Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: AHCCCS Medicaid	$9,254.97
Rate for Payer: Allwell Medicaid	$9,254.97
Rate for Payer: AZCH Complete Medicaid	$9,254.97
Rate for Payer: Banner UC Health Medicaid	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: AHCCCS Medicaid	$6,018.71
Rate for Payer: Allwell Medicaid	$6,018.71
Rate for Payer: AZCH Complete Medicaid	$6,018.71
Rate for Payer: Banner UC Health Medicaid	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: AHCCCS Medicaid	$9,254.97
Rate for Payer: Allwell Medicaid	$9,254.97
Rate for Payer: AZCH Complete Medicaid	$9,254.97
Rate for Payer: Banner UC Health Medicaid	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: AHCCCS Medicaid	$9,254.97
Rate for Payer: Allwell Medicaid	$9,254.97
Rate for Payer: AZCH Complete Medicaid	$9,254.97
Rate for Payer: Banner UC Health Medicaid	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: AHCCCS Medicaid	$6,018.71
Rate for Payer: Allwell Medicaid	$6,018.71
Rate for Payer: AZCH Complete Medicaid	$6,018.71
Rate for Payer: Banner UC Health Medicaid	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71

Behavioral Disorders

Facility

$6,018.71

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$6,018.71
Max. Negotiated Rate	$6,018.71
Rate for Payer: AHCCCS Medicaid	$6,018.71
Rate for Payer: Allwell Medicaid	$6,018.71
Rate for Payer: AZCH Complete Medicaid	$6,018.71
Rate for Payer: Banner UC Health Medicaid	$6,018.71
Rate for Payer: Mercy Care Medicaid	$6,018.71

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: AHCCCS Medicaid	$3,415.82
Rate for Payer: Allwell Medicaid	$3,415.82
Rate for Payer: AZCH Complete Medicaid	$3,415.82
Rate for Payer: Banner UC Health Medicaid	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: AHCCCS Medicaid	$2,675.14
Rate for Payer: Allwell Medicaid	$2,675.14
Rate for Payer: AZCH Complete Medicaid	$2,675.14
Rate for Payer: Banner UC Health Medicaid	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7584
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: AHCCCS Medicaid	$3,415.82
Rate for Payer: Allwell Medicaid	$3,415.82
Rate for Payer: AZCH Complete Medicaid	$3,415.82
Rate for Payer: Banner UC Health Medicaid	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82

Behavioral Disorders

Facility

$9,254.97

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$9,254.97
Max. Negotiated Rate	$9,254.97
Rate for Payer: AHCCCS Medicaid	$9,254.97
Rate for Payer: Allwell Medicaid	$9,254.97
Rate for Payer: AZCH Complete Medicaid	$9,254.97
Rate for Payer: Banner UC Health Medicaid	$9,254.97
Rate for Payer: Mercy Care Medicaid	$9,254.97

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: AHCCCS Medicaid	$2,675.14
Rate for Payer: Allwell Medicaid	$2,675.14
Rate for Payer: AZCH Complete Medicaid	$2,675.14
Rate for Payer: Banner UC Health Medicaid	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7582
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: AHCCCS Medicaid	$3,415.82
Rate for Payer: Allwell Medicaid	$3,415.82
Rate for Payer: AZCH Complete Medicaid	$3,415.82
Rate for Payer: Banner UC Health Medicaid	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82

Behavioral Disorders

Facility

$2,675.14

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG7581
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$2,675.14
Rate for Payer: AHCCCS Medicaid	$2,675.14
Rate for Payer: Allwell Medicaid	$2,675.14
Rate for Payer: AZCH Complete Medicaid	$2,675.14
Rate for Payer: Banner UC Health Medicaid	$2,675.14
Rate for Payer: Mercy Care Medicaid	$2,675.14

Behavioral Disorders

Facility

$3,415.82

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG7583
Min. Negotiated Rate	$3,415.82
Max. Negotiated Rate	$3,415.82
Rate for Payer: AHCCCS Medicaid	$3,415.82
Rate for Payer: Allwell Medicaid	$3,415.82
Rate for Payer: AZCH Complete Medicaid	$3,415.82
Rate for Payer: Banner UC Health Medicaid	$3,415.82
Rate for Payer: Mercy Care Medicaid	$3,415.82

belimumab 120 mg REC[CQCH]

Facility

$580.80

Service Code	HCPCS J0490
Hospital Charge Code	202718790
Hospital Revenue Code	250
Min. Negotiated Rate	$80.32
Max. Negotiated Rate	$522.72
Rate for Payer: Aetna of AZ Commercial	$522.72
Rate for Payer: Aetna of AZ Medicare	$162.62
Rate for Payer: AHCCCS Medicaid	$80.32
Rate for Payer: Allwell Medicaid	$80.32
Rate for Payer: Allwell Medicare	$87.12
Rate for Payer: Amerigroup Medicare	$87.12
Rate for Payer: APIPA Medicare/Medicaid	$216.93
Rate for Payer: AZCH Complete Medicaid	$80.32
Rate for Payer: AZCH Complete Medicare	$87.12
Rate for Payer: Banner UC Health Medicaid	$80.32
Rate for Payer: Banner UC Health Medicare	$87.12
Rate for Payer: Bisbee Police All Plans	$151.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$394.94
Rate for Payer: Cash Price	$464.64
Rate for Payer: Cash Price	$464.64
Rate for Payer: Cigna of AZ Commercial	$377.52
Rate for Payer: Copperpoint Commercial	$143.75
Rate for Payer: Health Net of AZ Commercial	$348.48
Rate for Payer: Health Net of AZ Medicare	$162.62
Rate for Payer: Humana of AZ Medicare	$87.12
Rate for Payer: Mercy Care Medicaid	$80.32
Rate for Payer: Self Pay Self Pay	$464.64
Rate for Payer: TriWest Medicare	$87.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$338.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.54

belimumab 120 mg REC[CQCH]

Facility

$580.80

Service Code	HCPCS J0490
Hospital Charge Code	202718790
Hospital Revenue Code	250
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$522.72
Rate for Payer: Aetna of AZ Commercial	$522.72
Rate for Payer: Bisbee Police All Plans	$151.01
Rate for Payer: Cash Price	$464.64
Rate for Payer: Self Pay Self Pay	$464.64

belimumab 400 mg REC[CQCH]

Facility

$1,482.80

Service Code	HCPCS J0490
Hospital Charge Code	212085212
Hospital Revenue Code	250
Min. Negotiated Rate	$80.32
Max. Negotiated Rate	$1,334.52
Rate for Payer: Aetna of AZ Commercial	$1,334.52
Rate for Payer: Aetna of AZ Medicare	$415.18
Rate for Payer: AHCCCS Medicaid	$80.32
Rate for Payer: Allwell Medicaid	$80.32
Rate for Payer: Allwell Medicare	$222.42
Rate for Payer: Amerigroup Medicare	$222.42
Rate for Payer: APIPA Medicare/Medicaid	$553.83
Rate for Payer: AZCH Complete Medicaid	$80.32
Rate for Payer: AZCH Complete Medicare	$222.42
Rate for Payer: Banner UC Health Medicaid	$80.32
Rate for Payer: Banner UC Health Medicare	$222.42
Rate for Payer: Bisbee Police All Plans	$385.53
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,008.30
Rate for Payer: Cash Price	$1,186.24
Rate for Payer: Cash Price	$1,186.24
Rate for Payer: Cigna of AZ Commercial	$963.82
Rate for Payer: Copperpoint Commercial	$366.99
Rate for Payer: Health Net of AZ Commercial	$889.68
Rate for Payer: Health Net of AZ Medicare	$415.18
Rate for Payer: Humana of AZ Medicare	$222.42
Rate for Payer: Mercy Care Medicaid	$80.32
Rate for Payer: Self Pay Self Pay	$1,186.24
Rate for Payer: TriWest Medicare	$222.42
Rate for Payer: UnitedHealth Group of AZ Commercial	$864.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$266.90

belimumab 400 mg REC[CQCH]

Facility

$1,482.80

Service Code	HCPCS J0490
Hospital Charge Code	212085212
Hospital Revenue Code	250
Min. Negotiated Rate	$385.53
Max. Negotiated Rate	$1,334.52
Rate for Payer: Aetna of AZ Commercial	$1,334.52
Rate for Payer: Bisbee Police All Plans	$385.53
Rate for Payer: Cash Price	$1,186.24
Rate for Payer: Self Pay Self Pay	$1,186.24

benazepril 10 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 43547033610
Hospital Charge Code	105912642
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

benazepril 10 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 43547033610
Hospital Charge Code	105912642
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
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	$0.02
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	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
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	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Bent Beaver Blade

Facility

$176.00

Hospital Charge Code	22926410
Hospital Revenue Code	272
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Aetna of AZ Medicare	$49.28
Rate for Payer: Allwell Medicare	$26.40
Rate for Payer: Amerigroup Medicare	$26.40
Rate for Payer: APIPA Medicare/Medicaid	$65.74
Rate for Payer: AZCH Complete Medicare	$26.40
Rate for Payer: Banner UC Health Medicare	$26.40
Rate for Payer: Bisbee Police All Plans	$45.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$119.68
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cigna of AZ Commercial	$123.20
Rate for Payer: Copperpoint Commercial	$43.56
Rate for Payer: Health Net of AZ Commercial	$105.60
Rate for Payer: Health Net of AZ Medicare	$49.28
Rate for Payer: Humana of AZ Medicare	$26.40
Rate for Payer: Self Pay Self Pay	$140.80
Rate for Payer: TriWest Medicare	$26.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$102.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.68

Bent Beaver Blade

Facility

$176.00

Hospital Charge Code	22926410
Hospital Revenue Code	272
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Bisbee Police All Plans	$45.76
Rate for Payer: Cash Price	$140.80
Rate for Payer: Self Pay Self Pay	$140.80

benzocaine top 20% 0.5mL oral anesthetic

Facility

$18.24

Service Code	NDC 283061043
Hospital Charge Code	112661648
Hospital Revenue Code	251
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$16.42
Rate for Payer: Aetna of AZ Commercial	$16.42
Rate for Payer: Aetna of AZ Medicare	$5.11
Rate for Payer: Allwell Medicare	$2.74
Rate for Payer: Amerigroup Medicare	$2.74
Rate for Payer: APIPA Medicare/Medicaid	$6.81
Rate for Payer: AZCH Complete Medicare	$2.74
Rate for Payer: Banner UC Health Medicare	$2.74
Rate for Payer: Bisbee Police All Plans	$4.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.40
Rate for Payer: Cash Price	$14.59
Rate for Payer: Cigna of AZ Commercial	$11.86
Rate for Payer: Copperpoint Commercial	$4.51
Rate for Payer: Health Net of AZ Commercial	$10.94
Rate for Payer: Health Net of AZ Medicare	$5.11
Rate for Payer: Humana of AZ Medicare	$2.74
Rate for Payer: Self Pay Self Pay	$14.59
Rate for Payer: TriWest Medicare	$2.74
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.28

benzocaine top 20% 0.5mL oral anesthetic

Facility

$18.24

Service Code	NDC 283061043
Hospital Charge Code	112661648
Hospital Revenue Code	251
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$16.42
Rate for Payer: Aetna of AZ Commercial	$16.42
Rate for Payer: Bisbee Police All Plans	$4.74
Rate for Payer: Cash Price	$14.59
Rate for Payer: Self Pay Self Pay	$14.59

benzocaine Top 20% mucous membrane spray [CQCH]

Facility

$0.04

Service Code	NDC 283067902
Hospital Charge Code	105912709
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
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	$0.01
Rate for Payer: Self Pay Self Pay	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges