Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TUBE TRACH CUFFED 7.5

Facility

$8.00

Hospital Charge Code	22354960
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

TUBE TRACH CUFFED 7.5

Facility

$8.00

Hospital Charge Code	22354960
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

TUBE TRACH CUFFED 8.5

Facility

$11.00

Hospital Charge Code	22354929
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Arizona Complete Health Allwell	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.76
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Devoted Health Medicare	$1.98
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Southwest Service Administrators UFCW	$7.48
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: United Healthcare Commercial	$6.29
Rate for Payer: United Healthcare Medicare	$1.76
Rate for Payer: Veterans Affairs TRICARE	$1.74

TUBE TRACH CUFFED 8.5

Facility

$11.00

Hospital Charge Code	22354929
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Cash Price	$8.80

TUBE TRACH UNCUFFED 2.0

Facility

$38.00

Hospital Charge Code	22354956
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Cash Price	$30.40

TUBE TRACH UNCUFFED 2.0

Facility

$38.00

Hospital Charge Code	22354956
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Arizona Complete Health Allwell	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.08
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Devoted Health Medicare	$6.84
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Southwest Service Administrators UFCW	$25.84
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: United Healthcare Commercial	$21.74
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: Veterans Affairs TRICARE	$6.02

TUBE TRACH UNCUFFED 4.0 PED

Facility

$8.00

Hospital Charge Code	22354962
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

TUBE TRACH UNCUFFED 4.0 PED

Facility

$8.00

Hospital Charge Code	22354962
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

TUBE TRACH UNCUFFED 4.5 PED

Facility

$8.00

Hospital Charge Code	22354923
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

TUBE TRACH UNCUFFED 4.5 PED

Facility

$8.00

Hospital Charge Code	22354923
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

TUBE TRACH UNCUFFED 5.0 PED

Facility

$16.00

Hospital Charge Code	22354957
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Cash Price	$12.80

TUBE TRACH UNCUFFED 5.0 PED

Facility

$16.00

Hospital Charge Code	22354957
Hospital Revenue Code	270
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Arizona Complete Health Allwell	$2.56
Rate for Payer: Banner UC Health Medicare	$2.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$10.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.56
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Devoted Health Medicare	$2.88
Rate for Payer: Humana of AZ Medicare	$2.56
Rate for Payer: Southwest Service Administrators UFCW	$10.88
Rate for Payer: TriWest Medicare	$2.56
Rate for Payer: United Healthcare Commercial	$9.15
Rate for Payer: United Healthcare Medicare	$2.56
Rate for Payer: Veterans Affairs TRICARE	$2.53

TUBE TRACH UNCUFFED 5.5 PED

Facility

$38.00

Hospital Charge Code	22354954
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Arizona Complete Health Allwell	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.08
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Devoted Health Medicare	$6.84
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Southwest Service Administrators UFCW	$25.84
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: United Healthcare Commercial	$21.74
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: Veterans Affairs TRICARE	$6.02

TUBE TRACH UNCUFFED 5.5 PED

Facility

$38.00

Hospital Charge Code	22354954
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Cash Price	$30.40

TUBE TRACH UNCUFFED 6.0 PED

Facility

$9.00

Hospital Charge Code	22354970
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

TUBE TRACH UNCUFFED 6.0 PED

Facility

$9.00

Hospital Charge Code	22354970
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

TUBE TRACH UNCUFFED 8.5

Facility

$9.00

Hospital Charge Code	22354973
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

TUBE TRACH UNCUFFED 8.5

Facility

$9.00

Hospital Charge Code	22354973
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

TUBING BLOOD

Facility

$232.00

Hospital Charge Code	22355317
Hospital Revenue Code	270
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$208.80
Rate for Payer: Aetna of AZ Commercial	$208.80
Rate for Payer: Arizona Complete Health Allwell	$37.12
Rate for Payer: Banner UC Health Medicare	$37.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$157.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.12
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cigna of AZ Commercial	$162.40
Rate for Payer: Devoted Health Medicare	$41.76
Rate for Payer: Humana of AZ Medicare	$37.12
Rate for Payer: Southwest Service Administrators UFCW	$157.76
Rate for Payer: TriWest Medicare	$37.12
Rate for Payer: United Healthcare Commercial	$132.70
Rate for Payer: United Healthcare Medicare	$37.12
Rate for Payer: Veterans Affairs TRICARE	$36.75

TUBING BLOOD

Facility

$232.00

Hospital Charge Code	22355317
Hospital Revenue Code	270
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$208.80
Rate for Payer: Aetna of AZ Commercial	$208.80
Rate for Payer: Cash Price	$185.60

TUBING BUBBLE

Facility

$49.00

Service Code	CPT 36000
Hospital Charge Code	22355703
Hospital Revenue Code	270
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Arizona Complete Health Allwell	$7.84
Rate for Payer: Banner UC Health Medicare	$7.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$33.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.84
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$34.30
Rate for Payer: Devoted Health Medicare	$8.82
Rate for Payer: Humana of AZ Medicare	$7.84
Rate for Payer: Mercy Care Medicaid	$22.32
Rate for Payer: NaphCare Correctional Healthcare	$22.32
Rate for Payer: Southwest Service Administrators UFCW	$33.32
Rate for Payer: TriWest Medicare	$7.84
Rate for Payer: United Healthcare Commercial	$28.03
Rate for Payer: United Healthcare Medicare	$7.84
Rate for Payer: Veterans Affairs TRICARE	$7.76

TUBING BUBBLE

Facility

$49.00

Service Code	CPT 36000
Hospital Charge Code	22355703
Hospital Revenue Code	270
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Cash Price	$39.20

TUBING INFUSION PUMP NXT

Facility

$128.00

Hospital Charge Code	28265123
Hospital Revenue Code	270
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of AZ Commercial	$115.20
Rate for Payer: Cash Price	$102.40

TUBING INFUSION PUMP NXT

Facility

$128.00

Hospital Charge Code	28265123
Hospital Revenue Code	270
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of AZ Commercial	$115.20
Rate for Payer: Arizona Complete Health Allwell	$20.48
Rate for Payer: Banner UC Health Medicare	$20.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.48
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cigna of AZ Commercial	$89.60
Rate for Payer: Devoted Health Medicare	$23.04
Rate for Payer: Humana of AZ Medicare	$20.48
Rate for Payer: Southwest Service Administrators UFCW	$87.04
Rate for Payer: TriWest Medicare	$20.48
Rate for Payer: United Healthcare Commercial	$73.22
Rate for Payer: United Healthcare Medicare	$20.48
Rate for Payer: Veterans Affairs TRICARE	$20.28

TUMOR IMMUNOHISTOCHEM/MANUAL

Facility

$401.00

Service Code	CPT 88360
Hospital Charge Code	22545741
Hospital Revenue Code	310
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$360.90
Rate for Payer: Aetna of AZ Commercial	$360.90
Rate for Payer: Cash Price	$320.80

Know your out-of-pocket cost for care.

All Charges