Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PULSE OX PROBE ADULT DISP

Facility

$74.00

Hospital Charge Code	22355395
Hospital Revenue Code	272
Min. Negotiated Rate	$11.10
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	$11.10
Rate for Payer: Amerigroup Medicare	$11.10
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.10
Rate for Payer: Banner UC Health Medicare	$11.10
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	$51.80
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	$11.10
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

PURAFORCE COM 6X2

Facility

$6,563.00

Hospital Charge Code	27393136
Hospital Revenue Code	270
Min. Negotiated Rate	$1,706.38
Max. Negotiated Rate	$5,906.70
Rate for Payer: Aetna of AZ Commercial	$5,906.70
Rate for Payer: Bisbee Police All Plans	$1,706.38
Rate for Payer: Cash Price	$5,250.40
Rate for Payer: Self Pay Self Pay	$5,250.40

PURAFORCE COM 6X2

Facility

$6,563.00

Hospital Charge Code	27393136
Hospital Revenue Code	270
Min. Negotiated Rate	$984.45
Max. Negotiated Rate	$5,906.70
Rate for Payer: Aetna of AZ Commercial	$5,906.70
Rate for Payer: Aetna of AZ Medicare	$1,837.64
Rate for Payer: Allwell Medicare	$984.45
Rate for Payer: Amerigroup Medicare	$984.45
Rate for Payer: APIPA Medicare/Medicaid	$2,451.28
Rate for Payer: AZCH Complete Medicare	$984.45
Rate for Payer: Banner UC Health Medicare	$984.45
Rate for Payer: Bisbee Police All Plans	$1,706.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,462.84
Rate for Payer: Cash Price	$5,250.40
Rate for Payer: Cigna of AZ Commercial	$4,594.10
Rate for Payer: Copperpoint Commercial	$1,624.34
Rate for Payer: Health Net of AZ Commercial	$3,937.80
Rate for Payer: Health Net of AZ Medicare	$1,837.64
Rate for Payer: Humana of AZ Medicare	$984.45
Rate for Payer: Self Pay Self Pay	$5,250.40
Rate for Payer: TriWest Medicare	$984.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,826.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,181.34

PURAPLAY AM 3X4 FENESTRATED

Facility

$880.00

Service Code	CPT Q4196
Hospital Charge Code	24358090
Hospital Revenue Code	636
Min. Negotiated Rate	$228.80
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna of AZ Commercial	$792.00
Rate for Payer: Bisbee Police All Plans	$228.80
Rate for Payer: Cash Price	$704.00
Rate for Payer: Self Pay Self Pay	$704.00

PURAPLAY AM 3X4 FENESTRATED

Facility

$880.00

Service Code	CPT Q4196
Hospital Charge Code	24358090
Hospital Revenue Code	636
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna of AZ Commercial	$792.00
Rate for Payer: Aetna of AZ Medicare	$246.40
Rate for Payer: Allwell Medicare	$132.00
Rate for Payer: Amerigroup Medicare	$132.00
Rate for Payer: APIPA Medicare/Medicaid	$328.68
Rate for Payer: AZCH Complete Medicare	$132.00
Rate for Payer: Banner UC Health Medicare	$132.00
Rate for Payer: Bisbee Police All Plans	$228.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$598.40
Rate for Payer: Cash Price	$704.00
Rate for Payer: Cigna of AZ Commercial	$616.00
Rate for Payer: Copperpoint Commercial	$217.80
Rate for Payer: Health Net of AZ Commercial	$528.00
Rate for Payer: Health Net of AZ Medicare	$246.40
Rate for Payer: Humana of AZ Medicare	$132.00
Rate for Payer: Self Pay Self Pay	$704.00
Rate for Payer: TriWest Medicare	$132.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$513.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$158.40

PURAPLYAM

Facility

$6,143.00

Service Code	CPT Q4196
Hospital Charge Code	24358088
Hospital Revenue Code	636
Min. Negotiated Rate	$1,597.18
Max. Negotiated Rate	$5,528.70
Rate for Payer: Aetna of AZ Commercial	$5,528.70
Rate for Payer: Bisbee Police All Plans	$1,597.18
Rate for Payer: Cash Price	$4,914.40
Rate for Payer: Self Pay Self Pay	$4,914.40

PURAPLYAM

Facility

$1,500.00

Service Code	CPT Q4196
Hospital Charge Code	24358083
Hospital Revenue Code	636
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna of AZ Commercial	$1,350.00
Rate for Payer: Bisbee Police All Plans	$390.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Self Pay Self Pay	$1,200.00

PURAPLYAM

Facility

$1,500.00

Service Code	CPT Q4196
Hospital Charge Code	24358083
Hospital Revenue Code	636
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna of AZ Commercial	$1,350.00
Rate for Payer: Aetna of AZ Medicare	$420.00
Rate for Payer: Allwell Medicare	$225.00
Rate for Payer: Amerigroup Medicare	$225.00
Rate for Payer: APIPA Medicare/Medicaid	$560.25
Rate for Payer: AZCH Complete Medicare	$225.00
Rate for Payer: Banner UC Health Medicare	$225.00
Rate for Payer: Bisbee Police All Plans	$390.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,020.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Cigna of AZ Commercial	$1,050.00
Rate for Payer: Copperpoint Commercial	$371.25
Rate for Payer: Health Net of AZ Commercial	$900.00
Rate for Payer: Health Net of AZ Medicare	$420.00
Rate for Payer: Humana of AZ Medicare	$225.00
Rate for Payer: Self Pay Self Pay	$1,200.00
Rate for Payer: TriWest Medicare	$225.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$874.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$270.00

PURAPLYAM

Facility

$6,143.00

Service Code	CPT Q4196
Hospital Charge Code	24358088
Hospital Revenue Code	636
Min. Negotiated Rate	$921.45
Max. Negotiated Rate	$5,528.70
Rate for Payer: Aetna of AZ Commercial	$5,528.70
Rate for Payer: Aetna of AZ Medicare	$1,720.04
Rate for Payer: Allwell Medicare	$921.45
Rate for Payer: Amerigroup Medicare	$921.45
Rate for Payer: APIPA Medicare/Medicaid	$2,294.41
Rate for Payer: AZCH Complete Medicare	$921.45
Rate for Payer: Banner UC Health Medicare	$921.45
Rate for Payer: Bisbee Police All Plans	$1,597.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,177.24
Rate for Payer: Cash Price	$4,914.40
Rate for Payer: Cigna of AZ Commercial	$4,300.10
Rate for Payer: Copperpoint Commercial	$1,520.39
Rate for Payer: Health Net of AZ Commercial	$3,685.80
Rate for Payer: Health Net of AZ Medicare	$1,720.04
Rate for Payer: Humana of AZ Medicare	$921.45
Rate for Payer: Self Pay Self Pay	$4,914.40
Rate for Payer: TriWest Medicare	$921.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,581.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,105.74

PURAPLY AM 3X4

Facility

$833.33

Service Code	CPT Q4196
Hospital Charge Code	24358089
Hospital Revenue Code	636
Min. Negotiated Rate	$125.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna of AZ Commercial	$750.00
Rate for Payer: Aetna of AZ Medicare	$233.33
Rate for Payer: Allwell Medicare	$125.00
Rate for Payer: Amerigroup Medicare	$125.00
Rate for Payer: APIPA Medicare/Medicaid	$311.25
Rate for Payer: AZCH Complete Medicare	$125.00
Rate for Payer: Banner UC Health Medicare	$125.00
Rate for Payer: Bisbee Police All Plans	$216.67
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$566.66
Rate for Payer: Cash Price	$666.66
Rate for Payer: Cigna of AZ Commercial	$583.33
Rate for Payer: Copperpoint Commercial	$206.25
Rate for Payer: Health Net of AZ Commercial	$500.00
Rate for Payer: Health Net of AZ Medicare	$233.33
Rate for Payer: Humana of AZ Medicare	$125.00
Rate for Payer: Self Pay Self Pay	$666.66
Rate for Payer: TriWest Medicare	$125.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$485.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$150.00

PURAPLY AM 3X4

Facility

$833.33

Service Code	CPT Q4196
Hospital Charge Code	24358089
Hospital Revenue Code	636
Min. Negotiated Rate	$216.67
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna of AZ Commercial	$750.00
Rate for Payer: Bisbee Police All Plans	$216.67
Rate for Payer: Cash Price	$666.66
Rate for Payer: Self Pay Self Pay	$666.66

PURAPLY AM 4X4

Facility

$864.00

Service Code	CPT Q4196
Hospital Charge Code	24358091
Hospital Revenue Code	636
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$777.60
Rate for Payer: Aetna of AZ Commercial	$777.60
Rate for Payer: Bisbee Police All Plans	$224.64
Rate for Payer: Cash Price	$691.20
Rate for Payer: Self Pay Self Pay	$691.20

PURAPLY AM 4X4

Facility

$864.00

Service Code	CPT Q4196
Hospital Charge Code	24358091
Hospital Revenue Code	636
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$777.60
Rate for Payer: Aetna of AZ Commercial	$777.60
Rate for Payer: Aetna of AZ Medicare	$241.92
Rate for Payer: Allwell Medicare	$129.60
Rate for Payer: Amerigroup Medicare	$129.60
Rate for Payer: APIPA Medicare/Medicaid	$322.70
Rate for Payer: AZCH Complete Medicare	$129.60
Rate for Payer: Banner UC Health Medicare	$129.60
Rate for Payer: Bisbee Police All Plans	$224.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$587.52
Rate for Payer: Cash Price	$691.20
Rate for Payer: Cigna of AZ Commercial	$604.80
Rate for Payer: Copperpoint Commercial	$213.84
Rate for Payer: Health Net of AZ Commercial	$518.40
Rate for Payer: Health Net of AZ Medicare	$241.92
Rate for Payer: Humana of AZ Medicare	$129.60
Rate for Payer: Self Pay Self Pay	$691.20
Rate for Payer: TriWest Medicare	$129.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$503.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.52

PURAPLY AM 4X4 FENESTRATED

Facility

$864.00

Hospital Charge Code	24358092
Hospital Revenue Code	636
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$777.60
Rate for Payer: Aetna of AZ Commercial	$777.60
Rate for Payer: Aetna of AZ Medicare	$241.92
Rate for Payer: Allwell Medicare	$129.60
Rate for Payer: Amerigroup Medicare	$129.60
Rate for Payer: APIPA Medicare/Medicaid	$322.70
Rate for Payer: AZCH Complete Medicare	$129.60
Rate for Payer: Banner UC Health Medicare	$129.60
Rate for Payer: Bisbee Police All Plans	$224.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$587.52
Rate for Payer: Cash Price	$691.20
Rate for Payer: Cigna of AZ Commercial	$604.80
Rate for Payer: Copperpoint Commercial	$213.84
Rate for Payer: Health Net of AZ Commercial	$518.40
Rate for Payer: Health Net of AZ Medicare	$241.92
Rate for Payer: Humana of AZ Medicare	$129.60
Rate for Payer: Self Pay Self Pay	$691.20
Rate for Payer: TriWest Medicare	$129.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$503.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.52

PURAPLY AM 4X4 FENESTRATED

Facility

$864.00

Hospital Charge Code	24358092
Hospital Revenue Code	636
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$777.60
Rate for Payer: Aetna of AZ Commercial	$777.60
Rate for Payer: Bisbee Police All Plans	$224.64
Rate for Payer: Cash Price	$691.20
Rate for Payer: Self Pay Self Pay	$691.20

PURAPLY AM 5X5

Facility

$832.00

Service Code	CPT Q4196
Hospital Charge Code	24358093
Hospital Revenue Code	636
Min. Negotiated Rate	$216.32
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna of AZ Commercial	$748.80
Rate for Payer: Bisbee Police All Plans	$216.32
Rate for Payer: Cash Price	$665.60
Rate for Payer: Self Pay Self Pay	$665.60

PURAPLY AM 5X5

Facility

$832.00

Service Code	CPT Q4196
Hospital Charge Code	24358093
Hospital Revenue Code	636
Min. Negotiated Rate	$124.80
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna of AZ Commercial	$748.80
Rate for Payer: Aetna of AZ Medicare	$232.96
Rate for Payer: Allwell Medicare	$124.80
Rate for Payer: Amerigroup Medicare	$124.80
Rate for Payer: APIPA Medicare/Medicaid	$310.75
Rate for Payer: AZCH Complete Medicare	$124.80
Rate for Payer: Banner UC Health Medicare	$124.80
Rate for Payer: Bisbee Police All Plans	$216.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$565.76
Rate for Payer: Cash Price	$665.60
Rate for Payer: Cigna of AZ Commercial	$582.40
Rate for Payer: Copperpoint Commercial	$205.92
Rate for Payer: Health Net of AZ Commercial	$499.20
Rate for Payer: Health Net of AZ Medicare	$232.96
Rate for Payer: Humana of AZ Medicare	$124.80
Rate for Payer: Self Pay Self Pay	$665.60
Rate for Payer: TriWest Medicare	$124.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$485.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$149.76

PURAPLY AM 6X9

Facility

$760.00

Service Code	CPT Q4196
Hospital Charge Code	24358094
Hospital Revenue Code	636
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$684.00
Rate for Payer: Aetna of AZ Commercial	$684.00
Rate for Payer: Aetna of AZ Medicare	$212.80
Rate for Payer: Allwell Medicare	$114.00
Rate for Payer: Amerigroup Medicare	$114.00
Rate for Payer: APIPA Medicare/Medicaid	$283.86
Rate for Payer: AZCH Complete Medicare	$114.00
Rate for Payer: Banner UC Health Medicare	$114.00
Rate for Payer: Bisbee Police All Plans	$197.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$516.80
Rate for Payer: Cash Price	$608.00
Rate for Payer: Cigna of AZ Commercial	$532.00
Rate for Payer: Copperpoint Commercial	$188.10
Rate for Payer: Health Net of AZ Commercial	$456.00
Rate for Payer: Health Net of AZ Medicare	$212.80
Rate for Payer: Humana of AZ Medicare	$114.00
Rate for Payer: Self Pay Self Pay	$608.00
Rate for Payer: TriWest Medicare	$114.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$443.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$136.80

PURAPLY AM 6X9

Facility

$760.00

Service Code	CPT Q4196
Hospital Charge Code	24358094
Hospital Revenue Code	636
Min. Negotiated Rate	$197.60
Max. Negotiated Rate	$684.00
Rate for Payer: Aetna of AZ Commercial	$684.00
Rate for Payer: Bisbee Police All Plans	$197.60
Rate for Payer: Cash Price	$608.00
Rate for Payer: Self Pay Self Pay	$608.00

PURAPLY AM XT EF 4.91 X4.91

Facility

$601.00

Hospital Charge Code	27690859
Hospital Revenue Code	270
Min. Negotiated Rate	$156.26
Max. Negotiated Rate	$540.90
Rate for Payer: Aetna of AZ Commercial	$540.90
Rate for Payer: Bisbee Police All Plans	$156.26
Rate for Payer: Cash Price	$480.80
Rate for Payer: Self Pay Self Pay	$480.80

PURAPLY AM XT EF 4.91 X4.91

Facility

$601.00

Hospital Charge Code	27690859
Hospital Revenue Code	270
Min. Negotiated Rate	$90.15
Max. Negotiated Rate	$540.90
Rate for Payer: Aetna of AZ Commercial	$540.90
Rate for Payer: Aetna of AZ Medicare	$168.28
Rate for Payer: Allwell Medicare	$90.15
Rate for Payer: Amerigroup Medicare	$90.15
Rate for Payer: APIPA Medicare/Medicaid	$224.47
Rate for Payer: AZCH Complete Medicare	$90.15
Rate for Payer: Banner UC Health Medicare	$90.15
Rate for Payer: Bisbee Police All Plans	$156.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$408.68
Rate for Payer: Cash Price	$480.80
Rate for Payer: Cigna of AZ Commercial	$420.70
Rate for Payer: Copperpoint Commercial	$148.75
Rate for Payer: Health Net of AZ Commercial	$360.60
Rate for Payer: Health Net of AZ Medicare	$168.28
Rate for Payer: Humana of AZ Medicare	$90.15
Rate for Payer: Self Pay Self Pay	$480.80
Rate for Payer: TriWest Medicare	$90.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$350.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$108.18

PURAPLY MZ 1000MG

Facility

$18,520.00

Hospital Charge Code	27570614
Hospital Revenue Code	270
Min. Negotiated Rate	$2,778.00
Max. Negotiated Rate	$16,668.00
Rate for Payer: Aetna of AZ Commercial	$16,668.00
Rate for Payer: Aetna of AZ Medicare	$5,185.60
Rate for Payer: Allwell Medicare	$2,778.00
Rate for Payer: Amerigroup Medicare	$2,778.00
Rate for Payer: APIPA Medicare/Medicaid	$6,917.22
Rate for Payer: AZCH Complete Medicare	$2,778.00
Rate for Payer: Banner UC Health Medicare	$2,778.00
Rate for Payer: Bisbee Police All Plans	$4,815.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12,593.60
Rate for Payer: Cash Price	$14,816.00
Rate for Payer: Cigna of AZ Commercial	$12,964.00
Rate for Payer: Copperpoint Commercial	$4,583.70
Rate for Payer: Health Net of AZ Commercial	$11,112.00
Rate for Payer: Health Net of AZ Medicare	$5,185.60
Rate for Payer: Humana of AZ Medicare	$2,778.00
Rate for Payer: Self Pay Self Pay	$14,816.00
Rate for Payer: TriWest Medicare	$2,778.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$10,797.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$3,333.60

PURAPLY MZ 1000MG

Facility

$18,520.00

Hospital Charge Code	27570614
Hospital Revenue Code	270
Min. Negotiated Rate	$4,815.20
Max. Negotiated Rate	$16,668.00
Rate for Payer: Aetna of AZ Commercial	$16,668.00
Rate for Payer: Bisbee Police All Plans	$4,815.20
Rate for Payer: Cash Price	$14,816.00
Rate for Payer: Self Pay Self Pay	$14,816.00

PURAPLY MZ 100MG

Facility

$2,040.00

Hospital Charge Code	27570615
Hospital Revenue Code	270
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$1,836.00
Rate for Payer: Aetna of AZ Commercial	$1,836.00
Rate for Payer: Aetna of AZ Medicare	$571.20
Rate for Payer: Allwell Medicare	$306.00
Rate for Payer: Amerigroup Medicare	$306.00
Rate for Payer: APIPA Medicare/Medicaid	$761.94
Rate for Payer: AZCH Complete Medicare	$306.00
Rate for Payer: Banner UC Health Medicare	$306.00
Rate for Payer: Bisbee Police All Plans	$530.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,387.20
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cigna of AZ Commercial	$1,428.00
Rate for Payer: Copperpoint Commercial	$504.90
Rate for Payer: Health Net of AZ Commercial	$1,224.00
Rate for Payer: Health Net of AZ Medicare	$571.20
Rate for Payer: Humana of AZ Medicare	$306.00
Rate for Payer: Self Pay Self Pay	$1,632.00
Rate for Payer: TriWest Medicare	$306.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,189.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$367.20

PURAPLY MZ 100MG

Facility

$2,040.00

Hospital Charge Code	27570615
Hospital Revenue Code	270
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$1,836.00
Rate for Payer: Aetna of AZ Commercial	$1,836.00
Rate for Payer: Bisbee Police All Plans	$530.40
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Self Pay Self Pay	$1,632.00

Know your out-of-pocket cost for care.

All Charges