Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TROCAR 12MM BLADELESS

Facility

$1,198.00

Hospital Charge Code	22528801
Hospital Revenue Code	270
Min. Negotiated Rate	$191.68
Max. Negotiated Rate	$1,078.20
Rate for Payer: Aetna of AZ Commercial	$1,078.20
Rate for Payer: Aetna of AZ Medicare	$335.44
Rate for Payer: Allwell Medicare	$191.68
Rate for Payer: Amerigroup Medicare	$191.68
Rate for Payer: APIPA Medicare/Medicaid	$447.45
Rate for Payer: AZCH Complete Medicare	$191.68
Rate for Payer: Banner UC Health Medicare	$191.68
Rate for Payer: Bisbee Police All Plans	$311.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$814.64
Rate for Payer: Cash Price	$958.40
Rate for Payer: Cigna of AZ Commercial	$838.60
Rate for Payer: Copperpoint Commercial	$296.50
Rate for Payer: Health Net of AZ Commercial	$718.80
Rate for Payer: Health Net of AZ Medicare	$335.44
Rate for Payer: Humana of AZ Medicare	$191.68
Rate for Payer: Self Pay Self Pay	$958.40
Rate for Payer: TriWest Medicare	$191.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$698.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$215.64

TROCAR 12MM BLADELESS

Facility

$1,198.00

Hospital Charge Code	22528801
Hospital Revenue Code	270
Min. Negotiated Rate	$311.48
Max. Negotiated Rate	$1,078.20
Rate for Payer: Aetna of AZ Commercial	$1,078.20
Rate for Payer: Bisbee Police All Plans	$311.48
Rate for Payer: Cash Price	$958.40
Rate for Payer: Self Pay Self Pay	$958.40

TROCAR 5-11MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354204
Hospital Revenue Code	270
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Aetna of AZ Medicare	$294.84
Rate for Payer: Allwell Medicare	$168.48
Rate for Payer: Amerigroup Medicare	$168.48
Rate for Payer: APIPA Medicare/Medicaid	$393.30
Rate for Payer: AZCH Complete Medicare	$168.48
Rate for Payer: Banner UC Health Medicare	$168.48
Rate for Payer: Bisbee Police All Plans	$273.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$716.04
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cigna of AZ Commercial	$737.10
Rate for Payer: Copperpoint Commercial	$260.62
Rate for Payer: Health Net of AZ Commercial	$631.80
Rate for Payer: Health Net of AZ Medicare	$294.84
Rate for Payer: Humana of AZ Medicare	$168.48
Rate for Payer: Self Pay Self Pay	$842.40
Rate for Payer: TriWest Medicare	$168.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$613.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$189.54

TROCAR 5-11MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354204
Hospital Revenue Code	270
Min. Negotiated Rate	$273.78
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Bisbee Police All Plans	$273.78
Rate for Payer: Cash Price	$842.40
Rate for Payer: Self Pay Self Pay	$842.40

TROCAR 5-12MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354205
Hospital Revenue Code	270
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Aetna of AZ Medicare	$294.84
Rate for Payer: Allwell Medicare	$168.48
Rate for Payer: Amerigroup Medicare	$168.48
Rate for Payer: APIPA Medicare/Medicaid	$393.30
Rate for Payer: AZCH Complete Medicare	$168.48
Rate for Payer: Banner UC Health Medicare	$168.48
Rate for Payer: Bisbee Police All Plans	$273.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$716.04
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cigna of AZ Commercial	$737.10
Rate for Payer: Copperpoint Commercial	$260.62
Rate for Payer: Health Net of AZ Commercial	$631.80
Rate for Payer: Health Net of AZ Medicare	$294.84
Rate for Payer: Humana of AZ Medicare	$168.48
Rate for Payer: Self Pay Self Pay	$842.40
Rate for Payer: TriWest Medicare	$168.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$613.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$189.54

TROCAR 5-12MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354205
Hospital Revenue Code	270
Min. Negotiated Rate	$273.78
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Bisbee Police All Plans	$273.78
Rate for Payer: Cash Price	$842.40
Rate for Payer: Self Pay Self Pay	$842.40

TROCAR VERSAPORT 8MM

Facility

$398.00

Hospital Charge Code	22354264
Hospital Revenue Code	270
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$358.20
Rate for Payer: Aetna of AZ Commercial	$358.20
Rate for Payer: Bisbee Police All Plans	$103.48
Rate for Payer: Cash Price	$318.40
Rate for Payer: Self Pay Self Pay	$318.40

TROCAR VERSAPORT 8MM

Facility

$398.00

Hospital Charge Code	22354264
Hospital Revenue Code	270
Min. Negotiated Rate	$63.68
Max. Negotiated Rate	$358.20
Rate for Payer: Aetna of AZ Commercial	$358.20
Rate for Payer: Aetna of AZ Medicare	$111.44
Rate for Payer: Allwell Medicare	$63.68
Rate for Payer: Amerigroup Medicare	$63.68
Rate for Payer: APIPA Medicare/Medicaid	$148.65
Rate for Payer: AZCH Complete Medicare	$63.68
Rate for Payer: Banner UC Health Medicare	$63.68
Rate for Payer: Bisbee Police All Plans	$103.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$270.64
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cigna of AZ Commercial	$278.60
Rate for Payer: Copperpoint Commercial	$98.50
Rate for Payer: Health Net of AZ Commercial	$238.80
Rate for Payer: Health Net of AZ Medicare	$111.44
Rate for Payer: Humana of AZ Medicare	$63.68
Rate for Payer: Self Pay Self Pay	$318.40
Rate for Payer: TriWest Medicare	$63.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$232.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.64

TROCAR W/SHIELD 5MM CONMED

Facility

$203.00

Hospital Charge Code	22354869
Hospital Revenue Code	270
Min. Negotiated Rate	$32.48
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: Allwell Medicare	$32.48
Rate for Payer: Amerigroup Medicare	$32.48
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicare	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

TROCAR W/SHIELD 5MM CONMED

Facility

$203.00

Hospital Charge Code	22354869
Hospital Revenue Code	270
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

TROCAR XCEL BLADELESS 8MM

Facility

$186.00

Hospital Charge Code	22354868
Hospital Revenue Code	270
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: Allwell Medicare	$29.76
Rate for Payer: Amerigroup Medicare	$29.76
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicare	$29.76
Rate for Payer: Banner UC Health Medicare	$29.76
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$130.20
Rate for Payer: Copperpoint Commercial	$46.03
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$29.76
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$29.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

TROCAR XCEL BLADELESS 8MM

Facility

$186.00

Hospital Charge Code	22354868
Hospital Revenue Code	270
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Cash Price	$148.80
Rate for Payer: Self Pay Self Pay	$148.80

TROCLEAN TROCAR CLEANING DEVICE

Facility

$62.06

Hospital Charge Code	27446586
Hospital Revenue Code	270
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$55.85
Rate for Payer: Aetna of AZ Commercial	$55.85
Rate for Payer: Bisbee Police All Plans	$16.14
Rate for Payer: Cash Price	$49.65
Rate for Payer: Self Pay Self Pay	$49.65

TROCLEAN TROCAR CLEANING DEVICE

Facility

$62.06

Hospital Charge Code	27446586
Hospital Revenue Code	270
Min. Negotiated Rate	$9.93
Max. Negotiated Rate	$55.85
Rate for Payer: Aetna of AZ Commercial	$55.85
Rate for Payer: Aetna of AZ Medicare	$17.38
Rate for Payer: Allwell Medicare	$9.93
Rate for Payer: Amerigroup Medicare	$9.93
Rate for Payer: APIPA Medicare/Medicaid	$23.18
Rate for Payer: AZCH Complete Medicare	$9.93
Rate for Payer: Banner UC Health Medicare	$9.93
Rate for Payer: Bisbee Police All Plans	$16.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.20
Rate for Payer: Cash Price	$49.65
Rate for Payer: Cigna of AZ Commercial	$43.44
Rate for Payer: Copperpoint Commercial	$15.36
Rate for Payer: Health Net of AZ Commercial	$37.24
Rate for Payer: Health Net of AZ Medicare	$17.38
Rate for Payer: Humana of AZ Medicare	$9.93
Rate for Payer: Self Pay Self Pay	$49.65
Rate for Payer: TriWest Medicare	$9.93
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.17

Troponin

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	22525240
Hospital Revenue Code	301
Min. Negotiated Rate	$80.86
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Cash Price	$248.80
Rate for Payer: Self Pay Self Pay	$248.80

Troponin

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	22525240
Hospital Revenue Code	301
Min. Negotiated Rate	$49.76
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Aetna of AZ Medicare	$87.08
Rate for Payer: Allwell Medicare	$49.76
Rate for Payer: Amerigroup Medicare	$49.76
Rate for Payer: APIPA Medicare/Medicaid	$116.16
Rate for Payer: AZCH Complete Medicare	$49.76
Rate for Payer: Banner UC Health Medicare	$49.76
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$211.48
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Copperpoint Commercial	$76.97
Rate for Payer: Health Net of AZ Commercial	$186.60
Rate for Payer: Health Net of AZ Medicare	$87.08
Rate for Payer: Humana of AZ Medicare	$49.76
Rate for Payer: Self Pay Self Pay	$248.80
Rate for Payer: TriWest Medicare	$49.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$181.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.98

Troponin I

Facility

$295.00

Service Code	CPT 84484
Hospital Charge Code	908527
Hospital Revenue Code	301
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Cash Price	$236.00
Rate for Payer: Self Pay Self Pay	$236.00

Troponin I

Facility

$295.00

Service Code	CPT 84484
Hospital Charge Code	908527
Hospital Revenue Code	301
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Aetna of AZ Medicare	$82.60
Rate for Payer: Allwell Medicare	$47.20
Rate for Payer: Amerigroup Medicare	$47.20
Rate for Payer: APIPA Medicare/Medicaid	$110.18
Rate for Payer: AZCH Complete Medicare	$47.20
Rate for Payer: Banner UC Health Medicare	$47.20
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$200.60
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Copperpoint Commercial	$73.01
Rate for Payer: Health Net of AZ Commercial	$177.00
Rate for Payer: Health Net of AZ Medicare	$82.60
Rate for Payer: Humana of AZ Medicare	$47.20
Rate for Payer: Self Pay Self Pay	$236.00
Rate for Payer: TriWest Medicare	$47.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$171.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.10

TSH w/ Reflex to FT4

Facility

$242.00

Service Code	CPT 84443
Hospital Charge Code	15961923
Hospital Revenue Code	301
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Cash Price	$193.60
Rate for Payer: Self Pay Self Pay	$193.60

TSH w/ Reflex to FT4

Facility

$242.00

Service Code	CPT 84443
Hospital Charge Code	15961923
Hospital Revenue Code	301
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Medicare	$67.76
Rate for Payer: Allwell Medicare	$38.72
Rate for Payer: Amerigroup Medicare	$38.72
Rate for Payer: APIPA Medicare/Medicaid	$90.39
Rate for Payer: AZCH Complete Medicare	$38.72
Rate for Payer: Banner UC Health Medicare	$38.72
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$164.56
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$157.30
Rate for Payer: Copperpoint Commercial	$59.90
Rate for Payer: Health Net of AZ Commercial	$145.20
Rate for Payer: Health Net of AZ Medicare	$67.76
Rate for Payer: Humana of AZ Medicare	$38.72
Rate for Payer: Self Pay Self Pay	$193.60
Rate for Payer: TriWest Medicare	$38.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.56

.TT Mix+TTN LC

Facility

$124.00

Service Code	CPT 85670
Hospital Charge Code	1285818
Hospital Revenue Code	305
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Cash Price	$99.20
Rate for Payer: Self Pay Self Pay	$99.20

.TT Mix+TTN LC

Facility

$124.00

Service Code	CPT 85670
Hospital Charge Code	1285818
Hospital Revenue Code	305
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Aetna of AZ Medicare	$34.72
Rate for Payer: Allwell Medicare	$19.84
Rate for Payer: Amerigroup Medicare	$19.84
Rate for Payer: APIPA Medicare/Medicaid	$46.31
Rate for Payer: AZCH Complete Medicare	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$84.32
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Copperpoint Commercial	$30.69
Rate for Payer: Health Net of AZ Commercial	$74.40
Rate for Payer: Health Net of AZ Medicare	$34.72
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Self Pay Self Pay	$99.20
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.32

T TRANSGL IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481504
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

T TRANSGL IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481504
Hospital Revenue Code	301
Min. Negotiated Rate	$239.20
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: Allwell Medicare	$239.20
Rate for Payer: Amerigroup Medicare	$239.20
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicare	$239.20
Rate for Payer: Banner UC Health Medicare	$239.20
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$239.20
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$239.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

t-Transglutaminase (tTG) IgA LC

Facility

$1,422.00

Service Code	CPT 83516
Hospital Charge Code	2087656
Hospital Revenue Code	301
Min. Negotiated Rate	$227.52
Max. Negotiated Rate	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Aetna of AZ Medicare	$398.16
Rate for Payer: Allwell Medicare	$227.52
Rate for Payer: Amerigroup Medicare	$227.52
Rate for Payer: APIPA Medicare/Medicaid	$531.12
Rate for Payer: AZCH Complete Medicare	$227.52
Rate for Payer: Banner UC Health Medicare	$227.52
Rate for Payer: Bisbee Police All Plans	$369.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$966.96
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cigna of AZ Commercial	$924.30
Rate for Payer: Copperpoint Commercial	$351.94
Rate for Payer: Health Net of AZ Commercial	$853.20
Rate for Payer: Health Net of AZ Medicare	$398.16
Rate for Payer: Humana of AZ Medicare	$227.52
Rate for Payer: Self Pay Self Pay	$1,137.60
Rate for Payer: TriWest Medicare	$227.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$829.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$255.96

Know your out-of-pocket cost for care.

All Charges