Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Plasma CPD Cryo Red

Facility

$504.00

Service Code	CPT P9044
Hospital Charge Code	1221760
Hospital Revenue Code	390
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Aetna of AZ Medicare	$141.12
Rate for Payer: Allwell Medicare	$80.64
Rate for Payer: Amerigroup Medicare	$80.64
Rate for Payer: APIPA Medicare/Medicaid	$188.24
Rate for Payer: AZCH Complete Medicare	$80.64
Rate for Payer: Banner UC Health Medicare	$80.64
Rate for Payer: Bisbee Police All Plans	$131.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$342.72
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna of AZ Commercial	$327.60
Rate for Payer: Copperpoint Commercial	$124.74
Rate for Payer: Health Net of AZ Commercial	$302.40
Rate for Payer: Health Net of AZ Medicare	$141.12
Rate for Payer: Humana of AZ Medicare	$80.64
Rate for Payer: Self Pay Self Pay	$403.20
Rate for Payer: TriWest Medicare	$80.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$293.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$90.72

Plasma CPD Cryo Red Thawed

Facility

$504.00

Service Code	CPT P9044
Hospital Charge Code	1221768
Hospital Revenue Code	390
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Bisbee Police All Plans	$131.04
Rate for Payer: Cash Price	$403.20
Rate for Payer: Self Pay Self Pay	$403.20

Plasma CPD Cryo Red Thawed

Facility

$504.00

Service Code	CPT P9044
Hospital Charge Code	1221768
Hospital Revenue Code	390
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Aetna of AZ Medicare	$141.12
Rate for Payer: Allwell Medicare	$80.64
Rate for Payer: Amerigroup Medicare	$80.64
Rate for Payer: APIPA Medicare/Medicaid	$188.24
Rate for Payer: AZCH Complete Medicare	$80.64
Rate for Payer: Banner UC Health Medicare	$80.64
Rate for Payer: Bisbee Police All Plans	$131.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$342.72
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna of AZ Commercial	$327.60
Rate for Payer: Copperpoint Commercial	$124.74
Rate for Payer: Health Net of AZ Commercial	$302.40
Rate for Payer: Health Net of AZ Medicare	$141.12
Rate for Payer: Humana of AZ Medicare	$80.64
Rate for Payer: Self Pay Self Pay	$403.20
Rate for Payer: TriWest Medicare	$80.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$293.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$90.72

Plasma Thawed CPD

Facility

$177.00

Service Code	CPT P9017
Hospital Charge Code	1757552
Hospital Revenue Code	390
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

Plasma Thawed CPD

Facility

$177.00

Service Code	CPT P9017
Hospital Charge Code	1757552
Hospital Revenue Code	390
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

Plastic repari of introitus

Facility

$1,300.00

Service Code	CPT 56800
Hospital Charge Code	27267829
Hospital Revenue Code	360
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,170.00
Rate for Payer: Aetna of AZ Medicare	$364.00
Rate for Payer: AHCCCS Medicaid	$1,901.83
Rate for Payer: Allwell Medicaid	$1,901.83
Rate for Payer: Allwell Medicare	$208.00
Rate for Payer: Amerigroup Medicare	$208.00
Rate for Payer: APIPA Medicare/Medicaid	$485.55
Rate for Payer: AZCH Complete Medicaid	$1,901.83
Rate for Payer: AZCH Complete Medicare	$208.00
Rate for Payer: Banner UC Health Medicaid	$1,901.83
Rate for Payer: Banner UC Health Medicare	$208.00
Rate for Payer: Bisbee Police All Plans	$338.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$884.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cigna of AZ Commercial	$650.00
Rate for Payer: Copperpoint Commercial	$321.75
Rate for Payer: Health Net of AZ Commercial	$780.00
Rate for Payer: Health Net of AZ Medicare	$364.00
Rate for Payer: Humana of AZ Medicare	$208.00
Rate for Payer: Mercy Care Medicaid	$1,901.83
Rate for Payer: Self Pay Self Pay	$1,040.00
Rate for Payer: TriWest Medicare	$208.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$234.00

Plastic repari of introitus

Facility

$1,300.00

Service Code	CPT 56800
Hospital Charge Code	27267829
Hospital Revenue Code	360
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna of AZ Commercial	$1,170.00
Rate for Payer: Bisbee Police All Plans	$338.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Self Pay Self Pay	$1,040.00

Platelet Antibody Profile LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	23018011
Hospital Revenue Code	302
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Aetna of AZ Medicare	$114.24
Rate for Payer: Allwell Medicare	$65.28
Rate for Payer: Amerigroup Medicare	$65.28
Rate for Payer: APIPA Medicare/Medicaid	$152.39
Rate for Payer: AZCH Complete Medicare	$65.28
Rate for Payer: Banner UC Health Medicare	$65.28
Rate for Payer: Bisbee Police All Plans	$106.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$277.44
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna of AZ Commercial	$265.20
Rate for Payer: Copperpoint Commercial	$100.98
Rate for Payer: Health Net of AZ Commercial	$244.80
Rate for Payer: Health Net of AZ Medicare	$114.24
Rate for Payer: Humana of AZ Medicare	$65.28
Rate for Payer: Self Pay Self Pay	$326.40
Rate for Payer: TriWest Medicare	$65.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$237.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$73.44

Platelet Antibody Profile LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	23018011
Hospital Revenue Code	302
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Bisbee Police All Plans	$106.08
Rate for Payer: Cash Price	$326.40
Rate for Payer: Self Pay Self Pay	$326.40

Platelet Autoantibody Panel LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	22311202
Hospital Revenue Code	302
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Bisbee Police All Plans	$106.08
Rate for Payer: Cash Price	$326.40
Rate for Payer: Self Pay Self Pay	$326.40

Platelet Autoantibody Panel LC

Facility

$408.00

Service Code	CPT 86022
Hospital Charge Code	22311202
Hospital Revenue Code	302
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Aetna of AZ Medicare	$114.24
Rate for Payer: Allwell Medicare	$65.28
Rate for Payer: Amerigroup Medicare	$65.28
Rate for Payer: APIPA Medicare/Medicaid	$152.39
Rate for Payer: AZCH Complete Medicare	$65.28
Rate for Payer: Banner UC Health Medicare	$65.28
Rate for Payer: Bisbee Police All Plans	$106.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$277.44
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna of AZ Commercial	$265.20
Rate for Payer: Copperpoint Commercial	$100.98
Rate for Payer: Health Net of AZ Commercial	$244.80
Rate for Payer: Health Net of AZ Medicare	$114.24
Rate for Payer: Humana of AZ Medicare	$65.28
Rate for Payer: Self Pay Self Pay	$326.40
Rate for Payer: TriWest Medicare	$65.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$237.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$73.44

Platelet Count

Facility

$89.00

Service Code	CPT 85049
Hospital Charge Code	633807
Hospital Revenue Code	305
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	$57.85
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

Platelet Count

Facility

$89.00

Service Code	CPT 85049
Hospital Charge Code	633807
Hospital Revenue Code	305
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

Platelets.

Facility

$129.00

Service Code	CPT 85595
Hospital Charge Code	22165974
Hospital Revenue Code	305
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Aetna of AZ Medicare	$36.12
Rate for Payer: Allwell Medicare	$20.64
Rate for Payer: Amerigroup Medicare	$20.64
Rate for Payer: APIPA Medicare/Medicaid	$48.18
Rate for Payer: AZCH Complete Medicare	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.72
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Copperpoint Commercial	$31.93
Rate for Payer: Health Net of AZ Commercial	$77.40
Rate for Payer: Health Net of AZ Medicare	$36.12
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Self Pay Self Pay	$103.20
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.22

Platelets.

Facility

$129.00

Service Code	CPT 85595
Hospital Charge Code	22165974
Hospital Revenue Code	305
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Cash Price	$103.20
Rate for Payer: Self Pay Self Pay	$103.20

PLETH TRACE

Facility

$483.00

Service Code	CPT 94726
Hospital Charge Code	3230228
Hospital Revenue Code	460
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Aetna of AZ Medicare	$135.24
Rate for Payer: Allwell Medicare	$77.28
Rate for Payer: Amerigroup Medicare	$77.28
Rate for Payer: APIPA Medicare/Medicaid	$180.40
Rate for Payer: AZCH Complete Medicare	$77.28
Rate for Payer: Banner UC Health Medicare	$77.28
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$328.44
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$338.10
Rate for Payer: Copperpoint Commercial	$119.54
Rate for Payer: Health Net of AZ Commercial	$289.80
Rate for Payer: Health Net of AZ Medicare	$135.24
Rate for Payer: Humana of AZ Medicare	$77.28
Rate for Payer: Self Pay Self Pay	$386.40
Rate for Payer: TriWest Medicare	$77.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.94

PLETH TRACE

Facility

$483.00

Service Code	CPT 94726
Hospital Charge Code	3230228
Hospital Revenue Code	460
Min. Negotiated Rate	$125.58
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Cash Price	$386.40
Rate for Payer: Self Pay Self Pay	$386.40

PLUG FISTULA .7 COOK

Facility

$2,854.00

Hospital Charge Code	22955986
Hospital Revenue Code	272
Min. Negotiated Rate	$456.64
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Aetna of AZ Medicare	$799.12
Rate for Payer: Allwell Medicare	$456.64
Rate for Payer: Amerigroup Medicare	$456.64
Rate for Payer: APIPA Medicare/Medicaid	$1,065.97
Rate for Payer: AZCH Complete Medicare	$456.64
Rate for Payer: Banner UC Health Medicare	$456.64
Rate for Payer: Bisbee Police All Plans	$742.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,940.72
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Cigna of AZ Commercial	$1,997.80
Rate for Payer: Copperpoint Commercial	$706.37
Rate for Payer: Health Net of AZ Commercial	$1,712.40
Rate for Payer: Health Net of AZ Medicare	$799.12
Rate for Payer: Humana of AZ Medicare	$456.64
Rate for Payer: Self Pay Self Pay	$2,283.20
Rate for Payer: TriWest Medicare	$456.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,663.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$513.72

PLUG FISTULA .7 COOK

Facility

$2,854.00

Hospital Charge Code	22955986
Hospital Revenue Code	272
Min. Negotiated Rate	$742.04
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Bisbee Police All Plans	$742.04
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Self Pay Self Pay	$2,283.20

PM BARBITURATES

Facility

$281.00

Service Code	CPT 80307
Hospital Charge Code	23293446
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

PM BARBITURATES

Facility

$281.00

Service Code	CPT 80307
Hospital Charge Code	23293446
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

PM Benzos:1-12

Facility

$217.00

Service Code	CPT 80346
Hospital Charge Code	23293443
Hospital Revenue Code	301
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Cash Price	$173.60
Rate for Payer: Self Pay Self Pay	$173.60

PM Benzos:1-12

Facility

$217.00

Service Code	CPT 80346
Hospital Charge Code	23293443
Hospital Revenue Code	301
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Aetna of AZ Medicare	$60.76
Rate for Payer: Allwell Medicare	$34.72
Rate for Payer: Amerigroup Medicare	$34.72
Rate for Payer: APIPA Medicare/Medicaid	$81.05
Rate for Payer: AZCH Complete Medicare	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Bisbee Police All Plans	$56.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$147.56
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Copperpoint Commercial	$53.71
Rate for Payer: Health Net of AZ Commercial	$130.20
Rate for Payer: Health Net of AZ Medicare	$60.76
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Self Pay Self Pay	$173.60
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$126.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.06

PM CANNABINOIDS

Facility

$239.00

Service Code	CPT 80349
Hospital Charge Code	23293447
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Cash Price	$191.20
Rate for Payer: Self Pay Self Pay	$191.20

PM CANNABINOIDS

Facility

$239.00

Service Code	CPT 80349
Hospital Charge Code	23293447
Hospital Revenue Code	301
Min. Negotiated Rate	$38.24
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Aetna of AZ Medicare	$66.92
Rate for Payer: Allwell Medicare	$38.24
Rate for Payer: Amerigroup Medicare	$38.24
Rate for Payer: APIPA Medicare/Medicaid	$89.27
Rate for Payer: AZCH Complete Medicare	$38.24
Rate for Payer: Banner UC Health Medicare	$38.24
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$162.52
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cigna of AZ Commercial	$155.35
Rate for Payer: Copperpoint Commercial	$59.15
Rate for Payer: Health Net of AZ Commercial	$143.40
Rate for Payer: Health Net of AZ Medicare	$66.92
Rate for Payer: Humana of AZ Medicare	$38.24
Rate for Payer: Self Pay Self Pay	$191.20
Rate for Payer: TriWest Medicare	$38.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.02

Know your out-of-pocket cost for care.

All Charges