Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

TRANSCORTIN (CORTISOL BINDING GLOBULIN)

Facility

$90.00

Service Code	CPT 84449
Hospital Charge Code	28010046
Hospital Revenue Code	302
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$58.50
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Seven Corners Travel Insurance	$26.10
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

TRANSCORTIN (CORTISOL BINDING GLOBULIN)

Facility

$90.00

Service Code	CPT 84449
Hospital Charge Code	28010046
Hospital Revenue Code	302
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

Transferrin LC

Facility

$189.00

Service Code	CPT 84466
Hospital Charge Code	1909569
Hospital Revenue Code	301
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Arizona Complete Health Allwell	$30.24
Rate for Payer: Banner UC Health Medicare	$30.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$128.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$30.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.24
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna of AZ Commercial	$122.85
Rate for Payer: Devoted Health Medicare	$34.02
Rate for Payer: Humana of AZ Medicare	$30.24
Rate for Payer: Seven Corners Travel Insurance	$18.50
Rate for Payer: Southwest Service Administrators UFCW	$128.52
Rate for Payer: TriWest Medicare	$30.24
Rate for Payer: United Healthcare Commercial	$108.11
Rate for Payer: United Healthcare Medicare	$30.24
Rate for Payer: Veterans Affairs TRICARE	$29.94

Transferrin LC

Facility

$189.00

Service Code	CPT 84466
Hospital Charge Code	1909569
Hospital Revenue Code	301
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Cash Price	$151.20

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: Blue Cross Blue Shield of Arizona Health Choice	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72
Rate for Payer: NaphCare Correctional Healthcare	$11,383.72

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: Blue Cross Blue Shield of Arizona Health Choice	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69
Rate for Payer: NaphCare Correctional Healthcare	$6,159.69

Transient Ischemia

Facility

$11,383.72

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG0474
Min. Negotiated Rate	$11,383.72
Max. Negotiated Rate	$11,383.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72
Rate for Payer: NaphCare Correctional Healthcare	$11,383.72

Transient Ischemia

Facility

$11,383.72

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG0472
Min. Negotiated Rate	$11,383.72
Max. Negotiated Rate	$11,383.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72
Rate for Payer: NaphCare Correctional Healthcare	$11,383.72

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: Blue Cross Blue Shield of Arizona Health Choice	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$11,383.72
Rate for Payer: Mercy Care Medicaid	$11,383.72
Rate for Payer: NaphCare Correctional Healthcare	$11,383.72

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: Blue Cross Blue Shield of Arizona Health Choice	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69
Rate for Payer: NaphCare Correctional Healthcare	$6,159.69

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: Blue Cross Blue Shield of Arizona Health Choice	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98
Rate for Payer: NaphCare Correctional Healthcare	$4,300.98

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: Blue Cross Blue Shield of Arizona Health Choice	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69
Rate for Payer: NaphCare Correctional Healthcare	$6,159.69

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: Blue Cross Blue Shield of Arizona Health Choice	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31
Rate for Payer: NaphCare Correctional Healthcare	$4,765.31

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: Blue Cross Blue Shield of Arizona Health Choice	$4,300.98
Rate for Payer: Mercy Care Medicaid	$4,300.98
Rate for Payer: NaphCare Correctional Healthcare	$4,300.98

Transient Ischemia

Facility

$4,765.31

Service Code	APR-DRG 0472
Hospital Charge Code	APRDRG0472
Min. Negotiated Rate	$4,765.31
Max. Negotiated Rate	$4,765.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31
Rate for Payer: NaphCare Correctional Healthcare	$4,765.31

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: Blue Cross Blue Shield of Arizona Health Choice	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$4,765.31
Rate for Payer: Mercy Care Medicaid	$4,765.31
Rate for Payer: NaphCare Correctional Healthcare	$4,765.31

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$10,477.19

Service Code	MSDRG 069
Min. Negotiated Rate	$10,477.19
Max. Negotiated Rate	$10,477.19
Rate for Payer: Seven Corners Travel Insurance	$10,477.19

TRANSPERINEAL PLACEMENT OF BIODEGRADABLE MATERIAL PERI PROST

Facility

$1,470.00

Service Code	CPT 55877
Hospital Charge Code	28254338
Hospital Revenue Code	360
Min. Negotiated Rate	$232.85
Max. Negotiated Rate	$16,447.22
Rate for Payer: Aetna of AZ Commercial	$1,323.00
Rate for Payer: Arizona Complete Health Allwell	$235.20
Rate for Payer: Banner UC Health Medicare	$4,819.91
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$999.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$235.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$235.20
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cigna of AZ Commercial	$735.00
Rate for Payer: Devoted Health Medicare	$264.60
Rate for Payer: Humana of AZ Medicare	$235.20
Rate for Payer: NaphCare Correctional Healthcare	$4,819.91
Rate for Payer: Seven Corners Travel Insurance	$16,447.22
Rate for Payer: Southwest Service Administrators UFCW	$999.60
Rate for Payer: TriWest Medicare	$235.20
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$235.20
Rate for Payer: Veterans Affairs TRICARE	$232.85

TRANSPERINEAL PLACEMENT OF BIODEGRADABLE MATERIAL PERI PROST

Facility

$1,470.00

Service Code	CPT 55877
Hospital Charge Code	28254338
Hospital Revenue Code	360
Min. Negotiated Rate	$1,323.00
Max. Negotiated Rate	$1,323.00
Rate for Payer: Aetna of AZ Commercial	$1,323.00
Rate for Payer: Cash Price	$1,176.00

TRANSURETHRAL PROCEDURES WITH CC

Facility

$20,058.24

Service Code	MSDRG 669
Min. Negotiated Rate	$20,058.24
Max. Negotiated Rate	$20,058.24
Rate for Payer: Seven Corners Travel Insurance	$20,058.24

Know your out-of-pocket cost for care.

All Charges