Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TRAY LACERATION STR ER

Facility

$34.00

Hospital Charge Code	22355311
Hospital Revenue Code	270
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna of AZ Commercial	$30.60
Rate for Payer: Bisbee Police All Plans	$8.84
Rate for Payer: Cash Price	$27.20
Rate for Payer: Self Pay Self Pay	$27.20

TRAY LUMBAR ADULT

Facility

$143.00

Hospital Charge Code	22354932
Hospital Revenue Code	270
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Bisbee Police All Plans	$37.18
Rate for Payer: Cash Price	$114.40
Rate for Payer: Self Pay Self Pay	$114.40

TRAY LUMBAR ADULT

Facility

$143.00

Hospital Charge Code	22354932
Hospital Revenue Code	270
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Aetna of AZ Medicare	$40.04
Rate for Payer: Allwell Medicare	$21.45
Rate for Payer: Amerigroup Medicare	$21.45
Rate for Payer: APIPA Medicare/Medicaid	$53.41
Rate for Payer: AZCH Complete Medicare	$21.45
Rate for Payer: Banner UC Health Medicare	$21.45
Rate for Payer: Bisbee Police All Plans	$37.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$97.24
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Copperpoint Commercial	$35.39
Rate for Payer: Health Net of AZ Commercial	$85.80
Rate for Payer: Health Net of AZ Medicare	$40.04
Rate for Payer: Humana of AZ Medicare	$21.45
Rate for Payer: Self Pay Self Pay	$114.40
Rate for Payer: TriWest Medicare	$21.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$83.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.74

TRAY LUMBAR PED

Facility

$159.00

Hospital Charge Code	22354182
Hospital Revenue Code	270
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

TRAY LUMBAR PED

Facility

$159.00

Hospital Charge Code	22354182
Hospital Revenue Code	270
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: Allwell Medicare	$23.85
Rate for Payer: Amerigroup Medicare	$23.85
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$23.85
Rate for Payer: Banner UC Health Medicare	$23.85
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$111.30
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$23.85
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$23.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

TRAY SPINAL 25G WHITACRE

Facility

$75.00

Hospital Charge Code	22354922
Hospital Revenue Code	270
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Cash Price	$60.00
Rate for Payer: Self Pay Self Pay	$60.00

TRAY SPINAL 25G WHITACRE

Facility

$75.00

Hospital Charge Code	22354922
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Aetna of AZ Medicare	$21.00
Rate for Payer: Allwell Medicare	$11.25
Rate for Payer: Amerigroup Medicare	$11.25
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicare	$11.25
Rate for Payer: Banner UC Health Medicare	$11.25
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Copperpoint Commercial	$18.56
Rate for Payer: Health Net of AZ Commercial	$45.00
Rate for Payer: Health Net of AZ Medicare	$21.00
Rate for Payer: Humana of AZ Medicare	$11.25
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$11.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

TRAY SUTURE REMOVAL SET

Facility

$8.00

Hospital Charge Code	22355579
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Cash Price	$6.40
Rate for Payer: Self Pay Self Pay	$6.40

TRAY SUTURE REMOVAL SET

Facility

$8.00

Hospital Charge Code	22355579
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Aetna of AZ Medicare	$2.24
Rate for Payer: Allwell Medicare	$1.20
Rate for Payer: Amerigroup Medicare	$1.20
Rate for Payer: APIPA Medicare/Medicaid	$2.99
Rate for Payer: AZCH Complete Medicare	$1.20
Rate for Payer: Banner UC Health Medicare	$1.20
Rate for Payer: Bisbee Police All Plans	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.44
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Copperpoint Commercial	$1.98
Rate for Payer: Health Net of AZ Commercial	$4.80
Rate for Payer: Health Net of AZ Medicare	$2.24
Rate for Payer: Humana of AZ Medicare	$1.20
Rate for Payer: Self Pay Self Pay	$6.40
Rate for Payer: TriWest Medicare	$1.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.44

TRAY THORACENTESIS

Facility

$161.00

Hospital Charge Code	22354948
Hospital Revenue Code	270
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Aetna of AZ Medicare	$45.08
Rate for Payer: Allwell Medicare	$24.15
Rate for Payer: Amerigroup Medicare	$24.15
Rate for Payer: APIPA Medicare/Medicaid	$60.13
Rate for Payer: AZCH Complete Medicare	$24.15
Rate for Payer: Banner UC Health Medicare	$24.15
Rate for Payer: Bisbee Police All Plans	$41.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$109.48
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cigna of AZ Commercial	$112.70
Rate for Payer: Copperpoint Commercial	$39.85
Rate for Payer: Health Net of AZ Commercial	$96.60
Rate for Payer: Health Net of AZ Medicare	$45.08
Rate for Payer: Humana of AZ Medicare	$24.15
Rate for Payer: Self Pay Self Pay	$128.80
Rate for Payer: TriWest Medicare	$24.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.98

TRAY THORACENTESIS

Facility

$161.00

Hospital Charge Code	22354948
Hospital Revenue Code	270
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$144.90
Rate for Payer: Aetna of AZ Commercial	$144.90
Rate for Payer: Bisbee Police All Plans	$41.86
Rate for Payer: Cash Price	$128.80
Rate for Payer: Self Pay Self Pay	$128.80

TRAY THORA PARA

Facility

$209.00

Hospital Charge Code	22355049
Hospital Revenue Code	272
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna of AZ Commercial	$188.10
Rate for Payer: Aetna of AZ Medicare	$58.52
Rate for Payer: Allwell Medicare	$31.35
Rate for Payer: Amerigroup Medicare	$31.35
Rate for Payer: APIPA Medicare/Medicaid	$78.06
Rate for Payer: AZCH Complete Medicare	$31.35
Rate for Payer: Banner UC Health Medicare	$31.35
Rate for Payer: Bisbee Police All Plans	$54.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$142.12
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cigna of AZ Commercial	$146.30
Rate for Payer: Copperpoint Commercial	$51.73
Rate for Payer: Health Net of AZ Commercial	$125.40
Rate for Payer: Health Net of AZ Medicare	$58.52
Rate for Payer: Humana of AZ Medicare	$31.35
Rate for Payer: Self Pay Self Pay	$167.20
Rate for Payer: TriWest Medicare	$31.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$121.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.62

TRAY THORA PARA

Facility

$209.00

Hospital Charge Code	22355049
Hospital Revenue Code	272
Min. Negotiated Rate	$54.34
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna of AZ Commercial	$188.10
Rate for Payer: Bisbee Police All Plans	$54.34
Rate for Payer: Cash Price	$167.20
Rate for Payer: Self Pay Self Pay	$167.20

TRAY TRACH CLEAN

Facility

$9.00

Hospital Charge Code	22355352
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 TRACH CLEAN

Facility

$9.00

Hospital Charge Code	22355352
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

TRAY UROLOGICAL 18F

Facility

$1,511.00

Hospital Charge Code	22354267
Hospital Revenue Code	270
Min. Negotiated Rate	$392.86
Max. Negotiated Rate	$1,359.90
Rate for Payer: Aetna of AZ Commercial	$1,359.90
Rate for Payer: Bisbee Police All Plans	$392.86
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Self Pay Self Pay	$1,208.80

TRAY UROLOGICAL 18F

Facility

$1,511.00

Hospital Charge Code	22354267
Hospital Revenue Code	270
Min. Negotiated Rate	$226.65
Max. Negotiated Rate	$1,359.90
Rate for Payer: Aetna of AZ Commercial	$1,359.90
Rate for Payer: Aetna of AZ Medicare	$423.08
Rate for Payer: Allwell Medicare	$226.65
Rate for Payer: Amerigroup Medicare	$226.65
Rate for Payer: APIPA Medicare/Medicaid	$564.36
Rate for Payer: AZCH Complete Medicare	$226.65
Rate for Payer: Banner UC Health Medicare	$226.65
Rate for Payer: Bisbee Police All Plans	$392.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,027.48
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Cigna of AZ Commercial	$1,057.70
Rate for Payer: Copperpoint Commercial	$373.97
Rate for Payer: Health Net of AZ Commercial	$906.60
Rate for Payer: Health Net of AZ Medicare	$423.08
Rate for Payer: Humana of AZ Medicare	$226.65
Rate for Payer: Self Pay Self Pay	$1,208.80
Rate for Payer: TriWest Medicare	$226.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$880.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$271.98

traZODone 100 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 904686961
Hospital Charge Code	105944266
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.14

traZODone 100 mg Tab [CQCH]

Facility

$0.17

Service Code	NDC 904686961
Hospital Charge Code	105944266
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Aetna of AZ Medicare	$0.05
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.12
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.11
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

triamcinolone 0.1% Top Crm 30Gm [CQCH]

Facility

$0.21

Service Code	NDC 603786278
Hospital Charge Code	105944407
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.17
Rate for Payer: Self Pay Self Pay	$0.17

triamcinolone 0.1% Top Crm 30Gm [CQCH]

Facility

$0.21

Service Code	NDC 603786278
Hospital Charge Code	105944407
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.08
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.14
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.13
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.17
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

triamcinolone acetonide 40 mg/1 mL IM Inj [CQCH]

Facility

$6.89

Service Code	HCPCS J3300
Hospital Charge Code	105944336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$7.96
Rate for Payer: Aetna of AZ Commercial	$6.20
Rate for Payer: Aetna of AZ Medicare	$1.93
Rate for Payer: AHCCCS Medicaid	$7.96
Rate for Payer: Allwell Medicaid	$7.96
Rate for Payer: Allwell Medicare	$1.03
Rate for Payer: Amerigroup Medicare	$1.03
Rate for Payer: APIPA Medicare/Medicaid	$2.57
Rate for Payer: AZCH Complete Medicaid	$7.96
Rate for Payer: AZCH Complete Medicare	$1.03
Rate for Payer: Banner UC Health Medicaid	$7.96
Rate for Payer: Banner UC Health Medicare	$1.03
Rate for Payer: Bisbee Police All Plans	$1.79
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.69
Rate for Payer: Cash Price	$5.52
Rate for Payer: Cash Price	$5.52
Rate for Payer: Cigna of AZ Commercial	$4.48
Rate for Payer: Copperpoint Commercial	$1.71
Rate for Payer: Health Net of AZ Commercial	$4.13
Rate for Payer: Health Net of AZ Medicare	$1.93
Rate for Payer: Humana of AZ Medicare	$1.03
Rate for Payer: Mercy Care Medicaid	$7.96
Rate for Payer: Self Pay Self Pay	$5.51
Rate for Payer: TriWest Medicare	$1.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.24

triamcinolone acetonide 40 mg/1 mL IM Inj [CQCH]

Facility

$6.89

Service Code	HCPCS J3300
Hospital Charge Code	105944336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna of AZ Commercial	$6.20
Rate for Payer: Bisbee Police All Plans	$1.79
Rate for Payer: Cash Price	$5.52
Rate for Payer: Self Pay Self Pay	$5.51

TRI FLOW RESP

Facility

$26.00

Hospital Charge Code	22355210
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

TRI FLOW RESP

Facility

$26.00

Hospital Charge Code	22355210
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
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	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
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	$6.44
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	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

Know your out-of-pocket cost for care.

All Charges