Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Triglycerides

Facility

$129.00

Service Code	CPT 84478
Hospital Charge Code	633852
Hospital Revenue Code	301
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Cash Price	$103.20

Triglycerides

Facility

$129.00

Service Code	CPT 84478
Hospital Charge Code	633852
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Seven Corners Travel Insurance	$8.32
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: Veterans Affairs TRICARE	$20.43

Triiodothyronine,Free,Serum LC

Facility

$451.00

Service Code	CPT 84481
Hospital Charge Code	1285541
Hospital Revenue Code	301
Min. Negotiated Rate	$405.90
Max. Negotiated Rate	$405.90
Rate for Payer: Aetna of AZ Commercial	$405.90
Rate for Payer: Cash Price	$360.80

Triiodothyronine,Free,Serum LC

Facility

$451.00

Service Code	CPT 84481
Hospital Charge Code	1285541
Hospital Revenue Code	301
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$405.90
Rate for Payer: Aetna of AZ Commercial	$405.90
Rate for Payer: Arizona Complete Health Allwell	$72.16
Rate for Payer: Banner UC Health Medicare	$72.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$306.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$72.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$72.16
Rate for Payer: Cash Price	$360.80
Rate for Payer: Cash Price	$360.80
Rate for Payer: Cigna of AZ Commercial	$293.15
Rate for Payer: Devoted Health Medicare	$81.18
Rate for Payer: Humana of AZ Medicare	$72.16
Rate for Payer: Seven Corners Travel Insurance	$24.56
Rate for Payer: Southwest Service Administrators UFCW	$306.68
Rate for Payer: TriWest Medicare	$72.16
Rate for Payer: United Healthcare Commercial	$257.97
Rate for Payer: United Healthcare Medicare	$72.16
Rate for Payer: Veterans Affairs TRICARE	$71.44

Triiodothyronine (T3) LC

Facility

$258.00

Service Code	CPT 84480
Hospital Charge Code	1285540
Hospital Revenue Code	301
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Arizona Complete Health Allwell	$41.28
Rate for Payer: Banner UC Health Medicare	$41.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$175.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.28
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$167.70
Rate for Payer: Devoted Health Medicare	$46.44
Rate for Payer: Humana of AZ Medicare	$41.28
Rate for Payer: Seven Corners Travel Insurance	$20.56
Rate for Payer: Southwest Service Administrators UFCW	$175.44
Rate for Payer: TriWest Medicare	$41.28
Rate for Payer: United Healthcare Commercial	$147.58
Rate for Payer: United Healthcare Medicare	$41.28
Rate for Payer: Veterans Affairs TRICARE	$40.87

Triiodothyronine (T3) LC

Facility

$258.00

Service Code	CPT 84480
Hospital Charge Code	1285540
Hospital Revenue Code	301
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Cash Price	$206.40

Trim Dystrophic Nails Any Numb

Facility

$51.00

Service Code	HCPCS G0127
Hospital Charge Code	1902181
Hospital Revenue Code	521
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Cash Price	$40.80

Trim Dystrophic Nails Any Numb

Facility

$51.00

Service Code	HCPCS G0127
Hospital Charge Code	1902181
Hospital Revenue Code	521
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$91.28
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Arizona Complete Health Allwell	$8.16
Rate for Payer: Banner UC Health Medicare	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$34.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.16
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$35.70
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Humana of AZ Medicare	$8.16
Rate for Payer: Mercy Care Medicaid	$17.52
Rate for Payer: NaphCare Correctional Healthcare	$17.52
Rate for Payer: Seven Corners Travel Insurance	$91.28
Rate for Payer: Southwest Service Administrators UFCW	$34.68
Rate for Payer: TriWest Medicare	$8.16
Rate for Payer: United Healthcare Commercial	$29.17
Rate for Payer: United Healthcare Medicare	$8.16
Rate for Payer: Veterans Affairs TRICARE	$8.08

Trimming of nondystrophic nails, any number Charge

Facility

$47.00

Service Code	CPT 11719
Hospital Charge Code	749428
Hospital Revenue Code	521
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Cash Price	$37.60

Trimming of nondystrophic nails, any number Charge

Facility

$47.00

Service Code	CPT 11719
Hospital Charge Code	749428
Hospital Revenue Code	521
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$91.28
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Arizona Complete Health Allwell	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.52
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Devoted Health Medicare	$8.46
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Mercy Care Medicaid	$7.15
Rate for Payer: NaphCare Correctional Healthcare	$7.15
Rate for Payer: Seven Corners Travel Insurance	$91.28
Rate for Payer: Southwest Service Administrators UFCW	$31.96
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: United Healthcare Medicare	$7.52
Rate for Payer: Veterans Affairs TRICARE	$7.44

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	$6.18
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Arizona Complete Health Allwell	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.24
Rate for Payer: Cash Price	$31.20
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: Devoted Health Medicare	$7.02
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Mercy Care Medicaid	$7.15
Rate for Payer: NaphCare Correctional Healthcare	$7.15
Rate for Payer: Seven Corners Travel Insurance	$91.28
Rate for Payer: Southwest Service Administrators UFCW	$26.52
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$6.24
Rate for Payer: Veterans Affairs TRICARE	$6.18

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	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Cash Price	$31.20

TRINITY 37CM

Facility

$1,352.00

Hospital Charge Code	27445199
Hospital Revenue Code	270
Min. Negotiated Rate	$214.16
Max. Negotiated Rate	$1,216.80
Rate for Payer: Aetna of AZ Commercial	$1,216.80
Rate for Payer: Arizona Complete Health Allwell	$216.32
Rate for Payer: Banner UC Health Medicare	$216.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$919.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$216.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$216.32
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Cigna of AZ Commercial	$946.40
Rate for Payer: Devoted Health Medicare	$243.36
Rate for Payer: Humana of AZ Medicare	$216.32
Rate for Payer: Southwest Service Administrators UFCW	$919.36
Rate for Payer: TriWest Medicare	$216.32
Rate for Payer: United Healthcare Commercial	$773.34
Rate for Payer: United Healthcare Medicare	$216.32
Rate for Payer: Veterans Affairs TRICARE	$214.16

TRINITY 37CM

Facility

$1,352.00

Hospital Charge Code	27445199
Hospital Revenue Code	270
Min. Negotiated Rate	$1,216.80
Max. Negotiated Rate	$1,216.80
Rate for Payer: Aetna of AZ Commercial	$1,216.80
Rate for Payer: Cash Price	$1,081.60

TRITOME TRIPLE EDGE RELEASE INSTRUMENT

Facility

$4,975.00

Hospital Charge Code	27820410
Hospital Revenue Code	270
Min. Negotiated Rate	$4,477.50
Max. Negotiated Rate	$4,477.50
Rate for Payer: Aetna of AZ Commercial	$4,477.50
Rate for Payer: Cash Price	$3,980.00

TRITOME TRIPLE EDGE RELEASE INSTRUMENT

Facility

$4,975.00

Hospital Charge Code	27820410
Hospital Revenue Code	270
Min. Negotiated Rate	$788.04
Max. Negotiated Rate	$4,477.50
Rate for Payer: Aetna of AZ Commercial	$4,477.50
Rate for Payer: Arizona Complete Health Allwell	$796.00
Rate for Payer: Banner UC Health Medicare	$796.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,383.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$796.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$796.00
Rate for Payer: Cash Price	$3,980.00
Rate for Payer: Cigna of AZ Commercial	$3,482.50
Rate for Payer: Devoted Health Medicare	$895.50
Rate for Payer: Humana of AZ Medicare	$796.00
Rate for Payer: Southwest Service Administrators UFCW	$3,383.00
Rate for Payer: TriWest Medicare	$796.00
Rate for Payer: United Healthcare Commercial	$2,845.70
Rate for Payer: United Healthcare Medicare	$796.00
Rate for Payer: Veterans Affairs TRICARE	$788.04

TROCAR 10-12MM (LONG) CONMED

Facility

$909.00

Hospital Charge Code	22354203
Hospital Revenue Code	270
Min. Negotiated Rate	$818.10
Max. Negotiated Rate	$818.10
Rate for Payer: Aetna of AZ Commercial	$818.10
Rate for Payer: Cash Price	$727.20

TROCAR 10-12MM (LONG) CONMED

Facility

$909.00

Hospital Charge Code	22354203
Hospital Revenue Code	270
Min. Negotiated Rate	$143.99
Max. Negotiated Rate	$818.10
Rate for Payer: Aetna of AZ Commercial	$818.10
Rate for Payer: Arizona Complete Health Allwell	$145.44
Rate for Payer: Banner UC Health Medicare	$145.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$618.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$145.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$145.44
Rate for Payer: Cash Price	$727.20
Rate for Payer: Cigna of AZ Commercial	$636.30
Rate for Payer: Devoted Health Medicare	$163.62
Rate for Payer: Humana of AZ Medicare	$145.44
Rate for Payer: Southwest Service Administrators UFCW	$618.12
Rate for Payer: TriWest Medicare	$145.44
Rate for Payer: United Healthcare Commercial	$519.95
Rate for Payer: United Healthcare Medicare	$145.44
Rate for Payer: Veterans Affairs TRICARE	$143.99

TROCAR 12MM BLADELESS

Facility

$1,198.00

Hospital Charge Code	22528801
Hospital Revenue Code	270
Min. Negotiated Rate	$189.76
Max. Negotiated Rate	$1,078.20
Rate for Payer: Aetna of AZ Commercial	$1,078.20
Rate for Payer: Arizona Complete Health Allwell	$191.68
Rate for Payer: Banner UC Health Medicare	$191.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$814.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$191.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$191.68
Rate for Payer: Cash Price	$958.40
Rate for Payer: Cigna of AZ Commercial	$838.60
Rate for Payer: Devoted Health Medicare	$215.64
Rate for Payer: Humana of AZ Medicare	$191.68
Rate for Payer: Southwest Service Administrators UFCW	$814.64
Rate for Payer: TriWest Medicare	$191.68
Rate for Payer: United Healthcare Commercial	$685.26
Rate for Payer: United Healthcare Medicare	$191.68
Rate for Payer: Veterans Affairs TRICARE	$189.76

TROCAR 12MM BLADELESS

Facility

$1,198.00

Hospital Charge Code	22528801
Hospital Revenue Code	270
Min. Negotiated Rate	$1,078.20
Max. Negotiated Rate	$1,078.20
Rate for Payer: Aetna of AZ Commercial	$1,078.20
Rate for Payer: Cash Price	$958.40

TROCAR 12MM BLADELESS 150MM

Facility

$730.00

Hospital Charge Code	23752300
Min. Negotiated Rate	$657.00
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of AZ Commercial	$657.00
Rate for Payer: Cash Price	$584.00

TROCAR 12MM BLADELESS 150MM

Facility

$730.00

Hospital Charge Code	23752300
Min. Negotiated Rate	$115.63
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of AZ Commercial	$657.00
Rate for Payer: Arizona Complete Health Allwell	$116.80
Rate for Payer: Banner UC Health Medicare	$116.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$496.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$116.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$116.80
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cigna of AZ Commercial	$511.00
Rate for Payer: Devoted Health Medicare	$131.40
Rate for Payer: Humana of AZ Medicare	$116.80
Rate for Payer: Southwest Service Administrators UFCW	$496.40
Rate for Payer: TriWest Medicare	$116.80
Rate for Payer: United Healthcare Commercial	$417.56
Rate for Payer: United Healthcare Medicare	$116.80
Rate for Payer: Veterans Affairs TRICARE	$115.63

TROCAR 5-11MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354204
Hospital Revenue Code	270
Min. Negotiated Rate	$947.70
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Cash Price	$842.40

TROCAR 5-11MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354204
Hospital Revenue Code	270
Min. Negotiated Rate	$166.80
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Arizona Complete Health Allwell	$168.48
Rate for Payer: Banner UC Health Medicare	$168.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$716.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$168.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$168.48
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cigna of AZ Commercial	$737.10
Rate for Payer: Devoted Health Medicare	$189.54
Rate for Payer: Humana of AZ Medicare	$168.48
Rate for Payer: Southwest Service Administrators UFCW	$716.04
Rate for Payer: TriWest Medicare	$168.48
Rate for Payer: United Healthcare Commercial	$602.32
Rate for Payer: United Healthcare Medicare	$168.48
Rate for Payer: Veterans Affairs TRICARE	$166.80

TROCAR 5-12MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354205
Hospital Revenue Code	270
Min. Negotiated Rate	$166.80
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna of AZ Commercial	$947.70
Rate for Payer: Arizona Complete Health Allwell	$168.48
Rate for Payer: Banner UC Health Medicare	$168.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$716.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$168.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$168.48
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cigna of AZ Commercial	$737.10
Rate for Payer: Devoted Health Medicare	$189.54
Rate for Payer: Humana of AZ Medicare	$168.48
Rate for Payer: Southwest Service Administrators UFCW	$716.04
Rate for Payer: TriWest Medicare	$168.48
Rate for Payer: United Healthcare Commercial	$602.32
Rate for Payer: United Healthcare Medicare	$168.48
Rate for Payer: Veterans Affairs TRICARE	$166.80

Know your out-of-pocket cost for care.

All Charges