Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

$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

$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

$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

$2,741.07

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG1413
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

$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

$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

$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

$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

atenolol 25 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 51079075920
Hospital Charge Code	105911831
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Aetna of AZ Medicare	$0.05
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.12
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.11
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

atenolol 25 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 51079075920
Hospital Charge Code	105911831
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.14

atenolol 50 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 51079068420
Hospital Charge Code	105911766
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

atenolol 50 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 51079068420
Hospital Charge Code	105911766
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.06

atorvastatin 20 mg Tab [CQCH]

Facility

$0.75

Service Code	NDC 904629161
Hospital Charge Code	105911897
Hospital Revenue Code	251
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of AZ Commercial	$0.68
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Cash Price	$0.60
Rate for Payer: Self Pay Self Pay	$0.60

atorvastatin 20 mg Tab [CQCH]

Facility

$0.75

Service Code	NDC 904629161
Hospital Charge Code	105911897
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of AZ Commercial	$0.68
Rate for Payer: Aetna of AZ Medicare	$0.21
Rate for Payer: Allwell Medicare	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.28
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.51
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cigna of AZ Commercial	$0.49
Rate for Payer: Copperpoint Commercial	$0.19
Rate for Payer: Health Net of AZ Commercial	$0.45
Rate for Payer: Health Net of AZ Medicare	$0.21
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Self Pay Self Pay	$0.60
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.14

atropine 0.1 mg/mL Inj PFS [CQCH]

Facility

$0.81

Service Code	HCPCS J0461
Hospital Charge Code	105912104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.73
Rate for Payer: Aetna of AZ Commercial	$0.73
Rate for Payer: Bisbee Police All Plans	$0.21
Rate for Payer: Cash Price	$0.64
Rate for Payer: Self Pay Self Pay	$0.65

atropine 0.1 mg/mL Inj PFS [CQCH]

Facility

$0.81

Service Code	HCPCS J0461
Hospital Charge Code	105912104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.73
Rate for Payer: Aetna of AZ Commercial	$0.73
Rate for Payer: Aetna of AZ Medicare	$0.23
Rate for Payer: Allwell Medicare	$0.13
Rate for Payer: Amerigroup Medicare	$0.13
Rate for Payer: APIPA Medicare/Medicaid	$0.30
Rate for Payer: AZCH Complete Medicare	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Bisbee Police All Plans	$0.21
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.55
Rate for Payer: Cash Price	$0.64
Rate for Payer: Cigna of AZ Commercial	$0.53
Rate for Payer: Copperpoint Commercial	$0.20
Rate for Payer: Health Net of AZ Commercial	$0.49
Rate for Payer: Health Net of AZ Medicare	$0.23
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Self Pay Self Pay	$0.65
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

atropine 1 mg/mL Inj Sol [CQCH]

Facility

$5.97

Service Code	HCPCS J0461
Hospital Charge Code	105912035
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna of AZ Commercial	$5.37
Rate for Payer: Bisbee Police All Plans	$1.55
Rate for Payer: Cash Price	$4.78
Rate for Payer: Self Pay Self Pay	$4.78

atropine 1 mg/mL Inj Sol [CQCH]

Facility

$5.97

Service Code	HCPCS J0461
Hospital Charge Code	105912035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna of AZ Commercial	$5.37
Rate for Payer: Aetna of AZ Medicare	$1.67
Rate for Payer: Allwell Medicare	$0.96
Rate for Payer: Amerigroup Medicare	$0.96
Rate for Payer: APIPA Medicare/Medicaid	$2.23
Rate for Payer: AZCH Complete Medicare	$0.96
Rate for Payer: Banner UC Health Medicare	$0.96
Rate for Payer: Bisbee Police All Plans	$1.55
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.06
Rate for Payer: Cash Price	$4.78
Rate for Payer: Cigna of AZ Commercial	$3.88
Rate for Payer: Copperpoint Commercial	$1.48
Rate for Payer: Health Net of AZ Commercial	$3.58
Rate for Payer: Health Net of AZ Medicare	$1.67
Rate for Payer: Humana of AZ Medicare	$0.96
Rate for Payer: Self Pay Self Pay	$4.78
Rate for Payer: TriWest Medicare	$0.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.07

atropine-diphenoxylate 0.025 mg-2.5 mg Tab [CQCH]

Facility

$0.16

Service Code	NDC 71205090960
Hospital Charge Code	105912306
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.13

atropine-diphenoxylate 0.025 mg-2.5 mg Tab [CQCH]

Facility

$0.16

Service Code	NDC 71205090960
Hospital Charge Code	105912306
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.11
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

atropine Ophth 1% Sol [CQCH]

Facility

$44.74

Service Code	NDC 65030355
Hospital Charge Code	105912175
Hospital Revenue Code	251
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna of AZ Commercial	$40.27
Rate for Payer: Bisbee Police All Plans	$11.63
Rate for Payer: Cash Price	$35.79
Rate for Payer: Self Pay Self Pay	$35.79

atropine Ophth 1% Sol [CQCH]

Facility

$44.74

Service Code	NDC 65030355
Hospital Charge Code	105912175
Hospital Revenue Code	251
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna of AZ Commercial	$40.27
Rate for Payer: Aetna of AZ Medicare	$12.53
Rate for Payer: Allwell Medicare	$7.16
Rate for Payer: Amerigroup Medicare	$7.16
Rate for Payer: APIPA Medicare/Medicaid	$16.71
Rate for Payer: AZCH Complete Medicare	$7.16
Rate for Payer: Banner UC Health Medicare	$7.16
Rate for Payer: Bisbee Police All Plans	$11.63
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.42
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cigna of AZ Commercial	$29.08
Rate for Payer: Copperpoint Commercial	$11.07
Rate for Payer: Health Net of AZ Commercial	$26.84
Rate for Payer: Health Net of AZ Medicare	$12.53
Rate for Payer: Humana of AZ Medicare	$7.16
Rate for Payer: Self Pay Self Pay	$35.79
Rate for Payer: TriWest Medicare	$7.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.05

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

$27,684.26

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG0082
Min. Negotiated Rate	$27,684.26
Max. Negotiated Rate	$27,684.26
Rate for Payer: AHCCCS Medicaid	$27,684.26
Rate for Payer: Allwell Medicaid	$27,684.26
Rate for Payer: AZCH Complete Medicaid	$27,684.26
Rate for Payer: Banner UC Health Medicaid	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

$62,166.48

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG0083
Min. Negotiated Rate	$62,166.48
Max. Negotiated Rate	$62,166.48
Rate for Payer: AHCCCS Medicaid	$62,166.48
Rate for Payer: Allwell Medicaid	$62,166.48
Rate for Payer: AZCH Complete Medicaid	$62,166.48
Rate for Payer: Banner UC Health Medicaid	$62,166.48
Rate for Payer: Mercy Care Medicaid	$62,166.48

Know your out-of-pocket cost for care.

All Charges