Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

QuantiFERON Client Incubated LC

Facility

$770.00

Service Code	CPT 86480
Hospital Charge Code	6781827
Hospital Revenue Code	302
Min. Negotiated Rate	$200.20
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna of AZ Commercial	$693.00
Rate for Payer: Bisbee Police All Plans	$200.20
Rate for Payer: Cash Price	$616.00
Rate for Payer: Self Pay Self Pay	$616.00

QuantiFERON TB Gold (In Tube) LC

Facility

$152.00

Service Code	CPT 86480
Hospital Charge Code	2087648
Hospital Revenue Code	302
Min. Negotiated Rate	$22.80
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: AHCCCS Medicaid	$61.98
Rate for Payer: Allwell Medicaid	$61.98
Rate for Payer: Allwell Medicare	$22.80
Rate for Payer: Amerigroup Medicare	$22.80
Rate for Payer: APIPA Medicare/Medicaid	$56.77
Rate for Payer: AZCH Complete Medicaid	$61.98
Rate for Payer: AZCH Complete Medicare	$22.80
Rate for Payer: Banner UC Health Medicaid	$61.98
Rate for Payer: Banner UC Health Medicare	$22.80
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: 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	$22.80
Rate for Payer: Mercy Care Medicaid	$61.98
Rate for Payer: Self Pay Self Pay	$121.60
Rate for Payer: TriWest Medicare	$22.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.36

QuantiFERON TB Gold (In Tube) LC

Facility

$152.00

Service Code	CPT 86480
Hospital Charge Code	2087648
Hospital Revenue Code	302
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

QUANT LIPOPR

Facility

$426.00

Service Code	CPT 83704
Hospital Charge Code	22481501
Hospital Revenue Code	301
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Bisbee Police All Plans	$110.76
Rate for Payer: Cash Price	$340.80
Rate for Payer: Self Pay Self Pay	$340.80

QUANT LIPOPR

Facility

$426.00

Service Code	CPT 83704
Hospital Charge Code	22481501
Hospital Revenue Code	301
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Aetna of AZ Medicare	$119.28
Rate for Payer: AHCCCS Medicaid	$34.19
Rate for Payer: Allwell Medicaid	$34.19
Rate for Payer: Allwell Medicare	$63.90
Rate for Payer: Amerigroup Medicare	$63.90
Rate for Payer: APIPA Medicare/Medicaid	$159.11
Rate for Payer: AZCH Complete Medicaid	$34.19
Rate for Payer: AZCH Complete Medicare	$63.90
Rate for Payer: Banner UC Health Medicaid	$34.19
Rate for Payer: Banner UC Health Medicare	$63.90
Rate for Payer: Bisbee Police All Plans	$110.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$289.68
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cigna of AZ Commercial	$276.90
Rate for Payer: Copperpoint Commercial	$105.44
Rate for Payer: Health Net of AZ Commercial	$255.60
Rate for Payer: Health Net of AZ Medicare	$119.28
Rate for Payer: Humana of AZ Medicare	$63.90
Rate for Payer: Mercy Care Medicaid	$34.19
Rate for Payer: Self Pay Self Pay	$340.80
Rate for Payer: TriWest Medicare	$63.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$248.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$76.68

QUEtiapine 100 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 63739066510
Hospital Charge Code	105938895
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.33
Rate for Payer: Self Pay Self Pay	$0.33

QUEtiapine 100 mg Tab [CQCH]

Facility

$0.41

Service Code	NDC 63739066510
Hospital Charge Code	105938895
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.15
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.28
Rate for Payer: Cash Price	$0.33
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.25
Rate for Payer: Health Net of AZ Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.33
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

QUEtiapine 25 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 16714045201
Hospital Charge Code	105938962
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.03

QUEtiapine 25 mg Tab [CQCH]

Facility

$0.04

Service Code	NDC 16714045201
Hospital Charge Code	105938962
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
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	$0.01
Rate for Payer: Self Pay Self Pay	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

QUICK CARE URINALYSIS DIPSTICK

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	22422559
Hospital Revenue Code	307
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Cash Price	$21.60
Rate for Payer: Self Pay Self Pay	$21.60

QUICK CARE URINALYSIS DIPSTICK

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	22422559
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Aetna of AZ Medicare	$7.56
Rate for Payer: AHCCCS Medicaid	$3.48
Rate for Payer: Allwell Medicaid	$3.48
Rate for Payer: Allwell Medicare	$4.05
Rate for Payer: Amerigroup Medicare	$4.05
Rate for Payer: APIPA Medicare/Medicaid	$10.08
Rate for Payer: AZCH Complete Medicaid	$3.48
Rate for Payer: AZCH Complete Medicare	$4.05
Rate for Payer: Banner UC Health Medicaid	$3.48
Rate for Payer: Banner UC Health Medicare	$4.05
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$18.36
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$17.55
Rate for Payer: Copperpoint Commercial	$6.68
Rate for Payer: Health Net of AZ Commercial	$16.20
Rate for Payer: Health Net of AZ Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$4.05
Rate for Payer: Mercy Care Medicaid	$3.48
Rate for Payer: Self Pay Self Pay	$21.60
Rate for Payer: TriWest Medicare	$4.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.86

QUICKCLIP PRO 230XM

Facility

$676.00

Hospital Charge Code	27443862
Hospital Revenue Code	270
Min. Negotiated Rate	$101.40
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Aetna of AZ Medicare	$189.28
Rate for Payer: Allwell Medicare	$101.40
Rate for Payer: Amerigroup Medicare	$101.40
Rate for Payer: APIPA Medicare/Medicaid	$252.49
Rate for Payer: AZCH Complete Medicare	$101.40
Rate for Payer: Banner UC Health Medicare	$101.40
Rate for Payer: Bisbee Police All Plans	$175.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$459.68
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cigna of AZ Commercial	$473.20
Rate for Payer: Copperpoint Commercial	$167.31
Rate for Payer: Health Net of AZ Commercial	$405.60
Rate for Payer: Health Net of AZ Medicare	$189.28
Rate for Payer: Humana of AZ Medicare	$101.40
Rate for Payer: Self Pay Self Pay	$540.80
Rate for Payer: TriWest Medicare	$101.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$394.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$121.68

QUICKCLIP PRO 230XM

Facility

$676.00

Hospital Charge Code	27443862
Hospital Revenue Code	270
Min. Negotiated Rate	$175.76
Max. Negotiated Rate	$608.40
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Bisbee Police All Plans	$175.76
Rate for Payer: Cash Price	$540.80
Rate for Payer: Self Pay Self Pay	$540.80

QUICKSNAP 2MM X8MM SCREW

Facility

$3,032.00

Hospital Charge Code	27555211
Hospital Revenue Code	270
Min. Negotiated Rate	$788.32
Max. Negotiated Rate	$2,728.80
Rate for Payer: Aetna of AZ Commercial	$2,728.80
Rate for Payer: Bisbee Police All Plans	$788.32
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Self Pay Self Pay	$2,425.60

QUICKSNAP 2MM X8MM SCREW

Facility

$3,032.00

Hospital Charge Code	27555211
Hospital Revenue Code	270
Min. Negotiated Rate	$454.80
Max. Negotiated Rate	$2,728.80
Rate for Payer: Aetna of AZ Commercial	$2,728.80
Rate for Payer: Aetna of AZ Medicare	$848.96
Rate for Payer: Allwell Medicare	$454.80
Rate for Payer: Amerigroup Medicare	$454.80
Rate for Payer: APIPA Medicare/Medicaid	$1,132.45
Rate for Payer: AZCH Complete Medicare	$454.80
Rate for Payer: Banner UC Health Medicare	$454.80
Rate for Payer: Bisbee Police All Plans	$788.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,061.76
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cigna of AZ Commercial	$2,122.40
Rate for Payer: Copperpoint Commercial	$750.42
Rate for Payer: Health Net of AZ Commercial	$1,819.20
Rate for Payer: Health Net of AZ Medicare	$848.96
Rate for Payer: Humana of AZ Medicare	$454.80
Rate for Payer: Self Pay Self Pay	$2,425.60
Rate for Payer: TriWest Medicare	$454.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,767.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$545.76

quinapril 10 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 65862061890
Hospital Charge Code	105939029
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.09
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.12
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

quinapril 10 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 65862061890
Hospital Charge Code	105939029
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.12
Rate for Payer: Self Pay Self Pay	$0.12

QWIX DRILL AO 2IN SIA 2MM X L65MM

Facility

$935.00

Hospital Charge Code	27341817
Hospital Revenue Code	270
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Aetna of AZ Medicare	$261.80
Rate for Payer: Allwell Medicare	$140.25
Rate for Payer: Amerigroup Medicare	$140.25
Rate for Payer: APIPA Medicare/Medicaid	$349.22
Rate for Payer: AZCH Complete Medicare	$140.25
Rate for Payer: Banner UC Health Medicare	$140.25
Rate for Payer: Bisbee Police All Plans	$243.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$635.80
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cigna of AZ Commercial	$654.50
Rate for Payer: Copperpoint Commercial	$231.41
Rate for Payer: Health Net of AZ Commercial	$561.00
Rate for Payer: Health Net of AZ Medicare	$261.80
Rate for Payer: Humana of AZ Medicare	$140.25
Rate for Payer: Self Pay Self Pay	$748.00
Rate for Payer: TriWest Medicare	$140.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$545.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$168.30

QWIX DRILL AO 2IN SIA 2MM X L65MM

Facility

$935.00

Hospital Charge Code	27341817
Hospital Revenue Code	270
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Bisbee Police All Plans	$243.10
Rate for Payer: Cash Price	$748.00
Rate for Payer: Self Pay Self Pay	$748.00

QWIX SCREW 3MM DIAM X 30MM LG

Facility

$1,185.60

Hospital Charge Code	27340120
Hospital Revenue Code	270
Min. Negotiated Rate	$177.84
Max. Negotiated Rate	$1,067.04
Rate for Payer: Aetna of AZ Commercial	$1,067.04
Rate for Payer: Aetna of AZ Medicare	$331.97
Rate for Payer: Allwell Medicare	$177.84
Rate for Payer: Amerigroup Medicare	$177.84
Rate for Payer: APIPA Medicare/Medicaid	$442.82
Rate for Payer: AZCH Complete Medicare	$177.84
Rate for Payer: Banner UC Health Medicare	$177.84
Rate for Payer: Bisbee Police All Plans	$308.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$806.21
Rate for Payer: Cash Price	$948.48
Rate for Payer: Cigna of AZ Commercial	$829.92
Rate for Payer: Copperpoint Commercial	$293.44
Rate for Payer: Health Net of AZ Commercial	$711.36
Rate for Payer: Health Net of AZ Medicare	$331.97
Rate for Payer: Humana of AZ Medicare	$177.84
Rate for Payer: Self Pay Self Pay	$948.48
Rate for Payer: TriWest Medicare	$177.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$691.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$213.41

QWIX SCREW 3MM DIAM X 30MM LG

Facility

$1,185.60

Hospital Charge Code	27340120
Hospital Revenue Code	270
Min. Negotiated Rate	$308.26
Max. Negotiated Rate	$1,067.04
Rate for Payer: Aetna of AZ Commercial	$1,067.04
Rate for Payer: Bisbee Police All Plans	$308.26
Rate for Payer: Cash Price	$948.48
Rate for Payer: Self Pay Self Pay	$948.48

QWIX SCREW 3MM DIA X 26MM LG

Facility

$1,245.00

Hospital Charge Code	27341818
Hospital Revenue Code	270
Min. Negotiated Rate	$186.75
Max. Negotiated Rate	$1,120.50
Rate for Payer: Aetna of AZ Commercial	$1,120.50
Rate for Payer: Aetna of AZ Medicare	$348.60
Rate for Payer: Allwell Medicare	$186.75
Rate for Payer: Amerigroup Medicare	$186.75
Rate for Payer: APIPA Medicare/Medicaid	$465.01
Rate for Payer: AZCH Complete Medicare	$186.75
Rate for Payer: Banner UC Health Medicare	$186.75
Rate for Payer: Bisbee Police All Plans	$323.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$846.60
Rate for Payer: Cash Price	$996.00
Rate for Payer: Cigna of AZ Commercial	$871.50
Rate for Payer: Copperpoint Commercial	$308.14
Rate for Payer: Health Net of AZ Commercial	$747.00
Rate for Payer: Health Net of AZ Medicare	$348.60
Rate for Payer: Humana of AZ Medicare	$186.75
Rate for Payer: Self Pay Self Pay	$996.00
Rate for Payer: TriWest Medicare	$186.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$725.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$224.10

QWIX SCREW 3MM DIA X 26MM LG

Facility

$1,245.00

Hospital Charge Code	27341818
Hospital Revenue Code	270
Min. Negotiated Rate	$323.70
Max. Negotiated Rate	$1,120.50
Rate for Payer: Aetna of AZ Commercial	$1,120.50
Rate for Payer: Bisbee Police All Plans	$323.70
Rate for Payer: Cash Price	$996.00
Rate for Payer: Self Pay Self Pay	$996.00

rabies immune globulin, human 300 units/mL 1 mL Sol[CQCH]

Facility

$646.31

Service Code	NDC 13533031801
Hospital Charge Code	142368685
Hospital Revenue Code	250
Min. Negotiated Rate	$168.04
Max. Negotiated Rate	$581.68
Rate for Payer: Aetna of AZ Commercial	$581.68
Rate for Payer: Bisbee Police All Plans	$168.04
Rate for Payer: Cash Price	$517.05
Rate for Payer: Self Pay Self Pay	$517.05

rabies immune globulin, human 300 units/mL 1 mL Sol[CQCH]

Facility

$646.31

Service Code	NDC 13533031801
Hospital Charge Code	142368685
Hospital Revenue Code	250
Min. Negotiated Rate	$96.95
Max. Negotiated Rate	$581.68
Rate for Payer: Aetna of AZ Commercial	$581.68
Rate for Payer: Aetna of AZ Medicare	$180.97
Rate for Payer: Allwell Medicare	$96.95
Rate for Payer: Amerigroup Medicare	$96.95
Rate for Payer: APIPA Medicare/Medicaid	$241.40
Rate for Payer: AZCH Complete Medicare	$96.95
Rate for Payer: Banner UC Health Medicare	$96.95
Rate for Payer: Bisbee Police All Plans	$168.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$439.49
Rate for Payer: Cash Price	$517.05
Rate for Payer: Cigna of AZ Commercial	$420.10
Rate for Payer: Copperpoint Commercial	$159.96
Rate for Payer: Health Net of AZ Commercial	$387.79
Rate for Payer: Health Net of AZ Medicare	$180.97
Rate for Payer: Humana of AZ Medicare	$96.95
Rate for Payer: Self Pay Self Pay	$517.05
Rate for Payer: TriWest Medicare	$96.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$376.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$116.34

Know your out-of-pocket cost for care.

All Charges