Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ASCORBIC ACID (VITAMIN C), BLOOD

Facility

$41.00

Service Code	CPT 82180
Hospital Charge Code	23603251
Hospital Revenue Code	301
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

ASCORBIC ACID (VITAMIN C), BLOOD

Facility

$41.00

Service Code	CPT 82180
Hospital Charge Code	23603251
Hospital Revenue Code	301
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

Aspartate Aminotransferase

Facility

$124.00

Service Code	CPT 84450
Hospital Charge Code	633633
Hospital Revenue Code	301
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Aetna of AZ Medicare	$34.72
Rate for Payer: Allwell Medicare	$19.84
Rate for Payer: Amerigroup Medicare	$19.84
Rate for Payer: APIPA Medicare/Medicaid	$46.31
Rate for Payer: AZCH Complete Medicare	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$84.32
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Copperpoint Commercial	$30.69
Rate for Payer: Health Net of AZ Commercial	$74.40
Rate for Payer: Health Net of AZ Medicare	$34.72
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Self Pay Self Pay	$99.20
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.32

Aspartate Aminotransferase

Facility

$124.00

Service Code	CPT 84450
Hospital Charge Code	633633
Hospital Revenue Code	301
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Cash Price	$99.20
Rate for Payer: Self Pay Self Pay	$99.20

Aspergillus Antibodies, Quantitative LC

Facility

$403.00

Service Code	CPT 86606
Hospital Charge Code	12689406
Hospital Revenue Code	302
Min. Negotiated Rate	$64.48
Max. Negotiated Rate	$362.70
Rate for Payer: Aetna of AZ Commercial	$362.70
Rate for Payer: Aetna of AZ Medicare	$112.84
Rate for Payer: Allwell Medicare	$64.48
Rate for Payer: Amerigroup Medicare	$64.48
Rate for Payer: APIPA Medicare/Medicaid	$150.52
Rate for Payer: AZCH Complete Medicare	$64.48
Rate for Payer: Banner UC Health Medicare	$64.48
Rate for Payer: Bisbee Police All Plans	$104.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$274.04
Rate for Payer: Cash Price	$322.40
Rate for Payer: Cigna of AZ Commercial	$261.95
Rate for Payer: Copperpoint Commercial	$99.74
Rate for Payer: Health Net of AZ Commercial	$241.80
Rate for Payer: Health Net of AZ Medicare	$112.84
Rate for Payer: Humana of AZ Medicare	$64.48
Rate for Payer: Self Pay Self Pay	$322.40
Rate for Payer: TriWest Medicare	$64.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$234.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.54

Aspergillus Antibodies, Quantitative LC

Facility

$403.00

Service Code	CPT 86606
Hospital Charge Code	12689406
Hospital Revenue Code	302
Min. Negotiated Rate	$104.78
Max. Negotiated Rate	$362.70
Rate for Payer: Aetna of AZ Commercial	$362.70
Rate for Payer: Bisbee Police All Plans	$104.78
Rate for Payer: Cash Price	$322.40
Rate for Payer: Self Pay Self Pay	$322.40

ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION

Facility

$267.00

Service Code	CPT 20612
Hospital Charge Code	24049291
Hospital Revenue Code	360
Min. Negotiated Rate	$42.72
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Aetna of AZ Medicare	$74.76
Rate for Payer: AHCCCS Medicaid	$189.35
Rate for Payer: Allwell Medicaid	$189.35
Rate for Payer: Allwell Medicare	$42.72
Rate for Payer: Amerigroup Medicare	$42.72
Rate for Payer: APIPA Medicare/Medicaid	$99.72
Rate for Payer: AZCH Complete Medicaid	$189.35
Rate for Payer: AZCH Complete Medicare	$42.72
Rate for Payer: Banner UC Health Medicaid	$189.35
Rate for Payer: Banner UC Health Medicare	$42.72
Rate for Payer: Bisbee Police All Plans	$69.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$181.56
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cigna of AZ Commercial	$133.50
Rate for Payer: Copperpoint Commercial	$66.08
Rate for Payer: Health Net of AZ Commercial	$160.20
Rate for Payer: Health Net of AZ Medicare	$74.76
Rate for Payer: Humana of AZ Medicare	$42.72
Rate for Payer: Mercy Care Medicaid	$189.35
Rate for Payer: Self Pay Self Pay	$213.60
Rate for Payer: TriWest Medicare	$42.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.06

ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION

Facility

$267.00

Service Code	CPT 20612
Hospital Charge Code	24049291
Hospital Revenue Code	360
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Bisbee Police All Plans	$69.42
Rate for Payer: Cash Price	$213.60
Rate for Payer: Self Pay Self Pay	$213.60

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: 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 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 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 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

$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

$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	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

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

$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	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

Know your out-of-pocket cost for care.

All Charges