Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

thiamine 200 mg/ 2 mL Inj Sol [CQCH]

Facility

$2.61

Service Code	HCPCS J3411
Hospital Charge Code	105943788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna of AZ Commercial	$2.35
Rate for Payer: Bisbee Police All Plans	$0.68
Rate for Payer: Cash Price	$2.08
Rate for Payer: Self Pay Self Pay	$2.09

Thiopurine Methyltransferase LC

Facility

$708.00

Service Code	CPT 82542
Hospital Charge Code	2087652
Hospital Revenue Code	301
Min. Negotiated Rate	$184.08
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Bisbee Police All Plans	$184.08
Rate for Payer: Cash Price	$566.40
Rate for Payer: Self Pay Self Pay	$566.40

Thiopurine Methyltransferase LC

Facility

$708.00

Service Code	CPT 82542
Hospital Charge Code	2087652
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Aetna of AZ Medicare	$198.24
Rate for Payer: AHCCCS Medicaid	$24.09
Rate for Payer: Allwell Medicaid	$24.09
Rate for Payer: Allwell Medicare	$106.20
Rate for Payer: Amerigroup Medicare	$106.20
Rate for Payer: APIPA Medicare/Medicaid	$264.44
Rate for Payer: AZCH Complete Medicaid	$24.09
Rate for Payer: AZCH Complete Medicare	$106.20
Rate for Payer: Banner UC Health Medicaid	$24.09
Rate for Payer: Banner UC Health Medicare	$106.20
Rate for Payer: Bisbee Police All Plans	$184.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$481.44
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cigna of AZ Commercial	$460.20
Rate for Payer: Copperpoint Commercial	$175.23
Rate for Payer: Health Net of AZ Commercial	$424.80
Rate for Payer: Health Net of AZ Medicare	$198.24
Rate for Payer: Humana of AZ Medicare	$106.20
Rate for Payer: Mercy Care Medicaid	$24.09
Rate for Payer: Self Pay Self Pay	$566.40
Rate for Payer: TriWest Medicare	$106.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$412.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$127.44

THORACENTESIS

Facility

$440.00

Hospital Charge Code	22282949
Hospital Revenue Code	302
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Aetna of AZ Medicare	$123.20
Rate for Payer: Allwell Medicare	$66.00
Rate for Payer: Amerigroup Medicare	$66.00
Rate for Payer: APIPA Medicare/Medicaid	$164.34
Rate for Payer: AZCH Complete Medicare	$66.00
Rate for Payer: Banner UC Health Medicare	$66.00
Rate for Payer: Bisbee Police All Plans	$114.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$299.20
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cigna of AZ Commercial	$286.00
Rate for Payer: Copperpoint Commercial	$108.90
Rate for Payer: Health Net of AZ Commercial	$264.00
Rate for Payer: Health Net of AZ Medicare	$123.20
Rate for Payer: Humana of AZ Medicare	$66.00
Rate for Payer: Self Pay Self Pay	$352.00
Rate for Payer: TriWest Medicare	$66.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$256.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$79.20

THORACENTESIS

Facility

$440.00

Hospital Charge Code	22282949
Hospital Revenue Code	302
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Bisbee Police All Plans	$114.40
Rate for Payer: Cash Price	$352.00
Rate for Payer: Self Pay Self Pay	$352.00

THP albuterol MDI-90 mcg/inh 8 gm [CQCH]

Facility

$35.00

Service Code	NDC 99999999968
Hospital Charge Code	110285600
Hospital Revenue Code	253
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Aetna of AZ Medicare	$9.80
Rate for Payer: Allwell Medicare	$5.25
Rate for Payer: Amerigroup Medicare	$5.25
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.25
Rate for Payer: Banner UC Health Medicare	$5.25
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$22.75
Rate for Payer: Copperpoint Commercial	$8.66
Rate for Payer: Health Net of AZ Commercial	$21.00
Rate for Payer: Health Net of AZ Medicare	$9.80
Rate for Payer: Humana of AZ Medicare	$5.25
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

THP albuterol MDI-90 mcg/inh 8 gm [CQCH]

Facility

$35.00

Service Code	NDC 99999999968
Hospital Charge Code	110285600
Hospital Revenue Code	253
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Cash Price	$28.00
Rate for Payer: Self Pay Self Pay	$28.00

THP amoxicillin 250 mg/5 mL Oral susp (80 mL after reconst) [CQCH]

Facility

$3.24

Service Code	NDC 99999999970
Hospital Charge Code	110285383
Hospital Revenue Code	253
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of AZ Commercial	$2.92
Rate for Payer: Bisbee Police All Plans	$0.84
Rate for Payer: Cash Price	$2.59
Rate for Payer: Self Pay Self Pay	$2.59

THP amoxicillin 250 mg/5 mL Oral susp (80 mL after reconst) [CQCH]

Facility

$3.24

Service Code	NDC 99999999970
Hospital Charge Code	110285383
Hospital Revenue Code	253
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of AZ Commercial	$2.92
Rate for Payer: Aetna of AZ Medicare	$0.91
Rate for Payer: Allwell Medicare	$0.49
Rate for Payer: Amerigroup Medicare	$0.49
Rate for Payer: APIPA Medicare/Medicaid	$1.21
Rate for Payer: AZCH Complete Medicare	$0.49
Rate for Payer: Banner UC Health Medicare	$0.49
Rate for Payer: Bisbee Police All Plans	$0.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.20
Rate for Payer: Cash Price	$2.59
Rate for Payer: Cigna of AZ Commercial	$2.11
Rate for Payer: Copperpoint Commercial	$0.80
Rate for Payer: Health Net of AZ Commercial	$1.94
Rate for Payer: Health Net of AZ Medicare	$0.91
Rate for Payer: Humana of AZ Medicare	$0.49
Rate for Payer: Self Pay Self Pay	$2.59
Rate for Payer: TriWest Medicare	$0.49
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.58

THP amoxicillin 500 mg Cap [CQCH]

Facility

$0.28

Service Code	NDC 99999999972
Hospital Charge Code	110285149
Hospital Revenue Code	253
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of AZ Commercial	$0.25
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	$0.19
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	$0.17
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

THP amoxicillin 500 mg Cap [CQCH]

Facility

$0.28

Service Code	NDC 99999999972
Hospital Charge Code	110285149
Hospital Revenue Code	253
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of AZ Commercial	$0.25
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

THP amoxicillin-clavulanate 600 mg/5 mL Oral Liq (75 mL after reconst.) [CQCH]

Facility

$25.26

Service Code	NDC 99999999969
Hospital Charge Code	110285455
Hospital Revenue Code	253
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$22.73
Rate for Payer: Aetna of AZ Commercial	$22.73
Rate for Payer: Aetna of AZ Medicare	$7.07
Rate for Payer: Allwell Medicare	$3.79
Rate for Payer: Amerigroup Medicare	$3.79
Rate for Payer: APIPA Medicare/Medicaid	$9.43
Rate for Payer: AZCH Complete Medicare	$3.79
Rate for Payer: Banner UC Health Medicare	$3.79
Rate for Payer: Bisbee Police All Plans	$6.57
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.18
Rate for Payer: Cash Price	$20.21
Rate for Payer: Cigna of AZ Commercial	$16.42
Rate for Payer: Copperpoint Commercial	$6.25
Rate for Payer: Health Net of AZ Commercial	$15.16
Rate for Payer: Health Net of AZ Medicare	$7.07
Rate for Payer: Humana of AZ Medicare	$3.79
Rate for Payer: Self Pay Self Pay	$20.21
Rate for Payer: TriWest Medicare	$3.79
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.55

THP amoxicillin-clavulanate 600 mg/5 mL Oral Liq (75 mL after reconst.) [CQCH]

Facility

$25.26

Service Code	NDC 99999999969
Hospital Charge Code	110285455
Hospital Revenue Code	253
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$22.73
Rate for Payer: Aetna of AZ Commercial	$22.73
Rate for Payer: Bisbee Police All Plans	$6.57
Rate for Payer: Cash Price	$20.21
Rate for Payer: Self Pay Self Pay	$20.21

THP azithromycin 200 mg/5 mL Oral Susp (22.5 mL after reconst) [CQCH]

Facility

$25.88

Service Code	NDC 99999999971
Hospital Charge Code	110285309
Hospital Revenue Code	253
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$23.29
Rate for Payer: Aetna of AZ Commercial	$23.29
Rate for Payer: Aetna of AZ Medicare	$7.25
Rate for Payer: Allwell Medicare	$3.88
Rate for Payer: Amerigroup Medicare	$3.88
Rate for Payer: APIPA Medicare/Medicaid	$9.67
Rate for Payer: AZCH Complete Medicare	$3.88
Rate for Payer: Banner UC Health Medicare	$3.88
Rate for Payer: Bisbee Police All Plans	$6.73
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cigna of AZ Commercial	$16.82
Rate for Payer: Copperpoint Commercial	$6.41
Rate for Payer: Health Net of AZ Commercial	$15.53
Rate for Payer: Health Net of AZ Medicare	$7.25
Rate for Payer: Humana of AZ Medicare	$3.88
Rate for Payer: Self Pay Self Pay	$20.70
Rate for Payer: TriWest Medicare	$3.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.66

THP azithromycin 200 mg/5 mL Oral Susp (22.5 mL after reconst) [CQCH]

Facility

$25.88

Service Code	NDC 99999999971
Hospital Charge Code	110285309
Hospital Revenue Code	253
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$23.29
Rate for Payer: Aetna of AZ Commercial	$23.29
Rate for Payer: Bisbee Police All Plans	$6.73
Rate for Payer: Cash Price	$20.70
Rate for Payer: Self Pay Self Pay	$20.70

THP cephalexin 500 mg Cap [CQCH]

Facility

$0.32

Service Code	NDC 99999999977
Hospital Charge Code	110283528
Hospital Revenue Code	253
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

THP cephalexin 500 mg Cap [CQCH]

Facility

$0.32

Service Code	NDC 99999999977
Hospital Charge Code	110283528
Hospital Revenue Code	253
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

THP cephalexin oral susp. 250 mg/5 mL (100 mL) [CQCH]

Facility

$12.93

Service Code	NDC 99999999973
Hospital Charge Code	110285053
Hospital Revenue Code	253
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$11.64
Rate for Payer: Aetna of AZ Commercial	$11.64
Rate for Payer: Bisbee Police All Plans	$3.36
Rate for Payer: Cash Price	$10.34
Rate for Payer: Self Pay Self Pay	$10.34

THP cephalexin oral susp. 250 mg/5 mL (100 mL) [CQCH]

Facility

$12.93

Service Code	NDC 99999999973
Hospital Charge Code	110285053
Hospital Revenue Code	253
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$11.64
Rate for Payer: Aetna of AZ Commercial	$11.64
Rate for Payer: Aetna of AZ Medicare	$3.62
Rate for Payer: Allwell Medicare	$1.94
Rate for Payer: Amerigroup Medicare	$1.94
Rate for Payer: APIPA Medicare/Medicaid	$4.83
Rate for Payer: AZCH Complete Medicare	$1.94
Rate for Payer: Banner UC Health Medicare	$1.94
Rate for Payer: Bisbee Police All Plans	$3.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.79
Rate for Payer: Cash Price	$10.34
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$3.20
Rate for Payer: Health Net of AZ Commercial	$7.76
Rate for Payer: Health Net of AZ Medicare	$3.62
Rate for Payer: Humana of AZ Medicare	$1.94
Rate for Payer: Self Pay Self Pay	$10.34
Rate for Payer: TriWest Medicare	$1.94
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.33

THP ciprofloxacin 500 mg Tab [CQCH]

Facility

$0.32

Service Code	NDC 99999999978
Hospital Charge Code	110283248
Hospital Revenue Code	253
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

THP ciprofloxacin 500 mg Tab [CQCH]

Facility

$0.32

Service Code	NDC 99999999978
Hospital Charge Code	110283248
Hospital Revenue Code	253
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

THP ondansetron 4 mg Dis Tab [CQCH]

Facility

$2.48

Service Code	NDC 99999999979
Hospital Charge Code	110283021
Hospital Revenue Code	253
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$2.23
Rate for Payer: Aetna of AZ Commercial	$2.23
Rate for Payer: Aetna of AZ Medicare	$0.69
Rate for Payer: Allwell Medicare	$0.37
Rate for Payer: Amerigroup Medicare	$0.37
Rate for Payer: APIPA Medicare/Medicaid	$0.93
Rate for Payer: AZCH Complete Medicare	$0.37
Rate for Payer: Banner UC Health Medicare	$0.37
Rate for Payer: Bisbee Police All Plans	$0.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.69
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cigna of AZ Commercial	$1.61
Rate for Payer: Copperpoint Commercial	$0.61
Rate for Payer: Health Net of AZ Commercial	$1.49
Rate for Payer: Health Net of AZ Medicare	$0.69
Rate for Payer: Humana of AZ Medicare	$0.37
Rate for Payer: Self Pay Self Pay	$1.98
Rate for Payer: TriWest Medicare	$0.37
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.45

THP ondansetron 4 mg Dis Tab [CQCH]

Facility

$2.48

Service Code	NDC 99999999979
Hospital Charge Code	110283021
Hospital Revenue Code	253
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.23
Rate for Payer: Aetna of AZ Commercial	$2.23
Rate for Payer: Bisbee Police All Plans	$0.64
Rate for Payer: Cash Price	$1.98
Rate for Payer: Self Pay Self Pay	$1.98

THP Tramadol 50 mg [CQCH]

Facility

$0.27

Service Code	NDC 99999999981
Hospital Charge Code	141650147
Hospital Revenue Code	253
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

THP Tramadol 50 mg [CQCH]

Facility

$0.27

Service Code	NDC 99999999981
Hospital Charge Code	141650147
Hospital Revenue Code	253
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

Know your out-of-pocket cost for care.

All Charges