Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TRAY EZ PREP

Facility

$41.00

Hospital Charge Code	22355323
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
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	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
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	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

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 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 10CC W/O BAG

Facility

$155.00

Hospital Charge Code	22355307
Hospital Revenue Code	270
Min. Negotiated Rate	$24.80
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	$24.80
Rate for Payer: Amerigroup Medicare	$24.80
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
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	$24.80
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

TRAY FOLEY 18F AUTO

Facility

$43.00

Service Code	CPT A4314
Hospital Charge Code	22354964
Hospital Revenue Code	270
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of AZ Commercial	$38.70
Rate for Payer: Aetna of AZ Medicare	$12.04
Rate for Payer: Allwell Medicare	$6.88
Rate for Payer: Amerigroup Medicare	$6.88
Rate for Payer: APIPA Medicare/Medicaid	$16.06
Rate for Payer: AZCH Complete Medicare	$6.88
Rate for Payer: Banner UC Health Medicare	$6.88
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: 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	$6.88
Rate for Payer: Self Pay Self Pay	$34.40
Rate for Payer: TriWest Medicare	$6.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.74

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 GASTROSTOMY 20F

Facility

$1,332.00

Hospital Charge Code	22354768
Hospital Revenue Code	270
Min. Negotiated Rate	$213.12
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	$213.12
Rate for Payer: Amerigroup Medicare	$213.12
Rate for Payer: APIPA Medicare/Medicaid	$497.50
Rate for Payer: AZCH Complete Medicare	$213.12
Rate for Payer: Banner UC Health Medicare	$213.12
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	$213.12
Rate for Payer: Self Pay Self Pay	$1,065.60
Rate for Payer: TriWest Medicare	$213.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$776.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$239.76

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 IRRIG PISTON SYRINGE 70CC

Facility

$9.00

Hospital Charge Code	22355319
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
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	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
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	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

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 LACERATION STR ER

Facility

$34.00

Hospital Charge Code	22355311
Hospital Revenue Code	270
Min. Negotiated Rate	$5.44
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	$5.44
Rate for Payer: Amerigroup Medicare	$5.44
Rate for Payer: APIPA Medicare/Medicaid	$12.70
Rate for Payer: AZCH Complete Medicare	$5.44
Rate for Payer: Banner UC Health Medicare	$5.44
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	$8.41
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	$5.44
Rate for Payer: Self Pay Self Pay	$27.20
Rate for Payer: TriWest Medicare	$5.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.12

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	$22.88
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	$22.88
Rate for Payer: Amerigroup Medicare	$22.88
Rate for Payer: APIPA Medicare/Medicaid	$53.41
Rate for Payer: AZCH Complete Medicare	$22.88
Rate for Payer: Banner UC Health Medicare	$22.88
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	$22.88
Rate for Payer: Self Pay Self Pay	$114.40
Rate for Payer: TriWest Medicare	$22.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$83.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.74

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 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	$25.44
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	$25.44
Rate for Payer: Amerigroup Medicare	$25.44
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
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	$25.44
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$25.44
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	$12.00
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	$12.00
Rate for Payer: Amerigroup Medicare	$12.00
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicare	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
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	$12.00
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

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 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	$1.28
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	$1.28
Rate for Payer: Amerigroup Medicare	$1.28
Rate for Payer: APIPA Medicare/Medicaid	$2.99
Rate for Payer: AZCH Complete Medicare	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
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	$1.28
Rate for Payer: Self Pay Self Pay	$6.40
Rate for Payer: TriWest Medicare	$1.28
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	$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 THORACENTESIS

Facility

$161.00

Hospital Charge Code	22354948
Hospital Revenue Code	270
Min. Negotiated Rate	$25.76
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	$25.76
Rate for Payer: Amerigroup Medicare	$25.76
Rate for Payer: APIPA Medicare/Medicaid	$60.13
Rate for Payer: AZCH Complete Medicare	$25.76
Rate for Payer: Banner UC Health Medicare	$25.76
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	$25.76
Rate for Payer: Self Pay Self Pay	$128.80
Rate for Payer: TriWest Medicare	$25.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.98

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	$1.44
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	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
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	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
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

Know your out-of-pocket cost for care.

All Charges