Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TUBE CHEST 16FR

Facility

$172.00

Hospital Charge Code	22354951
Hospital Revenue Code	270
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

TUBE CHEST 16FR

Facility

$172.00

Hospital Charge Code	22354951
Hospital Revenue Code	270
Min. Negotiated Rate	$27.24
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.52
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: Veterans Affairs TRICARE	$27.24

TUBE CHEST 28FR

Facility

$97.00

Hospital Charge Code	22354953
Hospital Revenue Code	270
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Cash Price	$77.60

TUBE CHEST 28FR

Facility

$97.00

Hospital Charge Code	22354953
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

TUBE CHEST 32FR

Facility

$79.00

Hospital Charge Code	22354959
Hospital Revenue Code	270
Min. Negotiated Rate	$71.10
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Cash Price	$63.20

TUBE CHEST 32FR

Facility

$79.00

Hospital Charge Code	22354959
Hospital Revenue Code	270
Min. Negotiated Rate	$12.51
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Arizona Complete Health Allwell	$12.64
Rate for Payer: Banner UC Health Medicare	$12.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.64
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$55.30
Rate for Payer: Devoted Health Medicare	$14.22
Rate for Payer: Humana of AZ Medicare	$12.64
Rate for Payer: Southwest Service Administrators UFCW	$53.72
Rate for Payer: TriWest Medicare	$12.64
Rate for Payer: United Healthcare Commercial	$45.19
Rate for Payer: United Healthcare Medicare	$12.64
Rate for Payer: Veterans Affairs TRICARE	$12.51

Tube Coagulase

Facility

$33.00

Service Code	CPT 87147
Hospital Charge Code	634042
Hospital Revenue Code	301
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Cash Price	$26.40

Tube Coagulase

Facility

$33.00

Service Code	CPT 87147
Hospital Charge Code	634042
Hospital Revenue Code	301
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Arizona Complete Health Allwell	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$22.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.28
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$21.45
Rate for Payer: Devoted Health Medicare	$5.94
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$22.44
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: United Healthcare Commercial	$18.88
Rate for Payer: United Healthcare Medicare	$5.28
Rate for Payer: Veterans Affairs TRICARE	$5.23

TUBE CONCT 18-IN

Facility

$7.00

Hospital Charge Code	22355701
Hospital Revenue Code	270
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Arizona Complete Health Allwell	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.12
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cigna of AZ Commercial	$4.90
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Southwest Service Administrators UFCW	$4.76
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: United Healthcare Commercial	$4.00
Rate for Payer: United Healthcare Medicare	$1.12
Rate for Payer: Veterans Affairs TRICARE	$1.11

TUBE CONCT 18-IN

Facility

$7.00

Hospital Charge Code	22355701
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Cash Price	$5.60

TUBE FEEDING GASTRO 12FR SILICONE MIC

Facility

$286.00

Hospital Charge Code	23371938
Hospital Revenue Code	270
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Arizona Complete Health Allwell	$45.76
Rate for Payer: Banner UC Health Medicare	$45.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$194.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.76
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cigna of AZ Commercial	$200.20
Rate for Payer: Devoted Health Medicare	$51.48
Rate for Payer: Humana of AZ Medicare	$45.76
Rate for Payer: Southwest Service Administrators UFCW	$194.48
Rate for Payer: TriWest Medicare	$45.76
Rate for Payer: United Healthcare Commercial	$163.59
Rate for Payer: United Healthcare Medicare	$45.76
Rate for Payer: Veterans Affairs TRICARE	$45.30

TUBE FEEDING GASTRO 12FR SILICONE MIC

Facility

$286.00

Hospital Charge Code	23371938
Hospital Revenue Code	270
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$257.40
Rate for Payer: Aetna of AZ Commercial	$257.40
Rate for Payer: Cash Price	$228.80

TUBE GASTRIC LAVAGE 32FR LAVACUATOR

Facility

$46.00

Hospital Charge Code	22354174
Hospital Revenue Code	270
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Arizona Complete Health Allwell	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.36
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Devoted Health Medicare	$8.28
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Southwest Service Administrators UFCW	$31.28
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: United Healthcare Commercial	$26.31
Rate for Payer: United Healthcare Medicare	$7.36
Rate for Payer: Veterans Affairs TRICARE	$7.29

TUBE GASTRIC LAVAGE 32FR LAVACUATOR

Facility

$46.00

Hospital Charge Code	22354174
Hospital Revenue Code	270
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Cash Price	$36.80

TUBE GEL IODOSORB 10 GRAM

Facility

$179.00

Hospital Charge Code	23362064
Hospital Revenue Code	272
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Arizona Complete Health Allwell	$28.64
Rate for Payer: Banner UC Health Medicare	$28.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$121.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.64
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$125.30
Rate for Payer: Devoted Health Medicare	$32.22
Rate for Payer: Humana of AZ Medicare	$28.64
Rate for Payer: Southwest Service Administrators UFCW	$121.72
Rate for Payer: TriWest Medicare	$28.64
Rate for Payer: United Healthcare Commercial	$102.39
Rate for Payer: United Healthcare Medicare	$28.64
Rate for Payer: Veterans Affairs TRICARE	$28.35

TUBE GEL IODOSORB 10 GRAM

Facility

$179.00

Hospital Charge Code	23362064
Hospital Revenue Code	272
Min. Negotiated Rate	$161.10
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Cash Price	$143.20

TUBE HOLDER-DEVON VELCRO

Facility

$76.00

Hospital Charge Code	22355690
Hospital Revenue Code	270
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Arizona Complete Health Allwell	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.16
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$53.20
Rate for Payer: Devoted Health Medicare	$13.68
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Southwest Service Administrators UFCW	$51.68
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: United Healthcare Commercial	$43.47
Rate for Payer: United Healthcare Medicare	$12.16
Rate for Payer: Veterans Affairs TRICARE	$12.04

TUBE HOLDER-DEVON VELCRO

Facility

$76.00

Hospital Charge Code	22355690
Hospital Revenue Code	270
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Cash Price	$60.80

TUBE HOLDER HOLLISTER ACHORFAST

Facility

$51.00

Hospital Charge Code	22584324
Hospital Revenue Code	272
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Cash Price	$40.80

TUBE HOLDER HOLLISTER ACHORFAST

Facility

$51.00

Hospital Charge Code	22584324
Hospital Revenue Code	272
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Arizona Complete Health Allwell	$8.16
Rate for Payer: Banner UC Health Medicare	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$34.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.16
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$35.70
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Humana of AZ Medicare	$8.16
Rate for Payer: Southwest Service Administrators UFCW	$34.68
Rate for Payer: TriWest Medicare	$8.16
Rate for Payer: United Healthcare Commercial	$29.17
Rate for Payer: United Healthcare Medicare	$8.16
Rate for Payer: Veterans Affairs TRICARE	$8.08

TUBE HOLDER TRACH

Facility

$7.00

Hospital Charge Code	22926448
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Arizona Complete Health Allwell	$1.12
Rate for Payer: Banner UC Health Medicare	$1.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.12
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cigna of AZ Commercial	$4.90
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Humana of AZ Medicare	$1.12
Rate for Payer: Southwest Service Administrators UFCW	$4.76
Rate for Payer: TriWest Medicare	$1.12
Rate for Payer: United Healthcare Commercial	$4.00
Rate for Payer: United Healthcare Medicare	$1.12
Rate for Payer: Veterans Affairs TRICARE	$1.11

TUBE HOLDER TRACH

Facility

$7.00

Hospital Charge Code	22926448
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna of AZ Commercial	$6.30
Rate for Payer: Cash Price	$5.60

TUBE NG SALEM SUMP 10FR

Facility

$13.00

Hospital Charge Code	22355584
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Cash Price	$10.40

TUBE NG SALEM SUMP 10FR

Facility

$13.00

Hospital Charge Code	22355584
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Arizona Complete Health Allwell	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.08
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Devoted Health Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Southwest Service Administrators UFCW	$8.84
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: United Healthcare Commercial	$7.44
Rate for Payer: United Healthcare Medicare	$2.08
Rate for Payer: Veterans Affairs TRICARE	$2.06

TUBE NG SALEM SUMP 12FR

Facility

$12.00

Hospital Charge Code	22355571
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

Know your out-of-pocket cost for care.

All Charges