Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ziprasidone 40 mg Cap [CQCH]

Facility

$2.25

Service Code	NDC 904627045
Hospital Charge Code	105945855
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of AZ Commercial	$2.02
Rate for Payer: Bisbee Police All Plans	$0.59
Rate for Payer: Cash Price	$1.80
Rate for Payer: Self Pay Self Pay	$1.80

zoledronic acid 4 mg/100 mL IVPB [CQCH]

Facility

$0.24

Service Code	HCPCS J3489
Hospital Charge Code	105945920
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

zoledronic acid 4 mg/100 mL IVPB [CQCH]

Facility

$0.24

Service Code	HCPCS J3489
Hospital Charge Code	105945920
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

zoledronic acid 5 mg/100 mL IVPB[CQCH]

Facility

$0.29

Service Code	HCPCS J3489
Hospital Charge Code	223969697
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.23
Rate for Payer: Self Pay Self Pay	$0.23

zoledronic acid 5 mg/100 mL IVPB[CQCH]

Facility

$0.29

Service Code	HCPCS J3489
Hospital Charge Code	223969697
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Aetna of AZ Medicare	$0.08
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.11
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	$0.20
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of AZ Commercial	$0.19
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	$0.05
Rate for Payer: Self Pay Self Pay	$0.23
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

zolpidem 5 mg Tab [CQCH]

Facility

$0.03

Service Code	NDC 16714062101
Hospital Charge Code	105945989
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.02

zolpidem 5 mg Tab [CQCH]

Facility

$0.03

Service Code	NDC 16714062101
Hospital Charge Code	105945989
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.02
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	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Zonisamide(Zonegran), Serum LC

Facility

$343.00

Service Code	CPT 82542
Hospital Charge Code	1285611
Hospital Revenue Code	301
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna of AZ Commercial	$308.70
Rate for Payer: Bisbee Police All Plans	$89.18
Rate for Payer: Cash Price	$274.40
Rate for Payer: Self Pay Self Pay	$274.40

Zonisamide(Zonegran), Serum LC

Facility

$343.00

Service Code	CPT 82542
Hospital Charge Code	1285611
Hospital Revenue Code	301
Min. Negotiated Rate	$54.88
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna of AZ Commercial	$308.70
Rate for Payer: Aetna of AZ Medicare	$96.04
Rate for Payer: Allwell Medicare	$54.88
Rate for Payer: Amerigroup Medicare	$54.88
Rate for Payer: APIPA Medicare/Medicaid	$128.11
Rate for Payer: AZCH Complete Medicare	$54.88
Rate for Payer: Banner UC Health Medicare	$54.88
Rate for Payer: Bisbee Police All Plans	$89.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$233.24
Rate for Payer: Cash Price	$274.40
Rate for Payer: Cigna of AZ Commercial	$222.95
Rate for Payer: Copperpoint Commercial	$84.89
Rate for Payer: Health Net of AZ Commercial	$205.80
Rate for Payer: Health Net of AZ Medicare	$96.04
Rate for Payer: Humana of AZ Medicare	$54.88
Rate for Payer: Self Pay Self Pay	$274.40
Rate for Payer: TriWest Medicare	$54.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$199.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.74

zoster vaccine, inactivated adjuvanted REC[CQCH]

Facility

$133.99

Service Code	NDC 58160082311
Hospital Charge Code	136004511
Hospital Revenue Code	250
Min. Negotiated Rate	$34.84
Max. Negotiated Rate	$120.59
Rate for Payer: Aetna of AZ Commercial	$120.59
Rate for Payer: Bisbee Police All Plans	$34.84
Rate for Payer: Cash Price	$107.19
Rate for Payer: Self Pay Self Pay	$107.19

zoster vaccine, inactivated adjuvanted REC[CQCH]

Facility

$133.99

Service Code	NDC 58160082311
Hospital Charge Code	136004511
Hospital Revenue Code	250
Min. Negotiated Rate	$21.44
Max. Negotiated Rate	$120.59
Rate for Payer: Aetna of AZ Commercial	$120.59
Rate for Payer: Aetna of AZ Medicare	$37.52
Rate for Payer: Allwell Medicare	$21.44
Rate for Payer: Amerigroup Medicare	$21.44
Rate for Payer: APIPA Medicare/Medicaid	$50.05
Rate for Payer: AZCH Complete Medicare	$21.44
Rate for Payer: Banner UC Health Medicare	$21.44
Rate for Payer: Bisbee Police All Plans	$34.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.11
Rate for Payer: Cash Price	$107.19
Rate for Payer: Cigna of AZ Commercial	$87.09
Rate for Payer: Copperpoint Commercial	$33.16
Rate for Payer: Health Net of AZ Commercial	$80.39
Rate for Payer: Health Net of AZ Medicare	$37.52
Rate for Payer: Humana of AZ Medicare	$21.44
Rate for Payer: Self Pay Self Pay	$107.19
Rate for Payer: TriWest Medicare	$21.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.12

Know your out-of-pocket cost for care.

All Charges