Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

vasopressin 20 units/1 mL Inj Sol [CQCH]

Facility

$183.23

Service Code	NDC 42023016425
Hospital Charge Code	105944809
Hospital Revenue Code	251
Min. Negotiated Rate	$47.64
Max. Negotiated Rate	$164.91
Rate for Payer: Aetna of AZ Commercial	$164.91
Rate for Payer: Bisbee Police All Plans	$47.64
Rate for Payer: Cash Price	$146.58
Rate for Payer: Self Pay Self Pay	$146.58

VATHIN DISP FLEX URTETEROSCOPE QUANTA

Facility

$3,725.00

Hospital Charge Code	27936382
Hospital Revenue Code	270
Min. Negotiated Rate	$968.50
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna of AZ Commercial	$3,352.50
Rate for Payer: Bisbee Police All Plans	$968.50
Rate for Payer: Cash Price	$2,980.00
Rate for Payer: Self Pay Self Pay	$2,980.00

VATHIN DISP FLEX URTETEROSCOPE QUANTA

Facility

$3,725.00

Hospital Charge Code	27936382
Hospital Revenue Code	270
Min. Negotiated Rate	$596.00
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna of AZ Commercial	$3,352.50
Rate for Payer: Aetna of AZ Medicare	$1,043.00
Rate for Payer: Allwell Medicare	$596.00
Rate for Payer: Amerigroup Medicare	$596.00
Rate for Payer: APIPA Medicare/Medicaid	$1,391.29
Rate for Payer: AZCH Complete Medicare	$596.00
Rate for Payer: Banner UC Health Medicare	$596.00
Rate for Payer: Bisbee Police All Plans	$968.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,533.00
Rate for Payer: Cash Price	$2,980.00
Rate for Payer: Cigna of AZ Commercial	$2,607.50
Rate for Payer: Copperpoint Commercial	$921.94
Rate for Payer: Health Net of AZ Commercial	$2,235.00
Rate for Payer: Health Net of AZ Medicare	$1,043.00
Rate for Payer: Humana of AZ Medicare	$596.00
Rate for Payer: Self Pay Self Pay	$2,980.00
Rate for Payer: TriWest Medicare	$596.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,171.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$670.50

vecuronium 10 mg REC PWD [CQCH]

Facility

$4.63

Service Code	NDC 47335093144
Hospital Charge Code	111168336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna of AZ Commercial	$4.17
Rate for Payer: Aetna of AZ Medicare	$1.30
Rate for Payer: Allwell Medicare	$0.74
Rate for Payer: Amerigroup Medicare	$0.74
Rate for Payer: APIPA Medicare/Medicaid	$1.73
Rate for Payer: AZCH Complete Medicare	$0.74
Rate for Payer: Banner UC Health Medicare	$0.74
Rate for Payer: Bisbee Police All Plans	$1.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.15
Rate for Payer: Cash Price	$3.70
Rate for Payer: Cigna of AZ Commercial	$3.01
Rate for Payer: Copperpoint Commercial	$1.15
Rate for Payer: Health Net of AZ Commercial	$2.78
Rate for Payer: Health Net of AZ Medicare	$1.30
Rate for Payer: Humana of AZ Medicare	$0.74
Rate for Payer: Self Pay Self Pay	$3.70
Rate for Payer: TriWest Medicare	$0.74
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.83

vecuronium 10 mg REC PWD [CQCH]

Facility

$4.63

Service Code	NDC 47335093144
Hospital Charge Code	111168336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna of AZ Commercial	$4.17
Rate for Payer: Bisbee Police All Plans	$1.20
Rate for Payer: Cash Price	$3.70
Rate for Payer: Self Pay Self Pay	$3.70

vedolizumab 300 mg REC[CQCH]

Facility

$8,666.58

Service Code	HCPCS J3380
Hospital Charge Code	228424664
Hospital Revenue Code	250
Min. Negotiated Rate	$2,253.31
Max. Negotiated Rate	$7,799.92
Rate for Payer: Aetna of AZ Commercial	$7,799.92
Rate for Payer: Bisbee Police All Plans	$2,253.31
Rate for Payer: Cash Price	$6,933.26
Rate for Payer: Self Pay Self Pay	$6,933.26

vedolizumab 300 mg REC[CQCH]

Facility

$8,666.58

Service Code	HCPCS J3380
Hospital Charge Code	228424664
Hospital Revenue Code	250
Min. Negotiated Rate	$1,386.65
Max. Negotiated Rate	$7,799.92
Rate for Payer: Aetna of AZ Commercial	$7,799.92
Rate for Payer: Aetna of AZ Medicare	$2,426.64
Rate for Payer: Allwell Medicare	$1,386.65
Rate for Payer: Amerigroup Medicare	$1,386.65
Rate for Payer: APIPA Medicare/Medicaid	$3,236.97
Rate for Payer: AZCH Complete Medicare	$1,386.65
Rate for Payer: Banner UC Health Medicare	$1,386.65
Rate for Payer: Bisbee Police All Plans	$2,253.31
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5,893.27
Rate for Payer: Cash Price	$6,933.26
Rate for Payer: Cigna of AZ Commercial	$5,633.28
Rate for Payer: Copperpoint Commercial	$2,144.98
Rate for Payer: Health Net of AZ Commercial	$5,199.95
Rate for Payer: Health Net of AZ Medicare	$2,426.64
Rate for Payer: Humana of AZ Medicare	$1,386.65
Rate for Payer: Self Pay Self Pay	$6,933.26
Rate for Payer: TriWest Medicare	$1,386.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,052.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,559.98

venlafaxine 75 mg ER Capsule [CQCH]

Facility

$0.35

Service Code	NDC 904646961
Hospital Charge Code	160253304
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.24
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.21
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.28
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

venlafaxine 75 mg ER Capsule [CQCH]

Facility

$0.35

Service Code	NDC 904646961
Hospital Charge Code	160253304
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.28
Rate for Payer: Self Pay Self Pay	$0.28

venlafaxine 75 mg Tab IR [CQCH]

Facility

$0.39

Service Code	NDC 68084085601
Hospital Charge Code	105944939
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of AZ Commercial	$0.35
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.15
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.27
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of AZ Commercial	$0.25
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.23
Rate for Payer: Health Net of AZ Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.31
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

venlafaxine 75 mg Tab IR [CQCH]

Facility

$0.39

Service Code	NDC 68084085601
Hospital Charge Code	105944939
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of AZ Commercial	$0.35
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Cash Price	$0.31
Rate for Payer: Self Pay Self Pay	$0.31

Venous Blood Gas..

Facility

$309.00

Service Code	CPT 82803
Hospital Charge Code	22040456
Hospital Revenue Code	301
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Aetna of AZ Medicare	$86.52
Rate for Payer: Allwell Medicare	$49.44
Rate for Payer: Amerigroup Medicare	$49.44
Rate for Payer: APIPA Medicare/Medicaid	$115.41
Rate for Payer: AZCH Complete Medicare	$49.44
Rate for Payer: Banner UC Health Medicare	$49.44
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.12
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cigna of AZ Commercial	$200.85
Rate for Payer: Copperpoint Commercial	$76.48
Rate for Payer: Health Net of AZ Commercial	$185.40
Rate for Payer: Health Net of AZ Medicare	$86.52
Rate for Payer: Humana of AZ Medicare	$49.44
Rate for Payer: Self Pay Self Pay	$247.20
Rate for Payer: TriWest Medicare	$49.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$180.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.62

Venous Blood Gas..

Facility

$309.00

Service Code	CPT 82803
Hospital Charge Code	22040456
Hospital Revenue Code	301
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Cash Price	$247.20
Rate for Payer: Self Pay Self Pay	$247.20

Venous Blood Gas...

Facility

$338.00

Service Code	CPT 82803
Hospital Charge Code	23122859
Hospital Revenue Code	301
Min. Negotiated Rate	$54.08
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Aetna of AZ Medicare	$94.64
Rate for Payer: Allwell Medicare	$54.08
Rate for Payer: Amerigroup Medicare	$54.08
Rate for Payer: APIPA Medicare/Medicaid	$126.24
Rate for Payer: AZCH Complete Medicare	$54.08
Rate for Payer: Banner UC Health Medicare	$54.08
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$229.84
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cigna of AZ Commercial	$219.70
Rate for Payer: Copperpoint Commercial	$83.66
Rate for Payer: Health Net of AZ Commercial	$202.80
Rate for Payer: Health Net of AZ Medicare	$94.64
Rate for Payer: Humana of AZ Medicare	$54.08
Rate for Payer: Self Pay Self Pay	$270.40
Rate for Payer: TriWest Medicare	$54.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$197.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.84

Venous Blood Gas...

Facility

$338.00

Service Code	CPT 82803
Hospital Charge Code	23122859
Hospital Revenue Code	301
Min. Negotiated Rate	$87.88
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Cash Price	$270.40
Rate for Payer: Self Pay Self Pay	$270.40

Venous Draw Charge

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	2240048
Hospital Revenue Code	300
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Bisbee Police All Plans	$9.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Self Pay Self Pay	$28.80

Venous Draw Charge

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	2240048
Hospital Revenue Code	300
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Aetna of AZ Medicare	$10.08
Rate for Payer: Allwell Medicare	$5.76
Rate for Payer: Amerigroup Medicare	$5.76
Rate for Payer: APIPA Medicare/Medicaid	$13.45
Rate for Payer: AZCH Complete Medicare	$5.76
Rate for Payer: Banner UC Health Medicare	$5.76
Rate for Payer: Bisbee Police All Plans	$9.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$24.48
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of AZ Commercial	$23.40
Rate for Payer: Copperpoint Commercial	$8.91
Rate for Payer: Health Net of AZ Commercial	$21.60
Rate for Payer: Health Net of AZ Medicare	$10.08
Rate for Payer: Humana of AZ Medicare	$5.76
Rate for Payer: Self Pay Self Pay	$28.80
Rate for Payer: TriWest Medicare	$5.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.48

Ventilator Services Initial

Facility

$2,336.00

Service Code	CPT 94002
Hospital Charge Code	1886947
Hospital Revenue Code	410
Min. Negotiated Rate	$607.36
Max. Negotiated Rate	$2,102.40
Rate for Payer: Aetna of AZ Commercial	$2,102.40
Rate for Payer: Bisbee Police All Plans	$607.36
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Self Pay Self Pay	$1,868.80

Ventilator Services Initial

Facility

$2,336.00

Service Code	CPT 94002
Hospital Charge Code	1886947
Hospital Revenue Code	410
Min. Negotiated Rate	$373.76
Max. Negotiated Rate	$2,102.40
Rate for Payer: Aetna of AZ Commercial	$2,102.40
Rate for Payer: Aetna of AZ Medicare	$654.08
Rate for Payer: Allwell Medicare	$373.76
Rate for Payer: Amerigroup Medicare	$373.76
Rate for Payer: APIPA Medicare/Medicaid	$872.50
Rate for Payer: AZCH Complete Medicare	$373.76
Rate for Payer: Banner UC Health Medicare	$373.76
Rate for Payer: Bisbee Police All Plans	$607.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,588.48
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Cigna of AZ Commercial	$1,635.20
Rate for Payer: Copperpoint Commercial	$578.16
Rate for Payer: Health Net of AZ Commercial	$1,401.60
Rate for Payer: Health Net of AZ Medicare	$654.08
Rate for Payer: Humana of AZ Medicare	$373.76
Rate for Payer: Self Pay Self Pay	$1,868.80
Rate for Payer: TriWest Medicare	$373.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,361.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$420.48

Ventricular Shunt Procedures

Facility

$40,079.40

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG0221
Min. Negotiated Rate	$40,079.40
Max. Negotiated Rate	$40,079.40
Rate for Payer: AHCCCS Medicaid	$40,079.40
Rate for Payer: Allwell Medicaid	$40,079.40
Rate for Payer: AZCH Complete Medicaid	$40,079.40
Rate for Payer: Banner UC Health Medicaid	$40,079.40
Rate for Payer: Mercy Care Medicaid	$40,079.40

Ventricular Shunt Procedures

Facility

$40,079.40

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG0224
Min. Negotiated Rate	$40,079.40
Max. Negotiated Rate	$40,079.40
Rate for Payer: AHCCCS Medicaid	$40,079.40
Rate for Payer: Allwell Medicaid	$40,079.40
Rate for Payer: AZCH Complete Medicaid	$40,079.40
Rate for Payer: Banner UC Health Medicaid	$40,079.40
Rate for Payer: Mercy Care Medicaid	$40,079.40

Ventricular Shunt Procedures

Facility

$18,163.45

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG0222
Min. Negotiated Rate	$18,163.45
Max. Negotiated Rate	$18,163.45
Rate for Payer: AHCCCS Medicaid	$18,163.45
Rate for Payer: Allwell Medicaid	$18,163.45
Rate for Payer: AZCH Complete Medicaid	$18,163.45
Rate for Payer: Banner UC Health Medicaid	$18,163.45
Rate for Payer: Mercy Care Medicaid	$18,163.45

Ventricular Shunt Procedures

Facility

$11,077.21

Service Code	APR-DRG 0222
Hospital Charge Code	APRDRG0222
Min. Negotiated Rate	$11,077.21
Max. Negotiated Rate	$11,077.21
Rate for Payer: AHCCCS Medicaid	$11,077.21
Rate for Payer: Allwell Medicaid	$11,077.21
Rate for Payer: AZCH Complete Medicaid	$11,077.21
Rate for Payer: Banner UC Health Medicaid	$11,077.21
Rate for Payer: Mercy Care Medicaid	$11,077.21

Ventricular Shunt Procedures

Facility

$18,163.45

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG0224
Min. Negotiated Rate	$18,163.45
Max. Negotiated Rate	$18,163.45
Rate for Payer: AHCCCS Medicaid	$18,163.45
Rate for Payer: Allwell Medicaid	$18,163.45
Rate for Payer: AZCH Complete Medicaid	$18,163.45
Rate for Payer: Banner UC Health Medicaid	$18,163.45
Rate for Payer: Mercy Care Medicaid	$18,163.45

Ventricular Shunt Procedures

Facility

$8,652.47

Service Code	APR-DRG 0221
Hospital Charge Code	APRDRG0223
Min. Negotiated Rate	$8,652.47
Max. Negotiated Rate	$8,652.47
Rate for Payer: AHCCCS Medicaid	$8,652.47
Rate for Payer: Allwell Medicaid	$8,652.47
Rate for Payer: AZCH Complete Medicaid	$8,652.47
Rate for Payer: Banner UC Health Medicaid	$8,652.47
Rate for Payer: Mercy Care Medicaid	$8,652.47

Know your out-of-pocket cost for care.

All Charges