Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

INTRODUCER BOUGIE TRACH ADULT

Facility

$455.00

Hospital Charge Code	22592653
Hospital Revenue Code	272
Min. Negotiated Rate	$118.30
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna of AZ Commercial	$409.50
Rate for Payer: Bisbee Police All Plans	$118.30
Rate for Payer: Cash Price	$364.00
Rate for Payer: Self Pay Self Pay	$364.00

INTRODUCER BOUGIE TRACH ADULT

Facility

$455.00

Hospital Charge Code	22592653
Hospital Revenue Code	272
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna of AZ Commercial	$409.50
Rate for Payer: Aetna of AZ Medicare	$127.40
Rate for Payer: Allwell Medicare	$68.25
Rate for Payer: Amerigroup Medicare	$68.25
Rate for Payer: APIPA Medicare/Medicaid	$169.94
Rate for Payer: AZCH Complete Medicare	$68.25
Rate for Payer: Banner UC Health Medicare	$68.25
Rate for Payer: Bisbee Police All Plans	$118.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$309.40
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cigna of AZ Commercial	$318.50
Rate for Payer: Copperpoint Commercial	$112.61
Rate for Payer: Health Net of AZ Commercial	$273.00
Rate for Payer: Health Net of AZ Medicare	$127.40
Rate for Payer: Humana of AZ Medicare	$68.25
Rate for Payer: Self Pay Self Pay	$364.00
Rate for Payer: TriWest Medicare	$68.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$265.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$81.90

INTRODUCER NEEDLE SET 12CM 18G

Facility

$180.00

Hospital Charge Code	22354314
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

INTRODUCER NEEDLE SET 12CM 18G

Facility

$180.00

Hospital Charge Code	22354314
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$27.00
Rate for Payer: Amerigroup Medicare	$27.00
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$27.00
Rate for Payer: Banner UC Health Medicare	$27.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$27.00
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$27.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

INTRODUCER NEEDLE SET 20CM 18G

Facility

$180.00

Hospital Charge Code	22354315
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$27.00
Rate for Payer: Amerigroup Medicare	$27.00
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$27.00
Rate for Payer: Banner UC Health Medicare	$27.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$27.00
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$27.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

INTRODUCER NEEDLE SET 20CM 18G

Facility

$180.00

Hospital Charge Code	22354315
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

INTUBATE

Facility

$1,257.00

Service Code	CPT 31500
Hospital Charge Code	1886875
Hospital Revenue Code	410
Min. Negotiated Rate	$188.55
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,131.30
Rate for Payer: Aetna of AZ Medicare	$351.96
Rate for Payer: AHCCCS Medicaid	$306.82
Rate for Payer: Allwell Medicaid	$306.82
Rate for Payer: Allwell Medicare	$188.55
Rate for Payer: Amerigroup Medicare	$188.55
Rate for Payer: APIPA Medicare/Medicaid	$469.49
Rate for Payer: AZCH Complete Medicaid	$306.82
Rate for Payer: AZCH Complete Medicare	$188.55
Rate for Payer: Banner UC Health Medicaid	$306.82
Rate for Payer: Banner UC Health Medicare	$188.55
Rate for Payer: Bisbee Police All Plans	$326.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$854.76
Rate for Payer: Cash Price	$1,005.60
Rate for Payer: Cash Price	$1,005.60
Rate for Payer: Cigna of AZ Commercial	$879.90
Rate for Payer: Copperpoint Commercial	$311.11
Rate for Payer: Health Net of AZ Commercial	$754.20
Rate for Payer: Health Net of AZ Medicare	$351.96
Rate for Payer: Humana of AZ Medicare	$188.55
Rate for Payer: Mercy Care Medicaid	$306.82
Rate for Payer: Self Pay Self Pay	$1,005.60
Rate for Payer: TriWest Medicare	$188.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$226.26

INTUBATE

Facility

$1,257.00

Service Code	CPT 31500
Hospital Charge Code	1886875
Hospital Revenue Code	410
Min. Negotiated Rate	$326.82
Max. Negotiated Rate	$1,131.30
Rate for Payer: Aetna of AZ Commercial	$1,131.30
Rate for Payer: Bisbee Police All Plans	$326.82
Rate for Payer: Cash Price	$1,005.60
Rate for Payer: Self Pay Self Pay	$1,005.60

Ionized Calcium Level

Facility

$177.00

Service Code	CPT 82330
Hospital Charge Code	9077417
Hospital Revenue Code	301
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

Ionized Calcium Level

Facility

$177.00

Service Code	CPT 82330
Hospital Charge Code	9077417
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: AHCCCS Medicaid	$13.68
Rate for Payer: Allwell Medicaid	$13.68
Rate for Payer: Allwell Medicare	$26.55
Rate for Payer: Amerigroup Medicare	$26.55
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicaid	$13.68
Rate for Payer: AZCH Complete Medicare	$26.55
Rate for Payer: Banner UC Health Medicaid	$13.68
Rate for Payer: Banner UC Health Medicare	$26.55
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$26.55
Rate for Payer: Mercy Care Medicaid	$13.68
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$26.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

ipratropium 0.02% Inh Sol 2.5 mL [CQCH]

Facility

$0.07

Service Code	HCPCS J7644
Hospital Charge Code	105927008
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.06

ipratropium 0.02% Inh Sol 2.5 mL [CQCH]

Facility

$0.07

Service Code	HCPCS J7644
Hospital Charge Code	105927008
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.42
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: AHCCCS Medicaid	$0.42
Rate for Payer: Allwell Medicaid	$0.42
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicaid	$0.42
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicaid	$0.42
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	$0.05
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
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: Mercy Care Medicaid	$0.42
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Iron

Facility

$82.00

Service Code	CPT 83540
Hospital Charge Code	22631513
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: AHCCCS Medicaid	$6.47
Rate for Payer: Allwell Medicaid	$6.47
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicaid	$6.47
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicaid	$6.47
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$53.30
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Mercy Care Medicaid	$6.47
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

Iron

Facility

$82.00

Service Code	CPT 83540
Hospital Charge Code	22631513
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

Iron Binding Capacity

Facility

$357.00

Service Code	CPT 83550
Hospital Charge Code	22481487
Hospital Revenue Code	301
Min. Negotiated Rate	$92.82
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Bisbee Police All Plans	$92.82
Rate for Payer: Cash Price	$285.60
Rate for Payer: Self Pay Self Pay	$285.60

Iron Binding Capacity

Facility

$357.00

Service Code	CPT 83550
Hospital Charge Code	22481487
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Aetna of AZ Medicare	$99.96
Rate for Payer: AHCCCS Medicaid	$8.74
Rate for Payer: Allwell Medicaid	$8.74
Rate for Payer: Allwell Medicare	$53.55
Rate for Payer: Amerigroup Medicare	$53.55
Rate for Payer: APIPA Medicare/Medicaid	$133.34
Rate for Payer: AZCH Complete Medicaid	$8.74
Rate for Payer: AZCH Complete Medicare	$53.55
Rate for Payer: Banner UC Health Medicaid	$8.74
Rate for Payer: Banner UC Health Medicare	$53.55
Rate for Payer: Bisbee Police All Plans	$92.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$242.76
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cigna of AZ Commercial	$232.05
Rate for Payer: Copperpoint Commercial	$88.36
Rate for Payer: Health Net of AZ Commercial	$214.20
Rate for Payer: Health Net of AZ Medicare	$99.96
Rate for Payer: Humana of AZ Medicare	$53.55
Rate for Payer: Mercy Care Medicaid	$8.74
Rate for Payer: Self Pay Self Pay	$285.60
Rate for Payer: TriWest Medicare	$53.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$208.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.26

iron dextran 50 mg/mL Sol[CQCH]

Facility

$15.54

Service Code	HCPCS J1750
Hospital Charge Code	216496522
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$26.52
Rate for Payer: Aetna of AZ Commercial	$13.99
Rate for Payer: Aetna of AZ Medicare	$4.35
Rate for Payer: AHCCCS Medicaid	$26.52
Rate for Payer: Allwell Medicaid	$26.52
Rate for Payer: Allwell Medicare	$2.33
Rate for Payer: Amerigroup Medicare	$2.33
Rate for Payer: APIPA Medicare/Medicaid	$5.80
Rate for Payer: AZCH Complete Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$2.33
Rate for Payer: Banner UC Health Medicaid	$26.52
Rate for Payer: Banner UC Health Medicare	$2.33
Rate for Payer: Bisbee Police All Plans	$4.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.57
Rate for Payer: Cash Price	$12.43
Rate for Payer: Cash Price	$12.43
Rate for Payer: Cigna of AZ Commercial	$10.10
Rate for Payer: Copperpoint Commercial	$3.85
Rate for Payer: Health Net of AZ Commercial	$9.32
Rate for Payer: Health Net of AZ Medicare	$4.35
Rate for Payer: Humana of AZ Medicare	$2.33
Rate for Payer: Mercy Care Medicaid	$26.52
Rate for Payer: Self Pay Self Pay	$12.43
Rate for Payer: TriWest Medicare	$2.33
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.80

iron dextran 50 mg/mL Sol[CQCH]

Facility

$15.54

Service Code	HCPCS J1750
Hospital Charge Code	216496522
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$13.99
Rate for Payer: Aetna of AZ Commercial	$13.99
Rate for Payer: Bisbee Police All Plans	$4.04
Rate for Payer: Cash Price	$12.43
Rate for Payer: Self Pay Self Pay	$12.43

Iron Level

Facility

$82.00

Service Code	CPT 83540
Hospital Charge Code	1137680
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

Iron Level

Facility

$82.00

Service Code	CPT 83540
Hospital Charge Code	1137680
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: AHCCCS Medicaid	$6.47
Rate for Payer: Allwell Medicaid	$6.47
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicaid	$6.47
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicaid	$6.47
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$53.30
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Mercy Care Medicaid	$6.47
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

Iron Profile Standard

Facility

$82.00

Service Code	CPT 83540
Hospital Charge Code	22141050
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

Iron Profile Standard

Facility

$82.00

Service Code	CPT 83540
Hospital Charge Code	22141050
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: AHCCCS Medicaid	$6.47
Rate for Payer: Allwell Medicaid	$6.47
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicaid	$6.47
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicaid	$6.47
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$53.30
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Mercy Care Medicaid	$6.47
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

iron sucrose 100 mg/ 5 mL IV Sol [CQCH]

Facility

$5.95

Service Code	HCPCS J1756
Hospital Charge Code	105927079
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna of AZ Commercial	$5.36
Rate for Payer: Aetna of AZ Medicare	$1.67
Rate for Payer: AHCCCS Medicaid	$0.42
Rate for Payer: Allwell Medicaid	$0.42
Rate for Payer: Allwell Medicare	$0.89
Rate for Payer: Amerigroup Medicare	$0.89
Rate for Payer: APIPA Medicare/Medicaid	$2.22
Rate for Payer: AZCH Complete Medicaid	$0.42
Rate for Payer: AZCH Complete Medicare	$0.89
Rate for Payer: Banner UC Health Medicaid	$0.42
Rate for Payer: Banner UC Health Medicare	$0.89
Rate for Payer: Bisbee Police All Plans	$1.55
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.05
Rate for Payer: Cash Price	$4.76
Rate for Payer: Cash Price	$4.76
Rate for Payer: Cigna of AZ Commercial	$3.87
Rate for Payer: Copperpoint Commercial	$1.47
Rate for Payer: Health Net of AZ Commercial	$3.57
Rate for Payer: Health Net of AZ Medicare	$1.67
Rate for Payer: Humana of AZ Medicare	$0.89
Rate for Payer: Mercy Care Medicaid	$0.42
Rate for Payer: Self Pay Self Pay	$4.76
Rate for Payer: TriWest Medicare	$0.89
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.07

iron sucrose 100 mg/ 5 mL IV Sol [CQCH]

Facility

$5.95

Service Code	HCPCS J1756
Hospital Charge Code	105927079
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna of AZ Commercial	$5.36
Rate for Payer: Bisbee Police All Plans	$1.55
Rate for Payer: Cash Price	$4.76
Rate for Payer: Self Pay Self Pay	$4.76

IRRG SOL GLYC 3000

Facility

$72.00

Hospital Charge Code	22354802
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Aetna of AZ Medicare	$20.16
Rate for Payer: Allwell Medicare	$10.80
Rate for Payer: Amerigroup Medicare	$10.80
Rate for Payer: APIPA Medicare/Medicaid	$26.89
Rate for Payer: AZCH Complete Medicare	$10.80
Rate for Payer: Banner UC Health Medicare	$10.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Copperpoint Commercial	$17.82
Rate for Payer: Health Net of AZ Commercial	$43.20
Rate for Payer: Health Net of AZ Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$10.80
Rate for Payer: Self Pay Self Pay	$57.60
Rate for Payer: TriWest Medicare	$10.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.96

Know your out-of-pocket cost for care.

All Charges