rate	$581.68
Rate for Payer: Aetna of AZ Commercial	$581.68
Rate for Payer: Aetna of AZ Medicare	$180.97
Rate for Payer: Allwell Medicare	$103.41
Rate for Payer: Amerigroup Medicare	$103.41
Rate for Payer: APIPA Medicare/Medicaid	$241.40
Rate for Payer: AZCH Complete Medicare	$103.41
Rate for Payer: Banner UC Health Medicare	$103.41
Rate for Payer: Bisbee Police All Plans	$168.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$439.49
Rate for Payer: Cash Price	$517.05
Rate for Payer: Cigna of AZ Commercial	$420.10
Rate for Payer: Copperpoint Commercial	$159.96
Rate for Payer: Health Net of AZ Commercial	$387.79
Rate for Payer: Health Net of AZ Medicare	$180.97
Rate for Payer: Humana of AZ Medicare	$103.41
Rate for Payer: Self Pay Self Pay	$517.05
Rate for Payer: TriWest Medicare	$103.41
Rate for Payer: UnitedHealth Group of AZ Commercial	$376.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$116.34

rabies immune globulin, human 300 units/mL 5 mL Sol[CQCH]

Facility

$3,231.55

Service Code	NDC 13533031805
Hospital Charge Code	135027576
Hospital Revenue Code	250
Min. Negotiated Rate	$517.05
Max. Negotiated Rate	$2,908.39
Rate for Payer: Aetna of AZ Commercial	$2,908.39
Rate for Payer: Aetna of AZ Medicare	$904.83
Rate for Payer: Allwell Medicare	$517.05
Rate for Payer: Amerigroup Medicare	$517.05
Rate for Payer: APIPA Medicare/Medicaid	$1,206.98
Rate for Payer: AZCH Complete Medicare	$517.05
Rate for Payer: Banner UC Health Medicare	$517.05
Rate for Payer: Bisbee Police All Plans	$840.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,197.45
Rate for Payer: Cash Price	$2,585.24
Rate for Payer: Cigna of AZ Commercial	$2,100.51
Rate for Payer: Copperpoint Commercial	$799.81
Rate for Payer: Health Net of AZ Commercial	$1,938.93
Rate for Payer: Health Net of AZ Medicare	$904.83
Rate for Payer: Humana of AZ Medicare	$517.05
Rate for Payer: Self Pay Self Pay	$2,585.24
Rate for Payer: TriWest Medicare	$517.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,883.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$581.68

rabies immune globulin, human 300 units/mL 5 mL Sol[CQCH]

Facility

$3,231.55

Service Code	NDC 13533031805
Hospital Charge Code	135027576
Hospital Revenue Code	250
Min. Negotiated Rate	$840.20
Max. Negotiated Rate	$2,908.39
Rate for Payer: Aetna of AZ Commercial	$2,908.39
Rate for Payer: Bisbee Police All Plans	$840.20
Rate for Payer: Cash Price	$2,585.24
Rate for Payer: Self Pay Self Pay	$2,585.24

Rabies Neut. Abs Titrat. (RFFIT) LC

Facility

$104.00

Service Code	CPT 86382
Hospital Charge Code	22617332
Hospital Revenue Code	300
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$16.64
Rate for Payer: Amerigroup Medicare	$16.64
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$67.60
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

Rabies Neut. Abs Titrat. (RFFIT) LC

Facility

$104.00

Service Code	CPT 86382
Hospital Charge Code	22617332
Hospital Revenue Code	300
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

racepinephrine 2.25% Inh Sol UD [CQCH]

Facility

$6.62

Service Code	NDC 487278401
Hospital Charge Code	105939234
Hospital Revenue Code	251
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna of AZ Commercial	$5.96
Rate for Payer: Aetna of AZ Medicare	$1.85
Rate for Payer: Allwell Medicare	$1.06
Rate for Payer: Amerigroup Medicare	$1.06
Rate for Payer: APIPA Medicare/Medicaid	$2.47
Rate for Payer: AZCH Complete Medicare	$1.06
Rate for Payer: Banner UC Health Medicare	$1.06
Rate for Payer: Bisbee Police All Plans	$1.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.50
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cigna of AZ Commercial	$4.30
Rate for Payer: Copperpoint Commercial	$1.64
Rate for Payer: Health Net of AZ Commercial	$3.97
Rate for Payer: Health Net of AZ Medicare	$1.85
Rate for Payer: Humana of AZ Medicare	$1.06
Rate for Payer: Self Pay Self Pay	$5.30
Rate for Payer: TriWest Medicare	$1.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.19

racepinephrine 2.25% Inh Sol UD [CQCH]

Facility

$6.62

Service Code	NDC 487278401
Hospital Charge Code	105939234
Hospital Revenue Code	251
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna of AZ Commercial	$5.96
Rate for Payer: Bisbee Police All Plans	$1.72
Rate for Payer: Cash Price	$5.30
Rate for Payer: Self Pay Self Pay	$5.30

Radiology Misc

Facility

$862.00

Service Code	CPT 93971 RT
Hospital Charge Code	22828024
Hospital Revenue Code	921
Min. Negotiated Rate	$224.12
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Cash Price	$689.60
Rate for Payer: Self Pay Self Pay	$689.60

Radiology Misc

Facility

$862.00

Service Code	CPT 93971 RT
Hospital Charge Code	22828024
Hospital Revenue Code	921
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Aetna of AZ Medicare	$241.36
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$137.92
Rate for Payer: Amerigroup Medicare	$137.92
Rate for Payer: APIPA Medicare/Medicaid	$321.96
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$137.92
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$137.92
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$586.16
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cigna of AZ Commercial	$603.40
Rate for Payer: Copperpoint Commercial	$213.34
Rate for Payer: Health Net of AZ Commercial	$517.20
Rate for Payer: Health Net of AZ Medicare	$241.36
Rate for Payer: Humana of AZ Medicare	$137.92
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$689.60
Rate for Payer: TriWest Medicare	$137.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$502.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.16

Know your out-of-pocket cost for care.

All Charges