Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

INTUBATE

Facility

$1,547.00

Service Code	CPT 31500
Hospital Charge Code	1886875
Hospital Revenue Code	410
Min. Negotiated Rate	$402.22
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna of AZ Commercial	$1,392.30
Rate for Payer: Bisbee Police All Plans	$402.22
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Self Pay Self Pay	$1,237.60

INTUBATE

Facility

$1,547.00

Service Code	CPT 31500
Hospital Charge Code	1886875
Hospital Revenue Code	410
Min. Negotiated Rate	$153.41
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,392.30
Rate for Payer: Aetna of AZ Medicare	$433.16
Rate for Payer: AHCCCS Medicaid	$153.41
Rate for Payer: Allwell Medicaid	$153.41
Rate for Payer: Allwell Medicare	$247.52
Rate for Payer: Amerigroup Medicare	$247.52
Rate for Payer: APIPA Medicare/Medicaid	$577.80
Rate for Payer: AZCH Complete Medicaid	$153.41
Rate for Payer: AZCH Complete Medicare	$247.52
Rate for Payer: Banner UC Health Medicaid	$153.41
Rate for Payer: Banner UC Health Medicare	$247.52
Rate for Payer: Bisbee Police All Plans	$402.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,051.96
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Cigna of AZ Commercial	$1,082.90
Rate for Payer: Copperpoint Commercial	$382.88
Rate for Payer: Health Net of AZ Commercial	$928.20
Rate for Payer: Health Net of AZ Medicare	$433.16
Rate for Payer: Humana of AZ Medicare	$247.52
Rate for Payer: Mercy Care Medicaid	$153.41
Rate for Payer: Self Pay Self Pay	$1,237.60
Rate for Payer: TriWest Medicare	$247.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$278.46

Ionized Calcium Level

Facility

$177.00

Service Code	CPT 82330
Hospital Charge Code	9077417
Hospital Revenue Code	301
Min. Negotiated Rate	$28.32
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: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
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: 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	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

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

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	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Aetna of AZ Medicare	$0.02
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 Medicare	$0.01
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: 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: 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	$13.12
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: Allwell Medicare	$13.12
Rate for Payer: Amerigroup Medicare	$13.12
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicare	$13.12
Rate for Payer: Banner UC Health Medicare	$13.12
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: 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	$13.12
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$13.12
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

$447.00

Service Code	CPT 83550
Hospital Charge Code	22481487
Hospital Revenue Code	301
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$402.30
Rate for Payer: Aetna of AZ Commercial	$402.30
Rate for Payer: Bisbee Police All Plans	$116.22
Rate for Payer: Cash Price	$357.60
Rate for Payer: Self Pay Self Pay	$357.60

Iron Binding Capacity

Facility

$447.00

Service Code	CPT 83550
Hospital Charge Code	22481487
Hospital Revenue Code	301
Min. Negotiated Rate	$71.52
Max. Negotiated Rate	$402.30
Rate for Payer: Aetna of AZ Commercial	$402.30
Rate for Payer: Aetna of AZ Medicare	$125.16
Rate for Payer: Allwell Medicare	$71.52
Rate for Payer: Amerigroup Medicare	$71.52
Rate for Payer: APIPA Medicare/Medicaid	$166.95
Rate for Payer: AZCH Complete Medicare	$71.52
Rate for Payer: Banner UC Health Medicare	$71.52
Rate for Payer: Bisbee Police All Plans	$116.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$303.96
Rate for Payer: Cash Price	$357.60
Rate for Payer: Cigna of AZ Commercial	$290.55
Rate for Payer: Copperpoint Commercial	$110.63
Rate for Payer: Health Net of AZ Commercial	$268.20
Rate for Payer: Health Net of AZ Medicare	$125.16
Rate for Payer: Humana of AZ Medicare	$71.52
Rate for Payer: Self Pay Self Pay	$357.60
Rate for Payer: TriWest Medicare	$71.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$260.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$80.46

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	$2.49
Max. Negotiated Rate	$13.99
Rate for Payer: Aetna of AZ Commercial	$13.99
Rate for Payer: Aetna of AZ Medicare	$4.35
Rate for Payer: Allwell Medicare	$2.49
Rate for Payer: Amerigroup Medicare	$2.49
Rate for Payer: APIPA Medicare/Medicaid	$5.80
Rate for Payer: AZCH Complete Medicare	$2.49
Rate for Payer: Banner UC Health Medicare	$2.49
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: 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	$2.49
Rate for Payer: Self Pay Self Pay	$12.43
Rate for Payer: TriWest Medicare	$2.49
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

$78.00

Service Code	CPT 83540
Hospital Charge Code	1137680
Hospital Revenue Code	301
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

Iron Level

Facility

$78.00

Service Code	CPT 83540
Hospital Charge Code	1137680
Hospital Revenue Code	301
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	$50.70
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

Iron Profile Standard

Facility

$78.00

Service Code	CPT 83540
Hospital Charge Code	22141050
Hospital Revenue Code	301
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	$50.70
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

Iron Profile Standard

Facility

$78.00

Service Code	CPT 83540
Hospital Charge Code	22141050
Hospital Revenue Code	301
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

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	$0.95
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: Allwell Medicare	$0.95
Rate for Payer: Amerigroup Medicare	$0.95
Rate for Payer: APIPA Medicare/Medicaid	$2.22
Rate for Payer: AZCH Complete Medicare	$0.95
Rate for Payer: Banner UC Health Medicare	$0.95
Rate for Payer: Bisbee Police All Plans	$1.55
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.05
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	$0.95
Rate for Payer: Self Pay Self Pay	$4.76
Rate for Payer: TriWest Medicare	$0.95
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	$18.72
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Cash Price	$57.60
Rate for Payer: Self Pay Self Pay	$57.60

IRRG SOL GLYC 3000

Facility

$72.00

Hospital Charge Code	22354802
Hospital Revenue Code	270
Min. Negotiated Rate	$11.52
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	$11.52
Rate for Payer: Amerigroup Medicare	$11.52
Rate for Payer: APIPA Medicare/Medicaid	$26.89
Rate for Payer: AZCH Complete Medicare	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
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	$11.52
Rate for Payer: Self Pay Self Pay	$57.60
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.96

IRRG TUR SET 21-IN

Facility

$57.00

Hospital Charge Code	22355106
Hospital Revenue Code	270
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

IRRG TUR SET 21-IN

Facility

$57.00

Hospital Charge Code	22355106
Hospital Revenue Code	270
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

IRRIG INSTR TRUMPIT

Facility

$269.00

Hospital Charge Code	22354940
Hospital Revenue Code	270
Min. Negotiated Rate	$69.94
Max. Negotiated Rate	$242.10
Rate for Payer: Aetna of AZ Commercial	$242.10
Rate for Payer: Bisbee Police All Plans	$69.94
Rate for Payer: Cash Price	$215.20
Rate for Payer: Self Pay Self Pay	$215.20

IRRIG INSTR TRUMPIT

Facility

$269.00

Hospital Charge Code	22354940
Hospital Revenue Code	270
Min. Negotiated Rate	$43.04
Max. Negotiated Rate	$242.10
Rate for Payer: Aetna of AZ Commercial	$242.10
Rate for Payer: Aetna of AZ Medicare	$75.32
Rate for Payer: Allwell Medicare	$43.04
Rate for Payer: Amerigroup Medicare	$43.04
Rate for Payer: APIPA Medicare/Medicaid	$100.47
Rate for Payer: AZCH Complete Medicare	$43.04
Rate for Payer: Banner UC Health Medicare	$43.04
Rate for Payer: Bisbee Police All Plans	$69.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$182.92
Rate for Payer: Cash Price	$215.20
Rate for Payer: Cigna of AZ Commercial	$188.30
Rate for Payer: Copperpoint Commercial	$66.58
Rate for Payer: Health Net of AZ Commercial	$161.40
Rate for Payer: Health Net of AZ Medicare	$75.32
Rate for Payer: Humana of AZ Medicare	$43.04
Rate for Payer: Self Pay Self Pay	$215.20
Rate for Payer: TriWest Medicare	$43.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$156.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.42

ISONEB FILTERED NEBULIZER SYSTEM

Facility

$29.00

Hospital Charge Code	23937347
Hospital Revenue Code	270
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

Know your out-of-pocket cost for care.

All Charges