Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TRAY UROLOGICAL 18F

Facility

$1,511.00

Hospital Charge Code	22354267
Hospital Revenue Code	270
Min. Negotiated Rate	$241.76
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	$241.76
Rate for Payer: Amerigroup Medicare	$241.76
Rate for Payer: APIPA Medicare/Medicaid	$564.36
Rate for Payer: AZCH Complete Medicare	$241.76
Rate for Payer: Banner UC Health Medicare	$241.76
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	$241.76
Rate for Payer: Self Pay Self Pay	$1,208.80
Rate for Payer: TriWest Medicare	$241.76
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	$0.03
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 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 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

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	$1.10
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna of AZ Commercial	$6.20
Rate for Payer: Aetna of AZ Medicare	$1.93
Rate for Payer: Allwell Medicare	$1.10
Rate for Payer: Amerigroup Medicare	$1.10
Rate for Payer: APIPA Medicare/Medicaid	$2.57
Rate for Payer: AZCH Complete Medicare	$1.10
Rate for Payer: Banner UC Health Medicare	$1.10
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: 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	$1.10
Rate for Payer: Self Pay Self Pay	$5.51
Rate for Payer: TriWest Medicare	$1.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.24

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	$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

TRIGGER POINT INJECTION

Facility

$227.00

Hospital Charge Code	22282950
Hospital Revenue Code	450
Min. Negotiated Rate	$59.02
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Bisbee Police All Plans	$59.02
Rate for Payer: Cash Price	$181.60
Rate for Payer: Self Pay Self Pay	$181.60

TRIGGER POINT INJECTION

Facility

$227.00

Hospital Charge Code	22282950
Hospital Revenue Code	450
Min. Negotiated Rate	$36.32
Max. Negotiated Rate	$204.30
Rate for Payer: Aetna of AZ Commercial	$204.30
Rate for Payer: Aetna of AZ Medicare	$63.56
Rate for Payer: Allwell Medicare	$36.32
Rate for Payer: Amerigroup Medicare	$36.32
Rate for Payer: APIPA Medicare/Medicaid	$84.78
Rate for Payer: AZCH Complete Medicare	$36.32
Rate for Payer: Banner UC Health Medicare	$36.32
Rate for Payer: Bisbee Police All Plans	$59.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$154.36
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cigna of AZ Commercial	$158.90
Rate for Payer: Copperpoint Commercial	$56.18
Rate for Payer: Health Net of AZ Commercial	$136.20
Rate for Payer: Health Net of AZ Medicare	$63.56
Rate for Payer: Humana of AZ Medicare	$36.32
Rate for Payer: Self Pay Self Pay	$181.60
Rate for Payer: TriWest Medicare	$36.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.86

Triglycerides

Facility

$129.00

Service Code	CPT 84478
Hospital Charge Code	633852
Hospital Revenue Code	301
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Aetna of AZ Medicare	$36.12
Rate for Payer: Allwell Medicare	$20.64
Rate for Payer: Amerigroup Medicare	$20.64
Rate for Payer: APIPA Medicare/Medicaid	$48.18
Rate for Payer: AZCH Complete Medicare	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.72
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Copperpoint Commercial	$31.93
Rate for Payer: Health Net of AZ Commercial	$77.40
Rate for Payer: Health Net of AZ Medicare	$36.12
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Self Pay Self Pay	$103.20
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.22

Triglycerides

Facility

$129.00

Service Code	CPT 84478
Hospital Charge Code	633852
Hospital Revenue Code	301
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Cash Price	$103.20
Rate for Payer: Self Pay Self Pay	$103.20

Triiodothyronine,Free,Serum LC

Facility

$451.00

Service Code	CPT 84481
Hospital Charge Code	1285541
Hospital Revenue Code	301
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$405.90
Rate for Payer: Aetna of AZ Commercial	$405.90
Rate for Payer: Aetna of AZ Medicare	$126.28
Rate for Payer: Allwell Medicare	$72.16
Rate for Payer: Amerigroup Medicare	$72.16
Rate for Payer: APIPA Medicare/Medicaid	$168.45
Rate for Payer: AZCH Complete Medicare	$72.16
Rate for Payer: Banner UC Health Medicare	$72.16
Rate for Payer: Bisbee Police All Plans	$117.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$306.68
Rate for Payer: Cash Price	$360.80
Rate for Payer: Cigna of AZ Commercial	$293.15
Rate for Payer: Copperpoint Commercial	$111.62
Rate for Payer: Health Net of AZ Commercial	$270.60
Rate for Payer: Health Net of AZ Medicare	$126.28
Rate for Payer: Humana of AZ Medicare	$72.16
Rate for Payer: Self Pay Self Pay	$360.80
Rate for Payer: TriWest Medicare	$72.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$262.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$81.18

Triiodothyronine,Free,Serum LC

Facility

$451.00

Service Code	CPT 84481
Hospital Charge Code	1285541
Hospital Revenue Code	301
Min. Negotiated Rate	$117.26
Max. Negotiated Rate	$405.90
Rate for Payer: Aetna of AZ Commercial	$405.90
Rate for Payer: Bisbee Police All Plans	$117.26
Rate for Payer: Cash Price	$360.80
Rate for Payer: Self Pay Self Pay	$360.80

Triiodothyronine (T3) LC

Facility

$258.00

Service Code	CPT 84480
Hospital Charge Code	1285540
Hospital Revenue Code	301
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

Triiodothyronine (T3) LC

Facility

$258.00

Service Code	CPT 84480
Hospital Charge Code	1285540
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: Allwell Medicare	$41.28
Rate for Payer: Amerigroup Medicare	$41.28
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicare	$41.28
Rate for Payer: Banner UC Health Medicare	$41.28
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$167.70
Rate for Payer: Copperpoint Commercial	$63.85
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$41.28
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$41.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER CQCH

Facility

$39.00

Service Code	CPT 11719
Hospital Charge Code	24049505
Hospital Revenue Code	360
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER CQCH

Facility

$39.00

Service Code	CPT 11719
Hospital Charge Code	24049505
Hospital Revenue Code	360
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: AHCCCS Medicaid	$40.35
Rate for Payer: Allwell Medicaid	$40.35
Rate for Payer: Allwell Medicare	$6.24
Rate for Payer: Amerigroup Medicare	$6.24
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicaid	$40.35
Rate for Payer: AZCH Complete Medicare	$6.24
Rate for Payer: Banner UC Health Medicaid	$40.35
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Mercy Care Medicaid	$40.35
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

TRINITY 37CM

Facility

$1,352.00

Hospital Charge Code	27445199
Hospital Revenue Code	270
Min. Negotiated Rate	$216.32
Max. Negotiated Rate	$1,216.80
Rate for Payer: Aetna of AZ Commercial	$1,216.80
Rate for Payer: Aetna of AZ Medicare	$378.56
Rate for Payer: Allwell Medicare	$216.32
Rate for Payer: Amerigroup Medicare	$216.32
Rate for Payer: APIPA Medicare/Medicaid	$504.97
Rate for Payer: AZCH Complete Medicare	$216.32
Rate for Payer: Banner UC Health Medicare	$216.32
Rate for Payer: Bisbee Police All Plans	$351.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$919.36
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Cigna of AZ Commercial	$946.40
Rate for Payer: Copperpoint Commercial	$334.62
Rate for Payer: Health Net of AZ Commercial	$811.20
Rate for Payer: Health Net of AZ Medicare	$378.56
Rate for Payer: Humana of AZ Medicare	$216.32
Rate for Payer: Self Pay Self Pay	$1,081.60
Rate for Payer: TriWest Medicare	$216.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$788.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$243.36

TRINITY 37CM

Facility

$1,352.00

Hospital Charge Code	27445199
Hospital Revenue Code	270
Min. Negotiated Rate	$351.52
Max. Negotiated Rate	$1,216.80
Rate for Payer: Aetna of AZ Commercial	$1,216.80
Rate for Payer: Bisbee Police All Plans	$351.52
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Self Pay Self Pay	$1,081.60

TRITOME TRIPLE EDGE RELEASE INSTRUMENT

Facility

$4,975.00

Hospital Charge Code	27820410
Hospital Revenue Code	270
Min. Negotiated Rate	$1,293.50
Max. Negotiated Rate	$4,477.50
Rate for Payer: Aetna of AZ Commercial	$4,477.50
Rate for Payer: Bisbee Police All Plans	$1,293.50
Rate for Payer: Cash Price	$3,980.00
Rate for Payer: Self Pay Self Pay	$3,980.00

TRITOME TRIPLE EDGE RELEASE INSTRUMENT

Facility

$4,975.00

Hospital Charge Code	27820410
Hospital Revenue Code	270
Min. Negotiated Rate	$796.00
Max. Negotiated Rate	$4,477.50
Rate for Payer: Aetna of AZ Commercial	$4,477.50
Rate for Payer: Aetna of AZ Medicare	$1,393.00
Rate for Payer: Allwell Medicare	$796.00
Rate for Payer: Amerigroup Medicare	$796.00
Rate for Payer: APIPA Medicare/Medicaid	$1,858.16
Rate for Payer: AZCH Complete Medicare	$796.00
Rate for Payer: Banner UC Health Medicare	$796.00
Rate for Payer: Bisbee Police All Plans	$1,293.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,383.00
Rate for Payer: Cash Price	$3,980.00
Rate for Payer: Cigna of AZ Commercial	$3,482.50
Rate for Payer: Copperpoint Commercial	$1,231.31
Rate for Payer: Health Net of AZ Commercial	$2,985.00
Rate for Payer: Health Net of AZ Medicare	$1,393.00
Rate for Payer: Humana of AZ Medicare	$796.00
Rate for Payer: Self Pay Self Pay	$3,980.00
Rate for Payer: TriWest Medicare	$796.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,900.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$895.50

TROCAR 10-12MM (LONG) CONMED

Facility

$909.00

Hospital Charge Code	22354203
Hospital Revenue Code	270
Min. Negotiated Rate	$145.44
Max. Negotiated Rate	$818.10
Rate for Payer: Aetna of AZ Commercial	$818.10
Rate for Payer: Aetna of AZ Medicare	$254.52
Rate for Payer: Allwell Medicare	$145.44
Rate for Payer: Amerigroup Medicare	$145.44
Rate for Payer: APIPA Medicare/Medicaid	$339.51
Rate for Payer: AZCH Complete Medicare	$145.44
Rate for Payer: Banner UC Health Medicare	$145.44
Rate for Payer: Bisbee Police All Plans	$236.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$618.12
Rate for Payer: Cash Price	$727.20
Rate for Payer: Cigna of AZ Commercial	$636.30
Rate for Payer: Copperpoint Commercial	$224.98
Rate for Payer: Health Net of AZ Commercial	$545.40
Rate for Payer: Health Net of AZ Medicare	$254.52
Rate for Payer: Humana of AZ Medicare	$145.44
Rate for Payer: Self Pay Self Pay	$727.20
Rate for Payer: TriWest Medicare	$145.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$529.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$163.62

TROCAR 10-12MM (LONG) CONMED

Facility

$909.00

Hospital Charge Code	22354203
Hospital Revenue Code	270
Min. Negotiated Rate	$236.34
Max. Negotiated Rate	$818.10
Rate for Payer: Aetna of AZ Commercial	$818.10
Rate for Payer: Bisbee Police All Plans	$236.34
Rate for Payer: Cash Price	$727.20
Rate for Payer: Self Pay Self Pay	$727.20

Know your out-of-pocket cost for care.

All Charges