Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TUBE INSUFFLATION O RING 10

Facility

$38.00

Hospital Charge Code	22355022
Hospital Revenue Code	272
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

TUBE NG SALEM SUMP 10FR

Facility

$13.00

Hospital Charge Code	22355584
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

TUBE NG SALEM SUMP 10FR

Facility

$13.00

Hospital Charge Code	22355584
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

TUBE NG SALEM SUMP 12FR

Facility

$12.00

Hospital Charge Code	22355571
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
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	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicare	$1.80
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	$1.80
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

TUBE NG SALEM SUMP 12FR

Facility

$12.00

Hospital Charge Code	22355571
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

TUBE NG SALEM SUMP 14FR

Facility

$12.00

Hospital Charge Code	22355572
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

TUBE NG SALEM SUMP 14FR

Facility

$12.00

Hospital Charge Code	22355572
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
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	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicare	$1.80
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	$1.80
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

TUBE NG SALEM SUMP 16FR

Facility

$13.00

Hospital Charge Code	22355585
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

TUBE NG SALEM SUMP 16FR

Facility

$13.00

Hospital Charge Code	22355585
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

TUBE NG SALEM SUMP 18FR

Facility

$13.00

Hospital Charge Code	22355586
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

TUBE NG SALEM SUMP 18FR

Facility

$13.00

Hospital Charge Code	22355586
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

TUBE NITRO GLYC IV

Facility

$70.00

Hospital Charge Code	22354259
Hospital Revenue Code	270
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

TUBE NITRO GLYC IV

Facility

$70.00

Hospital Charge Code	22354259
Hospital Revenue Code	270
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

tuberculin ppd 5 TU/0.1 mL ID Sol [CQCH]

Facility

$66.79

Service Code	NDC 49281075221
Hospital Charge Code	105944468
Hospital Revenue Code	251
Min. Negotiated Rate	$10.02
Max. Negotiated Rate	$60.11
Rate for Payer: Aetna of AZ Commercial	$60.11
Rate for Payer: Aetna of AZ Medicare	$18.70
Rate for Payer: Allwell Medicare	$10.02
Rate for Payer: Amerigroup Medicare	$10.02
Rate for Payer: APIPA Medicare/Medicaid	$24.95
Rate for Payer: AZCH Complete Medicare	$10.02
Rate for Payer: Banner UC Health Medicare	$10.02
Rate for Payer: Bisbee Police All Plans	$17.37
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.42
Rate for Payer: Cash Price	$53.43
Rate for Payer: Cigna of AZ Commercial	$43.41
Rate for Payer: Copperpoint Commercial	$16.53
Rate for Payer: Health Net of AZ Commercial	$40.07
Rate for Payer: Health Net of AZ Medicare	$18.70
Rate for Payer: Humana of AZ Medicare	$10.02
Rate for Payer: Self Pay Self Pay	$53.43
Rate for Payer: TriWest Medicare	$10.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$38.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.02

tuberculin ppd 5 TU/0.1 mL ID Sol [CQCH]

Facility

$66.79

Service Code	NDC 49281075221
Hospital Charge Code	105944468
Hospital Revenue Code	251
Min. Negotiated Rate	$17.37
Max. Negotiated Rate	$60.11
Rate for Payer: Aetna of AZ Commercial	$60.11
Rate for Payer: Bisbee Police All Plans	$17.37
Rate for Payer: Cash Price	$53.43
Rate for Payer: Self Pay Self Pay	$53.43

TUBE SECONDARY IV

Facility

$9.00

Hospital Charge Code	22355541
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

TUBE SECONDARY IV

Facility

$9.00

Hospital Charge Code	22355541
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

TUBE SUMP SALEM 8FR W/FUNNEL

Facility

$57.00

Hospital Charge Code	23371935
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$8.55
Rate for Payer: Amerigroup Medicare	$8.55
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$8.55
Rate for Payer: Banner UC Health Medicare	$8.55
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$8.55
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$8.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

TUBE SUMP SALEM 8FR W/FUNNEL

Facility

$57.00

Hospital Charge Code	23371935
Hospital Revenue Code	272
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

TUBE TRACH CUFFED 5.0

Facility

$9.00

Hospital Charge Code	22354958
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

TUBE TRACH CUFFED 5.0

Facility

$9.00

Hospital Charge Code	22354958
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

TUBE TRACH CUFFED 5.5

Facility

$8.00

Hospital Charge Code	22354930
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Cash Price	$6.40
Rate for Payer: Self Pay Self Pay	$6.40

TUBE TRACH CUFFED 5.5

Facility

$8.00

Hospital Charge Code	22354930
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Aetna of AZ Medicare	$2.24
Rate for Payer: Allwell Medicare	$1.20
Rate for Payer: Amerigroup Medicare	$1.20
Rate for Payer: APIPA Medicare/Medicaid	$2.99
Rate for Payer: AZCH Complete Medicare	$1.20
Rate for Payer: Banner UC Health Medicare	$1.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.44
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Copperpoint Commercial	$1.98
Rate for Payer: Health Net of AZ Commercial	$4.80
Rate for Payer: Health Net of AZ Medicare	$2.24
Rate for Payer: Humana of AZ Medicare	$1.20
Rate for Payer: Self Pay Self Pay	$6.40
Rate for Payer: TriWest Medicare	$1.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.44

TUBE TRACH CUFFED 6.0

Facility

$250.00

Hospital Charge Code	22354834
Hospital Revenue Code	270
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Bisbee Police All Plans	$65.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Self Pay Self Pay	$200.00

TUBE TRACH CUFFED 6.0

Facility

$250.00

Hospital Charge Code	22354834
Hospital Revenue Code	270
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Aetna of AZ Medicare	$70.00
Rate for Payer: Allwell Medicare	$37.50
Rate for Payer: Amerigroup Medicare	$37.50
Rate for Payer: APIPA Medicare/Medicaid	$93.38
Rate for Payer: AZCH Complete Medicare	$37.50
Rate for Payer: Banner UC Health Medicare	$37.50
Rate for Payer: Bisbee Police All Plans	$65.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$170.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cigna of AZ Commercial	$175.00
Rate for Payer: Copperpoint Commercial	$61.88
Rate for Payer: Health Net of AZ Commercial	$150.00
Rate for Payer: Health Net of AZ Medicare	$70.00
Rate for Payer: Humana of AZ Medicare	$37.50
Rate for Payer: Self Pay Self Pay	$200.00
Rate for Payer: TriWest Medicare	$37.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$145.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.00

Know your out-of-pocket cost for care.

All Charges