Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

36406 OTHER VEIN IV <3Y

Facility

$53.00

Service Code	CPT 36406
Hospital Charge Code	22282906
Hospital Revenue Code	450
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Cash Price	$42.40
Rate for Payer: Self Pay Self Pay	$42.40

36410 VENIPUNCTURE PHYSICIAN

Facility

$77.00

Service Code	CPT 36410
Hospital Charge Code	22282907
Hospital Revenue Code	450
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Cash Price	$61.60
Rate for Payer: Self Pay Self Pay	$61.60

36410 VENIPUNCTURE PHYSICIAN

Facility

$77.00

Service Code	CPT 36410
Hospital Charge Code	22282907
Hospital Revenue Code	450
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Aetna of AZ Medicare	$21.56
Rate for Payer: Allwell Medicare	$12.32
Rate for Payer: Amerigroup Medicare	$12.32
Rate for Payer: APIPA Medicare/Medicaid	$28.76
Rate for Payer: AZCH Complete Medicare	$12.32
Rate for Payer: Banner UC Health Medicare	$12.32
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$52.36
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$53.90
Rate for Payer: Copperpoint Commercial	$19.06
Rate for Payer: Health Net of AZ Commercial	$46.20
Rate for Payer: Health Net of AZ Medicare	$21.56
Rate for Payer: Humana of AZ Medicare	$12.32
Rate for Payer: Self Pay Self Pay	$61.60
Rate for Payer: TriWest Medicare	$12.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.86

36420 IV CUTDOWN<1Y

Facility

$310.00

Service Code	CPT 36420
Hospital Charge Code	22282908
Hospital Revenue Code	450
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Aetna of AZ Medicare	$86.80
Rate for Payer: Allwell Medicare	$49.60
Rate for Payer: Amerigroup Medicare	$49.60
Rate for Payer: APIPA Medicare/Medicaid	$115.78
Rate for Payer: AZCH Complete Medicare	$49.60
Rate for Payer: Banner UC Health Medicare	$49.60
Rate for Payer: Bisbee Police All Plans	$80.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.80
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cigna of AZ Commercial	$217.00
Rate for Payer: Copperpoint Commercial	$76.72
Rate for Payer: Health Net of AZ Commercial	$186.00
Rate for Payer: Health Net of AZ Medicare	$86.80
Rate for Payer: Humana of AZ Medicare	$49.60
Rate for Payer: Self Pay Self Pay	$248.00
Rate for Payer: TriWest Medicare	$49.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.80

36420 IV CUTDOWN<1Y

Facility

$310.00

Service Code	CPT 36420
Hospital Charge Code	22282908
Hospital Revenue Code	450
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Bisbee Police All Plans	$80.60
Rate for Payer: Cash Price	$248.00
Rate for Payer: Self Pay Self Pay	$248.00

36425 IV CUTDOWN AGE 1 OR OVER

Facility

$194.00

Service Code	CPT 36425
Hospital Charge Code	22282909
Hospital Revenue Code	450
Min. Negotiated Rate	$31.04
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$174.60
Rate for Payer: Aetna of AZ Medicare	$54.32
Rate for Payer: Allwell Medicare	$31.04
Rate for Payer: Amerigroup Medicare	$31.04
Rate for Payer: APIPA Medicare/Medicaid	$72.46
Rate for Payer: AZCH Complete Medicare	$31.04
Rate for Payer: Banner UC Health Medicare	$31.04
Rate for Payer: Bisbee Police All Plans	$50.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$131.92
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cigna of AZ Commercial	$135.80
Rate for Payer: Copperpoint Commercial	$48.02
Rate for Payer: Health Net of AZ Commercial	$116.40
Rate for Payer: Health Net of AZ Medicare	$54.32
Rate for Payer: Humana of AZ Medicare	$31.04
Rate for Payer: Self Pay Self Pay	$155.20
Rate for Payer: TriWest Medicare	$31.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.92

36425 IV CUTDOWN AGE 1 OR OVER

Facility

$194.00

Service Code	CPT 36425
Hospital Charge Code	22282909
Hospital Revenue Code	450
Min. Negotiated Rate	$50.44
Max. Negotiated Rate	$174.60
Rate for Payer: Aetna of AZ Commercial	$174.60
Rate for Payer: Bisbee Police All Plans	$50.44
Rate for Payer: Cash Price	$155.20
Rate for Payer: Self Pay Self Pay	$155.20

36430 BLOOD PRODUCT TRANSFUSION

Facility

$908.00

Service Code	CPT 36430
Hospital Charge Code	22282910
Hospital Revenue Code	391
Min. Negotiated Rate	$236.08
Max. Negotiated Rate	$817.20
Rate for Payer: Aetna of AZ Commercial	$817.20
Rate for Payer: Bisbee Police All Plans	$236.08
Rate for Payer: Cash Price	$726.40
Rate for Payer: Self Pay Self Pay	$726.40

36430 BLOOD PRODUCT TRANSFUSION

Facility

$908.00

Service Code	CPT 36430
Hospital Charge Code	22282910
Hospital Revenue Code	391
Min. Negotiated Rate	$145.28
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$817.20
Rate for Payer: Aetna of AZ Medicare	$254.24
Rate for Payer: AHCCCS Medicaid	$287.87
Rate for Payer: Allwell Medicaid	$287.87
Rate for Payer: Allwell Medicare	$145.28
Rate for Payer: Amerigroup Medicare	$145.28
Rate for Payer: APIPA Medicare/Medicaid	$339.14
Rate for Payer: AZCH Complete Medicaid	$287.87
Rate for Payer: AZCH Complete Medicare	$145.28
Rate for Payer: Banner UC Health Medicaid	$287.87
Rate for Payer: Banner UC Health Medicare	$145.28
Rate for Payer: Bisbee Police All Plans	$236.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$617.44
Rate for Payer: Cash Price	$726.40
Rate for Payer: Cash Price	$726.40
Rate for Payer: Cigna of AZ Commercial	$635.60
Rate for Payer: Copperpoint Commercial	$224.73
Rate for Payer: Health Net of AZ Commercial	$544.80
Rate for Payer: Health Net of AZ Medicare	$254.24
Rate for Payer: Humana of AZ Medicare	$145.28
Rate for Payer: Mercy Care Medicaid	$287.87
Rate for Payer: Self Pay Self Pay	$726.40
Rate for Payer: TriWest Medicare	$145.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$163.44

36510 UMBIL VEIN CATH

Facility

$233.00

Service Code	CPT 36510
Hospital Charge Code	22282911
Hospital Revenue Code	450
Min. Negotiated Rate	$60.58
Max. Negotiated Rate	$209.70
Rate for Payer: Aetna of AZ Commercial	$209.70
Rate for Payer: Bisbee Police All Plans	$60.58
Rate for Payer: Cash Price	$186.40
Rate for Payer: Self Pay Self Pay	$186.40

36510 UMBIL VEIN CATH

Facility

$233.00

Service Code	CPT 36510
Hospital Charge Code	22282911
Hospital Revenue Code	450
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$209.70
Rate for Payer: Aetna of AZ Medicare	$65.24
Rate for Payer: Allwell Medicare	$37.28
Rate for Payer: Amerigroup Medicare	$37.28
Rate for Payer: APIPA Medicare/Medicaid	$87.03
Rate for Payer: AZCH Complete Medicare	$37.28
Rate for Payer: Banner UC Health Medicare	$37.28
Rate for Payer: Bisbee Police All Plans	$60.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$158.44
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cigna of AZ Commercial	$163.10
Rate for Payer: Copperpoint Commercial	$57.67
Rate for Payer: Health Net of AZ Commercial	$139.80
Rate for Payer: Health Net of AZ Medicare	$65.24
Rate for Payer: Humana of AZ Medicare	$37.28
Rate for Payer: Self Pay Self Pay	$186.40
Rate for Payer: TriWest Medicare	$37.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.94

36550 THROMBOLYTIC AGENT

Facility

$91.00

Service Code	CPT 36550
Hospital Charge Code	22282912
Hospital Revenue Code	450
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Cash Price	$72.80
Rate for Payer: Self Pay Self Pay	$72.80

36550 THROMBOLYTIC AGENT

Facility

$91.00

Service Code	CPT 36550
Hospital Charge Code	22282912
Hospital Revenue Code	450
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Aetna of AZ Medicare	$25.48
Rate for Payer: Allwell Medicare	$14.56
Rate for Payer: Amerigroup Medicare	$14.56
Rate for Payer: APIPA Medicare/Medicaid	$33.99
Rate for Payer: AZCH Complete Medicare	$14.56
Rate for Payer: Banner UC Health Medicare	$14.56
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.88
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$63.70
Rate for Payer: Copperpoint Commercial	$22.52
Rate for Payer: Health Net of AZ Commercial	$54.60
Rate for Payer: Health Net of AZ Medicare	$25.48
Rate for Payer: Humana of AZ Medicare	$14.56
Rate for Payer: Self Pay Self Pay	$72.80
Rate for Payer: TriWest Medicare	$14.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.38

36556 CENTRAL LINE INSERTION

Facility

$392.00

Service Code	CPT 36556
Hospital Charge Code	22282913
Hospital Revenue Code	760
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$352.80
Rate for Payer: Aetna of AZ Commercial	$352.80
Rate for Payer: Bisbee Police All Plans	$101.92
Rate for Payer: Cash Price	$313.60
Rate for Payer: Self Pay Self Pay	$313.60

36556 CENTRAL LINE INSERTION

Facility

$392.00

Service Code	CPT 36556
Hospital Charge Code	22282913
Hospital Revenue Code	760
Min. Negotiated Rate	$62.72
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$352.80
Rate for Payer: Aetna of AZ Medicare	$109.76
Rate for Payer: AHCCCS Medicaid	$2,074.70
Rate for Payer: Allwell Medicaid	$2,074.70
Rate for Payer: Allwell Medicare	$62.72
Rate for Payer: Amerigroup Medicare	$62.72
Rate for Payer: APIPA Medicare/Medicaid	$146.41
Rate for Payer: AZCH Complete Medicaid	$2,074.70
Rate for Payer: AZCH Complete Medicare	$62.72
Rate for Payer: Banner UC Health Medicaid	$2,074.70
Rate for Payer: Banner UC Health Medicare	$62.72
Rate for Payer: Bisbee Police All Plans	$101.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$266.56
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cigna of AZ Commercial	$274.40
Rate for Payer: Copperpoint Commercial	$97.02
Rate for Payer: Health Net of AZ Commercial	$235.20
Rate for Payer: Health Net of AZ Medicare	$109.76
Rate for Payer: Humana of AZ Medicare	$62.72
Rate for Payer: Mercy Care Medicaid	$2,074.70
Rate for Payer: Self Pay Self Pay	$313.60
Rate for Payer: TriWest Medicare	$62.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$70.56

36600 ART PUNCTURE DIANOSTIC

Facility

$111.00

Service Code	CPT 36600
Hospital Charge Code	22282915
Hospital Revenue Code	450
Min. Negotiated Rate	$17.76
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Aetna of AZ Medicare	$31.08
Rate for Payer: Allwell Medicare	$17.76
Rate for Payer: Amerigroup Medicare	$17.76
Rate for Payer: APIPA Medicare/Medicaid	$41.46
Rate for Payer: AZCH Complete Medicare	$17.76
Rate for Payer: Banner UC Health Medicare	$17.76
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$75.48
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cigna of AZ Commercial	$77.70
Rate for Payer: Copperpoint Commercial	$27.47
Rate for Payer: Health Net of AZ Commercial	$66.60
Rate for Payer: Health Net of AZ Medicare	$31.08
Rate for Payer: Humana of AZ Medicare	$17.76
Rate for Payer: Self Pay Self Pay	$88.80
Rate for Payer: TriWest Medicare	$17.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.98

36600 ART PUNCTURE DIANOSTIC

Facility

$111.00

Service Code	CPT 36600
Hospital Charge Code	22282915
Hospital Revenue Code	450
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Cash Price	$88.80
Rate for Payer: Self Pay Self Pay	$88.80

36620 ARTCANN/SAMPL MNT

Facility

$338.00

Service Code	CPT 36620
Hospital Charge Code	22282916
Hospital Revenue Code	450
Min. Negotiated Rate	$54.08
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Aetna of AZ Medicare	$94.64
Rate for Payer: Allwell Medicare	$54.08
Rate for Payer: Amerigroup Medicare	$54.08
Rate for Payer: APIPA Medicare/Medicaid	$126.24
Rate for Payer: AZCH Complete Medicare	$54.08
Rate for Payer: Banner UC Health Medicare	$54.08
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$229.84
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cigna of AZ Commercial	$236.60
Rate for Payer: Copperpoint Commercial	$83.66
Rate for Payer: Health Net of AZ Commercial	$202.80
Rate for Payer: Health Net of AZ Medicare	$94.64
Rate for Payer: Humana of AZ Medicare	$54.08
Rate for Payer: Self Pay Self Pay	$270.40
Rate for Payer: TriWest Medicare	$54.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.84

36620 ARTCANN/SAMPL MNT

Facility

$338.00

Service Code	CPT 36620
Hospital Charge Code	22282916
Hospital Revenue Code	450
Min. Negotiated Rate	$87.88
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Cash Price	$270.40
Rate for Payer: Self Pay Self Pay	$270.40

36680 INTRAOSSEOUS CNNULA PLCM

Facility

$471.00

Service Code	CPT 36680
Hospital Charge Code	22282917
Hospital Revenue Code	450
Min. Negotiated Rate	$75.36
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$423.90
Rate for Payer: Aetna of AZ Medicare	$131.88
Rate for Payer: AHCCCS Medicaid	$195.91
Rate for Payer: Allwell Medicaid	$195.91
Rate for Payer: Allwell Medicare	$75.36
Rate for Payer: Amerigroup Medicare	$75.36
Rate for Payer: APIPA Medicare/Medicaid	$175.92
Rate for Payer: AZCH Complete Medicaid	$195.91
Rate for Payer: AZCH Complete Medicare	$75.36
Rate for Payer: Banner UC Health Medicaid	$195.91
Rate for Payer: Banner UC Health Medicare	$75.36
Rate for Payer: Bisbee Police All Plans	$122.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$320.28
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cigna of AZ Commercial	$329.70
Rate for Payer: Copperpoint Commercial	$116.57
Rate for Payer: Health Net of AZ Commercial	$282.60
Rate for Payer: Health Net of AZ Medicare	$131.88
Rate for Payer: Humana of AZ Medicare	$75.36
Rate for Payer: Mercy Care Medicaid	$195.91
Rate for Payer: Self Pay Self Pay	$376.80
Rate for Payer: TriWest Medicare	$75.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$84.78

36680 INTRAOSSEOUS CNNULA PLCM

Facility

$471.00

Service Code	CPT 36680
Hospital Charge Code	22282917
Hospital Revenue Code	450
Min. Negotiated Rate	$122.46
Max. Negotiated Rate	$423.90
Rate for Payer: Aetna of AZ Commercial	$423.90
Rate for Payer: Bisbee Police All Plans	$122.46
Rate for Payer: Cash Price	$376.80
Rate for Payer: Self Pay Self Pay	$376.80

4-0 Ethilon KS

Facility

$13.00

Hospital Charge Code	22926442
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

4-0 Ethilon KS

Facility

$13.00

Hospital Charge Code	22926442
Hospital Revenue Code	272
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

4-0 Surgigut

Facility

$51.00

Hospital Charge Code	22926447
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Bisbee Police All Plans	$13.26
Rate for Payer: Cash Price	$40.80
Rate for Payer: Self Pay Self Pay	$40.80

4-0 Surgigut

Facility

$51.00

Hospital Charge Code	22926447
Hospital Revenue Code	272
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna of AZ Commercial	$45.90
Rate for Payer: Aetna of AZ Medicare	$14.28
Rate for Payer: Allwell Medicare	$8.16
Rate for Payer: Amerigroup Medicare	$8.16
Rate for Payer: APIPA Medicare/Medicaid	$19.05
Rate for Payer: AZCH Complete Medicare	$8.16
Rate for Payer: Banner UC Health Medicare	$8.16
Rate for Payer: Bisbee Police All Plans	$13.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cigna of AZ Commercial	$35.70
Rate for Payer: Copperpoint Commercial	$12.62
Rate for Payer: Health Net of AZ Commercial	$30.60
Rate for Payer: Health Net of AZ Medicare	$14.28
Rate for Payer: Humana of AZ Medicare	$8.16
Rate for Payer: Self Pay Self Pay	$40.80
Rate for Payer: TriWest Medicare	$8.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.18

Know your out-of-pocket cost for care.

All Charges