Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

timolol Ophth 0.5% Sol [CQCH]

Facility

$0.88

Service Code	NDC 64980051405
Hospital Charge Code	105943863
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.79
Rate for Payer: Aetna of AZ Commercial	$0.79
Rate for Payer: Aetna of AZ Medicare	$0.25
Rate for Payer: Allwell Medicare	$0.14
Rate for Payer: Amerigroup Medicare	$0.14
Rate for Payer: APIPA Medicare/Medicaid	$0.33
Rate for Payer: AZCH Complete Medicare	$0.14
Rate for Payer: Banner UC Health Medicare	$0.14
Rate for Payer: Bisbee Police All Plans	$0.23
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.60
Rate for Payer: Cash Price	$0.71
Rate for Payer: Cigna of AZ Commercial	$0.57
Rate for Payer: Copperpoint Commercial	$0.22
Rate for Payer: Health Net of AZ Commercial	$0.53
Rate for Payer: Health Net of AZ Medicare	$0.25
Rate for Payer: Humana of AZ Medicare	$0.14
Rate for Payer: Self Pay Self Pay	$0.70
Rate for Payer: TriWest Medicare	$0.14
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.16

timolol Ophth 0.5% Sol [CQCH]

Facility

$0.88

Service Code	NDC 64980051405
Hospital Charge Code	105943863
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.79
Rate for Payer: Aetna of AZ Commercial	$0.79
Rate for Payer: Bisbee Police All Plans	$0.23
Rate for Payer: Cash Price	$0.71
Rate for Payer: Self Pay Self Pay	$0.70

TINTRA OK MESH

Facility

$8,171.00

Hospital Charge Code	22354194
Hospital Revenue Code	270
Min. Negotiated Rate	$1,307.36
Max. Negotiated Rate	$7,353.90
Rate for Payer: Aetna of AZ Commercial	$7,353.90
Rate for Payer: Aetna of AZ Medicare	$2,287.88
Rate for Payer: Allwell Medicare	$1,307.36
Rate for Payer: Amerigroup Medicare	$1,307.36
Rate for Payer: APIPA Medicare/Medicaid	$3,051.87
Rate for Payer: AZCH Complete Medicare	$1,307.36
Rate for Payer: Banner UC Health Medicare	$1,307.36
Rate for Payer: Bisbee Police All Plans	$2,124.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5,556.28
Rate for Payer: Cash Price	$6,536.80
Rate for Payer: Cigna of AZ Commercial	$5,719.70
Rate for Payer: Copperpoint Commercial	$2,022.32
Rate for Payer: Health Net of AZ Commercial	$4,902.60
Rate for Payer: Health Net of AZ Medicare	$2,287.88
Rate for Payer: Humana of AZ Medicare	$1,307.36
Rate for Payer: Self Pay Self Pay	$6,536.80
Rate for Payer: TriWest Medicare	$1,307.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,763.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,470.78

TINTRA OK MESH

Facility

$8,171.00

Hospital Charge Code	22354194
Hospital Revenue Code	270
Min. Negotiated Rate	$2,124.46
Max. Negotiated Rate	$7,353.90
Rate for Payer: Aetna of AZ Commercial	$7,353.90
Rate for Payer: Bisbee Police All Plans	$2,124.46
Rate for Payer: Cash Price	$6,536.80
Rate for Payer: Self Pay Self Pay	$6,536.80

tiotropium HandiHaler -with # 5 each 18 mcg Inh Cap [CQCH]

Facility

$37.22

Service Code	NDC 597007575
Hospital Charge Code	105943928
Hospital Revenue Code	251
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna of AZ Commercial	$33.50
Rate for Payer: Bisbee Police All Plans	$9.68
Rate for Payer: Cash Price	$29.78
Rate for Payer: Self Pay Self Pay	$29.78

tiotropium HandiHaler -with # 5 each 18 mcg Inh Cap [CQCH]

Facility

$37.22

Service Code	NDC 597007575
Hospital Charge Code	105943928
Hospital Revenue Code	251
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna of AZ Commercial	$33.50
Rate for Payer: Aetna of AZ Medicare	$10.42
Rate for Payer: Allwell Medicare	$5.96
Rate for Payer: Amerigroup Medicare	$5.96
Rate for Payer: APIPA Medicare/Medicaid	$13.90
Rate for Payer: AZCH Complete Medicare	$5.96
Rate for Payer: Banner UC Health Medicare	$5.96
Rate for Payer: Bisbee Police All Plans	$9.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.31
Rate for Payer: Cash Price	$29.78
Rate for Payer: Cigna of AZ Commercial	$24.19
Rate for Payer: Copperpoint Commercial	$9.21
Rate for Payer: Health Net of AZ Commercial	$22.33
Rate for Payer: Health Net of AZ Medicare	$10.42
Rate for Payer: Humana of AZ Medicare	$5.96
Rate for Payer: Self Pay Self Pay	$29.78
Rate for Payer: TriWest Medicare	$5.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$21.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.70

Tissue Culture

Facility

$237.00

Service Code	CPT 87070
Hospital Charge Code	633906
Hospital Revenue Code	306
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Cash Price	$189.60
Rate for Payer: Self Pay Self Pay	$189.60

Tissue Culture

Facility

$237.00

Service Code	CPT 87070
Hospital Charge Code	633906
Hospital Revenue Code	306
Min. Negotiated Rate	$37.92
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Aetna of AZ Medicare	$66.36
Rate for Payer: Allwell Medicare	$37.92
Rate for Payer: Amerigroup Medicare	$37.92
Rate for Payer: APIPA Medicare/Medicaid	$88.52
Rate for Payer: AZCH Complete Medicare	$37.92
Rate for Payer: Banner UC Health Medicare	$37.92
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Copperpoint Commercial	$58.66
Rate for Payer: Health Net of AZ Commercial	$142.20
Rate for Payer: Health Net of AZ Medicare	$66.36
Rate for Payer: Humana of AZ Medicare	$37.92
Rate for Payer: Self Pay Self Pay	$189.60
Rate for Payer: TriWest Medicare	$37.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.66

tobramycin 80 mg/2 mL Inj Sol [CQCH]

Facility

$0.70

Service Code	HCPCS J3260
Hospital Charge Code	105943993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of AZ Commercial	$0.63
Rate for Payer: Aetna of AZ Medicare	$0.20
Rate for Payer: Allwell Medicare	$0.11
Rate for Payer: Amerigroup Medicare	$0.11
Rate for Payer: APIPA Medicare/Medicaid	$0.26
Rate for Payer: AZCH Complete Medicare	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Bisbee Police All Plans	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.48
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cigna of AZ Commercial	$0.46
Rate for Payer: Copperpoint Commercial	$0.17
Rate for Payer: Health Net of AZ Commercial	$0.42
Rate for Payer: Health Net of AZ Medicare	$0.20
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Self Pay Self Pay	$0.56
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.13

tobramycin 80 mg/2 mL Inj Sol [CQCH]

Facility

$0.70

Service Code	HCPCS J3260
Hospital Charge Code	105943993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of AZ Commercial	$0.63
Rate for Payer: Bisbee Police All Plans	$0.18
Rate for Payer: Cash Price	$0.56
Rate for Payer: Self Pay Self Pay	$0.56

tocilizumab 200 mg/10 ml Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233011115
Hospital Revenue Code	250
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Aetna of AZ Medicare	$36.06
Rate for Payer: Allwell Medicare	$20.61
Rate for Payer: Amerigroup Medicare	$20.61
Rate for Payer: APIPA Medicare/Medicaid	$48.11
Rate for Payer: AZCH Complete Medicare	$20.61
Rate for Payer: Banner UC Health Medicare	$20.61
Rate for Payer: Bisbee Police All Plans	$33.49
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.58
Rate for Payer: Cash Price	$103.04
Rate for Payer: Cigna of AZ Commercial	$83.72
Rate for Payer: Copperpoint Commercial	$31.88
Rate for Payer: Health Net of AZ Commercial	$77.28
Rate for Payer: Health Net of AZ Medicare	$36.06
Rate for Payer: Humana of AZ Medicare	$20.61
Rate for Payer: Self Pay Self Pay	$103.04
Rate for Payer: TriWest Medicare	$20.61
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.18

tocilizumab 200 mg/10 ml Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233011115
Hospital Revenue Code	250
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Bisbee Police All Plans	$33.49
Rate for Payer: Cash Price	$103.04
Rate for Payer: Self Pay Self Pay	$103.04

tocilizumab 80 mg/4 mL Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233007748
Hospital Revenue Code	250
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Aetna of AZ Medicare	$36.06
Rate for Payer: Allwell Medicare	$20.61
Rate for Payer: Amerigroup Medicare	$20.61
Rate for Payer: APIPA Medicare/Medicaid	$48.11
Rate for Payer: AZCH Complete Medicare	$20.61
Rate for Payer: Banner UC Health Medicare	$20.61
Rate for Payer: Bisbee Police All Plans	$33.49
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.58
Rate for Payer: Cash Price	$103.04
Rate for Payer: Cigna of AZ Commercial	$83.72
Rate for Payer: Copperpoint Commercial	$31.88
Rate for Payer: Health Net of AZ Commercial	$77.28
Rate for Payer: Health Net of AZ Medicare	$36.06
Rate for Payer: Humana of AZ Medicare	$20.61
Rate for Payer: Self Pay Self Pay	$103.04
Rate for Payer: TriWest Medicare	$20.61
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.18

tocilizumab 80 mg/4 mL Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233007748
Hospital Revenue Code	250
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Bisbee Police All Plans	$33.49
Rate for Payer: Cash Price	$103.04
Rate for Payer: Self Pay Self Pay	$103.04

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: AHCCCS Medicaid	$5,522.12
Rate for Payer: Allwell Medicaid	$5,522.12
Rate for Payer: AZCH Complete Medicaid	$5,522.12
Rate for Payer: Banner UC Health Medicaid	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0971
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: AHCCCS Medicaid	$3,787.56
Rate for Payer: Allwell Medicaid	$3,787.56
Rate for Payer: AZCH Complete Medicaid	$3,787.56
Rate for Payer: Banner UC Health Medicaid	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: AHCCCS Medicaid	$9,659.68
Rate for Payer: Allwell Medicaid	$9,659.68
Rate for Payer: AZCH Complete Medicaid	$9,659.68
Rate for Payer: Banner UC Health Medicaid	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68

Tonsil And Adenoid Procedures

Facility

$17,184.30

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$17,184.30
Max. Negotiated Rate	$17,184.30
Rate for Payer: AHCCCS Medicaid	$17,184.30
Rate for Payer: Allwell Medicaid	$17,184.30
Rate for Payer: AZCH Complete Medicaid	$17,184.30
Rate for Payer: Banner UC Health Medicaid	$17,184.30
Rate for Payer: Mercy Care Medicaid	$17,184.30

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: AHCCCS Medicaid	$9,659.68
Rate for Payer: Allwell Medicaid	$9,659.68
Rate for Payer: AZCH Complete Medicaid	$9,659.68
Rate for Payer: Banner UC Health Medicaid	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0973
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: AHCCCS Medicaid	$5,522.12
Rate for Payer: Allwell Medicaid	$5,522.12
Rate for Payer: AZCH Complete Medicaid	$5,522.12
Rate for Payer: Banner UC Health Medicaid	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12

Tonsil And Adenoid Procedures

Facility

$17,184.30

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$17,184.30
Max. Negotiated Rate	$17,184.30
Rate for Payer: AHCCCS Medicaid	$17,184.30
Rate for Payer: Allwell Medicaid	$17,184.30
Rate for Payer: AZCH Complete Medicaid	$17,184.30
Rate for Payer: Banner UC Health Medicaid	$17,184.30
Rate for Payer: Mercy Care Medicaid	$17,184.30

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: AHCCCS Medicaid	$3,787.56
Rate for Payer: Allwell Medicaid	$3,787.56
Rate for Payer: AZCH Complete Medicaid	$3,787.56
Rate for Payer: Banner UC Health Medicaid	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: AHCCCS Medicaid	$3,787.56
Rate for Payer: Allwell Medicaid	$3,787.56
Rate for Payer: AZCH Complete Medicaid	$3,787.56
Rate for Payer: Banner UC Health Medicaid	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0973
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: AHCCCS Medicaid	$9,659.68
Rate for Payer: Allwell Medicaid	$9,659.68
Rate for Payer: AZCH Complete Medicaid	$9,659.68
Rate for Payer: Banner UC Health Medicaid	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: AHCCCS Medicaid	$5,522.12
Rate for Payer: Allwell Medicaid	$5,522.12
Rate for Payer: AZCH Complete Medicaid	$5,522.12
Rate for Payer: Banner UC Health Medicaid	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12

Know your out-of-pocket cost for care.

All Charges