Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

carBAMazepine 200 mg Tab [CQCH]

Facility

$0.45

Service Code	NDC 904617261
Hospital Charge Code	105914390
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Aetna of AZ Medicare	$0.13
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.17
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.31
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.29
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.27
Rate for Payer: Health Net of AZ Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.36
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

carBAMazepine 200 mg Tab [CQCH]

Facility

$0.45

Service Code	NDC 904617261
Hospital Charge Code	105914390
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Cash Price	$0.36
Rate for Payer: Self Pay Self Pay	$0.36

Carbamazepine Level

Facility

$218.00

Service Code	CPT 80156
Hospital Charge Code	633694
Hospital Revenue Code	301
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$196.20
Rate for Payer: Aetna of AZ Commercial	$196.20
Rate for Payer: Aetna of AZ Medicare	$61.04
Rate for Payer: Allwell Medicare	$34.88
Rate for Payer: Amerigroup Medicare	$34.88
Rate for Payer: APIPA Medicare/Medicaid	$81.42
Rate for Payer: AZCH Complete Medicare	$34.88
Rate for Payer: Banner UC Health Medicare	$34.88
Rate for Payer: Bisbee Police All Plans	$56.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$148.24
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cigna of AZ Commercial	$141.70
Rate for Payer: Copperpoint Commercial	$53.95
Rate for Payer: Health Net of AZ Commercial	$130.80
Rate for Payer: Health Net of AZ Medicare	$61.04
Rate for Payer: Humana of AZ Medicare	$34.88
Rate for Payer: Self Pay Self Pay	$174.40
Rate for Payer: TriWest Medicare	$34.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$127.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.24

Carbamazepine Level

Facility

$218.00

Service Code	CPT 80156
Hospital Charge Code	633694
Hospital Revenue Code	301
Min. Negotiated Rate	$56.68
Max. Negotiated Rate	$196.20
Rate for Payer: Aetna of AZ Commercial	$196.20
Rate for Payer: Bisbee Police All Plans	$56.68
Rate for Payer: Cash Price	$174.40
Rate for Payer: Self Pay Self Pay	$174.40

carbidopa-levodopa 10 mg-100 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 63739004610
Hospital Charge Code	105914455
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.14
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.12
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.16
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

carbidopa-levodopa 10 mg-100 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 63739004610
Hospital Charge Code	105914455
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.16

carbidopa-levodopa 25 mg-100 mg DIS Tablet [CQCH]

Facility

$0.84

Service Code	NDC 47335018788
Hospital Charge Code	126238058
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Aetna of AZ Medicare	$0.24
Rate for Payer: Allwell Medicare	$0.13
Rate for Payer: Amerigroup Medicare	$0.13
Rate for Payer: APIPA Medicare/Medicaid	$0.31
Rate for Payer: AZCH Complete Medicare	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.57
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of AZ Commercial	$0.55
Rate for Payer: Copperpoint Commercial	$0.21
Rate for Payer: Health Net of AZ Commercial	$0.50
Rate for Payer: Health Net of AZ Medicare	$0.24
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Self Pay Self Pay	$0.67
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

carbidopa-levodopa 25 mg-100 mg DIS Tablet [CQCH]

Facility

$0.84

Service Code	NDC 47335018788
Hospital Charge Code	126238058
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Cash Price	$0.68
Rate for Payer: Self Pay Self Pay	$0.67

carbidopa-levodopa 25 mg-100 mg ER Tab [CQCH]

Facility

$0.22

Service Code	NDC 51079097820
Hospital Charge Code	105914520
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.08
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	$0.15
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.13
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

carbidopa-levodopa 25 mg-100 mg ER Tab [CQCH]

Facility

$0.22

Service Code	NDC 51079097820
Hospital Charge Code	105914520
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.18
Rate for Payer: Self Pay Self Pay	$0.18

carbidopa-levodopa 25 mg-100 mg Tab-IR[CQCH]

Facility

$0.19

Service Code	NDC 904725761
Hospital Charge Code	105914587
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.15
Rate for Payer: Self Pay Self Pay	$0.15

carbidopa-levodopa 25 mg-100 mg Tab-IR[CQCH]

Facility

$0.19

Service Code	NDC 904725761
Hospital Charge Code	105914587
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
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	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.13
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.11
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	$0.15
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

carbidopa-levodopa 25 mg-250 mg IR Tab [CQCH]

Facility

$0.29

Service Code	NDC 60687083601
Hospital Charge Code	107994470
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

carbidopa-levodopa 25 mg-250 mg IR Tab [CQCH]

Facility

$0.29

Service Code	NDC 60687083601
Hospital Charge Code	107994470
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

Carbohydrate Antigen 19-9 LC

Facility

$245.00

Service Code	CPT 86301
Hospital Charge Code	2269492
Hospital Revenue Code	302
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Bisbee Police All Plans	$63.70
Rate for Payer: Cash Price	$196.00
Rate for Payer: Self Pay Self Pay	$196.00

Carbohydrate Antigen 19-9 LC

Facility

$245.00

Service Code	CPT 86301
Hospital Charge Code	2269492
Hospital Revenue Code	302
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Aetna of AZ Medicare	$68.60
Rate for Payer: Allwell Medicare	$39.20
Rate for Payer: Amerigroup Medicare	$39.20
Rate for Payer: APIPA Medicare/Medicaid	$91.51
Rate for Payer: AZCH Complete Medicare	$39.20
Rate for Payer: Banner UC Health Medicare	$39.20
Rate for Payer: Bisbee Police All Plans	$63.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$166.60
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cigna of AZ Commercial	$159.25
Rate for Payer: Copperpoint Commercial	$60.64
Rate for Payer: Health Net of AZ Commercial	$147.00
Rate for Payer: Health Net of AZ Medicare	$68.60
Rate for Payer: Humana of AZ Medicare	$39.20
Rate for Payer: Self Pay Self Pay	$196.00
Rate for Payer: TriWest Medicare	$39.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$142.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.10

Carbon Dioxide Level

Facility

$107.00

Service Code	CPT 82374
Hospital Charge Code	633626
Hospital Revenue Code	301
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Aetna of AZ Medicare	$29.96
Rate for Payer: Allwell Medicare	$17.12
Rate for Payer: Amerigroup Medicare	$17.12
Rate for Payer: APIPA Medicare/Medicaid	$39.96
Rate for Payer: AZCH Complete Medicare	$17.12
Rate for Payer: Banner UC Health Medicare	$17.12
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.76
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$69.55
Rate for Payer: Copperpoint Commercial	$26.48
Rate for Payer: Health Net of AZ Commercial	$64.20
Rate for Payer: Health Net of AZ Medicare	$29.96
Rate for Payer: Humana of AZ Medicare	$17.12
Rate for Payer: Self Pay Self Pay	$85.60
Rate for Payer: TriWest Medicare	$17.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.26

Carbon Dioxide Level

Facility

$107.00

Service Code	CPT 82374
Hospital Charge Code	633626
Hospital Revenue Code	301
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Cash Price	$85.60
Rate for Payer: Self Pay Self Pay	$85.60

Carbon Monoxide, Blood LC

Facility

$62.00

Service Code	CPT 82375
Hospital Charge Code	2029215
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

Carbon Monoxide, Blood LC

Facility

$62.00

Service Code	CPT 82375
Hospital Charge Code	2029215
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

CARBON MONOXIDE DIFFUSING CAPACITY

Facility

$871.00

Service Code	CPT 94729
Hospital Charge Code	1886870
Hospital Revenue Code	410
Min. Negotiated Rate	$226.46
Max. Negotiated Rate	$783.90
Rate for Payer: Aetna of AZ Commercial	$783.90
Rate for Payer: Bisbee Police All Plans	$226.46
Rate for Payer: Cash Price	$696.80
Rate for Payer: Self Pay Self Pay	$696.80

CARBON MONOXIDE DIFFUSING CAPACITY

Facility

$871.00

Service Code	CPT 94729
Hospital Charge Code	1886870
Hospital Revenue Code	410
Min. Negotiated Rate	$139.36
Max. Negotiated Rate	$783.90
Rate for Payer: Aetna of AZ Commercial	$783.90
Rate for Payer: Aetna of AZ Medicare	$243.88
Rate for Payer: Allwell Medicare	$139.36
Rate for Payer: Amerigroup Medicare	$139.36
Rate for Payer: APIPA Medicare/Medicaid	$325.32
Rate for Payer: AZCH Complete Medicare	$139.36
Rate for Payer: Banner UC Health Medicare	$139.36
Rate for Payer: Bisbee Police All Plans	$226.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$592.28
Rate for Payer: Cash Price	$696.80
Rate for Payer: Cigna of AZ Commercial	$609.70
Rate for Payer: Copperpoint Commercial	$215.57
Rate for Payer: Health Net of AZ Commercial	$522.60
Rate for Payer: Health Net of AZ Medicare	$243.88
Rate for Payer: Humana of AZ Medicare	$139.36
Rate for Payer: Self Pay Self Pay	$696.80
Rate for Payer: TriWest Medicare	$139.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$507.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$156.78

Cardiac Arrest And Shock

Facility

$2,874.34

Service Code	APR-DRG 1961
Hospital Charge Code	APRDRG1963
Min. Negotiated Rate	$2,874.34
Max. Negotiated Rate	$2,874.34
Rate for Payer: AHCCCS Medicaid	$2,874.34
Rate for Payer: Allwell Medicaid	$2,874.34
Rate for Payer: AZCH Complete Medicaid	$2,874.34
Rate for Payer: Banner UC Health Medicaid	$2,874.34
Rate for Payer: Mercy Care Medicaid	$2,874.34

Cardiac Arrest And Shock

Facility

$3,941.17

Service Code	APR-DRG 1962
Hospital Charge Code	APRDRG1963
Min. Negotiated Rate	$3,941.17
Max. Negotiated Rate	$3,941.17
Rate for Payer: AHCCCS Medicaid	$3,941.17
Rate for Payer: Allwell Medicaid	$3,941.17
Rate for Payer: AZCH Complete Medicaid	$3,941.17
Rate for Payer: Banner UC Health Medicaid	$3,941.17
Rate for Payer: Mercy Care Medicaid	$3,941.17

Cardiac Arrest And Shock

Facility

$3,941.17

Service Code	APR-DRG 1962
Hospital Charge Code	APRDRG1962
Min. Negotiated Rate	$3,941.17
Max. Negotiated Rate	$3,941.17
Rate for Payer: AHCCCS Medicaid	$3,941.17
Rate for Payer: Allwell Medicaid	$3,941.17
Rate for Payer: AZCH Complete Medicaid	$3,941.17
Rate for Payer: Banner UC Health Medicaid	$3,941.17
Rate for Payer: Mercy Care Medicaid	$3,941.17

Know your out-of-pocket cost for care.

All Charges