Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SOL IRRIG N/S 1000 BOTTLE

Facility

$30.00

Hospital Charge Code	22355109
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

SOL IRRIG N/S 1000 BOTTLE

Facility

$30.00

Hospital Charge Code	27571817
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

SOL IRRIG N/S 1000 BOTTLE

Facility

$30.00

Hospital Charge Code	27571817
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

SOL IRRIG N/S 500 BOTTLE

Facility

$30.00

Hospital Charge Code	22355365
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

SOL IRRIG N/S 500 BOTTLE

Facility

$30.00

Hospital Charge Code	22355365
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

sotalol 80 mg Tab [CQCH]

Facility

$0.31

Service Code	NDC 68084065401
Hospital Charge Code	105942235
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of AZ Commercial	$0.28
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.25
Rate for Payer: Self Pay Self Pay	$0.25

sotalol 80 mg Tab [CQCH]

Facility

$0.31

Service Code	NDC 68084065401
Hospital Charge Code	105942235
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of AZ Commercial	$0.28
Rate for Payer: Aetna of AZ Medicare	$0.09
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.12
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.21
Rate for Payer: Cash Price	$0.25
Rate for Payer: Cigna of AZ Commercial	$0.20
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.19
Rate for Payer: Health Net of AZ Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.25
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

SPACER OR CHAMBER FOR MDI

Facility

$97.00

Hospital Charge Code	22354981
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

SPACER OR CHAMBER FOR MDI

Facility

$97.00

Hospital Charge Code	22354981
Hospital Revenue Code	270
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$14.55
Rate for Payer: Amerigroup Medicare	$14.55
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$14.55
Rate for Payer: Banner UC Health Medicare	$14.55
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$14.55
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$14.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

SPACER RIGID RECLOSABLE BAG

Facility

$25.00

Hospital Charge Code	23589698
Hospital Revenue Code	272
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Cash Price	$20.00
Rate for Payer: Self Pay Self Pay	$20.00

SPACER RIGID RECLOSABLE BAG

Facility

$25.00

Hospital Charge Code	23589698
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Aetna of AZ Medicare	$7.00
Rate for Payer: Allwell Medicare	$3.75
Rate for Payer: Amerigroup Medicare	$3.75
Rate for Payer: APIPA Medicare/Medicaid	$9.34
Rate for Payer: AZCH Complete Medicare	$3.75
Rate for Payer: Banner UC Health Medicare	$3.75
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cigna of AZ Commercial	$17.50
Rate for Payer: Copperpoint Commercial	$6.19
Rate for Payer: Health Net of AZ Commercial	$15.00
Rate for Payer: Health Net of AZ Medicare	$7.00
Rate for Payer: Humana of AZ Medicare	$3.75
Rate for Payer: Self Pay Self Pay	$20.00
Rate for Payer: TriWest Medicare	$3.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.50

SPACER RIGID RECLOSABLE BAG W/ PED MASK

Facility

$70.00

Hospital Charge Code	23589699
Hospital Revenue Code	272
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Aetna of AZ Medicare	$19.60
Rate for Payer: Allwell Medicare	$10.50
Rate for Payer: Amerigroup Medicare	$10.50
Rate for Payer: APIPA Medicare/Medicaid	$26.14
Rate for Payer: AZCH Complete Medicare	$10.50
Rate for Payer: Banner UC Health Medicare	$10.50
Rate for Payer: Bisbee Police All Plans	$18.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$47.60
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cigna of AZ Commercial	$49.00
Rate for Payer: Copperpoint Commercial	$17.32
Rate for Payer: Health Net of AZ Commercial	$42.00
Rate for Payer: Health Net of AZ Medicare	$19.60
Rate for Payer: Humana of AZ Medicare	$10.50
Rate for Payer: Self Pay Self Pay	$56.00
Rate for Payer: TriWest Medicare	$10.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.60

SPACER RIGID RECLOSABLE BAG W/ PED MASK

Facility

$70.00

Hospital Charge Code	23589699
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Bisbee Police All Plans	$18.20
Rate for Payer: Cash Price	$56.00
Rate for Payer: Self Pay Self Pay	$56.00

SPECIAL STAINS GROUP 1

Facility

$1,788.00

Service Code	CPT 88312
Hospital Charge Code	22545719
Hospital Revenue Code	310
Min. Negotiated Rate	$464.88
Max. Negotiated Rate	$1,609.20
Rate for Payer: Aetna of AZ Commercial	$1,609.20
Rate for Payer: Bisbee Police All Plans	$464.88
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Self Pay Self Pay	$1,430.40

SPECIAL STAINS GROUP 1

Facility

$1,788.00

Service Code	CPT 88312
Hospital Charge Code	22545719
Hospital Revenue Code	310
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$1,609.20
Rate for Payer: Aetna of AZ Commercial	$1,609.20
Rate for Payer: Aetna of AZ Medicare	$500.64
Rate for Payer: AHCCCS Medicaid	$36.08
Rate for Payer: Allwell Medicaid	$36.08
Rate for Payer: Allwell Medicare	$268.20
Rate for Payer: Amerigroup Medicare	$268.20
Rate for Payer: APIPA Medicare/Medicaid	$667.82
Rate for Payer: AZCH Complete Medicaid	$36.08
Rate for Payer: AZCH Complete Medicare	$268.20
Rate for Payer: Banner UC Health Medicaid	$36.08
Rate for Payer: Banner UC Health Medicare	$268.20
Rate for Payer: Bisbee Police All Plans	$464.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,215.84
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Cigna of AZ Commercial	$1,162.20
Rate for Payer: Copperpoint Commercial	$442.53
Rate for Payer: Health Net of AZ Commercial	$1,072.80
Rate for Payer: Health Net of AZ Medicare	$500.64
Rate for Payer: Humana of AZ Medicare	$268.20
Rate for Payer: Mercy Care Medicaid	$36.08
Rate for Payer: Self Pay Self Pay	$1,430.40
Rate for Payer: TriWest Medicare	$268.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,042.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$321.84

SPECIAL STAINS GROUP 2

Facility

$1,442.00

Service Code	CPT 88313
Hospital Charge Code	22545721
Hospital Revenue Code	310
Min. Negotiated Rate	$374.92
Max. Negotiated Rate	$1,297.80
Rate for Payer: Aetna of AZ Commercial	$1,297.80
Rate for Payer: Bisbee Police All Plans	$374.92
Rate for Payer: Cash Price	$1,153.60
Rate for Payer: Self Pay Self Pay	$1,153.60

SPECIAL STAINS GROUP 2

Facility

$1,442.00

Service Code	CPT 88313
Hospital Charge Code	22545721
Hospital Revenue Code	310
Min. Negotiated Rate	$24.53
Max. Negotiated Rate	$1,297.80
Rate for Payer: Aetna of AZ Commercial	$1,297.80
Rate for Payer: Aetna of AZ Medicare	$403.76
Rate for Payer: AHCCCS Medicaid	$24.53
Rate for Payer: Allwell Medicaid	$24.53
Rate for Payer: Allwell Medicare	$216.30
Rate for Payer: Amerigroup Medicare	$216.30
Rate for Payer: APIPA Medicare/Medicaid	$538.59
Rate for Payer: AZCH Complete Medicaid	$24.53
Rate for Payer: AZCH Complete Medicare	$216.30
Rate for Payer: Banner UC Health Medicaid	$24.53
Rate for Payer: Banner UC Health Medicare	$216.30
Rate for Payer: Bisbee Police All Plans	$374.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$980.56
Rate for Payer: Cash Price	$1,153.60
Rate for Payer: Cash Price	$1,153.60
Rate for Payer: Cigna of AZ Commercial	$937.30
Rate for Payer: Copperpoint Commercial	$356.90
Rate for Payer: Health Net of AZ Commercial	$865.20
Rate for Payer: Health Net of AZ Medicare	$403.76
Rate for Payer: Humana of AZ Medicare	$216.30
Rate for Payer: Mercy Care Medicaid	$24.53
Rate for Payer: Self Pay Self Pay	$1,153.60
Rate for Payer: TriWest Medicare	$216.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$840.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$259.56

SPECIMEN TRAPS 70CC

Facility

$13.00

Hospital Charge Code	22355566
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

SPECIMEN TRAPS 70CC

Facility

$13.00

Hospital Charge Code	22355566
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

SPEC RETR BAG 10MM, 3CM CONMED

Facility

$326.00

Hospital Charge Code	22354853
Hospital Revenue Code	272
Min. Negotiated Rate	$84.76
Max. Negotiated Rate	$293.40
Rate for Payer: Aetna of AZ Commercial	$293.40
Rate for Payer: Bisbee Police All Plans	$84.76
Rate for Payer: Cash Price	$260.80
Rate for Payer: Self Pay Self Pay	$260.80

SPEC RETR BAG 10MM, 3CM CONMED

Facility

$326.00

Hospital Charge Code	22354853
Hospital Revenue Code	272
Min. Negotiated Rate	$48.90
Max. Negotiated Rate	$293.40
Rate for Payer: Aetna of AZ Commercial	$293.40
Rate for Payer: Aetna of AZ Medicare	$91.28
Rate for Payer: Allwell Medicare	$48.90
Rate for Payer: Amerigroup Medicare	$48.90
Rate for Payer: APIPA Medicare/Medicaid	$121.76
Rate for Payer: AZCH Complete Medicare	$48.90
Rate for Payer: Banner UC Health Medicare	$48.90
Rate for Payer: Bisbee Police All Plans	$84.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$221.68
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cigna of AZ Commercial	$228.20
Rate for Payer: Copperpoint Commercial	$80.68
Rate for Payer: Health Net of AZ Commercial	$195.60
Rate for Payer: Health Net of AZ Medicare	$91.28
Rate for Payer: Humana of AZ Medicare	$48.90
Rate for Payer: Self Pay Self Pay	$260.80
Rate for Payer: TriWest Medicare	$48.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$190.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.68

SPECULUM VAGINAL MEDIUM

Facility

$9.00

Hospital Charge Code	22355372
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

SPECULUM VAGINAL MEDIUM

Facility

$9.00

Hospital Charge Code	22355372
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

SPECULUM VAGINAL SMALL

Facility

$9.00

Hospital Charge Code	22354946
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

SPECULUM VAGINAL SMALL

Facility

$9.00

Hospital Charge Code	22354946
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

Know your out-of-pocket cost for care.

All Charges