Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

INSORB STAPLER

Facility

$121.00

Hospital Charge Code	22598339
Hospital Revenue Code	272
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of AZ Commercial	$108.90
Rate for Payer: Bisbee Police All Plans	$31.46
Rate for Payer: Cash Price	$96.80
Rate for Payer: Self Pay Self Pay	$96.80

insulin 70-30 100 units/mL 3 mL Inj [CQCH]

Facility

$4.49

Service Code	HCPCS J1815
Hospital Charge Code	105926789
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna of AZ Commercial	$4.04
Rate for Payer: Bisbee Police All Plans	$1.17
Rate for Payer: Cash Price	$3.59
Rate for Payer: Self Pay Self Pay	$3.59

insulin 70-30 100 units/mL 3 mL Inj [CQCH]

Facility

$4.49

Service Code	HCPCS J1815
Hospital Charge Code	105926789
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna of AZ Commercial	$4.04
Rate for Payer: Aetna of AZ Medicare	$1.26
Rate for Payer: Allwell Medicare	$0.72
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: APIPA Medicare/Medicaid	$1.68
Rate for Payer: AZCH Complete Medicare	$0.72
Rate for Payer: Banner UC Health Medicare	$0.72
Rate for Payer: Bisbee Police All Plans	$1.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.05
Rate for Payer: Cash Price	$3.59
Rate for Payer: Cigna of AZ Commercial	$2.92
Rate for Payer: Copperpoint Commercial	$1.11
Rate for Payer: Health Net of AZ Commercial	$2.69
Rate for Payer: Health Net of AZ Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$0.72
Rate for Payer: Self Pay Self Pay	$3.59
Rate for Payer: TriWest Medicare	$0.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.81

Insulin 70 units-30 units/mL 10 ml Sus[CQCH]

Facility

$1.74

Service Code	HCPCS J1815
Hospital Charge Code	233245743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1.57
Rate for Payer: Aetna of AZ Commercial	$1.57
Rate for Payer: Aetna of AZ Medicare	$0.49
Rate for Payer: Allwell Medicare	$0.28
Rate for Payer: Amerigroup Medicare	$0.28
Rate for Payer: APIPA Medicare/Medicaid	$0.65
Rate for Payer: AZCH Complete Medicare	$0.28
Rate for Payer: Banner UC Health Medicare	$0.28
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.18
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cigna of AZ Commercial	$1.13
Rate for Payer: Copperpoint Commercial	$0.43
Rate for Payer: Health Net of AZ Commercial	$1.04
Rate for Payer: Health Net of AZ Medicare	$0.49
Rate for Payer: Humana of AZ Medicare	$0.28
Rate for Payer: Self Pay Self Pay	$1.39
Rate for Payer: TriWest Medicare	$0.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.31

Insulin 70 units-30 units/mL 10 ml Sus[CQCH]

Facility

$1.74

Service Code	HCPCS J1815
Hospital Charge Code	233245743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.57
Rate for Payer: Aetna of AZ Commercial	$1.57
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Cash Price	$1.40
Rate for Payer: Self Pay Self Pay	$1.39

INSULIN AB

Facility

$389.00

Service Code	CPT 86337
Hospital Charge Code	23603250
Hospital Revenue Code	302
Min. Negotiated Rate	$62.24
Max. Negotiated Rate	$350.10
Rate for Payer: Aetna of AZ Commercial	$350.10
Rate for Payer: Aetna of AZ Medicare	$108.92
Rate for Payer: Allwell Medicare	$62.24
Rate for Payer: Amerigroup Medicare	$62.24
Rate for Payer: APIPA Medicare/Medicaid	$145.29
Rate for Payer: AZCH Complete Medicare	$62.24
Rate for Payer: Banner UC Health Medicare	$62.24
Rate for Payer: Bisbee Police All Plans	$101.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$264.52
Rate for Payer: Cash Price	$311.20
Rate for Payer: Cigna of AZ Commercial	$252.85
Rate for Payer: Copperpoint Commercial	$96.28
Rate for Payer: Health Net of AZ Commercial	$233.40
Rate for Payer: Health Net of AZ Medicare	$108.92
Rate for Payer: Humana of AZ Medicare	$62.24
Rate for Payer: Self Pay Self Pay	$311.20
Rate for Payer: TriWest Medicare	$62.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$226.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$70.02

INSULIN AB

Facility

$389.00

Service Code	CPT 86337
Hospital Charge Code	23603250
Hospital Revenue Code	302
Min. Negotiated Rate	$101.14
Max. Negotiated Rate	$350.10
Rate for Payer: Aetna of AZ Commercial	$350.10
Rate for Payer: Bisbee Police All Plans	$101.14
Rate for Payer: Cash Price	$311.20
Rate for Payer: Self Pay Self Pay	$311.20

insulin glargine 100 units/mL 10 mL MDV [CQCH]

Facility

$8.33

Service Code	HCPCS J1815
Hospital Charge Code	105926643
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna of AZ Commercial	$7.50
Rate for Payer: Bisbee Police All Plans	$2.17
Rate for Payer: Cash Price	$6.67
Rate for Payer: Self Pay Self Pay	$6.66

insulin glargine 100 units/mL 10 mL MDV [CQCH]

Facility

$8.33

Service Code	HCPCS J1815
Hospital Charge Code	105926643
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna of AZ Commercial	$7.50
Rate for Payer: Aetna of AZ Medicare	$2.33
Rate for Payer: Allwell Medicare	$1.33
Rate for Payer: Amerigroup Medicare	$1.33
Rate for Payer: APIPA Medicare/Medicaid	$3.11
Rate for Payer: AZCH Complete Medicare	$1.33
Rate for Payer: Banner UC Health Medicare	$1.33
Rate for Payer: Bisbee Police All Plans	$2.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.66
Rate for Payer: Cash Price	$6.67
Rate for Payer: Cigna of AZ Commercial	$5.41
Rate for Payer: Copperpoint Commercial	$2.06
Rate for Payer: Health Net of AZ Commercial	$5.00
Rate for Payer: Health Net of AZ Medicare	$2.33
Rate for Payer: Humana of AZ Medicare	$1.33
Rate for Payer: Self Pay Self Pay	$6.66
Rate for Payer: TriWest Medicare	$1.33
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.50

Insulin LC

Facility

$183.00

Service Code	CPT 83525
Hospital Charge Code	1285572
Hospital Revenue Code	301
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$164.70
Rate for Payer: Aetna of AZ Commercial	$164.70
Rate for Payer: Aetna of AZ Medicare	$51.24
Rate for Payer: Allwell Medicare	$29.28
Rate for Payer: Amerigroup Medicare	$29.28
Rate for Payer: APIPA Medicare/Medicaid	$68.35
Rate for Payer: AZCH Complete Medicare	$29.28
Rate for Payer: Banner UC Health Medicare	$29.28
Rate for Payer: Bisbee Police All Plans	$47.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$124.44
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cigna of AZ Commercial	$118.95
Rate for Payer: Copperpoint Commercial	$45.29
Rate for Payer: Health Net of AZ Commercial	$109.80
Rate for Payer: Health Net of AZ Medicare	$51.24
Rate for Payer: Humana of AZ Medicare	$29.28
Rate for Payer: Self Pay Self Pay	$146.40
Rate for Payer: TriWest Medicare	$29.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$106.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.94

Insulin LC

Facility

$183.00

Service Code	CPT 83525
Hospital Charge Code	1285572
Hospital Revenue Code	301
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$164.70
Rate for Payer: Aetna of AZ Commercial	$164.70
Rate for Payer: Bisbee Police All Plans	$47.58
Rate for Payer: Cash Price	$146.40
Rate for Payer: Self Pay Self Pay	$146.40

insulin lispro 100 units/mL 3 mL Inj [CQCH]

Facility

$5.93

Service Code	HCPCS J1817
Hospital Charge Code	105926862
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$5.34
Rate for Payer: Aetna of AZ Commercial	$5.34
Rate for Payer: Bisbee Police All Plans	$1.54
Rate for Payer: Cash Price	$4.74
Rate for Payer: Self Pay Self Pay	$4.74

insulin lispro 100 units/mL 3 mL Inj [CQCH]

Facility

$5.93

Service Code	HCPCS J1817
Hospital Charge Code	105926862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$5.34
Rate for Payer: Aetna of AZ Commercial	$5.34
Rate for Payer: Aetna of AZ Medicare	$1.66
Rate for Payer: Allwell Medicare	$0.95
Rate for Payer: Amerigroup Medicare	$0.95
Rate for Payer: APIPA Medicare/Medicaid	$2.21
Rate for Payer: AZCH Complete Medicare	$0.95
Rate for Payer: Banner UC Health Medicare	$0.95
Rate for Payer: Bisbee Police All Plans	$1.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.03
Rate for Payer: Cash Price	$4.74
Rate for Payer: Cigna of AZ Commercial	$3.85
Rate for Payer: Copperpoint Commercial	$1.47
Rate for Payer: Health Net of AZ Commercial	$3.56
Rate for Payer: Health Net of AZ Medicare	$1.66
Rate for Payer: Humana of AZ Medicare	$0.95
Rate for Payer: Self Pay Self Pay	$4.74
Rate for Payer: TriWest Medicare	$0.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.07

insulin NPH 100 units/mL 3 mL Inj [CQCH]

Facility

$4.49

Service Code	HCPCS J1815
Hospital Charge Code	105926716
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna of AZ Commercial	$4.04
Rate for Payer: Aetna of AZ Medicare	$1.26
Rate for Payer: Allwell Medicare	$0.72
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: APIPA Medicare/Medicaid	$1.68
Rate for Payer: AZCH Complete Medicare	$0.72
Rate for Payer: Banner UC Health Medicare	$0.72
Rate for Payer: Bisbee Police All Plans	$1.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.05
Rate for Payer: Cash Price	$3.59
Rate for Payer: Cigna of AZ Commercial	$2.92
Rate for Payer: Copperpoint Commercial	$1.11
Rate for Payer: Health Net of AZ Commercial	$2.69
Rate for Payer: Health Net of AZ Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$0.72
Rate for Payer: Self Pay Self Pay	$3.59
Rate for Payer: TriWest Medicare	$0.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.81

insulin NPH 100 units/mL 3 mL Inj [CQCH]

Facility

$4.49

Service Code	HCPCS J1815
Hospital Charge Code	105926716
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna of AZ Commercial	$4.04
Rate for Payer: Bisbee Police All Plans	$1.17
Rate for Payer: Cash Price	$3.59
Rate for Payer: Self Pay Self Pay	$3.59

insulin regular 100 units/mL 3 mL Inj [CQCH]

Facility

$4.49

Service Code	HCPCS J1815
Hospital Charge Code	105926935
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna of AZ Commercial	$4.04
Rate for Payer: Bisbee Police All Plans	$1.17
Rate for Payer: Cash Price	$3.59
Rate for Payer: Self Pay Self Pay	$3.59

insulin regular 100 units/mL 3 mL Inj [CQCH]

Facility

$4.49

Service Code	HCPCS J1815
Hospital Charge Code	105926935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$4.04
Rate for Payer: Aetna of AZ Commercial	$4.04
Rate for Payer: Aetna of AZ Medicare	$1.26
Rate for Payer: Allwell Medicare	$0.72
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: APIPA Medicare/Medicaid	$1.68
Rate for Payer: AZCH Complete Medicare	$0.72
Rate for Payer: Banner UC Health Medicare	$0.72
Rate for Payer: Bisbee Police All Plans	$1.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.05
Rate for Payer: Cash Price	$3.59
Rate for Payer: Cigna of AZ Commercial	$2.92
Rate for Payer: Copperpoint Commercial	$1.11
Rate for Payer: Health Net of AZ Commercial	$2.69
Rate for Payer: Health Net of AZ Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$0.72
Rate for Payer: Self Pay Self Pay	$3.59
Rate for Payer: TriWest Medicare	$0.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.81

INSULIN TOTL

Facility

$193.00

Service Code	CPT 83525
Hospital Charge Code	22481486
Hospital Revenue Code	301
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$173.70
Rate for Payer: Aetna of AZ Commercial	$173.70
Rate for Payer: Bisbee Police All Plans	$50.18
Rate for Payer: Cash Price	$154.40
Rate for Payer: Self Pay Self Pay	$154.40

INSULIN TOTL

Facility

$193.00

Service Code	CPT 83525
Hospital Charge Code	22481486
Hospital Revenue Code	301
Min. Negotiated Rate	$30.88
Max. Negotiated Rate	$173.70
Rate for Payer: Aetna of AZ Commercial	$173.70
Rate for Payer: Aetna of AZ Medicare	$54.04
Rate for Payer: Allwell Medicare	$30.88
Rate for Payer: Amerigroup Medicare	$30.88
Rate for Payer: APIPA Medicare/Medicaid	$72.09
Rate for Payer: AZCH Complete Medicare	$30.88
Rate for Payer: Banner UC Health Medicare	$30.88
Rate for Payer: Bisbee Police All Plans	$50.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$131.24
Rate for Payer: Cash Price	$154.40
Rate for Payer: Cigna of AZ Commercial	$125.45
Rate for Payer: Copperpoint Commercial	$47.77
Rate for Payer: Health Net of AZ Commercial	$115.80
Rate for Payer: Health Net of AZ Medicare	$54.04
Rate for Payer: Humana of AZ Medicare	$30.88
Rate for Payer: Self Pay Self Pay	$154.40
Rate for Payer: TriWest Medicare	$30.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$112.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.74

INTEGRATED TUBING FOR FLUID MANAGEMENT

Facility

$733.00

Hospital Charge Code	22354980
Hospital Revenue Code	270
Min. Negotiated Rate	$117.28
Max. Negotiated Rate	$659.70
Rate for Payer: Aetna of AZ Commercial	$659.70
Rate for Payer: Aetna of AZ Medicare	$205.24
Rate for Payer: Allwell Medicare	$117.28
Rate for Payer: Amerigroup Medicare	$117.28
Rate for Payer: APIPA Medicare/Medicaid	$273.78
Rate for Payer: AZCH Complete Medicare	$117.28
Rate for Payer: Banner UC Health Medicare	$117.28
Rate for Payer: Bisbee Police All Plans	$190.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$498.44
Rate for Payer: Cash Price	$586.40
Rate for Payer: Cigna of AZ Commercial	$513.10
Rate for Payer: Copperpoint Commercial	$181.42
Rate for Payer: Health Net of AZ Commercial	$439.80
Rate for Payer: Health Net of AZ Medicare	$205.24
Rate for Payer: Humana of AZ Medicare	$117.28
Rate for Payer: Self Pay Self Pay	$586.40
Rate for Payer: TriWest Medicare	$117.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$427.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$131.94

INTEGRATED TUBING FOR FLUID MANAGEMENT

Facility

$733.00

Hospital Charge Code	22354980
Hospital Revenue Code	270
Min. Negotiated Rate	$190.58
Max. Negotiated Rate	$659.70
Rate for Payer: Aetna of AZ Commercial	$659.70
Rate for Payer: Bisbee Police All Plans	$190.58
Rate for Payer: Cash Price	$586.40
Rate for Payer: Self Pay Self Pay	$586.40

Intentional Self-Harm And Attempted Suicide

Facility

$5,210.00

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG8173
Min. Negotiated Rate	$5,210.00
Max. Negotiated Rate	$5,210.00
Rate for Payer: AHCCCS Medicaid	$5,210.00
Rate for Payer: Allwell Medicaid	$5,210.00
Rate for Payer: AZCH Complete Medicaid	$5,210.00
Rate for Payer: Banner UC Health Medicaid	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00

Intentional Self-Harm And Attempted Suicide

Facility

$5,210.00

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG8172
Min. Negotiated Rate	$5,210.00
Max. Negotiated Rate	$5,210.00
Rate for Payer: AHCCCS Medicaid	$5,210.00
Rate for Payer: Allwell Medicaid	$5,210.00
Rate for Payer: AZCH Complete Medicaid	$5,210.00
Rate for Payer: Banner UC Health Medicaid	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00

Intentional Self-Harm And Attempted Suicide

Facility

$3,187.16

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG8172
Min. Negotiated Rate	$3,187.16
Max. Negotiated Rate	$3,187.16
Rate for Payer: AHCCCS Medicaid	$3,187.16
Rate for Payer: Allwell Medicaid	$3,187.16
Rate for Payer: AZCH Complete Medicaid	$3,187.16
Rate for Payer: Banner UC Health Medicaid	$3,187.16
Rate for Payer: Mercy Care Medicaid	$3,187.16

Intentional Self-Harm And Attempted Suicide

Facility

$3,187.16

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG8171
Min. Negotiated Rate	$3,187.16
Max. Negotiated Rate	$3,187.16
Rate for Payer: AHCCCS Medicaid	$3,187.16
Rate for Payer: Allwell Medicaid	$3,187.16
Rate for Payer: AZCH Complete Medicaid	$3,187.16
Rate for Payer: Banner UC Health Medicaid	$3,187.16
Rate for Payer: Mercy Care Medicaid	$3,187.16

Know your out-of-pocket cost for care.

All Charges