Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Thyroid Stim Immunoglobulin LC

Facility

$600.00

Service Code	CPT 84445
Hospital Charge Code	6780901
Hospital Revenue Code	301
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Bisbee Police All Plans	$156.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Self Pay Self Pay	$480.00

Thyroid Stim Immunoglobulin LC

Facility

$600.00

Service Code	CPT 84445
Hospital Charge Code	6780901
Hospital Revenue Code	301
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Aetna of AZ Medicare	$168.00
Rate for Payer: Allwell Medicare	$96.00
Rate for Payer: Amerigroup Medicare	$96.00
Rate for Payer: APIPA Medicare/Medicaid	$224.10
Rate for Payer: AZCH Complete Medicare	$96.00
Rate for Payer: Banner UC Health Medicare	$96.00
Rate for Payer: Bisbee Police All Plans	$156.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$408.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cigna of AZ Commercial	$390.00
Rate for Payer: Copperpoint Commercial	$148.50
Rate for Payer: Health Net of AZ Commercial	$360.00
Rate for Payer: Health Net of AZ Medicare	$168.00
Rate for Payer: Humana of AZ Medicare	$96.00
Rate for Payer: Self Pay Self Pay	$480.00
Rate for Payer: TriWest Medicare	$96.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$349.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$108.00

Thyroid Stimulating Hormone

Facility

$231.00

Service Code	CPT 84443
Hospital Charge Code	633844
Hospital Revenue Code	301
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Bisbee Police All Plans	$60.06
Rate for Payer: Cash Price	$184.80
Rate for Payer: Self Pay Self Pay	$184.80

Thyroid Stimulating Hormone

Facility

$231.00

Service Code	CPT 84443
Hospital Charge Code	633844
Hospital Revenue Code	301
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$207.90
Rate for Payer: Aetna of AZ Commercial	$207.90
Rate for Payer: Aetna of AZ Medicare	$64.68
Rate for Payer: Allwell Medicare	$36.96
Rate for Payer: Amerigroup Medicare	$36.96
Rate for Payer: APIPA Medicare/Medicaid	$86.28
Rate for Payer: AZCH Complete Medicare	$36.96
Rate for Payer: Banner UC Health Medicare	$36.96
Rate for Payer: Bisbee Police All Plans	$60.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$157.08
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cigna of AZ Commercial	$150.15
Rate for Payer: Copperpoint Commercial	$57.17
Rate for Payer: Health Net of AZ Commercial	$138.60
Rate for Payer: Health Net of AZ Medicare	$64.68
Rate for Payer: Humana of AZ Medicare	$36.96
Rate for Payer: Self Pay Self Pay	$184.80
Rate for Payer: TriWest Medicare	$36.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.58

THYROID STIMULATING IMMUNE GLOBULIN (TSI)

Facility

$643.00

Service Code	CPT 84445
Hospital Charge Code	22491211
Hospital Revenue Code	301
Min. Negotiated Rate	$102.88
Max. Negotiated Rate	$578.70
Rate for Payer: Aetna of AZ Commercial	$578.70
Rate for Payer: Aetna of AZ Medicare	$180.04
Rate for Payer: Allwell Medicare	$102.88
Rate for Payer: Amerigroup Medicare	$102.88
Rate for Payer: APIPA Medicare/Medicaid	$240.16
Rate for Payer: AZCH Complete Medicare	$102.88
Rate for Payer: Banner UC Health Medicare	$102.88
Rate for Payer: Bisbee Police All Plans	$167.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$437.24
Rate for Payer: Cash Price	$514.40
Rate for Payer: Cigna of AZ Commercial	$417.95
Rate for Payer: Copperpoint Commercial	$159.14
Rate for Payer: Health Net of AZ Commercial	$385.80
Rate for Payer: Health Net of AZ Medicare	$180.04
Rate for Payer: Humana of AZ Medicare	$102.88
Rate for Payer: Self Pay Self Pay	$514.40
Rate for Payer: TriWest Medicare	$102.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$374.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$115.74

THYROID STIMULATING IMMUNE GLOBULIN (TSI)

Facility

$643.00

Service Code	CPT 84445
Hospital Charge Code	22491211
Hospital Revenue Code	301
Min. Negotiated Rate	$167.18
Max. Negotiated Rate	$578.70
Rate for Payer: Aetna of AZ Commercial	$578.70
Rate for Payer: Bisbee Police All Plans	$167.18
Rate for Payer: Cash Price	$514.40
Rate for Payer: Self Pay Self Pay	$514.40

Thyrotropin Receptor Ab, Serum LC

Facility

$372.00

Service Code	CPT 83519
Hospital Charge Code	2087655
Hospital Revenue Code	301
Min. Negotiated Rate	$96.72
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Bisbee Police All Plans	$96.72
Rate for Payer: Cash Price	$297.60
Rate for Payer: Self Pay Self Pay	$297.60

Thyrotropin Receptor Ab, Serum LC

Facility

$372.00

Service Code	CPT 83519
Hospital Charge Code	2087655
Hospital Revenue Code	301
Min. Negotiated Rate	$59.52
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Aetna of AZ Medicare	$104.16
Rate for Payer: Allwell Medicare	$59.52
Rate for Payer: Amerigroup Medicare	$59.52
Rate for Payer: APIPA Medicare/Medicaid	$138.94
Rate for Payer: AZCH Complete Medicare	$59.52
Rate for Payer: Banner UC Health Medicare	$59.52
Rate for Payer: Bisbee Police All Plans	$96.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$252.96
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cigna of AZ Commercial	$241.80
Rate for Payer: Copperpoint Commercial	$92.07
Rate for Payer: Health Net of AZ Commercial	$223.20
Rate for Payer: Health Net of AZ Medicare	$104.16
Rate for Payer: Humana of AZ Medicare	$59.52
Rate for Payer: Self Pay Self Pay	$297.60
Rate for Payer: TriWest Medicare	$59.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$216.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$66.96

Thyroxine Binding Globulin LC

Facility

$100.00

Service Code	CPT 84442
Hospital Charge Code	6738642
Hospital Revenue Code	301
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Self Pay Self Pay	$80.00

Thyroxine Binding Globulin LC

Facility

$100.00

Service Code	CPT 84442
Hospital Charge Code	6738642
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Aetna of AZ Medicare	$28.00
Rate for Payer: Allwell Medicare	$16.00
Rate for Payer: Amerigroup Medicare	$16.00
Rate for Payer: APIPA Medicare/Medicaid	$37.35
Rate for Payer: AZCH Complete Medicare	$16.00
Rate for Payer: Banner UC Health Medicare	$16.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna of AZ Commercial	$65.00
Rate for Payer: Copperpoint Commercial	$24.75
Rate for Payer: Health Net of AZ Commercial	$60.00
Rate for Payer: Health Net of AZ Medicare	$28.00
Rate for Payer: Humana of AZ Medicare	$16.00
Rate for Payer: Self Pay Self Pay	$80.00
Rate for Payer: TriWest Medicare	$16.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.00

THYROXINE BINDING GLOBULIN (TBG)

Facility

$100.00

Service Code	CPT 84442
Hospital Charge Code	22949892
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Aetna of AZ Medicare	$28.00
Rate for Payer: Allwell Medicare	$16.00
Rate for Payer: Amerigroup Medicare	$16.00
Rate for Payer: APIPA Medicare/Medicaid	$37.35
Rate for Payer: AZCH Complete Medicare	$16.00
Rate for Payer: Banner UC Health Medicare	$16.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna of AZ Commercial	$65.00
Rate for Payer: Copperpoint Commercial	$24.75
Rate for Payer: Health Net of AZ Commercial	$60.00
Rate for Payer: Health Net of AZ Medicare	$28.00
Rate for Payer: Humana of AZ Medicare	$16.00
Rate for Payer: Self Pay Self Pay	$80.00
Rate for Payer: TriWest Medicare	$16.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.00

THYROXINE BINDING GLOBULIN (TBG)

Facility

$100.00

Service Code	CPT 84442
Hospital Charge Code	22949892
Hospital Revenue Code	301
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Self Pay Self Pay	$80.00

.Thyroxine (T4) Free, Direct H LC

Facility

$374.00

Service Code	CPT 84439
Hospital Charge Code	22531068
Hospital Revenue Code	302
Min. Negotiated Rate	$97.24
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Cash Price	$299.20
Rate for Payer: Self Pay Self Pay	$299.20

.Thyroxine (T4) Free, Direct H LC

Facility

$374.00

Service Code	CPT 84439
Hospital Charge Code	22531068
Hospital Revenue Code	302
Min. Negotiated Rate	$59.84
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Aetna of AZ Medicare	$104.72
Rate for Payer: Allwell Medicare	$59.84
Rate for Payer: Amerigroup Medicare	$59.84
Rate for Payer: APIPA Medicare/Medicaid	$139.69
Rate for Payer: AZCH Complete Medicare	$59.84
Rate for Payer: Banner UC Health Medicare	$59.84
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$254.32
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cigna of AZ Commercial	$243.10
Rate for Payer: Copperpoint Commercial	$92.56
Rate for Payer: Health Net of AZ Commercial	$224.40
Rate for Payer: Health Net of AZ Medicare	$104.72
Rate for Payer: Humana of AZ Medicare	$59.84
Rate for Payer: Self Pay Self Pay	$299.20
Rate for Payer: TriWest Medicare	$59.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$218.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$67.32

Thyroxine (T4) Free, Direct, LC

Facility

$374.00

Service Code	CPT 84439
Hospital Charge Code	1285539
Hospital Revenue Code	301
Min. Negotiated Rate	$97.24
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Cash Price	$299.20
Rate for Payer: Self Pay Self Pay	$299.20

Thyroxine (T4) Free, Direct, LC

Facility

$374.00

Service Code	CPT 84439
Hospital Charge Code	1285539
Hospital Revenue Code	301
Min. Negotiated Rate	$59.84
Max. Negotiated Rate	$336.60
Rate for Payer: Aetna of AZ Commercial	$336.60
Rate for Payer: Aetna of AZ Medicare	$104.72
Rate for Payer: Allwell Medicare	$59.84
Rate for Payer: Amerigroup Medicare	$59.84
Rate for Payer: APIPA Medicare/Medicaid	$139.69
Rate for Payer: AZCH Complete Medicare	$59.84
Rate for Payer: Banner UC Health Medicare	$59.84
Rate for Payer: Bisbee Police All Plans	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$254.32
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cigna of AZ Commercial	$243.10
Rate for Payer: Copperpoint Commercial	$92.56
Rate for Payer: Health Net of AZ Commercial	$224.40
Rate for Payer: Health Net of AZ Medicare	$104.72
Rate for Payer: Humana of AZ Medicare	$59.84
Rate for Payer: Self Pay Self Pay	$299.20
Rate for Payer: TriWest Medicare	$59.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$218.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$67.32

TI6 DIGITAL SCREW 2.0 X 36MM

Facility

$1,591.00

Hospital Charge Code	24127797
Hospital Revenue Code	270
Min. Negotiated Rate	$254.56
Max. Negotiated Rate	$1,431.90
Rate for Payer: Aetna of AZ Commercial	$1,431.90
Rate for Payer: Aetna of AZ Medicare	$445.48
Rate for Payer: Allwell Medicare	$254.56
Rate for Payer: Amerigroup Medicare	$254.56
Rate for Payer: APIPA Medicare/Medicaid	$594.24
Rate for Payer: AZCH Complete Medicare	$254.56
Rate for Payer: Banner UC Health Medicare	$254.56
Rate for Payer: Bisbee Police All Plans	$413.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,081.88
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Cigna of AZ Commercial	$1,113.70
Rate for Payer: Copperpoint Commercial	$393.77
Rate for Payer: Health Net of AZ Commercial	$954.60
Rate for Payer: Health Net of AZ Medicare	$445.48
Rate for Payer: Humana of AZ Medicare	$254.56
Rate for Payer: Self Pay Self Pay	$1,272.80
Rate for Payer: TriWest Medicare	$254.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$927.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$286.38

TI6 DIGITAL SCREW 2.0 X 36MM

Facility

$1,591.00

Hospital Charge Code	24127797
Hospital Revenue Code	270
Min. Negotiated Rate	$413.66
Max. Negotiated Rate	$1,431.90
Rate for Payer: Aetna of AZ Commercial	$1,431.90
Rate for Payer: Bisbee Police All Plans	$413.66
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Self Pay Self Pay	$1,272.80

TI6 DIGITAL SCREW 2.0 X 46MM

Facility

$1,591.00

Hospital Charge Code	24127800
Hospital Revenue Code	270
Min. Negotiated Rate	$254.56
Max. Negotiated Rate	$1,431.90
Rate for Payer: Aetna of AZ Commercial	$1,431.90
Rate for Payer: Aetna of AZ Medicare	$445.48
Rate for Payer: Allwell Medicare	$254.56
Rate for Payer: Amerigroup Medicare	$254.56
Rate for Payer: APIPA Medicare/Medicaid	$594.24
Rate for Payer: AZCH Complete Medicare	$254.56
Rate for Payer: Banner UC Health Medicare	$254.56
Rate for Payer: Bisbee Police All Plans	$413.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,081.88
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Cigna of AZ Commercial	$1,113.70
Rate for Payer: Copperpoint Commercial	$393.77
Rate for Payer: Health Net of AZ Commercial	$954.60
Rate for Payer: Health Net of AZ Medicare	$445.48
Rate for Payer: Humana of AZ Medicare	$254.56
Rate for Payer: Self Pay Self Pay	$1,272.80
Rate for Payer: TriWest Medicare	$254.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$927.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$286.38

TI6 DIGITAL SCREW 2.0 X 46MM

Facility

$1,591.00

Hospital Charge Code	24127800
Hospital Revenue Code	270
Min. Negotiated Rate	$413.66
Max. Negotiated Rate	$1,431.90
Rate for Payer: Aetna of AZ Commercial	$1,431.90
Rate for Payer: Bisbee Police All Plans	$413.66
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Self Pay Self Pay	$1,272.80

TI6 DIGITAL SCREW 2.0 X 48MM

Facility

$1,591.00

Hospital Charge Code	24127798
Hospital Revenue Code	270
Min. Negotiated Rate	$413.66
Max. Negotiated Rate	$1,431.90
Rate for Payer: Aetna of AZ Commercial	$1,431.90
Rate for Payer: Bisbee Police All Plans	$413.66
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Self Pay Self Pay	$1,272.80

TI6 DIGITAL SCREW 2.0 X 48MM

Facility

$1,591.00

Hospital Charge Code	24127798
Hospital Revenue Code	270
Min. Negotiated Rate	$254.56
Max. Negotiated Rate	$1,431.90
Rate for Payer: Aetna of AZ Commercial	$1,431.90
Rate for Payer: Aetna of AZ Medicare	$445.48
Rate for Payer: Allwell Medicare	$254.56
Rate for Payer: Amerigroup Medicare	$254.56
Rate for Payer: APIPA Medicare/Medicaid	$594.24
Rate for Payer: AZCH Complete Medicare	$254.56
Rate for Payer: Banner UC Health Medicare	$254.56
Rate for Payer: Bisbee Police All Plans	$413.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,081.88
Rate for Payer: Cash Price	$1,272.80
Rate for Payer: Cigna of AZ Commercial	$1,113.70
Rate for Payer: Copperpoint Commercial	$393.77
Rate for Payer: Health Net of AZ Commercial	$954.60
Rate for Payer: Health Net of AZ Medicare	$445.48
Rate for Payer: Humana of AZ Medicare	$254.56
Rate for Payer: Self Pay Self Pay	$1,272.80
Rate for Payer: TriWest Medicare	$254.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$927.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$286.38

TI6 DIGITAL SCREW 2MMX38MM

Facility

$2,549.00

Hospital Charge Code	27567204
Hospital Revenue Code	270
Min. Negotiated Rate	$662.74
Max. Negotiated Rate	$2,294.10
Rate for Payer: Aetna of AZ Commercial	$2,294.10
Rate for Payer: Bisbee Police All Plans	$662.74
Rate for Payer: Cash Price	$2,039.20
Rate for Payer: Self Pay Self Pay	$2,039.20

TI6 DIGITAL SCREW 2MMX38MM

Facility

$2,549.00

Hospital Charge Code	27567204
Hospital Revenue Code	270
Min. Negotiated Rate	$407.84
Max. Negotiated Rate	$2,294.10
Rate for Payer: Aetna of AZ Commercial	$2,294.10
Rate for Payer: Aetna of AZ Medicare	$713.72
Rate for Payer: Allwell Medicare	$407.84
Rate for Payer: Amerigroup Medicare	$407.84
Rate for Payer: APIPA Medicare/Medicaid	$952.05
Rate for Payer: AZCH Complete Medicare	$407.84
Rate for Payer: Banner UC Health Medicare	$407.84
Rate for Payer: Bisbee Police All Plans	$662.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,733.32
Rate for Payer: Cash Price	$2,039.20
Rate for Payer: Cigna of AZ Commercial	$1,784.30
Rate for Payer: Copperpoint Commercial	$630.88
Rate for Payer: Health Net of AZ Commercial	$1,529.40
Rate for Payer: Health Net of AZ Medicare	$713.72
Rate for Payer: Humana of AZ Medicare	$407.84
Rate for Payer: Self Pay Self Pay	$2,039.20
Rate for Payer: TriWest Medicare	$407.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,486.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$458.82

TI6 DIGITAL SCREW 2MMX40MM

Facility

$2,549.00

Hospital Charge Code	27567203
Hospital Revenue Code	270
Min. Negotiated Rate	$407.84
Max. Negotiated Rate	$2,294.10
Rate for Payer: Aetna of AZ Commercial	$2,294.10
Rate for Payer: Aetna of AZ Medicare	$713.72
Rate for Payer: Allwell Medicare	$407.84
Rate for Payer: Amerigroup Medicare	$407.84
Rate for Payer: APIPA Medicare/Medicaid	$952.05
Rate for Payer: AZCH Complete Medicare	$407.84
Rate for Payer: Banner UC Health Medicare	$407.84
Rate for Payer: Bisbee Police All Plans	$662.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,733.32
Rate for Payer: Cash Price	$2,039.20
Rate for Payer: Cigna of AZ Commercial	$1,784.30
Rate for Payer: Copperpoint Commercial	$630.88
Rate for Payer: Health Net of AZ Commercial	$1,529.40
Rate for Payer: Health Net of AZ Medicare	$713.72
Rate for Payer: Humana of AZ Medicare	$407.84
Rate for Payer: Self Pay Self Pay	$2,039.20
Rate for Payer: TriWest Medicare	$407.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,486.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$458.82

Know your out-of-pocket cost for care.

All Charges