Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

aspirin 300 mg Supp [CQCH]

Facility

$0.27

Service Code	NDC 574703412
Hospital Charge Code	105911455
Hospital Revenue Code	251
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	$0.22
Rate for Payer: Self Pay Self Pay	$0.22

aspirin 300 mg Supp [CQCH]

Facility

$0.27

Service Code	NDC 574703412
Hospital Charge Code	105911455
Hospital Revenue Code	251
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	$0.22
Rate for Payer: Cigna of AZ Commercial	$0.18
Rate for Payer: Copperpoint Commercial	$0.07
Rate for Payer: Health Net of AZ Commercial	$0.16
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

aspirin 325 mg Oral EC Tab [CQCH]

Facility

$0.01

Service Code	NDC 63739052301
Hospital Charge Code	105911703
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

aspirin 325 mg Oral EC Tab [CQCH]

Facility

$0.01

Service Code	NDC 63739052301
Hospital Charge Code	105911703
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

aspirin 325 mg Tab [CQCH]

Facility

$0.01

Service Code	NDC 66553000101
Hospital Charge Code	105911642
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

aspirin 325 mg Tab [CQCH]

Facility

$0.01

Service Code	NDC 66553000101
Hospital Charge Code	105911642
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

aspirin 81 mg Chew Tab [CQCH]

Facility

$0.01

Service Code	NDC 904679480
Hospital Charge Code	105911581
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

aspirin 81 mg Chew Tab [CQCH]

Facility

$0.01

Service Code	NDC 904679480
Hospital Charge Code	105911581
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

aspirin 81 mg Oral EC Tab [CQCH]

Facility

$0.03

Service Code	NDC 904770418
Hospital Charge Code	105911516
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

aspirin 81 mg Oral EC Tab [CQCH]

Facility

$0.03

Service Code	NDC 904770418
Hospital Charge Code	105911516
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

Asthma

Facility

$4,791.96

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$4,791.96
Max. Negotiated Rate	$4,791.96
Rate for Payer: AHCCCS Medicaid	$4,791.96
Rate for Payer: Allwell Medicaid	$4,791.96
Rate for Payer: AZCH Complete Medicaid	$4,791.96
Rate for Payer: Banner UC Health Medicaid	$4,791.96
Rate for Payer: Mercy Care Medicaid	$4,791.96

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: AHCCCS Medicaid	$3,985.35
Rate for Payer: Allwell Medicaid	$3,985.35
Rate for Payer: AZCH Complete Medicaid	$3,985.35
Rate for Payer: Banner UC Health Medicaid	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: AHCCCS Medicaid	$9,015.80
Rate for Payer: Allwell Medicaid	$9,015.80
Rate for Payer: AZCH Complete Medicaid	$9,015.80
Rate for Payer: Banner UC Health Medicaid	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80

Asthma

Facility

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1412
Min. Negotiated Rate	$2,741.07
Max. Negotiated Rate	$2,741.07
Rate for Payer: AHCCCS Medicaid	$2,741.07
Rate for Payer: Allwell Medicaid	$2,741.07
Rate for Payer: AZCH Complete Medicaid	$2,741.07
Rate for Payer: Banner UC Health Medicaid	$2,741.07
Rate for Payer: Mercy Care Medicaid	$2,741.07

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: AHCCCS Medicaid	$9,015.80
Rate for Payer: Allwell Medicaid	$9,015.80
Rate for Payer: AZCH Complete Medicaid	$9,015.80
Rate for Payer: Banner UC Health Medicaid	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80

Asthma

Facility

$4,791.96

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$4,791.96
Max. Negotiated Rate	$4,791.96
Rate for Payer: AHCCCS Medicaid	$4,791.96
Rate for Payer: Allwell Medicaid	$4,791.96
Rate for Payer: AZCH Complete Medicaid	$4,791.96
Rate for Payer: Banner UC Health Medicaid	$4,791.96
Rate for Payer: Mercy Care Medicaid	$4,791.96

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: AHCCCS Medicaid	$3,985.35
Rate for Payer: Allwell Medicaid	$3,985.35
Rate for Payer: AZCH Complete Medicaid	$3,985.35
Rate for Payer: Banner UC Health Medicaid	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1413
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: AHCCCS Medicaid	$3,985.35
Rate for Payer: Allwell Medicaid	$3,985.35
Rate for Payer: AZCH Complete Medicaid	$3,985.35
Rate for Payer: Banner UC Health Medicaid	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35

Asthma

Facility

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$2,741.07
Max. Negotiated Rate	$2,741.07
Rate for Payer: AHCCCS Medicaid	$2,741.07
Rate for Payer: Allwell Medicaid	$2,741.07
Rate for Payer: AZCH Complete Medicaid	$2,741.07
Rate for Payer: Banner UC Health Medicaid	$2,741.07
Rate for Payer: Mercy Care Medicaid	$2,741.07

Asthma

Facility

$4,791.96

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$4,791.96
Max. Negotiated Rate	$4,791.96
Rate for Payer: AHCCCS Medicaid	$4,791.96
Rate for Payer: Allwell Medicaid	$4,791.96
Rate for Payer: AZCH Complete Medicaid	$4,791.96
Rate for Payer: Banner UC Health Medicaid	$4,791.96
Rate for Payer: Mercy Care Medicaid	$4,791.96

Asthma

Facility

$4,791.96

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$4,791.96
Max. Negotiated Rate	$4,791.96
Rate for Payer: AHCCCS Medicaid	$4,791.96
Rate for Payer: Allwell Medicaid	$4,791.96
Rate for Payer: AZCH Complete Medicaid	$4,791.96
Rate for Payer: Banner UC Health Medicaid	$4,791.96
Rate for Payer: Mercy Care Medicaid	$4,791.96

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: AHCCCS Medicaid	$9,015.80
Rate for Payer: Allwell Medicaid	$9,015.80
Rate for Payer: AZCH Complete Medicaid	$9,015.80
Rate for Payer: Banner UC Health Medicaid	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80

Asthma

Facility

$3,985.35

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$3,985.35
Max. Negotiated Rate	$3,985.35
Rate for Payer: AHCCCS Medicaid	$3,985.35
Rate for Payer: Allwell Medicaid	$3,985.35
Rate for Payer: AZCH Complete Medicaid	$3,985.35
Rate for Payer: Banner UC Health Medicaid	$3,985.35
Rate for Payer: Mercy Care Medicaid	$3,985.35

Asthma

Facility

$9,015.80

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG1414
Min. Negotiated Rate	$9,015.80
Max. Negotiated Rate	$9,015.80
Rate for Payer: AHCCCS Medicaid	$9,015.80
Rate for Payer: Allwell Medicaid	$9,015.80
Rate for Payer: AZCH Complete Medicaid	$9,015.80
Rate for Payer: Banner UC Health Medicaid	$9,015.80
Rate for Payer: Mercy Care Medicaid	$9,015.80

Asthma

Facility

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1411
Min. Negotiated Rate	$2,741.07
Max. Negotiated Rate	$2,741.07
Rate for Payer: AHCCCS Medicaid	$2,741.07
Rate for Payer: Allwell Medicaid	$2,741.07
Rate for Payer: AZCH Complete Medicaid	$2,741.07
Rate for Payer: Banner UC Health Medicaid	$2,741.07
Rate for Payer: Mercy Care Medicaid	$2,741.07

Know your out-of-pocket cost for care.

All Charges