Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TROCAR 5-12MM CONMED

Facility

$1,053.00

Hospital Charge Code	22354205
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 VERSAPORT 8MM

Facility

$398.00

Hospital Charge Code	22354264
Hospital Revenue Code	270
Min. Negotiated Rate	$358.20
Max. Negotiated Rate	$358.20
Rate for Payer: Aetna of AZ Commercial	$358.20
Rate for Payer: Cash Price	$318.40

TROCAR VERSAPORT 8MM

Facility

$398.00

Hospital Charge Code	22354264
Hospital Revenue Code	270
Min. Negotiated Rate	$63.04
Max. Negotiated Rate	$358.20
Rate for Payer: Aetna of AZ Commercial	$358.20
Rate for Payer: Arizona Complete Health Allwell	$63.68
Rate for Payer: Banner UC Health Medicare	$63.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$270.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$63.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$63.68
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cigna of AZ Commercial	$278.60
Rate for Payer: Devoted Health Medicare	$71.64
Rate for Payer: Humana of AZ Medicare	$63.68
Rate for Payer: Southwest Service Administrators UFCW	$270.64
Rate for Payer: TriWest Medicare	$63.68
Rate for Payer: United Healthcare Commercial	$227.66
Rate for Payer: United Healthcare Medicare	$63.68
Rate for Payer: Veterans Affairs TRICARE	$63.04

TROCAR W/SHIELD 5MM CONMED

Facility

$203.00

Hospital Charge Code	22354869
Hospital Revenue Code	270
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Cash Price	$162.40

TROCAR W/SHIELD 5MM CONMED

Facility

$203.00

Hospital Charge Code	22354869
Hospital Revenue Code	270
Min. Negotiated Rate	$32.16
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Arizona Complete Health Allwell	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.48
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Devoted Health Medicare	$36.54
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Southwest Service Administrators UFCW	$138.04
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: United Healthcare Commercial	$116.12
Rate for Payer: United Healthcare Medicare	$32.48
Rate for Payer: Veterans Affairs TRICARE	$32.16

TROCAR XCEL BLADELESS 8MM

Facility

$186.00

Hospital Charge Code	22354868
Hospital Revenue Code	270
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Cash Price	$148.80

TROCAR XCEL BLADELESS 8MM

Facility

$186.00

Hospital Charge Code	22354868
Hospital Revenue Code	270
Min. Negotiated Rate	$29.46
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Arizona Complete Health Allwell	$29.76
Rate for Payer: Banner UC Health Medicare	$29.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$126.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.76
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$130.20
Rate for Payer: Devoted Health Medicare	$33.48
Rate for Payer: Humana of AZ Medicare	$29.76
Rate for Payer: Southwest Service Administrators UFCW	$126.48
Rate for Payer: TriWest Medicare	$29.76
Rate for Payer: United Healthcare Commercial	$106.39
Rate for Payer: United Healthcare Medicare	$29.76
Rate for Payer: Veterans Affairs TRICARE	$29.46

TROCLEAN TROCAR CLEANING DEVICE

Facility

$62.06

Hospital Charge Code	27446586
Hospital Revenue Code	270
Min. Negotiated Rate	$55.85
Max. Negotiated Rate	$55.85
Rate for Payer: Aetna of AZ Commercial	$55.85
Rate for Payer: Cash Price	$49.65

TROCLEAN TROCAR CLEANING DEVICE

Facility

$62.06

Hospital Charge Code	27446586
Hospital Revenue Code	270
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$55.85
Rate for Payer: Aetna of AZ Commercial	$55.85
Rate for Payer: Arizona Complete Health Allwell	$9.93
Rate for Payer: Banner UC Health Medicare	$9.93
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.93
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.93
Rate for Payer: Cash Price	$49.65
Rate for Payer: Cigna of AZ Commercial	$43.44
Rate for Payer: Devoted Health Medicare	$11.17
Rate for Payer: Humana of AZ Medicare	$9.93
Rate for Payer: Southwest Service Administrators UFCW	$42.20
Rate for Payer: TriWest Medicare	$9.93
Rate for Payer: United Healthcare Commercial	$35.50
Rate for Payer: United Healthcare Medicare	$9.93
Rate for Payer: Veterans Affairs TRICARE	$9.83

Troponin

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	22525240
Hospital Revenue Code	301
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Arizona Complete Health Allwell	$49.76
Rate for Payer: Banner UC Health Medicare	$49.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$211.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.76
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Devoted Health Medicare	$55.98
Rate for Payer: Humana of AZ Medicare	$49.76
Rate for Payer: Seven Corners Travel Insurance	$18.08
Rate for Payer: Southwest Service Administrators UFCW	$211.48
Rate for Payer: TriWest Medicare	$49.76
Rate for Payer: United Healthcare Commercial	$177.89
Rate for Payer: United Healthcare Medicare	$49.76
Rate for Payer: Veterans Affairs TRICARE	$49.26

Troponin

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	22525240
Hospital Revenue Code	301
Min. Negotiated Rate	$279.90
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Cash Price	$248.80

Troponin I

Facility

$295.00

Service Code	CPT 84484
Hospital Charge Code	908527
Hospital Revenue Code	301
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Cash Price	$236.00

Troponin I

Facility

$295.00

Service Code	CPT 84484
Hospital Charge Code	908527
Hospital Revenue Code	301
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Arizona Complete Health Allwell	$47.20
Rate for Payer: Banner UC Health Medicare	$47.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$200.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.20
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Devoted Health Medicare	$53.10
Rate for Payer: Humana of AZ Medicare	$47.20
Rate for Payer: Seven Corners Travel Insurance	$18.08
Rate for Payer: Southwest Service Administrators UFCW	$200.60
Rate for Payer: TriWest Medicare	$47.20
Rate for Payer: United Healthcare Commercial	$168.74
Rate for Payer: United Healthcare Medicare	$47.20
Rate for Payer: Veterans Affairs TRICARE	$46.73

TSH w/ Reflex to FT4

Facility

$335.00

Service Code	CPT 84443
Hospital Charge Code	15961923
Hospital Revenue Code	301
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$301.50
Rate for Payer: Aetna of AZ Commercial	$301.50
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Arizona Complete Health Allwell	$38.72
Rate for Payer: Arizona Complete Health Allwell	$53.60
Rate for Payer: Banner UC Health Medicare	$38.72
Rate for Payer: Banner UC Health Medicare	$53.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$227.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$164.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.60
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$217.75
Rate for Payer: Cigna of AZ Commercial	$157.30
Rate for Payer: Devoted Health Medicare	$60.30
Rate for Payer: Devoted Health Medicare	$43.56
Rate for Payer: Humana of AZ Medicare	$38.72
Rate for Payer: Humana of AZ Medicare	$53.60
Rate for Payer: Seven Corners Travel Insurance	$24.36
Rate for Payer: Seven Corners Travel Insurance	$24.36
Rate for Payer: Southwest Service Administrators UFCW	$164.56
Rate for Payer: Southwest Service Administrators UFCW	$227.80
Rate for Payer: TriWest Medicare	$38.72
Rate for Payer: TriWest Medicare	$53.60
Rate for Payer: United Healthcare Commercial	$191.62
Rate for Payer: United Healthcare Commercial	$138.42
Rate for Payer: United Healthcare Medicare	$38.72
Rate for Payer: United Healthcare Medicare	$53.60
Rate for Payer: Veterans Affairs TRICARE	$53.06
Rate for Payer: Veterans Affairs TRICARE	$38.33

TSH w/ Reflex to FT4

Facility

$242.00

Service Code	CPT 84443
Hospital Charge Code	15961923
Hospital Revenue Code	301
Min. Negotiated Rate	$217.80
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Commercial	$301.50
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$268.00

.TT Mix+TTN LC

Facility

$124.00

Service Code	CPT 85670
Hospital Charge Code	1285818
Hospital Revenue Code	305
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Cash Price	$99.20

.TT Mix+TTN LC

Facility

$124.00

Service Code	CPT 85670
Hospital Charge Code	1285818
Hospital Revenue Code	305
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Seven Corners Travel Insurance	$8.37
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: Veterans Affairs TRICARE	$19.64

T TRANSGL IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481504
Hospital Revenue Code	301
Min. Negotiated Rate	$1,345.50
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Cash Price	$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	$16.72
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Arizona Complete Health Allwell	$239.20
Rate for Payer: Banner UC Health Medicare	$239.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,016.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$239.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$239.20
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Devoted Health Medicare	$269.10
Rate for Payer: Humana of AZ Medicare	$239.20
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$1,016.60
Rate for Payer: TriWest Medicare	$239.20
Rate for Payer: United Healthcare Commercial	$855.14
Rate for Payer: United Healthcare Medicare	$239.20
Rate for Payer: Veterans Affairs TRICARE	$236.81

t-Transglutaminase (tTG) IgA LC

Facility

$2,065.00

Service Code	CPT 83516
Hospital Charge Code	2087656
Hospital Revenue Code	301
Min. Negotiated Rate	$1,858.50
Max. Negotiated Rate	$1,858.50
Rate for Payer: Aetna of AZ Commercial	$1,858.50
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Cash Price	$1,137.60

t-Transglutaminase (tTG) IgA LC

Facility

$1,422.00

Service Code	CPT 83516
Hospital Charge Code	2087656
Hospital Revenue Code	301
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,279.80
Rate for Payer: Aetna of AZ Commercial	$1,858.50
Rate for Payer: Arizona Complete Health Allwell	$330.40
Rate for Payer: Arizona Complete Health Allwell	$227.52
Rate for Payer: Banner UC Health Medicare	$330.40
Rate for Payer: Banner UC Health Medicare	$227.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$966.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,404.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$330.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$330.40
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Cash Price	$1,137.60
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Cigna of AZ Commercial	$1,342.25
Rate for Payer: Cigna of AZ Commercial	$924.30
Rate for Payer: Devoted Health Medicare	$371.70
Rate for Payer: Devoted Health Medicare	$255.96
Rate for Payer: Humana of AZ Medicare	$227.52
Rate for Payer: Humana of AZ Medicare	$330.40
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$1,404.20
Rate for Payer: Southwest Service Administrators UFCW	$966.96
Rate for Payer: TriWest Medicare	$227.52
Rate for Payer: TriWest Medicare	$330.40
Rate for Payer: United Healthcare Commercial	$813.38
Rate for Payer: United Healthcare Commercial	$1,181.18
Rate for Payer: United Healthcare Medicare	$227.52
Rate for Payer: United Healthcare Medicare	$330.40
Rate for Payer: Veterans Affairs TRICARE	$327.10
Rate for Payer: Veterans Affairs TRICARE	$225.24

t-Transglutaminase (tTG) IgG LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	2269437
Hospital Revenue Code	301
Min. Negotiated Rate	$1,278.00
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Cash Price	$1,136.00

t-Transglutaminase (tTG) IgG LC

Facility

$1,420.00

Service Code	CPT 83516
Hospital Charge Code	2269437
Hospital Revenue Code	301
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna of AZ Commercial	$1,278.00
Rate for Payer: Arizona Complete Health Allwell	$227.20
Rate for Payer: Banner UC Health Medicare	$227.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$965.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.20
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cigna of AZ Commercial	$923.00
Rate for Payer: Devoted Health Medicare	$255.60
Rate for Payer: Humana of AZ Medicare	$227.20
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$965.60
Rate for Payer: TriWest Medicare	$227.20
Rate for Payer: United Healthcare Commercial	$812.24
Rate for Payer: United Healthcare Medicare	$227.20
Rate for Payer: Veterans Affairs TRICARE	$224.93

T TRNSGLT IGA

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481505
Hospital Revenue Code	301
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Arizona Complete Health Allwell	$239.20
Rate for Payer: Banner UC Health Medicare	$239.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,016.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$239.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$239.20
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Devoted Health Medicare	$269.10
Rate for Payer: Humana of AZ Medicare	$239.20
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$1,016.60
Rate for Payer: TriWest Medicare	$239.20
Rate for Payer: United Healthcare Commercial	$855.14
Rate for Payer: United Healthcare Medicare	$239.20
Rate for Payer: Veterans Affairs TRICARE	$236.81

T TRNSGLT IGA

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481505
Hospital Revenue Code	301
Min. Negotiated Rate	$1,345.50
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Cash Price	$1,196.00

Know your out-of-pocket cost for care.

All Charges