Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

eptifibatide 0.75 mg/mL IV Sol [CQCH]

Facility

$0.58

Service Code	HCPCS J1327
Hospital Charge Code	105921209
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.52
Rate for Payer: Aetna of AZ Commercial	$0.52
Rate for Payer: Bisbee Police All Plans	$0.15
Rate for Payer: Cash Price	$0.46
Rate for Payer: Self Pay Self Pay	$0.46

eptifibatide 0.75 mg/mL IV Sol [CQCH]

Facility

$0.58

Service Code	HCPCS J1327
Hospital Charge Code	105921209
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.52
Rate for Payer: Aetna of AZ Commercial	$0.52
Rate for Payer: Aetna of AZ Medicare	$0.16
Rate for Payer: Allwell Medicare	$0.09
Rate for Payer: Amerigroup Medicare	$0.09
Rate for Payer: APIPA Medicare/Medicaid	$0.22
Rate for Payer: AZCH Complete Medicare	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Bisbee Police All Plans	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.39
Rate for Payer: Cash Price	$0.46
Rate for Payer: Cigna of AZ Commercial	$0.38
Rate for Payer: Copperpoint Commercial	$0.14
Rate for Payer: Health Net of AZ Commercial	$0.35
Rate for Payer: Health Net of AZ Medicare	$0.16
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Self Pay Self Pay	$0.46
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.10

eptifibatide 2 mg/mL IV Sol [CQCH]

Facility

$1.93

Service Code	HCPCS J1327
Hospital Charge Code	105921282
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna of AZ Commercial	$1.74
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Cash Price	$1.55
Rate for Payer: Self Pay Self Pay	$1.54

eptifibatide 2 mg/mL IV Sol [CQCH]

Facility

$1.93

Service Code	HCPCS J1327
Hospital Charge Code	105921282
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna of AZ Commercial	$1.74
Rate for Payer: Aetna of AZ Medicare	$0.54
Rate for Payer: Allwell Medicare	$0.31
Rate for Payer: Amerigroup Medicare	$0.31
Rate for Payer: APIPA Medicare/Medicaid	$0.72
Rate for Payer: AZCH Complete Medicare	$0.31
Rate for Payer: Banner UC Health Medicare	$0.31
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.31
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of AZ Commercial	$1.25
Rate for Payer: Copperpoint Commercial	$0.48
Rate for Payer: Health Net of AZ Commercial	$1.16
Rate for Payer: Health Net of AZ Medicare	$0.54
Rate for Payer: Humana of AZ Medicare	$0.31
Rate for Payer: Self Pay Self Pay	$1.54
Rate for Payer: TriWest Medicare	$0.31
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.35

ERBE FIAPC PROBE REF#20132-218

Facility

$738.00

Hospital Charge Code	23152397
Hospital Revenue Code	272
Min. Negotiated Rate	$118.08
Max. Negotiated Rate	$664.20
Rate for Payer: Aetna of AZ Commercial	$664.20
Rate for Payer: Aetna of AZ Medicare	$206.64
Rate for Payer: Allwell Medicare	$118.08
Rate for Payer: Amerigroup Medicare	$118.08
Rate for Payer: APIPA Medicare/Medicaid	$275.64
Rate for Payer: AZCH Complete Medicare	$118.08
Rate for Payer: Banner UC Health Medicare	$118.08
Rate for Payer: Bisbee Police All Plans	$191.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$501.84
Rate for Payer: Cash Price	$590.40
Rate for Payer: Cigna of AZ Commercial	$516.60
Rate for Payer: Copperpoint Commercial	$182.66
Rate for Payer: Health Net of AZ Commercial	$442.80
Rate for Payer: Health Net of AZ Medicare	$206.64
Rate for Payer: Humana of AZ Medicare	$118.08
Rate for Payer: Self Pay Self Pay	$590.40
Rate for Payer: TriWest Medicare	$118.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$430.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$132.84

ERBE FIAPC PROBE REF#20132-218

Facility

$738.00

Hospital Charge Code	23152397
Hospital Revenue Code	272
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$664.20
Rate for Payer: Aetna of AZ Commercial	$664.20
Rate for Payer: Bisbee Police All Plans	$191.88
Rate for Payer: Cash Price	$590.40
Rate for Payer: Self Pay Self Pay	$590.40

ertapenem 1 gm Inj [CQCH]

Facility

$74.41

Service Code	HCPCS J1335
Hospital Charge Code	105921355
Hospital Revenue Code	250
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$66.97
Rate for Payer: Aetna of AZ Commercial	$66.97
Rate for Payer: Bisbee Police All Plans	$19.35
Rate for Payer: Cash Price	$59.53
Rate for Payer: Self Pay Self Pay	$59.53

ertapenem 1 gm Inj [CQCH]

Facility

$74.41

Service Code	HCPCS J1335
Hospital Charge Code	105921355
Hospital Revenue Code	250
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$66.97
Rate for Payer: Aetna of AZ Commercial	$66.97
Rate for Payer: Aetna of AZ Medicare	$20.83
Rate for Payer: Allwell Medicare	$11.91
Rate for Payer: Amerigroup Medicare	$11.91
Rate for Payer: APIPA Medicare/Medicaid	$27.79
Rate for Payer: AZCH Complete Medicare	$11.91
Rate for Payer: Banner UC Health Medicare	$11.91
Rate for Payer: Bisbee Police All Plans	$19.35
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.60
Rate for Payer: Cash Price	$59.53
Rate for Payer: Cigna of AZ Commercial	$48.37
Rate for Payer: Copperpoint Commercial	$18.42
Rate for Payer: Health Net of AZ Commercial	$44.65
Rate for Payer: Health Net of AZ Medicare	$20.83
Rate for Payer: Humana of AZ Medicare	$11.91
Rate for Payer: Self Pay Self Pay	$59.53
Rate for Payer: TriWest Medicare	$11.91
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.39

erythromycin base 250 mg Tab [CQCH]

Facility

$6.98

Service Code	NDC 24338010213
Hospital Charge Code	105921514
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna of AZ Commercial	$6.28
Rate for Payer: Bisbee Police All Plans	$1.81
Rate for Payer: Cash Price	$5.58
Rate for Payer: Self Pay Self Pay	$5.58

erythromycin base 250 mg Tab [CQCH]

Facility

$6.98

Service Code	NDC 24338010213
Hospital Charge Code	105921514
Hospital Revenue Code	251
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna of AZ Commercial	$6.28
Rate for Payer: Aetna of AZ Medicare	$1.95
Rate for Payer: Allwell Medicare	$1.12
Rate for Payer: Amerigroup Medicare	$1.12
Rate for Payer: APIPA Medicare/Medicaid	$2.61
Rate for Payer: AZCH Complete Medicare	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Bisbee Police All Plans	$1.81
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.75
Rate for Payer: Cash Price	$5.58
Rate for Payer: Cigna of AZ Commercial	$4.54
Rate for Payer: Copperpoint Commercial	$1.73
Rate for Payer: Health Net of AZ Commercial	$4.19
Rate for Payer: Health Net of AZ Medicare	$1.95
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Self Pay Self Pay	$5.58
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.26

erythromycin lactobionate 500 mg Inj [CQCH]

Facility

$41.00

Service Code	HCPCS J1364
Hospital Charge Code	105921428
Hospital Revenue Code	250
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

erythromycin lactobionate 500 mg Inj [CQCH]

Facility

$41.00

Service Code	HCPCS J1364
Hospital Charge Code	105921428
Hospital Revenue Code	250
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

erythromycin Ophth 0.5% Oint 1gm Ud [CQCH]

Facility

$7.82

Service Code	NDC 17478007031
Hospital Charge Code	105921579
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$7.04
Rate for Payer: Aetna of AZ Commercial	$7.04
Rate for Payer: Aetna of AZ Medicare	$2.19
Rate for Payer: Allwell Medicare	$1.25
Rate for Payer: Amerigroup Medicare	$1.25
Rate for Payer: APIPA Medicare/Medicaid	$2.92
Rate for Payer: AZCH Complete Medicare	$1.25
Rate for Payer: Banner UC Health Medicare	$1.25
Rate for Payer: Bisbee Police All Plans	$2.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.32
Rate for Payer: Cash Price	$6.26
Rate for Payer: Cigna of AZ Commercial	$5.08
Rate for Payer: Copperpoint Commercial	$1.94
Rate for Payer: Health Net of AZ Commercial	$4.69
Rate for Payer: Health Net of AZ Medicare	$2.19
Rate for Payer: Humana of AZ Medicare	$1.25
Rate for Payer: Self Pay Self Pay	$6.26
Rate for Payer: TriWest Medicare	$1.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.41

erythromycin Ophth 0.5% Oint 1gm Ud [CQCH]

Facility

$7.82

Service Code	NDC 17478007031
Hospital Charge Code	105921579
Hospital Revenue Code	251
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$7.04
Rate for Payer: Aetna of AZ Commercial	$7.04
Rate for Payer: Bisbee Police All Plans	$2.03
Rate for Payer: Cash Price	$6.26
Rate for Payer: Self Pay Self Pay	$6.26

Erythropoietin (EPO), Serum LC

Facility

$360.00

Service Code	CPT 82668
Hospital Charge Code	1906839
Hospital Revenue Code	301
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of AZ Commercial	$324.00
Rate for Payer: Aetna of AZ Medicare	$100.80
Rate for Payer: Allwell Medicare	$57.60
Rate for Payer: Amerigroup Medicare	$57.60
Rate for Payer: APIPA Medicare/Medicaid	$134.46
Rate for Payer: AZCH Complete Medicare	$57.60
Rate for Payer: Banner UC Health Medicare	$57.60
Rate for Payer: Bisbee Police All Plans	$93.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$244.80
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cigna of AZ Commercial	$234.00
Rate for Payer: Copperpoint Commercial	$89.10
Rate for Payer: Health Net of AZ Commercial	$216.00
Rate for Payer: Health Net of AZ Medicare	$100.80
Rate for Payer: Humana of AZ Medicare	$57.60
Rate for Payer: Self Pay Self Pay	$288.00
Rate for Payer: TriWest Medicare	$57.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$209.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.80

Erythropoietin (EPO), Serum LC

Facility

$360.00

Service Code	CPT 82668
Hospital Charge Code	1906839
Hospital Revenue Code	301
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of AZ Commercial	$324.00
Rate for Payer: Bisbee Police All Plans	$93.60
Rate for Payer: Cash Price	$288.00
Rate for Payer: Self Pay Self Pay	$288.00

ESG PLASMALOOP LARGE 12

Facility

$2,664.00

Hospital Charge Code	27748824
Hospital Revenue Code	270
Min. Negotiated Rate	$426.24
Max. Negotiated Rate	$2,397.60
Rate for Payer: Aetna of AZ Commercial	$2,397.60
Rate for Payer: Aetna of AZ Medicare	$745.92
Rate for Payer: Allwell Medicare	$426.24
Rate for Payer: Amerigroup Medicare	$426.24
Rate for Payer: APIPA Medicare/Medicaid	$995.00
Rate for Payer: AZCH Complete Medicare	$426.24
Rate for Payer: Banner UC Health Medicare	$426.24
Rate for Payer: Bisbee Police All Plans	$692.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,811.52
Rate for Payer: Cash Price	$2,131.20
Rate for Payer: Cigna of AZ Commercial	$1,864.80
Rate for Payer: Copperpoint Commercial	$659.34
Rate for Payer: Health Net of AZ Commercial	$1,598.40
Rate for Payer: Health Net of AZ Medicare	$745.92
Rate for Payer: Humana of AZ Medicare	$426.24
Rate for Payer: Self Pay Self Pay	$2,131.20
Rate for Payer: TriWest Medicare	$426.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,553.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$479.52

ESG PLASMALOOP LARGE 12

Facility

$2,664.00

Hospital Charge Code	27748824
Hospital Revenue Code	270
Min. Negotiated Rate	$692.64
Max. Negotiated Rate	$2,397.60
Rate for Payer: Aetna of AZ Commercial	$2,397.60
Rate for Payer: Bisbee Police All Plans	$692.64
Rate for Payer: Cash Price	$2,131.20
Rate for Payer: Self Pay Self Pay	$2,131.20

ESMARK 4''''

Facility

$11.00

Hospital Charge Code	22926421
Hospital Revenue Code	272
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Cash Price	$8.80
Rate for Payer: Self Pay Self Pay	$8.80

ESMARK 4''''

Facility

$11.00

Hospital Charge Code	22926421
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Aetna of AZ Medicare	$3.08
Rate for Payer: Allwell Medicare	$1.76
Rate for Payer: Amerigroup Medicare	$1.76
Rate for Payer: APIPA Medicare/Medicaid	$4.11
Rate for Payer: AZCH Complete Medicare	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.48
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Copperpoint Commercial	$2.72
Rate for Payer: Health Net of AZ Commercial	$6.60
Rate for Payer: Health Net of AZ Medicare	$3.08
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Self Pay Self Pay	$8.80
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.98

ESMARK 6''''

Facility

$18.00

Hospital Charge Code	22926422
Hospital Revenue Code	272
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.88
Rate for Payer: Amerigroup Medicare	$2.88
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

ESMARK 6''''

Facility

$18.00

Hospital Charge Code	22926422
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

esmolol 10 mg/mL Sol[CQCH]

Facility

$0.19

Service Code	HCPCS J1805
Hospital Charge Code	233028583
Hospital Revenue Code	250
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

esmolol 10 mg/mL Sol[CQCH]

Facility

$0.19

Service Code	HCPCS J1805
Hospital Charge Code	233028583
Hospital Revenue Code	250
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

ESOPHAGEAL VARICIES BANDING

Facility

$6,347.00

Service Code	CPT 43244
Hospital Charge Code	23598982
Hospital Revenue Code	750
Min. Negotiated Rate	$1,650.22
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Bisbee Police All Plans	$1,650.22
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Self Pay Self Pay	$5,077.60

Know your out-of-pocket cost for care.

All Charges