Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PUREWICK FEMALE EXTERNAL CATHETER

Facility

$50.26

Hospital Charge Code	27437084
Hospital Revenue Code	270
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$45.23
Rate for Payer: Aetna of AZ Commercial	$45.23
Rate for Payer: Bisbee Police All Plans	$13.07
Rate for Payer: Cash Price	$40.21
Rate for Payer: Self Pay Self Pay	$40.21

PUREWICK FEMALE EXTERNAL CATHETER

Facility

$50.26

Hospital Charge Code	27437084
Hospital Revenue Code	270
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$45.23
Rate for Payer: Aetna of AZ Commercial	$45.23
Rate for Payer: Aetna of AZ Medicare	$14.07
Rate for Payer: Allwell Medicare	$8.04
Rate for Payer: Amerigroup Medicare	$8.04
Rate for Payer: APIPA Medicare/Medicaid	$18.77
Rate for Payer: AZCH Complete Medicare	$8.04
Rate for Payer: Banner UC Health Medicare	$8.04
Rate for Payer: Bisbee Police All Plans	$13.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.18
Rate for Payer: Cash Price	$40.21
Rate for Payer: Cigna of AZ Commercial	$35.18
Rate for Payer: Copperpoint Commercial	$12.44
Rate for Payer: Health Net of AZ Commercial	$30.16
Rate for Payer: Health Net of AZ Medicare	$14.07
Rate for Payer: Humana of AZ Medicare	$8.04
Rate for Payer: Self Pay Self Pay	$40.21
Rate for Payer: TriWest Medicare	$8.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.05

PVC SUCTION TUBING

Facility

$128.46

Hospital Charge Code	27839758
Hospital Revenue Code	270
Min. Negotiated Rate	$33.40
Max. Negotiated Rate	$115.61
Rate for Payer: Aetna of AZ Commercial	$115.61
Rate for Payer: Bisbee Police All Plans	$33.40
Rate for Payer: Cash Price	$102.77
Rate for Payer: Self Pay Self Pay	$102.77

PVC SUCTION TUBING

Facility

$128.46

Hospital Charge Code	27839758
Hospital Revenue Code	270
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$115.61
Rate for Payer: Aetna of AZ Commercial	$115.61
Rate for Payer: Aetna of AZ Medicare	$35.97
Rate for Payer: Allwell Medicare	$20.55
Rate for Payer: Amerigroup Medicare	$20.55
Rate for Payer: APIPA Medicare/Medicaid	$47.98
Rate for Payer: AZCH Complete Medicare	$20.55
Rate for Payer: Banner UC Health Medicare	$20.55
Rate for Payer: Bisbee Police All Plans	$33.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.35
Rate for Payer: Cash Price	$102.77
Rate for Payer: Cigna of AZ Commercial	$89.92
Rate for Payer: Copperpoint Commercial	$31.79
Rate for Payer: Health Net of AZ Commercial	$77.08
Rate for Payer: Health Net of AZ Medicare	$35.97
Rate for Payer: Humana of AZ Medicare	$20.55
Rate for Payer: Self Pay Self Pay	$102.77
Rate for Payer: TriWest Medicare	$20.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$74.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.12

Q3014 TELEHEALTH BURN SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282946
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH BURN SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282946
Hospital Revenue Code	780
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH CARDIO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282944
Hospital Revenue Code	780
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH CARDIO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282944
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH NEURO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282943
Hospital Revenue Code	780
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH NEURO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282943
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH PEDIATRICS SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282947
Hospital Revenue Code	780
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH PEDIATRICS SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282947
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH PULMON SITE FACILITY FEE

Facility

$62.00

Service Code	CPT Q3014
Hospital Charge Code	22282945
Hospital Revenue Code	780
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

Q3014 TELEHEALTH PULMON SITE FACILITY FEE

Facility

$62.00

Service Code	CPT Q3014
Hospital Charge Code	22282945
Hospital Revenue Code	780
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

Q LOOP MEDIUM BIPOLAR LOOP

Facility

$1,775.00

Hospital Charge Code	27881561
Hospital Revenue Code	270
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Bisbee Police All Plans	$461.50
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Self Pay Self Pay	$1,420.00

Q LOOP MEDIUM BIPOLAR LOOP

Facility

$1,775.00

Hospital Charge Code	27881561
Hospital Revenue Code	270
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Aetna of AZ Medicare	$497.00
Rate for Payer: Allwell Medicare	$284.00
Rate for Payer: Amerigroup Medicare	$284.00
Rate for Payer: APIPA Medicare/Medicaid	$662.96
Rate for Payer: AZCH Complete Medicare	$284.00
Rate for Payer: Banner UC Health Medicare	$284.00
Rate for Payer: Bisbee Police All Plans	$461.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,207.00
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Cigna of AZ Commercial	$1,242.50
Rate for Payer: Copperpoint Commercial	$439.31
Rate for Payer: Health Net of AZ Commercial	$1,065.00
Rate for Payer: Health Net of AZ Medicare	$497.00
Rate for Payer: Humana of AZ Medicare	$284.00
Rate for Payer: Self Pay Self Pay	$1,420.00
Rate for Payer: TriWest Medicare	$284.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,034.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$319.50

QUANTA LITHO 800 MICRON PROPRIETARY LASER FIBER RFID

Facility

$2,550.00

Hospital Charge Code	27887274
Hospital Revenue Code	270
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna of AZ Commercial	$2,295.00
Rate for Payer: Aetna of AZ Medicare	$714.00
Rate for Payer: Allwell Medicare	$408.00
Rate for Payer: Amerigroup Medicare	$408.00
Rate for Payer: APIPA Medicare/Medicaid	$952.42
Rate for Payer: AZCH Complete Medicare	$408.00
Rate for Payer: Banner UC Health Medicare	$408.00
Rate for Payer: Bisbee Police All Plans	$663.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,734.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Cigna of AZ Commercial	$1,785.00
Rate for Payer: Copperpoint Commercial	$631.12
Rate for Payer: Health Net of AZ Commercial	$1,530.00
Rate for Payer: Health Net of AZ Medicare	$714.00
Rate for Payer: Humana of AZ Medicare	$408.00
Rate for Payer: Self Pay Self Pay	$2,040.00
Rate for Payer: TriWest Medicare	$408.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,486.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$459.00

QUANTA LITHO 800 MICRON PROPRIETARY LASER FIBER RFID

Facility

$2,550.00

Hospital Charge Code	27887274
Hospital Revenue Code	270
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna of AZ Commercial	$2,295.00
Rate for Payer: Bisbee Police All Plans	$663.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Self Pay Self Pay	$2,040.00

QuantiFERONÂ®-TB Gold Plus (Client Incubated) LC

Facility

$150.00

Service Code	CPT 86480
Hospital Charge Code	23385510
Hospital Revenue Code	302
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Bisbee Police All Plans	$39.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Self Pay Self Pay	$120.00

QuantiFERONÂ®-TB Gold Plus (Client Incubated) LC

Facility

$150.00

Service Code	CPT 86480
Hospital Charge Code	23385510
Hospital Revenue Code	302
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Aetna of AZ Medicare	$42.00
Rate for Payer: Allwell Medicare	$24.00
Rate for Payer: Amerigroup Medicare	$24.00
Rate for Payer: APIPA Medicare/Medicaid	$56.02
Rate for Payer: AZCH Complete Medicare	$24.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Bisbee Police All Plans	$39.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$102.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cigna of AZ Commercial	$97.50
Rate for Payer: Copperpoint Commercial	$37.12
Rate for Payer: Health Net of AZ Commercial	$90.00
Rate for Payer: Health Net of AZ Medicare	$42.00
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Self Pay Self Pay	$120.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$87.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.00

QuantiFERON Client Incubated LC

Facility

$732.00

Service Code	CPT 86480
Hospital Charge Code	6781827
Hospital Revenue Code	302
Min. Negotiated Rate	$190.32
Max. Negotiated Rate	$658.80
Rate for Payer: Aetna of AZ Commercial	$658.80
Rate for Payer: Bisbee Police All Plans	$190.32
Rate for Payer: Cash Price	$585.60
Rate for Payer: Self Pay Self Pay	$585.60

QuantiFERON Client Incubated LC

Facility

$732.00

Service Code	CPT 86480
Hospital Charge Code	6781827
Hospital Revenue Code	302
Min. Negotiated Rate	$117.12
Max. Negotiated Rate	$658.80
Rate for Payer: Aetna of AZ Commercial	$658.80
Rate for Payer: Aetna of AZ Medicare	$204.96
Rate for Payer: Allwell Medicare	$117.12
Rate for Payer: Amerigroup Medicare	$117.12
Rate for Payer: APIPA Medicare/Medicaid	$273.40
Rate for Payer: AZCH Complete Medicare	$117.12
Rate for Payer: Banner UC Health Medicare	$117.12
Rate for Payer: Bisbee Police All Plans	$190.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$497.76
Rate for Payer: Cash Price	$585.60
Rate for Payer: Cigna of AZ Commercial	$475.80
Rate for Payer: Copperpoint Commercial	$181.17
Rate for Payer: Health Net of AZ Commercial	$439.20
Rate for Payer: Health Net of AZ Medicare	$204.96
Rate for Payer: Humana of AZ Medicare	$117.12
Rate for Payer: Self Pay Self Pay	$585.60
Rate for Payer: TriWest Medicare	$117.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$426.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$131.76

QuantiFERON TB Gold (In Tube) LC

Facility

$144.00

Service Code	CPT 86480
Hospital Charge Code	2087648
Hospital Revenue Code	302
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Bisbee Police All Plans	$37.44
Rate for Payer: Cash Price	$115.20
Rate for Payer: Self Pay Self Pay	$115.20

QuantiFERON TB Gold (In Tube) LC

Facility

$144.00

Service Code	CPT 86480
Hospital Charge Code	2087648
Hospital Revenue Code	302
Min. Negotiated Rate	$23.04
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of AZ Commercial	$129.60
Rate for Payer: Aetna of AZ Medicare	$40.32
Rate for Payer: Allwell Medicare	$23.04
Rate for Payer: Amerigroup Medicare	$23.04
Rate for Payer: APIPA Medicare/Medicaid	$53.78
Rate for Payer: AZCH Complete Medicare	$23.04
Rate for Payer: Banner UC Health Medicare	$23.04
Rate for Payer: Bisbee Police All Plans	$37.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$97.92
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna of AZ Commercial	$93.60
Rate for Payer: Copperpoint Commercial	$35.64
Rate for Payer: Health Net of AZ Commercial	$86.40
Rate for Payer: Health Net of AZ Medicare	$40.32
Rate for Payer: Humana of AZ Medicare	$23.04
Rate for Payer: Self Pay Self Pay	$115.20
Rate for Payer: TriWest Medicare	$23.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$83.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.92

QUANT LIPOPR

Facility

$426.00

Service Code	CPT 83704
Hospital Charge Code	22481501
Hospital Revenue Code	301
Min. Negotiated Rate	$68.16
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: Allwell Medicare	$68.16
Rate for Payer: Amerigroup Medicare	$68.16
Rate for Payer: APIPA Medicare/Medicaid	$159.11
Rate for Payer: AZCH Complete Medicare	$68.16
Rate for Payer: Banner UC Health Medicare	$68.16
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: 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	$68.16
Rate for Payer: Self Pay Self Pay	$340.80
Rate for Payer: TriWest Medicare	$68.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$248.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$76.68

Know your out-of-pocket cost for care.

All Charges