Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TRACH STRAP CHILD ADULT HOOK AND L

Facility

$13.00

Hospital Charge Code	23549206
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
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	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
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	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

TRACH STRAP CHILD ADULT HOOK AND L

Facility

$13.00

Hospital Charge Code	23549206
Hospital Revenue Code	270
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

traMADol 50 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904636561
Hospital Charge Code	105944199
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

traMADol 50 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904636561
Hospital Charge Code	105944199
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

tranexamic acid 100 mg/mL 10 ml inj[CQCH]

Facility

$0.21

Service Code	NDC 81284061110
Hospital Charge Code	241912544
Hospital Revenue Code	250
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

tranexamic acid 100 mg/mL 10 ml inj[CQCH]

Facility

$0.21

Service Code	NDC 81284061110
Hospital Charge Code	241912544
Hospital Revenue Code	250
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

tranexamic acid 10 mg/mL-NaCl 0.7% Sol[CQCH]

Facility

$0.01

Service Code	NDC 51754010803
Hospital Charge Code	197259247
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

tranexamic acid 10 mg/mL-NaCl 0.7% Sol[CQCH]

Facility

$0.01

Service Code	NDC 51754010803
Hospital Charge Code	197259247
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

TRANSCORTIN (CORTISOL BINDING GLOBULIN)

Facility

$90.00

Service Code	CPT 84449
Hospital Charge Code	28010046
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

TRANSCORTIN (CORTISOL BINDING GLOBULIN)

Facility

$90.00

Service Code	CPT 84449
Hospital Charge Code	28010046
Hospital Revenue Code	302
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$14.40
Rate for Payer: Amerigroup Medicare	$14.40
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$58.50
Rate for Payer: Copperpoint Commercial	$22.27
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

Transferrin LC

Facility

$189.00

Service Code	CPT 84466
Hospital Charge Code	1909569
Hospital Revenue Code	301
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Cash Price	$151.20
Rate for Payer: Self Pay Self Pay	$151.20

Transferrin LC

Facility

$189.00

Service Code	CPT 84466
Hospital Charge Code	1909569
Hospital Revenue Code	301
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Aetna of AZ Medicare	$52.92
Rate for Payer: Allwell Medicare	$30.24
Rate for Payer: Amerigroup Medicare	$30.24
Rate for Payer: APIPA Medicare/Medicaid	$70.59
Rate for Payer: AZCH Complete Medicare	$30.24
Rate for Payer: Banner UC Health Medicare	$30.24
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$128.52
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna of AZ Commercial	$122.85
Rate for Payer: Copperpoint Commercial	$46.78
Rate for Payer: Health Net of AZ Commercial	$113.40
Rate for Payer: Health Net of AZ Medicare	$52.92
Rate for Payer: Humana of AZ Medicare	$30.24
Rate for Payer: Self Pay Self Pay	$151.20
Rate for Payer: TriWest Medicare	$30.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$110.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.02

Transient Ischemia

Facility

$4,300.98

Service Code	APR-DRG 0471
Hospital Charge Code	APRDRG0473
Min. Negotiated Rate	$4,300.98
Max. Negotiated Rate	$4,300.98
Rate for Payer: AHCCCS Medicaid	$4,300.98
Rate for Payer: Allwell Medicaid	$4,300.98
Rate for Payer: AZCH Complete Medicaid	$4,300.98
Rate for Payer: Banner UC Health Medicaid	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98

Transient Ischemia

Facility

$4,765.31

Service Code	APR-DRG 0472
Hospital Charge Code	APRDRG0471
Min. Negotiated Rate	$4,765.31
Max. Negotiated Rate	$4,765.31
Rate for Payer: AHCCCS Medicaid	$4,765.31
Rate for Payer: Allwell Medicaid	$4,765.31
Rate for Payer: AZCH Complete Medicaid	$4,765.31
Rate for Payer: Banner UC Health Medicaid	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31

Transient Ischemia

Facility

$4,300.98

Service Code	APR-DRG 0471
Hospital Charge Code	APRDRG0472
Min. Negotiated Rate	$4,300.98
Max. Negotiated Rate	$4,300.98
Rate for Payer: AHCCCS Medicaid	$4,300.98
Rate for Payer: Allwell Medicaid	$4,300.98
Rate for Payer: AZCH Complete Medicaid	$4,300.98
Rate for Payer: Banner UC Health Medicaid	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98

Transient Ischemia

Facility

$11,383.72

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG0473
Min. Negotiated Rate	$11,383.72
Max. Negotiated Rate	$11,383.72
Rate for Payer: AHCCCS Medicaid	$11,383.72
Rate for Payer: Allwell Medicaid	$11,383.72
Rate for Payer: AZCH Complete Medicaid	$11,383.72
Rate for Payer: Banner UC Health Medicaid	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72

Transient Ischemia

Facility

$4,300.98

Service Code	APR-DRG 0471
Hospital Charge Code	APRDRG0474
Min. Negotiated Rate	$4,300.98
Max. Negotiated Rate	$4,300.98
Rate for Payer: AHCCCS Medicaid	$4,300.98
Rate for Payer: Allwell Medicaid	$4,300.98
Rate for Payer: AZCH Complete Medicaid	$4,300.98
Rate for Payer: Banner UC Health Medicaid	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98

Transient Ischemia

Facility

$6,159.69

Service Code	APR-DRG 0473
Hospital Charge Code	APRDRG0474
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Transient Ischemia

Facility

$6,159.69

Service Code	APR-DRG 0473
Hospital Charge Code	APRDRG0473
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Transient Ischemia

Facility

$11,383.72

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG0471
Min. Negotiated Rate	$11,383.72
Max. Negotiated Rate	$11,383.72
Rate for Payer: AHCCCS Medicaid	$11,383.72
Rate for Payer: Allwell Medicaid	$11,383.72
Rate for Payer: AZCH Complete Medicaid	$11,383.72
Rate for Payer: Banner UC Health Medicaid	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72

Transient Ischemia

Facility

$6,159.69

Service Code	APR-DRG 0473
Hospital Charge Code	APRDRG0472
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Transient Ischemia

Facility

$6,159.69

Service Code	APR-DRG 0473
Hospital Charge Code	APRDRG0471
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Transient Ischemia

Facility

$4,300.98

Service Code	APR-DRG 0471
Hospital Charge Code	APRDRG0471
Min. Negotiated Rate	$4,300.98
Max. Negotiated Rate	$4,300.98
Rate for Payer: AHCCCS Medicaid	$4,300.98
Rate for Payer: Allwell Medicaid	$4,300.98
Rate for Payer: AZCH Complete Medicaid	$4,300.98
Rate for Payer: Banner UC Health Medicaid	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98

Transient Ischemia

Facility

$4,765.31

Service Code	APR-DRG 0472
Hospital Charge Code	APRDRG0473
Min. Negotiated Rate	$4,765.31
Max. Negotiated Rate	$4,765.31
Rate for Payer: AHCCCS Medicaid	$4,765.31
Rate for Payer: Allwell Medicaid	$4,765.31
Rate for Payer: AZCH Complete Medicaid	$4,765.31
Rate for Payer: Banner UC Health Medicaid	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31

Transient Ischemia

Facility

$4,765.31

Service Code	APR-DRG 0472
Hospital Charge Code	APRDRG0474
Min. Negotiated Rate	$4,765.31
Max. Negotiated Rate	$4,765.31
Rate for Payer: AHCCCS Medicaid	$4,765.31
Rate for Payer: Allwell Medicaid	$4,765.31
Rate for Payer: AZCH Complete Medicaid	$4,765.31
Rate for Payer: Banner UC Health Medicaid	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31

Know your out-of-pocket cost for care.

All Charges