Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TI6 LOW PROFILE 3MMX20MM BONE SCREW

Facility

$1,915.00

Hospital Charge Code	24358110
Hospital Revenue Code	270
Min. Negotiated Rate	$1,723.50
Max. Negotiated Rate	$1,723.50
Rate for Payer: Aetna of AZ Commercial	$1,723.50
Rate for Payer: Cash Price	$1,532.00

TI6 LOW PROFILE 3MMX20MM BONE SCREW

Facility

$1,915.00

Hospital Charge Code	24358110
Hospital Revenue Code	270
Min. Negotiated Rate	$303.34
Max. Negotiated Rate	$1,723.50
Rate for Payer: Aetna of AZ Commercial	$1,723.50
Rate for Payer: Arizona Complete Health Allwell	$306.40
Rate for Payer: Banner UC Health Medicare	$306.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,302.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$306.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$306.40
Rate for Payer: Cash Price	$1,532.00
Rate for Payer: Cigna of AZ Commercial	$1,340.50
Rate for Payer: Devoted Health Medicare	$344.70
Rate for Payer: Humana of AZ Medicare	$306.40
Rate for Payer: Southwest Service Administrators UFCW	$1,302.20
Rate for Payer: TriWest Medicare	$306.40
Rate for Payer: United Healthcare Commercial	$1,095.38
Rate for Payer: United Healthcare Medicare	$306.40
Rate for Payer: Veterans Affairs TRICARE	$303.34

TI6 LOW PROFILE 3X14 BONE SCREW

Facility

$1,915.00

Hospital Charge Code	27738159
Hospital Revenue Code	270
Min. Negotiated Rate	$1,723.50
Max. Negotiated Rate	$1,723.50
Rate for Payer: Aetna of AZ Commercial	$1,723.50
Rate for Payer: Cash Price	$1,532.00

TI6 LOW PROFILE 3X14 BONE SCREW

Facility

$1,915.00

Hospital Charge Code	27738159
Hospital Revenue Code	270
Min. Negotiated Rate	$303.34
Max. Negotiated Rate	$1,723.50
Rate for Payer: Aetna of AZ Commercial	$1,723.50
Rate for Payer: Arizona Complete Health Allwell	$306.40
Rate for Payer: Banner UC Health Medicare	$306.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,302.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$306.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$306.40
Rate for Payer: Cash Price	$1,532.00
Rate for Payer: Cigna of AZ Commercial	$1,340.50
Rate for Payer: Devoted Health Medicare	$344.70
Rate for Payer: Humana of AZ Medicare	$306.40
Rate for Payer: Southwest Service Administrators UFCW	$1,302.20
Rate for Payer: TriWest Medicare	$306.40
Rate for Payer: United Healthcare Commercial	$1,095.38
Rate for Payer: United Healthcare Medicare	$306.40
Rate for Payer: Veterans Affairs TRICARE	$303.34

TI6 QUICKSNAP 2.0MM S 14MM SCREW

Facility

$1,377.00

Hospital Charge Code	24127775
Hospital Revenue Code	270
Min. Negotiated Rate	$1,239.30
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Cash Price	$1,101.60

TI6 QUICKSNAP 2.0MM S 14MM SCREW

Facility

$1,377.00

Hospital Charge Code	24127775
Hospital Revenue Code	270
Min. Negotiated Rate	$218.12
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Arizona Complete Health Allwell	$220.32
Rate for Payer: Banner UC Health Medicare	$220.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$936.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$220.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$220.32
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Cigna of AZ Commercial	$963.90
Rate for Payer: Devoted Health Medicare	$247.86
Rate for Payer: Humana of AZ Medicare	$220.32
Rate for Payer: Southwest Service Administrators UFCW	$936.36
Rate for Payer: TriWest Medicare	$220.32
Rate for Payer: United Healthcare Commercial	$787.64
Rate for Payer: United Healthcare Medicare	$220.32
Rate for Payer: Veterans Affairs TRICARE	$218.12

TI6 QUICKSNAP 2.0MM X 10MM SCREW

Facility

$1,377.00

Hospital Charge Code	24127795
Hospital Revenue Code	270
Min. Negotiated Rate	$1,239.30
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Cash Price	$1,101.60

TI6 QUICKSNAP 2.0MM X 10MM SCREW

Facility

$1,377.00

Hospital Charge Code	24127795
Hospital Revenue Code	270
Min. Negotiated Rate	$218.12
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Arizona Complete Health Allwell	$220.32
Rate for Payer: Banner UC Health Medicare	$220.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$936.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$220.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$220.32
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Cigna of AZ Commercial	$963.90
Rate for Payer: Devoted Health Medicare	$247.86
Rate for Payer: Humana of AZ Medicare	$220.32
Rate for Payer: Southwest Service Administrators UFCW	$936.36
Rate for Payer: TriWest Medicare	$220.32
Rate for Payer: United Healthcare Commercial	$787.64
Rate for Payer: United Healthcare Medicare	$220.32
Rate for Payer: Veterans Affairs TRICARE	$218.12

TI6 QUICKSNAP 2.0MM X 11MM SCREW

Facility

$1,377.00

Hospital Charge Code	24127787
Hospital Revenue Code	270
Min. Negotiated Rate	$218.12
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Arizona Complete Health Allwell	$220.32
Rate for Payer: Banner UC Health Medicare	$220.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$936.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$220.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$220.32
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Cigna of AZ Commercial	$963.90
Rate for Payer: Devoted Health Medicare	$247.86
Rate for Payer: Humana of AZ Medicare	$220.32
Rate for Payer: Southwest Service Administrators UFCW	$936.36
Rate for Payer: TriWest Medicare	$220.32
Rate for Payer: United Healthcare Commercial	$787.64
Rate for Payer: United Healthcare Medicare	$220.32
Rate for Payer: Veterans Affairs TRICARE	$218.12

TI6 QUICKSNAP 2.0MM X 11MM SCREW

Facility

$1,377.00

Hospital Charge Code	24127787
Hospital Revenue Code	270
Min. Negotiated Rate	$1,239.30
Max. Negotiated Rate	$1,239.30
Rate for Payer: Aetna of AZ Commercial	$1,239.30
Rate for Payer: Cash Price	$1,101.60

TI6 TC SERIES KWIRE 3.0/4.0 (1.1X120MM)

Facility

$98.00

Hospital Charge Code	24127773
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Arizona Complete Health Allwell	$15.68
Rate for Payer: Banner UC Health Medicare	$15.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$66.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.68
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Humana of AZ Medicare	$15.68
Rate for Payer: Southwest Service Administrators UFCW	$66.64
Rate for Payer: TriWest Medicare	$15.68
Rate for Payer: United Healthcare Commercial	$56.06
Rate for Payer: United Healthcare Medicare	$15.68
Rate for Payer: Veterans Affairs TRICARE	$15.52

TI6 TC SERIES KWIRE 3.0/4.0 (1.1X120MM)

Facility

$98.00

Hospital Charge Code	24127773
Hospital Revenue Code	270
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Cash Price	$78.40

TI6 TH SERIES KWIRE 0.80 x 70MM

Facility

$98.00

Hospital Charge Code	24358108
Hospital Revenue Code	270
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Cash Price	$78.40

TI6 TH SERIES KWIRE 0.80 x 70MM

Facility

$98.00

Hospital Charge Code	24358108
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Arizona Complete Health Allwell	$15.68
Rate for Payer: Banner UC Health Medicare	$15.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$66.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.68
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Humana of AZ Medicare	$15.68
Rate for Payer: Southwest Service Administrators UFCW	$66.64
Rate for Payer: TriWest Medicare	$15.68
Rate for Payer: United Healthcare Commercial	$56.06
Rate for Payer: United Healthcare Medicare	$15.68
Rate for Payer: Veterans Affairs TRICARE	$15.52

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: Arizona Complete Health Allwell	$0.14
Rate for Payer: Banner UC Health Medicare	$0.14
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.14
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.14
Rate for Payer: Cash Price	$0.71
Rate for Payer: Cigna of AZ Commercial	$0.57
Rate for Payer: Devoted Health Medicare	$0.16
Rate for Payer: Humana of AZ Medicare	$0.14
Rate for Payer: Southwest Service Administrators UFCW	$0.60
Rate for Payer: TriWest Medicare	$0.14
Rate for Payer: United Healthcare Commercial	$0.50
Rate for Payer: United Healthcare Medicare	$0.14
Rate for Payer: Veterans Affairs TRICARE	$0.14

timolol Ophth 0.5% Sol [CQCH]

Facility

$0.88

Service Code	NDC 64980051405
Hospital Charge Code	105943863
Hospital Revenue Code	251
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Aetna of AZ Commercial	$0.79
Rate for Payer: Cash Price	$0.71

TINTRA OK MESH

Facility

$8,171.00

Hospital Charge Code	22354194
Hospital Revenue Code	270
Min. Negotiated Rate	$1,294.29
Max. Negotiated Rate	$7,353.90
Rate for Payer: Aetna of AZ Commercial	$7,353.90
Rate for Payer: Arizona Complete Health Allwell	$1,307.36
Rate for Payer: Banner UC Health Medicare	$1,307.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5,556.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,307.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,307.36
Rate for Payer: Cash Price	$6,536.80
Rate for Payer: Cigna of AZ Commercial	$5,719.70
Rate for Payer: Devoted Health Medicare	$1,470.78
Rate for Payer: Humana of AZ Medicare	$1,307.36
Rate for Payer: Southwest Service Administrators UFCW	$5,556.28
Rate for Payer: TriWest Medicare	$1,307.36
Rate for Payer: United Healthcare Commercial	$4,673.81
Rate for Payer: United Healthcare Medicare	$1,307.36
Rate for Payer: Veterans Affairs TRICARE	$1,294.29

TINTRA OK MESH

Facility

$8,171.00

Hospital Charge Code	22354194
Hospital Revenue Code	270
Min. Negotiated Rate	$7,353.90
Max. Negotiated Rate	$7,353.90
Rate for Payer: Aetna of AZ Commercial	$7,353.90
Rate for Payer: Cash Price	$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	$5.90
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna of AZ Commercial	$33.50
Rate for Payer: Arizona Complete Health Allwell	$5.96
Rate for Payer: Banner UC Health Medicare	$5.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.96
Rate for Payer: Cash Price	$29.78
Rate for Payer: Cigna of AZ Commercial	$24.19
Rate for Payer: Devoted Health Medicare	$6.70
Rate for Payer: Humana of AZ Medicare	$5.96
Rate for Payer: Southwest Service Administrators UFCW	$25.31
Rate for Payer: TriWest Medicare	$5.96
Rate for Payer: United Healthcare Commercial	$21.29
Rate for Payer: United Healthcare Medicare	$5.96
Rate for Payer: Veterans Affairs TRICARE	$5.90

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	$33.50
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna of AZ Commercial	$33.50
Rate for Payer: Cash Price	$29.78

Tissue Culture

Facility

$237.00

Service Code	CPT 87070
Hospital Charge Code	633906
Hospital Revenue Code	306
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Arizona Complete Health Allwell	$37.92
Rate for Payer: Banner UC Health Medicare	$37.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.92
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Devoted Health Medicare	$42.66
Rate for Payer: Humana of AZ Medicare	$37.92
Rate for Payer: Seven Corners Travel Insurance	$12.50
Rate for Payer: Southwest Service Administrators UFCW	$161.16
Rate for Payer: TriWest Medicare	$37.92
Rate for Payer: United Healthcare Commercial	$135.56
Rate for Payer: United Healthcare Medicare	$37.92
Rate for Payer: Veterans Affairs TRICARE	$37.54

Tissue Culture

Facility

$237.00

Service Code	CPT 87070
Hospital Charge Code	633906
Hospital Revenue Code	306
Min. Negotiated Rate	$213.30
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Cash Price	$189.60

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: Arizona Complete Health Allwell	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.11
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.11
Rate for Payer: Cash Price	$0.56
Rate for Payer: Cigna of AZ Commercial	$0.46
Rate for Payer: Devoted Health Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Southwest Service Administrators UFCW	$0.48
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: United Healthcare Commercial	$0.40
Rate for Payer: United Healthcare Medicare	$0.11
Rate for Payer: Veterans Affairs TRICARE	$0.11

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	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna of AZ Commercial	$0.63
Rate for Payer: Cash Price	$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	$115.92
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Cash Price	$103.04

Know your out-of-pocket cost for care.

All Charges