Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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 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	$4.80
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	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.21
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
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	$4.80
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.80
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	22355109
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
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	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.21
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
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	$4.80
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.80
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	$4.80
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	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.21
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
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	$4.80
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.80
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	$0.05
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

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

SPACER OR CHAMBER FOR MDI

Facility

$97.00

Hospital Charge Code	22354981
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
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	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
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	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

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 RIGID RECLOSABLE BAG

Facility

$25.00

Hospital Charge Code	23589698
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
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	$4.00
Rate for Payer: Amerigroup Medicare	$4.00
Rate for Payer: APIPA Medicare/Medicaid	$9.34
Rate for Payer: AZCH Complete Medicare	$4.00
Rate for Payer: Banner UC Health Medicare	$4.00
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	$4.00
Rate for Payer: Self Pay Self Pay	$20.00
Rate for Payer: TriWest Medicare	$4.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.50

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 W/ PED MASK

Facility

$70.00

Hospital Charge Code	23589699
Hospital Revenue Code	272
Min. Negotiated Rate	$11.20
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	$11.20
Rate for Payer: Amerigroup Medicare	$11.20
Rate for Payer: APIPA Medicare/Medicaid	$26.14
Rate for Payer: AZCH Complete Medicare	$11.20
Rate for Payer: Banner UC Health Medicare	$11.20
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	$11.20
Rate for Payer: Self Pay Self Pay	$56.00
Rate for Payer: TriWest Medicare	$11.20
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

$1,699.00

Service Code	CPT 88312
Hospital Charge Code	22545719
Hospital Revenue Code	310
Min. Negotiated Rate	$441.74
Max. Negotiated Rate	$1,529.10
Rate for Payer: Aetna of AZ Commercial	$1,529.10
Rate for Payer: Bisbee Police All Plans	$441.74
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Self Pay Self Pay	$1,359.20

SPECIAL STAINS GROUP 1

Facility

$1,699.00

Service Code	CPT 88312
Hospital Charge Code	22545719
Hospital Revenue Code	310
Min. Negotiated Rate	$271.84
Max. Negotiated Rate	$1,529.10
Rate for Payer: Aetna of AZ Commercial	$1,529.10
Rate for Payer: Aetna of AZ Medicare	$475.72
Rate for Payer: Allwell Medicare	$271.84
Rate for Payer: Amerigroup Medicare	$271.84
Rate for Payer: APIPA Medicare/Medicaid	$634.58
Rate for Payer: AZCH Complete Medicare	$271.84
Rate for Payer: Banner UC Health Medicare	$271.84
Rate for Payer: Bisbee Police All Plans	$441.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,155.32
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cigna of AZ Commercial	$1,104.35
Rate for Payer: Copperpoint Commercial	$420.50
Rate for Payer: Health Net of AZ Commercial	$1,019.40
Rate for Payer: Health Net of AZ Medicare	$475.72
Rate for Payer: Humana of AZ Medicare	$271.84
Rate for Payer: Self Pay Self Pay	$1,359.20
Rate for Payer: TriWest Medicare	$271.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$990.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$305.82

SPECIAL STAINS GROUP 2

Facility

$1,368.00

Service Code	CPT 88313
Hospital Charge Code	22545721
Hospital Revenue Code	310
Min. Negotiated Rate	$355.68
Max. Negotiated Rate	$1,231.20
Rate for Payer: Aetna of AZ Commercial	$1,231.20
Rate for Payer: Bisbee Police All Plans	$355.68
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Self Pay Self Pay	$1,094.40

SPECIAL STAINS GROUP 2

Facility

$1,368.00

Service Code	CPT 88313
Hospital Charge Code	22545721
Hospital Revenue Code	310
Min. Negotiated Rate	$218.88
Max. Negotiated Rate	$1,231.20
Rate for Payer: Aetna of AZ Commercial	$1,231.20
Rate for Payer: Aetna of AZ Medicare	$383.04
Rate for Payer: Allwell Medicare	$218.88
Rate for Payer: Amerigroup Medicare	$218.88
Rate for Payer: APIPA Medicare/Medicaid	$510.95
Rate for Payer: AZCH Complete Medicare	$218.88
Rate for Payer: Banner UC Health Medicare	$218.88
Rate for Payer: Bisbee Police All Plans	$355.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$930.24
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cigna of AZ Commercial	$889.20
Rate for Payer: Copperpoint Commercial	$338.58
Rate for Payer: Health Net of AZ Commercial	$820.80
Rate for Payer: Health Net of AZ Medicare	$383.04
Rate for Payer: Humana of AZ Medicare	$218.88
Rate for Payer: Self Pay Self Pay	$1,094.40
Rate for Payer: TriWest Medicare	$218.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$797.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$246.24

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

SPECIMEN TRAPS 70CC

Facility

$13.00

Hospital Charge Code	22355566
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
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	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
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	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

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	$1.44
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	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
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	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
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	$1.44
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	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
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	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

Speed Band Superview Super 7

Facility

$1,222.00

Hospital Charge Code	22926474
Hospital Revenue Code	272
Min. Negotiated Rate	$195.52
Max. Negotiated Rate	$1,099.80
Rate for Payer: Aetna of AZ Commercial	$1,099.80
Rate for Payer: Aetna of AZ Medicare	$342.16
Rate for Payer: Allwell Medicare	$195.52
Rate for Payer: Amerigroup Medicare	$195.52
Rate for Payer: APIPA Medicare/Medicaid	$456.42
Rate for Payer: AZCH Complete Medicare	$195.52
Rate for Payer: Banner UC Health Medicare	$195.52
Rate for Payer: Bisbee Police All Plans	$317.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$830.96
Rate for Payer: Cash Price	$977.60
Rate for Payer: Cigna of AZ Commercial	$855.40
Rate for Payer: Copperpoint Commercial	$302.44
Rate for Payer: Health Net of AZ Commercial	$733.20
Rate for Payer: Health Net of AZ Medicare	$342.16
Rate for Payer: Humana of AZ Medicare	$195.52
Rate for Payer: Self Pay Self Pay	$977.60
Rate for Payer: TriWest Medicare	$195.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$712.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$219.96

Know your out-of-pocket cost for care.

All Charges