Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Transurethral Prostatectomy

Facility

$5,847.57

Service Code	APR-DRG 4822
Hospital Charge Code	APRDRG4822
Min. Negotiated Rate	$5,847.57
Max. Negotiated Rate	$5,847.57
Rate for Payer: AHCCCS Medicaid	$5,847.57
Rate for Payer: Allwell Medicaid	$5,847.57
Rate for Payer: AZCH Complete Medicaid	$5,847.57
Rate for Payer: Banner UC Health Medicaid	$5,847.57
Rate for Payer: Mercy Care Medicaid	$5,847.57

Transurethral Prostatectomy

Facility

$22,298.91

Service Code	APR-DRG 4824
Hospital Charge Code	APRDRG4824
Min. Negotiated Rate	$22,298.91
Max. Negotiated Rate	$22,298.91
Rate for Payer: AHCCCS Medicaid	$22,298.91
Rate for Payer: Allwell Medicaid	$22,298.91
Rate for Payer: AZCH Complete Medicaid	$22,298.91
Rate for Payer: Banner UC Health Medicaid	$22,298.91
Rate for Payer: Mercy Care Medicaid	$22,298.91

TRAP SPECIMEN 80CC

Facility

$9.00

Hospital Charge Code	22926449
Hospital Revenue Code	272
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

TRAP SPECIMEN 80CC

Facility

$9.00

Hospital Charge Code	22926449
Hospital Revenue Code	272
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

TRAY BASIC 30CC

Facility

$14.00

Hospital Charge Code	22355321
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Cash Price	$11.20
Rate for Payer: Self Pay Self Pay	$11.20

TRAY BASIC 30CC

Facility

$14.00

Hospital Charge Code	22355321
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Aetna of AZ Medicare	$3.92
Rate for Payer: Allwell Medicare	$2.10
Rate for Payer: Amerigroup Medicare	$2.10
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.10
Rate for Payer: Banner UC Health Medicare	$2.10
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$9.52
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Copperpoint Commercial	$3.46
Rate for Payer: Health Net of AZ Commercial	$8.40
Rate for Payer: Health Net of AZ Medicare	$3.92
Rate for Payer: Humana of AZ Medicare	$2.10
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

TRAY CATH URETHRAL 15FR

Facility

$13.00

Hospital Charge Code	22355344
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

TRAY CATH URETHRAL 15FR

Facility

$13.00

Hospital Charge Code	22355344
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

TRAY DRESSING CHANGE

Facility

$23.00

Hospital Charge Code	22531720
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Cash Price	$18.40
Rate for Payer: Self Pay Self Pay	$18.40

TRAY DRESSING CHANGE

Facility

$23.00

Hospital Charge Code	22531720
Hospital Revenue Code	272
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Aetna of AZ Medicare	$6.44
Rate for Payer: Allwell Medicare	$3.45
Rate for Payer: Amerigroup Medicare	$3.45
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.45
Rate for Payer: Banner UC Health Medicare	$3.45
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.64
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Copperpoint Commercial	$5.69
Rate for Payer: Health Net of AZ Commercial	$13.80
Rate for Payer: Health Net of AZ Medicare	$6.44
Rate for Payer: Humana of AZ Medicare	$3.45
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.14

TRAY EZ PREP

Facility

$41.00

Hospital Charge Code	22355323
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

TRAY EZ PREP

Facility

$41.00

Hospital Charge Code	22355323
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

TRAY FOLEY 10CC W/O BAG

Facility

$155.00

Hospital Charge Code	22355307
Hospital Revenue Code	270
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Aetna of AZ Medicare	$43.40
Rate for Payer: Allwell Medicare	$23.25
Rate for Payer: Amerigroup Medicare	$23.25
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$23.25
Rate for Payer: Banner UC Health Medicare	$23.25
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$105.40
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Copperpoint Commercial	$38.36
Rate for Payer: Health Net of AZ Commercial	$93.00
Rate for Payer: Health Net of AZ Medicare	$43.40
Rate for Payer: Humana of AZ Medicare	$23.25
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$23.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

TRAY FOLEY 10CC W/O BAG

Facility

$155.00

Hospital Charge Code	22355307
Hospital Revenue Code	270
Min. Negotiated Rate	$40.30
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Cash Price	$124.00
Rate for Payer: Self Pay Self Pay	$124.00

TRAY FOLEY 16FR

Facility

$44.00

Hospital Charge Code	22355051
Hospital Revenue Code	270
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

TRAY FOLEY 16FR

Facility

$44.00

Hospital Charge Code	22355051
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$6.60
Rate for Payer: Amerigroup Medicare	$6.60
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$6.60
Rate for Payer: Banner UC Health Medicare	$6.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$6.60
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$6.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

TRAY FOLEY 18F AUTO

Facility

$43.00

Service Code	CPT A4314
Hospital Charge Code	22354964
Hospital Revenue Code	270
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of AZ Commercial	$38.70
Rate for Payer: Bisbee Police All Plans	$11.18
Rate for Payer: Cash Price	$34.40
Rate for Payer: Self Pay Self Pay	$34.40

TRAY FOLEY 18F AUTO

Facility

$43.00

Service Code	CPT A4314
Hospital Charge Code	22354964
Hospital Revenue Code	270
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$38.72
Rate for Payer: Aetna of AZ Commercial	$38.70
Rate for Payer: Aetna of AZ Medicare	$12.04
Rate for Payer: AHCCCS Medicaid	$38.72
Rate for Payer: Allwell Medicaid	$38.72
Rate for Payer: Allwell Medicare	$6.45
Rate for Payer: Amerigroup Medicare	$6.45
Rate for Payer: APIPA Medicare/Medicaid	$16.06
Rate for Payer: AZCH Complete Medicaid	$38.72
Rate for Payer: AZCH Complete Medicare	$6.45
Rate for Payer: Banner UC Health Medicaid	$38.72
Rate for Payer: Banner UC Health Medicare	$6.45
Rate for Payer: Bisbee Police All Plans	$11.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.24
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cigna of AZ Commercial	$30.10
Rate for Payer: Copperpoint Commercial	$10.64
Rate for Payer: Health Net of AZ Commercial	$25.80
Rate for Payer: Health Net of AZ Medicare	$12.04
Rate for Payer: Humana of AZ Medicare	$6.45
Rate for Payer: Mercy Care Medicaid	$38.72
Rate for Payer: Self Pay Self Pay	$34.40
Rate for Payer: TriWest Medicare	$6.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.74

TRAY GASTROSTOMY 20F

Facility

$1,332.00

Hospital Charge Code	22354768
Hospital Revenue Code	270
Min. Negotiated Rate	$346.32
Max. Negotiated Rate	$1,198.80
Rate for Payer: Aetna of AZ Commercial	$1,198.80
Rate for Payer: Bisbee Police All Plans	$346.32
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Self Pay Self Pay	$1,065.60

TRAY GASTROSTOMY 20F

Facility

$1,332.00

Hospital Charge Code	22354768
Hospital Revenue Code	270
Min. Negotiated Rate	$199.80
Max. Negotiated Rate	$1,198.80
Rate for Payer: Aetna of AZ Commercial	$1,198.80
Rate for Payer: Aetna of AZ Medicare	$372.96
Rate for Payer: Allwell Medicare	$199.80
Rate for Payer: Amerigroup Medicare	$199.80
Rate for Payer: APIPA Medicare/Medicaid	$497.50
Rate for Payer: AZCH Complete Medicare	$199.80
Rate for Payer: Banner UC Health Medicare	$199.80
Rate for Payer: Bisbee Police All Plans	$346.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$905.76
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cigna of AZ Commercial	$932.40
Rate for Payer: Copperpoint Commercial	$329.67
Rate for Payer: Health Net of AZ Commercial	$799.20
Rate for Payer: Health Net of AZ Medicare	$372.96
Rate for Payer: Humana of AZ Medicare	$199.80
Rate for Payer: Self Pay Self Pay	$1,065.60
Rate for Payer: TriWest Medicare	$199.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$776.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$239.76

TRAY GAUZE X-RAY 4X4 OPAQUE

Facility

$19.00

Hospital Charge Code	22355761
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Aetna of AZ Medicare	$5.32
Rate for Payer: Allwell Medicare	$2.85
Rate for Payer: Amerigroup Medicare	$2.85
Rate for Payer: APIPA Medicare/Medicaid	$7.10
Rate for Payer: AZCH Complete Medicare	$2.85
Rate for Payer: Banner UC Health Medicare	$2.85
Rate for Payer: Bisbee Police All Plans	$4.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.92
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of AZ Commercial	$13.30
Rate for Payer: Copperpoint Commercial	$4.70
Rate for Payer: Health Net of AZ Commercial	$11.40
Rate for Payer: Health Net of AZ Medicare	$5.32
Rate for Payer: Humana of AZ Medicare	$2.85
Rate for Payer: Self Pay Self Pay	$15.20
Rate for Payer: TriWest Medicare	$2.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.42

TRAY GAUZE X-RAY 4X4 OPAQUE

Facility

$19.00

Hospital Charge Code	22355761
Hospital Revenue Code	272
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Bisbee Police All Plans	$4.94
Rate for Payer: Cash Price	$15.20
Rate for Payer: Self Pay Self Pay	$15.20

TRAY IRRIG PISTON SYRINGE 70CC

Facility

$9.00

Hospital Charge Code	22355319
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

TRAY IRRIG PISTON SYRINGE 70CC

Facility

$9.00

Hospital Charge Code	22355319
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

TRAY LACERATION STR ER

Facility

$34.00

Hospital Charge Code	22355311
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Aetna of AZ Medicare	$9.52
Rate for Payer: Allwell Medicare	$5.10
Rate for Payer: Amerigroup Medicare	$5.10
Rate for Payer: APIPA Medicare/Medicaid	$12.70
Rate for Payer: AZCH Complete Medicare	$5.10
Rate for Payer: Banner UC Health Medicare	$5.10
Rate for Payer: Bisbee Police All Plans	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.12
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna of AZ Commercial	$23.80
Rate for Payer: Copperpoint Commercial	$8.42
Rate for Payer: Health Net of AZ Commercial	$20.40
Rate for Payer: Health Net of AZ Medicare	$9.52
Rate for Payer: Humana of AZ Medicare	$5.10
Rate for Payer: Self Pay Self Pay	$27.20
Rate for Payer: TriWest Medicare	$5.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.12

Know your out-of-pocket cost for care.

All Charges