Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

carvedilol 12.5 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904630261
Hospital Charge Code	105914717
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

carvedilol 3.125 mg Tab UD [CQCH]

Facility

$0.08

Service Code	NDC 904630061
Hospital Charge Code	107994520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

carvedilol 3.125 mg Tab UD [CQCH]

Facility

$0.08

Service Code	NDC 904630061
Hospital Charge Code	107994520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

carvedilol 6.25 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 904630161
Hospital Charge Code	105914782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

carvedilol 6.25 mg Tab [CQCH]

Facility

$0.08

Service Code	NDC 904630161
Hospital Charge Code	105914782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

Catalase

Facility

$83.00

Service Code	CPT 86403
Hospital Charge Code	634031
Hospital Revenue Code	301
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Aetna of AZ Medicare	$23.24
Rate for Payer: Allwell Medicare	$13.28
Rate for Payer: Amerigroup Medicare	$13.28
Rate for Payer: APIPA Medicare/Medicaid	$31.00
Rate for Payer: AZCH Complete Medicare	$13.28
Rate for Payer: Banner UC Health Medicare	$13.28
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$56.44
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Copperpoint Commercial	$20.54
Rate for Payer: Health Net of AZ Commercial	$49.80
Rate for Payer: Health Net of AZ Medicare	$23.24
Rate for Payer: Humana of AZ Medicare	$13.28
Rate for Payer: Self Pay Self Pay	$66.40
Rate for Payer: TriWest Medicare	$13.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.94

Catalase

Facility

$83.00

Service Code	CPT 86403
Hospital Charge Code	634031
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Cash Price	$66.40
Rate for Payer: Self Pay Self Pay	$66.40

CATCHER BAGS

Facility

$62.00

Hospital Charge Code	22354919
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

CATCHER BAGS

Facility

$62.00

Hospital Charge Code	22354919
Hospital Revenue Code	270
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

Catecholamines, Plasma LC

Facility

$365.00

Service Code	CPT 82384
Hospital Charge Code	2029228
Hospital Revenue Code	301
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Cash Price	$292.00
Rate for Payer: Self Pay Self Pay	$292.00

Catecholamines, Plasma LC

Facility

$365.00

Service Code	CPT 82384
Hospital Charge Code	2029228
Hospital Revenue Code	301
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$328.50
Rate for Payer: Aetna of AZ Commercial	$328.50
Rate for Payer: Aetna of AZ Medicare	$102.20
Rate for Payer: Allwell Medicare	$58.40
Rate for Payer: Amerigroup Medicare	$58.40
Rate for Payer: APIPA Medicare/Medicaid	$136.33
Rate for Payer: AZCH Complete Medicare	$58.40
Rate for Payer: Banner UC Health Medicare	$58.40
Rate for Payer: Bisbee Police All Plans	$94.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$248.20
Rate for Payer: Cash Price	$292.00
Rate for Payer: Cigna of AZ Commercial	$237.25
Rate for Payer: Copperpoint Commercial	$90.34
Rate for Payer: Health Net of AZ Commercial	$219.00
Rate for Payer: Health Net of AZ Medicare	$102.20
Rate for Payer: Humana of AZ Medicare	$58.40
Rate for Payer: Self Pay Self Pay	$292.00
Rate for Payer: TriWest Medicare	$58.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$212.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.70

Catecholamines,Ur.,Free,24 Hr LC

Facility

$312.00

Service Code	CPT 82384
Hospital Charge Code	2029235
Hospital Revenue Code	301
Min. Negotiated Rate	$81.12
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Bisbee Police All Plans	$81.12
Rate for Payer: Cash Price	$249.60
Rate for Payer: Self Pay Self Pay	$249.60

Catecholamines,Ur.,Free,24 Hr LC

Facility

$312.00

Service Code	CPT 82384
Hospital Charge Code	2029235
Hospital Revenue Code	301
Min. Negotiated Rate	$49.92
Max. Negotiated Rate	$280.80
Rate for Payer: Aetna of AZ Commercial	$280.80
Rate for Payer: Aetna of AZ Medicare	$87.36
Rate for Payer: Allwell Medicare	$49.92
Rate for Payer: Amerigroup Medicare	$49.92
Rate for Payer: APIPA Medicare/Medicaid	$116.53
Rate for Payer: AZCH Complete Medicare	$49.92
Rate for Payer: Banner UC Health Medicare	$49.92
Rate for Payer: Bisbee Police All Plans	$81.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$212.16
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cigna of AZ Commercial	$202.80
Rate for Payer: Copperpoint Commercial	$77.22
Rate for Payer: Health Net of AZ Commercial	$187.20
Rate for Payer: Health Net of AZ Medicare	$87.36
Rate for Payer: Humana of AZ Medicare	$49.92
Rate for Payer: Self Pay Self Pay	$249.60
Rate for Payer: TriWest Medicare	$49.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$181.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$56.16

CATH, CLOSED SUCTION,14FR,DBL, ETT,24HR

Facility

$61.00

Hospital Charge Code	23028277
Hospital Revenue Code	272
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Aetna of AZ Medicare	$17.08
Rate for Payer: Allwell Medicare	$9.76
Rate for Payer: Amerigroup Medicare	$9.76
Rate for Payer: APIPA Medicare/Medicaid	$22.78
Rate for Payer: AZCH Complete Medicare	$9.76
Rate for Payer: Banner UC Health Medicare	$9.76
Rate for Payer: Bisbee Police All Plans	$15.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$41.48
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Copperpoint Commercial	$15.10
Rate for Payer: Health Net of AZ Commercial	$36.60
Rate for Payer: Health Net of AZ Medicare	$17.08
Rate for Payer: Humana of AZ Medicare	$9.76
Rate for Payer: Self Pay Self Pay	$48.80
Rate for Payer: TriWest Medicare	$9.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$35.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.98

CATH, CLOSED SUCTION,14FR,DBL, ETT,24HR

Facility

$61.00

Hospital Charge Code	23028277
Hospital Revenue Code	272
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Bisbee Police All Plans	$15.86
Rate for Payer: Cash Price	$48.80
Rate for Payer: Self Pay Self Pay	$48.80

CATH COUDE TIEMANN 12F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355182
Hospital Revenue Code	270
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.68
Rate for Payer: Amerigroup Medicare	$7.68
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CATH COUDE TIEMANN 12F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355182
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CATH COUDE TIEMANN 14F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355162
Hospital Revenue Code	270
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.68
Rate for Payer: Amerigroup Medicare	$7.68
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CATH COUDE TIEMANN 14F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355162
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CATH COUDE TIEMANN 16F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355163
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.43
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

CATH COUDE TIEMANN 16F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355163
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

CATH COUDE TIEMANN 18F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355105
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

CATH COUDE TIEMANN 18F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355105
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.43
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

CATH COUDE TIEMANN 20F

Facility

$180.00

Service Code	CPT A4340
Hospital Charge Code	22355135
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

CATH COUDE TIEMANN 20F

Facility

$180.00

Service Code	CPT A4340
Hospital Charge Code	22355135
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$28.80
Rate for Payer: Amerigroup Medicare	$28.80
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

Know your out-of-pocket cost for care.

All Charges