Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

t-Transglutaminase (tTG) IgA LC

Facility

$1,422.00

Service Code	CPT 83516
Hospital Charge Code	2087656
Hospital Revenue Code	301
Min. Negotiated Rate	$369.72
Max. Negotiated Rate	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Bisbee Police All Plans	$369.72
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Self Pay Self Pay	$1,137.60

t-Transglutaminase (tTG) IgG LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	2269437
Hospital Revenue Code	301
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Aetna of AZ Medicare	$397.60
Rate for Payer: Allwell Medicare	$227.20
Rate for Payer: Amerigroup Medicare	$227.20
Rate for Payer: APIPA Medicare/Medicaid	$530.37
Rate for Payer: AZCH Complete Medicare	$227.20
Rate for Payer: Banner UC Health Medicare	$227.20
Rate for Payer: Bisbee Police All Plans	$369.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$965.60
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cigna of AZ Commercial	$923.00
Rate for Payer: Copperpoint Commercial	$351.45
Rate for Payer: Health Net of AZ Commercial	$852.00
Rate for Payer: Health Net of AZ Medicare	$397.60
Rate for Payer: Humana of AZ Medicare	$227.20
Rate for Payer: Self Pay Self Pay	$1,136.00
Rate for Payer: TriWest Medicare	$227.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$827.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$255.60

t-Transglutaminase (tTG) IgG LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	2269437
Hospital Revenue Code	301
Min. Negotiated Rate	$369.20
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Bisbee Police All Plans	$369.20
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Self Pay Self Pay	$1,136.00

T TRNSGLT IGA

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481505
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

T TRNSGLT IGA

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481505
Hospital Revenue Code	301
Min. Negotiated Rate	$239.20
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: Allwell Medicare	$239.20
Rate for Payer: Amerigroup Medicare	$239.20
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicare	$239.20
Rate for Payer: Banner UC Health Medicare	$239.20
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$239.20
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$239.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

TUBE CHEST 16FR

Facility

$172.00

Hospital Charge Code	22354951
Hospital Revenue Code	270
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: Allwell Medicare	$27.52
Rate for Payer: Amerigroup Medicare	$27.52
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

TUBE CHEST 16FR

Facility

$172.00

Hospital Charge Code	22354951
Hospital Revenue Code	270
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

TUBE CHEST 28FR

Facility

$97.00

Hospital Charge Code	22354953
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

TUBE CHEST 28FR

Facility

$97.00

Hospital Charge Code	22354953
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

TUBE CHEST 32FR

Facility

$79.00

Hospital Charge Code	22354959
Hospital Revenue Code	270
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Aetna of AZ Medicare	$22.12
Rate for Payer: Allwell Medicare	$12.64
Rate for Payer: Amerigroup Medicare	$12.64
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicare	$12.64
Rate for Payer: Banner UC Health Medicare	$12.64
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.72
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$55.30
Rate for Payer: Copperpoint Commercial	$19.55
Rate for Payer: Health Net of AZ Commercial	$47.40
Rate for Payer: Health Net of AZ Medicare	$22.12
Rate for Payer: Humana of AZ Medicare	$12.64
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$12.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.22

TUBE CHEST 32FR

Facility

$79.00

Hospital Charge Code	22354959
Hospital Revenue Code	270
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Cash Price	$63.20
Rate for Payer: Self Pay Self Pay	$63.20

Tube Coagulase

Facility

$33.00

Service Code	CPT 87147
Hospital Charge Code	634042
Hospital Revenue Code	301
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$21.45
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

Tube Coagulase

Facility

$33.00

Service Code	CPT 87147
Hospital Charge Code	634042
Hospital Revenue Code	301
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

TUBE CONCT 18-IN

Facility

$7.00

Hospital Charge Code	22355701
Hospital Revenue Code	270
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

TUBE CONCT 18-IN

Facility

$7.00

Hospital Charge Code	22355701
Hospital Revenue Code	270
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

TUBE FEEDING GASTRO 12FR SILICONE MIC

Facility

$286.00

Hospital Charge Code	23371938
Hospital Revenue Code	270
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Aetna of AZ Medicare	$80.08
Rate for Payer: Allwell Medicare	$45.76
Rate for Payer: Amerigroup Medicare	$45.76
Rate for Payer: APIPA Medicare/Medicaid	$106.82
Rate for Payer: AZCH Complete Medicare	$45.76
Rate for Payer: Banner UC Health Medicare	$45.76
Rate for Payer: Bisbee Police All Plans	$74.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$194.48
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cigna of AZ Commercial	$200.20
Rate for Payer: Copperpoint Commercial	$70.78
Rate for Payer: Health Net of AZ Commercial	$171.60
Rate for Payer: Health Net of AZ Medicare	$80.08
Rate for Payer: Humana of AZ Medicare	$45.76
Rate for Payer: Self Pay Self Pay	$228.80
Rate for Payer: TriWest Medicare	$45.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$166.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.48

TUBE FEEDING GASTRO 12FR SILICONE MIC

Facility

$286.00

Hospital Charge Code	23371938
Hospital Revenue Code	270
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Bisbee Police All Plans	$74.36
Rate for Payer: Cash Price	$228.80
Rate for Payer: Self Pay Self Pay	$228.80

TUBE GASTRIC LAVAGE 32FR LAVACUATOR

Facility

$46.00

Hospital Charge Code	22354174
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$7.36
Rate for Payer: Amerigroup Medicare	$7.36
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

TUBE GASTRIC LAVAGE 32FR LAVACUATOR

Facility

$46.00

Hospital Charge Code	22354174
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

TUBE GEL IODOSORB 10 GRAM

Facility

$179.00

Hospital Charge Code	23362064
Hospital Revenue Code	272
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Cash Price	$143.20
Rate for Payer: Self Pay Self Pay	$143.20

TUBE GEL IODOSORB 10 GRAM

Facility

$179.00

Hospital Charge Code	23362064
Hospital Revenue Code	272
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Aetna of AZ Medicare	$50.12
Rate for Payer: Allwell Medicare	$28.64
Rate for Payer: Amerigroup Medicare	$28.64
Rate for Payer: APIPA Medicare/Medicaid	$66.86
Rate for Payer: AZCH Complete Medicare	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$121.72
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$125.30
Rate for Payer: Copperpoint Commercial	$44.30
Rate for Payer: Health Net of AZ Commercial	$107.40
Rate for Payer: Health Net of AZ Medicare	$50.12
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Self Pay Self Pay	$143.20
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.22

TUBE HOLDER-DEVON VELCRO

Facility

$76.00

Hospital Charge Code	22355690
Hospital Revenue Code	270
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$12.16
Rate for Payer: Amerigroup Medicare	$12.16
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$53.20
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

TUBE HOLDER-DEVON VELCRO

Facility

$76.00

Hospital Charge Code	22355690
Hospital Revenue Code	270
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

TUBE HOLDER HOLLISTER ACHORFAST

Facility

$51.00

Hospital Charge Code	22584324
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Bisbee Police All Plans	$13.26
Rate for Payer: Cash Price	$40.80
Rate for Payer: Self Pay Self Pay	$40.80

TUBE HOLDER HOLLISTER ACHORFAST

Facility

$51.00

Hospital Charge Code	22584324
Hospital Revenue Code	272
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Aetna of AZ Medicare	$14.28
Rate for Payer: Allwell Medicare	$8.16
Rate for Payer: Amerigroup Medicare	$8.16
Rate for Payer: APIPA Medicare/Medicaid	$19.05
Rate for Payer: AZCH Complete Medicare	$8.16
Rate for Payer: Banner UC Health Medicare	$8.16
Rate for Payer: Bisbee Police All Plans	$13.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$35.70
Rate for Payer: Copperpoint Commercial	$12.62
Rate for Payer: Health Net of AZ Commercial	$30.60
Rate for Payer: Health Net of AZ Medicare	$14.28
Rate for Payer: Humana of AZ Medicare	$8.16
Rate for Payer: Self Pay Self Pay	$40.80
Rate for Payer: TriWest Medicare	$8.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.18

Know your out-of-pocket cost for care.

All Charges