Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Zygomatic Arches

Facility

$680.00

Service Code	CPT 70150
Hospital Charge Code	2620463
Hospital Revenue Code	320
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Aetna of AZ Medicare	$190.40
Rate for Payer: Allwell Medicare	$108.80
Rate for Payer: Amerigroup Medicare	$108.80
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicare	$108.80
Rate for Payer: Banner UC Health Medicare	$108.80
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$462.40
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$442.00
Rate for Payer: Copperpoint Commercial	$168.30
Rate for Payer: Health Net of AZ Commercial	$408.00
Rate for Payer: Health Net of AZ Medicare	$190.40
Rate for Payer: Humana of AZ Medicare	$108.80
Rate for Payer: Self Pay Self Pay	$544.00
Rate for Payer: TriWest Medicare	$108.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$396.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.40

XR Zygomatic Arches

Facility

$680.00

Service Code	CPT 70150
Hospital Charge Code	2620463
Hospital Revenue Code	320
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Cash Price	$544.00
Rate for Payer: Self Pay Self Pay	$544.00

YANKAUER 72

Facility

$11.00

Hospital Charge Code	22355322
Hospital Revenue Code	270
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Aetna of AZ Medicare	$3.08
Rate for Payer: Allwell Medicare	$1.76
Rate for Payer: Amerigroup Medicare	$1.76
Rate for Payer: APIPA Medicare/Medicaid	$4.11
Rate for Payer: AZCH Complete Medicare	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.48
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Copperpoint Commercial	$2.72
Rate for Payer: Health Net of AZ Commercial	$6.60
Rate for Payer: Health Net of AZ Medicare	$3.08
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Self Pay Self Pay	$8.80
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.98

YANKAUER 72

Facility

$11.00

Hospital Charge Code	22355322
Hospital Revenue Code	270
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Cash Price	$8.80
Rate for Payer: Self Pay Self Pay	$8.80

YANKAUER HANDLE ONLY

Facility

$7.00

Hospital Charge Code	22355582
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Aetna of AZ Medicare	$1.96
Rate for Payer: Allwell Medicare	$1.12
Rate for Payer: Amerigroup Medicare	$1.12
Rate for Payer: APIPA Medicare/Medicaid	$2.61
Rate for Payer: AZCH Complete Medicare	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Bisbee Police All Plans	$1.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.76
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cigna of AZ Commercial	$4.90
Rate for Payer: Copperpoint Commercial	$1.73
Rate for Payer: Health Net of AZ Commercial	$4.20
Rate for Payer: Health Net of AZ Medicare	$1.96
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Self Pay Self Pay	$5.60
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.26

YANKAUER HANDLE ONLY

Facility

$7.00

Hospital Charge Code	22355582
Hospital Revenue Code	272
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Bisbee Police All Plans	$1.82
Rate for Payer: Cash Price	$5.60
Rate for Payer: Self Pay Self Pay	$5.60

Yes

Facility

$340.00

Hospital Charge Code	1230419
Hospital Revenue Code	434
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna of AZ Commercial	$306.00
Rate for Payer: Aetna of AZ Medicare	$95.20
Rate for Payer: Allwell Medicare	$54.40
Rate for Payer: Amerigroup Medicare	$54.40
Rate for Payer: APIPA Medicare/Medicaid	$126.99
Rate for Payer: AZCH Complete Medicare	$54.40
Rate for Payer: Banner UC Health Medicare	$54.40
Rate for Payer: Bisbee Police All Plans	$88.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$231.20
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cigna of AZ Commercial	$238.00
Rate for Payer: Copperpoint Commercial	$84.15
Rate for Payer: Health Net of AZ Commercial	$204.00
Rate for Payer: Health Net of AZ Medicare	$95.20
Rate for Payer: Humana of AZ Medicare	$54.40
Rate for Payer: Self Pay Self Pay	$272.00
Rate for Payer: TriWest Medicare	$54.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$198.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.20

Yes

Facility

$340.00

Hospital Charge Code	1230419
Hospital Revenue Code	434
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna of AZ Commercial	$306.00
Rate for Payer: Bisbee Police All Plans	$88.40
Rate for Payer: Cash Price	$272.00
Rate for Payer: Self Pay Self Pay	$272.00

ZACURATE FINGER PULSE OX

Facility

$28.00

Hospital Charge Code	24335303
Hospital Revenue Code	270
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of AZ Commercial	$25.20
Rate for Payer: Bisbee Police All Plans	$7.28
Rate for Payer: Cash Price	$22.40
Rate for Payer: Self Pay Self Pay	$22.40

ZACURATE FINGER PULSE OX

Facility

$28.00

Hospital Charge Code	24335303
Hospital Revenue Code	270
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna of AZ Commercial	$25.20
Rate for Payer: Aetna of AZ Medicare	$7.84
Rate for Payer: Allwell Medicare	$4.48
Rate for Payer: Amerigroup Medicare	$4.48
Rate for Payer: APIPA Medicare/Medicaid	$10.46
Rate for Payer: AZCH Complete Medicare	$4.48
Rate for Payer: Banner UC Health Medicare	$4.48
Rate for Payer: Bisbee Police All Plans	$7.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.04
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cigna of AZ Commercial	$19.60
Rate for Payer: Copperpoint Commercial	$6.93
Rate for Payer: Health Net of AZ Commercial	$16.80
Rate for Payer: Health Net of AZ Medicare	$7.84
Rate for Payer: Humana of AZ Medicare	$4.48
Rate for Payer: Self Pay Self Pay	$22.40
Rate for Payer: TriWest Medicare	$4.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.04

ZEROWET SUPER SHIELD

Facility

$12.00

Hospital Charge Code	22355773
Hospital Revenue Code	270
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.92
Rate for Payer: Amerigroup Medicare	$1.92
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

ZEROWET SUPER SHIELD

Facility

$12.00

Hospital Charge Code	22355773
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

Z GUIDE WIRE 1.5MMX80MM

Facility

$2,125.00

Hospital Charge Code	27887272
Hospital Revenue Code	270
Min. Negotiated Rate	$552.50
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna of AZ Commercial	$1,912.50
Rate for Payer: Bisbee Police All Plans	$552.50
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Self Pay Self Pay	$1,700.00

Z GUIDE WIRE 1.5MMX80MM

Facility

$2,125.00

Hospital Charge Code	27887272
Hospital Revenue Code	270
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna of AZ Commercial	$1,912.50
Rate for Payer: Aetna of AZ Medicare	$595.00
Rate for Payer: Allwell Medicare	$340.00
Rate for Payer: Amerigroup Medicare	$340.00
Rate for Payer: APIPA Medicare/Medicaid	$793.69
Rate for Payer: AZCH Complete Medicare	$340.00
Rate for Payer: Banner UC Health Medicare	$340.00
Rate for Payer: Bisbee Police All Plans	$552.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,445.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cigna of AZ Commercial	$1,487.50
Rate for Payer: Copperpoint Commercial	$525.94
Rate for Payer: Health Net of AZ Commercial	$1,275.00
Rate for Payer: Health Net of AZ Medicare	$595.00
Rate for Payer: Humana of AZ Medicare	$340.00
Rate for Payer: Self Pay Self Pay	$1,700.00
Rate for Payer: TriWest Medicare	$340.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,238.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$382.50

Zika Test

Facility

$151.00

Service Code	CPT 86790
Hospital Charge Code	22875060
Hospital Revenue Code	301
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Aetna of AZ Medicare	$42.28
Rate for Payer: Allwell Medicare	$24.16
Rate for Payer: Amerigroup Medicare	$24.16
Rate for Payer: APIPA Medicare/Medicaid	$56.40
Rate for Payer: AZCH Complete Medicare	$24.16
Rate for Payer: Banner UC Health Medicare	$24.16
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$102.68
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Copperpoint Commercial	$37.37
Rate for Payer: Health Net of AZ Commercial	$90.60
Rate for Payer: Health Net of AZ Medicare	$42.28
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Self Pay Self Pay	$120.80
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.18

Zika Test

Facility

$151.00

Service Code	CPT 86790
Hospital Charge Code	22875060
Hospital Revenue Code	301
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Cash Price	$120.80
Rate for Payer: Self Pay Self Pay	$120.80

Zika Viru NAA

Facility

$449.00

Service Code	CPT 87798
Hospital Charge Code	22929297
Hospital Revenue Code	306
Min. Negotiated Rate	$116.74
Max. Negotiated Rate	$404.10
Rate for Payer: Aetna of AZ Commercial	$404.10
Rate for Payer: Bisbee Police All Plans	$116.74
Rate for Payer: Cash Price	$359.20
Rate for Payer: Self Pay Self Pay	$359.20

Zika Viru NAA

Facility

$449.00

Service Code	CPT 87798
Hospital Charge Code	22929297
Hospital Revenue Code	306
Min. Negotiated Rate	$71.84
Max. Negotiated Rate	$404.10
Rate for Payer: Aetna of AZ Commercial	$404.10
Rate for Payer: Aetna of AZ Medicare	$125.72
Rate for Payer: Allwell Medicare	$71.84
Rate for Payer: Amerigroup Medicare	$71.84
Rate for Payer: APIPA Medicare/Medicaid	$167.70
Rate for Payer: AZCH Complete Medicare	$71.84
Rate for Payer: Banner UC Health Medicare	$71.84
Rate for Payer: Bisbee Police All Plans	$116.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$305.32
Rate for Payer: Cash Price	$359.20
Rate for Payer: Cigna of AZ Commercial	$291.85
Rate for Payer: Copperpoint Commercial	$111.13
Rate for Payer: Health Net of AZ Commercial	$269.40
Rate for Payer: Health Net of AZ Medicare	$125.72
Rate for Payer: Humana of AZ Medicare	$71.84
Rate for Payer: Self Pay Self Pay	$359.20
Rate for Payer: TriWest Medicare	$71.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$261.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$80.82

zinc oxide Top Oint 56.7gm [CQCH]

Facility

$0.05

Service Code	NDC 168006202
Hospital Charge Code	105945790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
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	$0.02
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	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.03
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	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

zinc oxide Top Oint 56.7gm [CQCH]

Facility

$0.05

Service Code	NDC 168006202
Hospital Charge Code	105945790
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

Zinc, Plasma or Serum LC

Facility

$249.00

Service Code	CPT 84630
Hospital Charge Code	1285555
Hospital Revenue Code	301
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$224.10
Rate for Payer: Aetna of AZ Commercial	$224.10
Rate for Payer: Aetna of AZ Medicare	$69.72
Rate for Payer: Allwell Medicare	$39.84
Rate for Payer: Amerigroup Medicare	$39.84
Rate for Payer: APIPA Medicare/Medicaid	$93.00
Rate for Payer: AZCH Complete Medicare	$39.84
Rate for Payer: Banner UC Health Medicare	$39.84
Rate for Payer: Bisbee Police All Plans	$64.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$169.32
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cigna of AZ Commercial	$161.85
Rate for Payer: Copperpoint Commercial	$61.63
Rate for Payer: Health Net of AZ Commercial	$149.40
Rate for Payer: Health Net of AZ Medicare	$69.72
Rate for Payer: Humana of AZ Medicare	$39.84
Rate for Payer: Self Pay Self Pay	$199.20
Rate for Payer: TriWest Medicare	$39.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$145.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.82

Zinc, Plasma or Serum LC

Facility

$249.00

Service Code	CPT 84630
Hospital Charge Code	1285555
Hospital Revenue Code	301
Min. Negotiated Rate	$64.74
Max. Negotiated Rate	$224.10
Rate for Payer: Aetna of AZ Commercial	$224.10
Rate for Payer: Bisbee Police All Plans	$64.74
Rate for Payer: Cash Price	$199.20
Rate for Payer: Self Pay Self Pay	$199.20

Zinc, Whole Blood LC

Facility

$142.00

Service Code	CPT 84630
Hospital Charge Code	22242095
Hospital Revenue Code	301
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

Zinc, Whole Blood LC

Facility

$142.00

Service Code	CPT 84630
Hospital Charge Code	22242095
Hospital Revenue Code	301
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: Allwell Medicare	$22.72
Rate for Payer: Amerigroup Medicare	$22.72
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicare	$22.72
Rate for Payer: Banner UC Health Medicare	$22.72
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Copperpoint Commercial	$35.15
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$22.72
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$22.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

ziprasidone 40 mg Cap [CQCH]

Facility

$2.25

Service Code	NDC 904627045
Hospital Charge Code	105945855
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.02
Rate for Payer: Aetna of AZ Commercial	$2.02
Rate for Payer: Bisbee Police All Plans	$0.59
Rate for Payer: Cash Price	$1.80
Rate for Payer: Self Pay Self Pay	$1.80

Know your out-of-pocket cost for care.

All Charges