Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

calcium acetate 667 mg Cap UD [CQCH]

Facility

$1.04

Service Code	NDC 68084047901
Hospital Charge Code	107994427
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of AZ Commercial	$0.94
Rate for Payer: Bisbee Police All Plans	$0.27
Rate for Payer: Cash Price	$0.83
Rate for Payer: Self Pay Self Pay	$0.83

calcium acetate 667 mg Cap UD [CQCH]

Facility

$1.04

Service Code	NDC 68084047901
Hospital Charge Code	107994427
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna of AZ Commercial	$0.94
Rate for Payer: Aetna of AZ Medicare	$0.29
Rate for Payer: Allwell Medicare	$0.17
Rate for Payer: Amerigroup Medicare	$0.17
Rate for Payer: APIPA Medicare/Medicaid	$0.39
Rate for Payer: AZCH Complete Medicare	$0.17
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Bisbee Police All Plans	$0.27
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.71
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cigna of AZ Commercial	$0.68
Rate for Payer: Copperpoint Commercial	$0.26
Rate for Payer: Health Net of AZ Commercial	$0.62
Rate for Payer: Health Net of AZ Medicare	$0.29
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Self Pay Self Pay	$0.83
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.19

calcium carbonate 500 mg Chew Tab [CQCH]

Facility

$0.06

Service Code	NDC 66553000401
Hospital Charge Code	105914049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
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	$0.02
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	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
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	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

calcium carbonate 500 mg Chew Tab [CQCH]

Facility

$0.06

Service Code	NDC 66553000401
Hospital Charge Code	105914049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

calcium carbonate 500 mg Tab (Oscal) [CQCH]

Facility

$0.03

Service Code	NDC 904188361
Hospital Charge Code	105914116
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

calcium carbonate 500 mg Tab (Oscal) [CQCH]

Facility

$0.03

Service Code	NDC 904188361
Hospital Charge Code	105914116
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

calcium chloride 1 gm/ 10 ml PFS [CQCH]

Facility

$0.62

Service Code	NDC 409163110
Hospital Charge Code	105914181
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Aetna of AZ Medicare	$0.17
Rate for Payer: Allwell Medicare	$0.10
Rate for Payer: Amerigroup Medicare	$0.10
Rate for Payer: APIPA Medicare/Medicaid	$0.23
Rate for Payer: AZCH Complete Medicare	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.42
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Copperpoint Commercial	$0.15
Rate for Payer: Health Net of AZ Commercial	$0.37
Rate for Payer: Health Net of AZ Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

calcium chloride 1 gm/ 10 ml PFS [CQCH]

Facility

$0.62

Service Code	NDC 409163110
Hospital Charge Code	105914181
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.50
Rate for Payer: Self Pay Self Pay	$0.50

calcium gluconate 1 gm/ 10 mL Inj Sol [CQCH]

Facility

$0.77

Service Code	HCPCS J0610
Hospital Charge Code	105914248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Aetna of AZ Medicare	$0.22
Rate for Payer: Allwell Medicare	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.29
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.52
Rate for Payer: Cash Price	$0.61
Rate for Payer: Cigna of AZ Commercial	$0.50
Rate for Payer: Copperpoint Commercial	$0.19
Rate for Payer: Health Net of AZ Commercial	$0.46
Rate for Payer: Health Net of AZ Medicare	$0.22
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Self Pay Self Pay	$0.62
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.14

calcium gluconate 1 gm/ 10 mL Inj Sol [CQCH]

Facility

$0.77

Service Code	HCPCS J0610
Hospital Charge Code	105914248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.69
Rate for Payer: Aetna of AZ Commercial	$0.69
Rate for Payer: Bisbee Police All Plans	$0.20
Rate for Payer: Cash Price	$0.61
Rate for Payer: Self Pay Self Pay	$0.62

Calcium, Ionized, Serum LC

Facility

$163.00

Service Code	CPT 82330
Hospital Charge Code	1285782
Hospital Revenue Code	301
Min. Negotiated Rate	$26.08
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Aetna of AZ Medicare	$45.64
Rate for Payer: Allwell Medicare	$26.08
Rate for Payer: Amerigroup Medicare	$26.08
Rate for Payer: APIPA Medicare/Medicaid	$60.88
Rate for Payer: AZCH Complete Medicare	$26.08
Rate for Payer: Banner UC Health Medicare	$26.08
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$110.84
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cigna of AZ Commercial	$105.95
Rate for Payer: Copperpoint Commercial	$40.34
Rate for Payer: Health Net of AZ Commercial	$97.80
Rate for Payer: Health Net of AZ Medicare	$45.64
Rate for Payer: Humana of AZ Medicare	$26.08
Rate for Payer: Self Pay Self Pay	$130.40
Rate for Payer: TriWest Medicare	$26.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.34

Calcium, Ionized, Serum LC

Facility

$163.00

Service Code	CPT 82330
Hospital Charge Code	1285782
Hospital Revenue Code	301
Min. Negotiated Rate	$42.38
Max. Negotiated Rate	$146.70
Rate for Payer: Aetna of AZ Commercial	$146.70
Rate for Payer: Bisbee Police All Plans	$42.38
Rate for Payer: Cash Price	$130.40
Rate for Payer: Self Pay Self Pay	$130.40

Calcium Level Total

Facility

$74.00

Service Code	CPT 82310
Hospital Charge Code	633690
Hospital Revenue Code	301
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Aetna of AZ Medicare	$20.72
Rate for Payer: Allwell Medicare	$11.84
Rate for Payer: Amerigroup Medicare	$11.84
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.84
Rate for Payer: Banner UC Health Medicare	$11.84
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.32
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$48.10
Rate for Payer: Copperpoint Commercial	$18.32
Rate for Payer: Health Net of AZ Commercial	$44.40
Rate for Payer: Health Net of AZ Medicare	$20.72
Rate for Payer: Humana of AZ Medicare	$11.84
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

Calcium Level Total

Facility

$74.00

Service Code	CPT 82310
Hospital Charge Code	633690
Hospital Revenue Code	301
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Cash Price	$59.20
Rate for Payer: Self Pay Self Pay	$59.20

CALCUCATCH

Facility

$18.00

Hospital Charge Code	22355206
Hospital Revenue Code	270
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

CALCUCATCH

Facility

$18.00

Hospital Charge Code	22355206
Hospital Revenue Code	270
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

CALCULI, URIN

Facility

$152.00

Service Code	CPT 82340
Hospital Charge Code	22481465
Hospital Revenue Code	301
Min. Negotiated Rate	$39.52
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Bisbee Police All Plans	$39.52
Rate for Payer: Cash Price	$121.60
Rate for Payer: Self Pay Self Pay	$121.60

CALCULI, URIN

Facility

$152.00

Service Code	CPT 82340
Hospital Charge Code	22481465
Hospital Revenue Code	301
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$136.80
Rate for Payer: Aetna of AZ Commercial	$136.80
Rate for Payer: Aetna of AZ Medicare	$42.56
Rate for Payer: Allwell Medicare	$24.32
Rate for Payer: Amerigroup Medicare	$24.32
Rate for Payer: APIPA Medicare/Medicaid	$56.77
Rate for Payer: AZCH Complete Medicare	$24.32
Rate for Payer: Banner UC Health Medicare	$24.32
Rate for Payer: Bisbee Police All Plans	$39.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$103.36
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cigna of AZ Commercial	$98.80
Rate for Payer: Copperpoint Commercial	$37.62
Rate for Payer: Health Net of AZ Commercial	$91.20
Rate for Payer: Health Net of AZ Medicare	$42.56
Rate for Payer: Humana of AZ Medicare	$24.32
Rate for Payer: Self Pay Self Pay	$121.60
Rate for Payer: TriWest Medicare	$24.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.36

Calculi, Urinary LC

Facility

$139.00

Service Code	CPT 82340
Hospital Charge Code	2029217
Hospital Revenue Code	301
Min. Negotiated Rate	$22.24
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Aetna of AZ Medicare	$38.92
Rate for Payer: Allwell Medicare	$22.24
Rate for Payer: Amerigroup Medicare	$22.24
Rate for Payer: APIPA Medicare/Medicaid	$51.92
Rate for Payer: AZCH Complete Medicare	$22.24
Rate for Payer: Banner UC Health Medicare	$22.24
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$94.52
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$90.35
Rate for Payer: Copperpoint Commercial	$34.40
Rate for Payer: Health Net of AZ Commercial	$83.40
Rate for Payer: Health Net of AZ Medicare	$38.92
Rate for Payer: Humana of AZ Medicare	$22.24
Rate for Payer: Self Pay Self Pay	$111.20
Rate for Payer: TriWest Medicare	$22.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$81.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.02

Calculi, Urinary LC

Facility

$139.00

Service Code	CPT 82340
Hospital Charge Code	2029217
Hospital Revenue Code	301
Min. Negotiated Rate	$36.14
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Cash Price	$111.20
Rate for Payer: Self Pay Self Pay	$111.20

CALMOSEPTINE 2.50Z

Facility

$30.00

Hospital Charge Code	23288844
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.21
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

CALMOSEPTINE 2.50Z

Facility

$30.00

Hospital Charge Code	23288844
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

Calprotectin Fecal LC

Facility

$355.00

Service Code	CPT 83993
Hospital Charge Code	6780842
Hospital Revenue Code	301
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Bisbee Police All Plans	$92.30
Rate for Payer: Cash Price	$284.00
Rate for Payer: Self Pay Self Pay	$284.00

Calprotectin Fecal LC

Facility

$355.00

Service Code	CPT 83993
Hospital Charge Code	6780842
Hospital Revenue Code	301
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna of AZ Commercial	$319.50
Rate for Payer: Aetna of AZ Medicare	$99.40
Rate for Payer: Allwell Medicare	$56.80
Rate for Payer: Amerigroup Medicare	$56.80
Rate for Payer: APIPA Medicare/Medicaid	$132.59
Rate for Payer: AZCH Complete Medicare	$56.80
Rate for Payer: Banner UC Health Medicare	$56.80
Rate for Payer: Bisbee Police All Plans	$92.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$241.40
Rate for Payer: Cash Price	$284.00
Rate for Payer: Cigna of AZ Commercial	$230.75
Rate for Payer: Copperpoint Commercial	$87.86
Rate for Payer: Health Net of AZ Commercial	$213.00
Rate for Payer: Health Net of AZ Medicare	$99.40
Rate for Payer: Humana of AZ Medicare	$56.80
Rate for Payer: Self Pay Self Pay	$284.00
Rate for Payer: TriWest Medicare	$56.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$206.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$63.90

CALR Mutation Analysis LC

Facility

$701.00

Service Code	CPT 81219
Hospital Charge Code	22311181
Hospital Revenue Code	302
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$630.90
Rate for Payer: Aetna of AZ Commercial	$630.90
Rate for Payer: Bisbee Police All Plans	$182.26
Rate for Payer: Cash Price	$560.80
Rate for Payer: Self Pay Self Pay	$560.80

Know your out-of-pocket cost for care.

All Charges