Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

I-GEL 4

Facility

$60.00

Hospital Charge Code	22926457
Hospital Revenue Code	272
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.60
Rate for Payer: Amerigroup Medicare	$9.60
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

I-GEL 5

Facility

$57.00

Hospital Charge Code	22926458
Hospital Revenue Code	272
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

I-GEL 5

Facility

$57.00

Hospital Charge Code	22926458
Hospital Revenue Code	272
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$9.12
Rate for Payer: Amerigroup Medicare	$9.12
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$9.12
Rate for Payer: Banner UC Health Medicare	$9.12
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$9.12
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$9.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

IGF-1 LC

Facility

$480.00

Service Code	CPT 84305
Hospital Charge Code	1906904
Hospital Revenue Code	301
Min. Negotiated Rate	$124.80
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of AZ Commercial	$432.00
Rate for Payer: Bisbee Police All Plans	$124.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Self Pay Self Pay	$384.00

IGF-1 LC

Facility

$480.00

Service Code	CPT 84305
Hospital Charge Code	1906904
Hospital Revenue Code	301
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of AZ Commercial	$432.00
Rate for Payer: Aetna of AZ Medicare	$134.40
Rate for Payer: Allwell Medicare	$76.80
Rate for Payer: Amerigroup Medicare	$76.80
Rate for Payer: APIPA Medicare/Medicaid	$179.28
Rate for Payer: AZCH Complete Medicare	$76.80
Rate for Payer: Banner UC Health Medicare	$76.80
Rate for Payer: Bisbee Police All Plans	$124.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$326.40
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cigna of AZ Commercial	$312.00
Rate for Payer: Copperpoint Commercial	$118.80
Rate for Payer: Health Net of AZ Commercial	$288.00
Rate for Payer: Health Net of AZ Medicare	$134.40
Rate for Payer: Humana of AZ Medicare	$76.80
Rate for Payer: Self Pay Self Pay	$384.00
Rate for Payer: TriWest Medicare	$76.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$279.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.40

IgG Subclasses 1-4 LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	6781836
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

IgG Subclasses 1-4 LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	6781836
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$19.20
Rate for Payer: Amerigroup Medicare	$19.20
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IgG, Subclasses(1-4) LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2029255
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$19.20
Rate for Payer: Amerigroup Medicare	$19.20
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IgG, Subclasses(1-4) LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2029255
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

IGP,Aptima HPV,CtNg Age Gdln LC

Facility

$174.00

Service Code	CPT 87624
Hospital Charge Code	22660591
Hospital Revenue Code	300
Min. Negotiated Rate	$27.84
Max. Negotiated Rate	$156.60
Rate for Payer: Aetna of AZ Commercial	$156.60
Rate for Payer: Aetna of AZ Medicare	$48.72
Rate for Payer: Allwell Medicare	$27.84
Rate for Payer: Amerigroup Medicare	$27.84
Rate for Payer: APIPA Medicare/Medicaid	$64.99
Rate for Payer: AZCH Complete Medicare	$27.84
Rate for Payer: Banner UC Health Medicare	$27.84
Rate for Payer: Bisbee Police All Plans	$45.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$118.32
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cigna of AZ Commercial	$113.10
Rate for Payer: Copperpoint Commercial	$43.06
Rate for Payer: Health Net of AZ Commercial	$104.40
Rate for Payer: Health Net of AZ Medicare	$48.72
Rate for Payer: Humana of AZ Medicare	$27.84
Rate for Payer: Self Pay Self Pay	$139.20
Rate for Payer: TriWest Medicare	$27.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$101.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.32

IGP,Aptima HPV,CtNg Age Gdln LC

Facility

$174.00

Service Code	CPT 87624
Hospital Charge Code	22660591
Hospital Revenue Code	300
Min. Negotiated Rate	$45.24
Max. Negotiated Rate	$156.60
Rate for Payer: Aetna of AZ Commercial	$156.60
Rate for Payer: Bisbee Police All Plans	$45.24
Rate for Payer: Cash Price	$139.20
Rate for Payer: Self Pay Self Pay	$139.20

IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST A

Facility

$404.00

Service Code	CPT 74420
Hospital Charge Code	27797698
Hospital Revenue Code	360
Min. Negotiated Rate	$105.04
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Bisbee Police All Plans	$105.04
Rate for Payer: Cash Price	$323.20
Rate for Payer: Self Pay Self Pay	$323.20

IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST A

Facility

$404.00

Service Code	CPT 74420
Hospital Charge Code	27797698
Hospital Revenue Code	360
Min. Negotiated Rate	$64.64
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Aetna of AZ Medicare	$113.12
Rate for Payer: AHCCCS Medicaid	$266.89
Rate for Payer: Allwell Medicaid	$266.89
Rate for Payer: Allwell Medicare	$64.64
Rate for Payer: Amerigroup Medicare	$64.64
Rate for Payer: APIPA Medicare/Medicaid	$150.89
Rate for Payer: AZCH Complete Medicaid	$266.89
Rate for Payer: AZCH Complete Medicare	$64.64
Rate for Payer: Banner UC Health Medicaid	$266.89
Rate for Payer: Banner UC Health Medicare	$64.64
Rate for Payer: Bisbee Police All Plans	$105.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$274.72
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cigna of AZ Commercial	$202.00
Rate for Payer: Copperpoint Commercial	$99.99
Rate for Payer: Health Net of AZ Commercial	$242.40
Rate for Payer: Health Net of AZ Medicare	$113.12
Rate for Payer: Humana of AZ Medicare	$64.64
Rate for Payer: Mercy Care Medicaid	$266.89
Rate for Payer: Self Pay Self Pay	$323.20
Rate for Payer: TriWest Medicare	$64.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$235.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.72

imipenem-cilastatin 500 mg Inj [CQCH]

Facility

$8.35

Service Code	HCPCS J0743
Hospital Charge Code	120268247
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$7.51
Rate for Payer: Aetna of AZ Commercial	$7.51
Rate for Payer: Aetna of AZ Medicare	$2.34
Rate for Payer: Allwell Medicare	$1.34
Rate for Payer: Amerigroup Medicare	$1.34
Rate for Payer: APIPA Medicare/Medicaid	$3.12
Rate for Payer: AZCH Complete Medicare	$1.34
Rate for Payer: Banner UC Health Medicare	$1.34
Rate for Payer: Bisbee Police All Plans	$2.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.68
Rate for Payer: Cash Price	$6.68
Rate for Payer: Cigna of AZ Commercial	$5.43
Rate for Payer: Copperpoint Commercial	$2.07
Rate for Payer: Health Net of AZ Commercial	$5.01
Rate for Payer: Health Net of AZ Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$1.34
Rate for Payer: Self Pay Self Pay	$6.68
Rate for Payer: TriWest Medicare	$1.34
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.50

imipenem-cilastatin 500 mg Inj [CQCH]

Facility

$8.35

Service Code	HCPCS J0743
Hospital Charge Code	120268247
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$7.51
Rate for Payer: Aetna of AZ Commercial	$7.51
Rate for Payer: Bisbee Police All Plans	$2.17
Rate for Payer: Cash Price	$6.68
Rate for Payer: Self Pay Self Pay	$6.68

IMMNASSY FOR NONINFECT (CELIAC COMP)

Facility

$156.00

Service Code	CPT 83516
Hospital Charge Code	22481480
Hospital Revenue Code	301
Min. Negotiated Rate	$40.56
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Cash Price	$124.80
Rate for Payer: Self Pay Self Pay	$124.80

IMMNASSY FOR NONINFECT (CELIAC COMP)

Facility

$156.00

Service Code	CPT 83516
Hospital Charge Code	22481480
Hospital Revenue Code	301
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Aetna of AZ Medicare	$43.68
Rate for Payer: Allwell Medicare	$24.96
Rate for Payer: Amerigroup Medicare	$24.96
Rate for Payer: APIPA Medicare/Medicaid	$58.27
Rate for Payer: AZCH Complete Medicare	$24.96
Rate for Payer: Banner UC Health Medicare	$24.96
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$106.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cigna of AZ Commercial	$101.40
Rate for Payer: Copperpoint Commercial	$38.61
Rate for Payer: Health Net of AZ Commercial	$93.60
Rate for Payer: Health Net of AZ Medicare	$43.68
Rate for Payer: Humana of AZ Medicare	$24.96
Rate for Payer: Self Pay Self Pay	$124.80
Rate for Payer: TriWest Medicare	$24.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.08

IMMOBILIZER KNEE 20

Facility

$89.00

Hospital Charge Code	22354184
Hospital Revenue Code	270
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Cash Price	$71.20
Rate for Payer: Self Pay Self Pay	$71.20

IMMOBILIZER KNEE 20

Facility

$89.00

Hospital Charge Code	22354184
Hospital Revenue Code	270
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Aetna of AZ Medicare	$24.92
Rate for Payer: Allwell Medicare	$14.24
Rate for Payer: Amerigroup Medicare	$14.24
Rate for Payer: APIPA Medicare/Medicaid	$33.24
Rate for Payer: AZCH Complete Medicare	$14.24
Rate for Payer: Banner UC Health Medicare	$14.24
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$60.52
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$62.30
Rate for Payer: Copperpoint Commercial	$22.03
Rate for Payer: Health Net of AZ Commercial	$53.40
Rate for Payer: Health Net of AZ Medicare	$24.92
Rate for Payer: Humana of AZ Medicare	$14.24
Rate for Payer: Self Pay Self Pay	$71.20
Rate for Payer: TriWest Medicare	$14.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.02

IMMOBILIZER SHOULDER PED

Facility

$78.00

Hospital Charge Code	22354134
Hospital Revenue Code	270
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

IMMOBILIZER SHOULDER PED

Facility

$78.00

Hospital Charge Code	22354134
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: Allwell Medicare	$12.48
Rate for Payer: Amerigroup Medicare	$12.48
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicare	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

Immunofixation (IFE) Urine LC

Facility

$903.00

Service Code	CPT 86335
Hospital Charge Code	3451611
Hospital Revenue Code	302
Min. Negotiated Rate	$144.48
Max. Negotiated Rate	$812.70
Rate for Payer: Aetna of AZ Commercial	$812.70
Rate for Payer: Aetna of AZ Medicare	$252.84
Rate for Payer: Allwell Medicare	$144.48
Rate for Payer: Amerigroup Medicare	$144.48
Rate for Payer: APIPA Medicare/Medicaid	$337.27
Rate for Payer: AZCH Complete Medicare	$144.48
Rate for Payer: Banner UC Health Medicare	$144.48
Rate for Payer: Bisbee Police All Plans	$234.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$614.04
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cigna of AZ Commercial	$586.95
Rate for Payer: Copperpoint Commercial	$223.49
Rate for Payer: Health Net of AZ Commercial	$541.80
Rate for Payer: Health Net of AZ Medicare	$252.84
Rate for Payer: Humana of AZ Medicare	$144.48
Rate for Payer: Self Pay Self Pay	$722.40
Rate for Payer: TriWest Medicare	$144.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$526.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$162.54

Immunofixation (IFE) Urine LC

Facility

$903.00

Service Code	CPT 86335
Hospital Charge Code	3451611
Hospital Revenue Code	302
Min. Negotiated Rate	$234.78
Max. Negotiated Rate	$812.70
Rate for Payer: Aetna of AZ Commercial	$812.70
Rate for Payer: Bisbee Police All Plans	$234.78
Rate for Payer: Cash Price	$722.40
Rate for Payer: Self Pay Self Pay	$722.40

Immunofixation, Serum LC

Facility

$821.00

Service Code	CPT 86334
Hospital Charge Code	2269421
Hospital Revenue Code	302
Min. Negotiated Rate	$213.46
Max. Negotiated Rate	$738.90
Rate for Payer: Aetna of AZ Commercial	$738.90
Rate for Payer: Bisbee Police All Plans	$213.46
Rate for Payer: Cash Price	$656.80
Rate for Payer: Self Pay Self Pay	$656.80

Immunofixation, Serum LC

Facility

$821.00

Service Code	CPT 86334
Hospital Charge Code	2269421
Hospital Revenue Code	302
Min. Negotiated Rate	$131.36
Max. Negotiated Rate	$738.90
Rate for Payer: Aetna of AZ Commercial	$738.90
Rate for Payer: Aetna of AZ Medicare	$229.88
Rate for Payer: Allwell Medicare	$131.36
Rate for Payer: Amerigroup Medicare	$131.36
Rate for Payer: APIPA Medicare/Medicaid	$306.64
Rate for Payer: AZCH Complete Medicare	$131.36
Rate for Payer: Banner UC Health Medicare	$131.36
Rate for Payer: Bisbee Police All Plans	$213.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$558.28
Rate for Payer: Cash Price	$656.80
Rate for Payer: Cigna of AZ Commercial	$533.65
Rate for Payer: Copperpoint Commercial	$203.20
Rate for Payer: Health Net of AZ Commercial	$492.60
Rate for Payer: Health Net of AZ Medicare	$229.88
Rate for Payer: Humana of AZ Medicare	$131.36
Rate for Payer: Self Pay Self Pay	$656.80
Rate for Payer: TriWest Medicare	$131.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$478.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$147.78

Know your out-of-pocket cost for care.

All Charges