Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

32100 THORACOMY MAJOR

Facility

$4,956.00

Service Code	CPT 32100
Hospital Charge Code	22282901
Hospital Revenue Code	450
Min. Negotiated Rate	$4,460.40
Max. Negotiated Rate	$4,460.40
Rate for Payer: Aetna of AZ Commercial	$4,460.40
Rate for Payer: Cash Price	$3,964.80

32100 THORACOMY MAJOR

Facility

$4,956.00

Service Code	CPT 32100
Hospital Charge Code	22282901
Hospital Revenue Code	450
Min. Negotiated Rate	$785.03
Max. Negotiated Rate	$4,460.40
Rate for Payer: Aetna of AZ Commercial	$4,460.40
Rate for Payer: Arizona Complete Health Allwell	$792.96
Rate for Payer: Banner UC Health Medicare	$792.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,370.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$792.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$792.96
Rate for Payer: Cash Price	$3,964.80
Rate for Payer: Cigna of AZ Commercial	$3,469.20
Rate for Payer: Devoted Health Medicare	$892.08
Rate for Payer: Humana of AZ Medicare	$792.96
Rate for Payer: Southwest Service Administrators UFCW	$3,370.08
Rate for Payer: TriWest Medicare	$792.96
Rate for Payer: United Healthcare Commercial	$2,834.83
Rate for Payer: United Healthcare Medicare	$792.96
Rate for Payer: United Healthcare New Mexico Commercial	$941.64
Rate for Payer: Veterans Affairs TRICARE	$785.03

32551 CHEST TUBE INSRTATION

Facility

$1,958.00

Service Code	CPT 32551
Hospital Charge Code	22282902
Hospital Revenue Code	450
Min. Negotiated Rate	$1,762.20
Max. Negotiated Rate	$1,762.20
Rate for Payer: Aetna of AZ Commercial	$1,762.20
Rate for Payer: Cash Price	$1,566.40

32551 CHEST TUBE INSRTATION

Facility

$1,958.00

Service Code	CPT 32551
Hospital Charge Code	22282902
Hospital Revenue Code	450
Min. Negotiated Rate	$310.15
Max. Negotiated Rate	$2,435.64
Rate for Payer: Aetna of AZ Commercial	$1,762.20
Rate for Payer: Arizona Complete Health Allwell	$313.28
Rate for Payer: Banner UC Health Medicare	$313.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,331.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$313.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$313.28
Rate for Payer: Cash Price	$1,566.40
Rate for Payer: Cash Price	$1,566.40
Rate for Payer: Cigna of AZ Commercial	$1,370.60
Rate for Payer: Devoted Health Medicare	$352.44
Rate for Payer: Humana of AZ Medicare	$313.28
Rate for Payer: Seven Corners Travel Insurance	$2,435.64
Rate for Payer: Southwest Service Administrators UFCW	$1,331.44
Rate for Payer: TriWest Medicare	$313.28
Rate for Payer: United Healthcare Commercial	$1,119.98
Rate for Payer: United Healthcare Medicare	$313.28
Rate for Payer: United Healthcare New Mexico Commercial	$372.02
Rate for Payer: Veterans Affairs TRICARE	$310.15

3.4MM DRILL CANNULA

Facility

$683.00

Hospital Charge Code	22354196
Hospital Revenue Code	270
Min. Negotiated Rate	$108.19
Max. Negotiated Rate	$614.70
Rate for Payer: Aetna of AZ Commercial	$614.70
Rate for Payer: Arizona Complete Health Allwell	$109.28
Rate for Payer: Banner UC Health Medicare	$109.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$464.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$109.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$109.28
Rate for Payer: Cash Price	$546.40
Rate for Payer: Cigna of AZ Commercial	$478.10
Rate for Payer: Devoted Health Medicare	$122.94
Rate for Payer: Humana of AZ Medicare	$109.28
Rate for Payer: Southwest Service Administrators UFCW	$464.44
Rate for Payer: TriWest Medicare	$109.28
Rate for Payer: United Healthcare Commercial	$390.68
Rate for Payer: United Healthcare Medicare	$109.28
Rate for Payer: Veterans Affairs TRICARE	$108.19

3.4MM DRILL CANNULA

Facility

$683.00

Hospital Charge Code	22354196
Hospital Revenue Code	270
Min. Negotiated Rate	$614.70
Max. Negotiated Rate	$614.70
Rate for Payer: Aetna of AZ Commercial	$614.70
Rate for Payer: Cash Price	$546.40

36011 IV CENTRAL VEIN

Facility

$1,273.00

Service Code	CPT 36011
Hospital Charge Code	22282903
Hospital Revenue Code	450
Min. Negotiated Rate	$201.64
Max. Negotiated Rate	$1,145.70
Rate for Payer: Aetna of AZ Commercial	$1,145.70
Rate for Payer: Arizona Complete Health Allwell	$203.68
Rate for Payer: Banner UC Health Medicare	$203.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$865.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$622.38
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$203.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$203.68
Rate for Payer: Cash Price	$1,018.40
Rate for Payer: Cash Price	$1,018.40
Rate for Payer: Cigna of AZ Commercial	$891.10
Rate for Payer: Devoted Health Medicare	$229.14
Rate for Payer: Humana of AZ Medicare	$203.68
Rate for Payer: Mercy Care Medicaid	$622.38
Rate for Payer: NaphCare Correctional Healthcare	$622.38
Rate for Payer: Southwest Service Administrators UFCW	$865.64
Rate for Payer: TriWest Medicare	$203.68
Rate for Payer: United Healthcare Commercial	$728.16
Rate for Payer: United Healthcare Medicare	$203.68
Rate for Payer: United Healthcare New Mexico Commercial	$241.87
Rate for Payer: Veterans Affairs TRICARE	$201.64

36011 IV CENTRAL VEIN

Facility

$1,273.00

Service Code	CPT 36011
Hospital Charge Code	22282903
Hospital Revenue Code	450
Min. Negotiated Rate	$1,145.70
Max. Negotiated Rate	$1,145.70
Rate for Payer: Aetna of AZ Commercial	$1,145.70
Rate for Payer: Cash Price	$1,018.40

36400 VENIPUNCTURE <3Y CENTRAL

Facility

$53.00

Service Code	CPT 36400
Hospital Charge Code	22282904
Hospital Revenue Code	450
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Arizona Complete Health Allwell	$8.48
Rate for Payer: Banner UC Health Medicare	$8.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9.41
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.48
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Devoted Health Medicare	$9.54
Rate for Payer: Humana of AZ Medicare	$8.48
Rate for Payer: Mercy Care Medicaid	$9.41
Rate for Payer: NaphCare Correctional Healthcare	$9.41
Rate for Payer: Southwest Service Administrators UFCW	$36.04
Rate for Payer: TriWest Medicare	$8.48
Rate for Payer: United Healthcare Commercial	$30.32
Rate for Payer: United Healthcare Medicare	$8.48
Rate for Payer: United Healthcare New Mexico Commercial	$10.07
Rate for Payer: Veterans Affairs TRICARE	$8.40

36400 VENIPUNCTURE <3Y CENTRAL

Facility

$53.00

Service Code	CPT 36400
Hospital Charge Code	22282904
Hospital Revenue Code	450
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Cash Price	$42.40

36405 SCALP VEIN IV<3Y

Facility

$72.00

Service Code	CPT 36405
Hospital Charge Code	22282905
Hospital Revenue Code	450
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Cash Price	$57.60

36405 SCALP VEIN IV<3Y

Facility

$72.00

Service Code	CPT 36405
Hospital Charge Code	22282905
Hospital Revenue Code	450
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Arizona Complete Health Allwell	$11.52
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9.42
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.52
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Devoted Health Medicare	$12.96
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Mercy Care Medicaid	$9.42
Rate for Payer: NaphCare Correctional Healthcare	$9.42
Rate for Payer: Southwest Service Administrators UFCW	$48.96
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: United Healthcare Commercial	$41.18
Rate for Payer: United Healthcare Medicare	$11.52
Rate for Payer: United Healthcare New Mexico Commercial	$13.68
Rate for Payer: Veterans Affairs TRICARE	$11.40

36406 OTHER VEIN IV <3Y

Facility

$53.00

Service Code	CPT 36406
Hospital Charge Code	22282906
Hospital Revenue Code	450
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Cash Price	$42.40

36406 OTHER VEIN IV <3Y

Facility

$53.00

Service Code	CPT 36406
Hospital Charge Code	22282906
Hospital Revenue Code	450
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Arizona Complete Health Allwell	$8.48
Rate for Payer: Banner UC Health Medicare	$8.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9.06
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.48
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Devoted Health Medicare	$9.54
Rate for Payer: Humana of AZ Medicare	$8.48
Rate for Payer: Mercy Care Medicaid	$9.06
Rate for Payer: NaphCare Correctional Healthcare	$9.06
Rate for Payer: Southwest Service Administrators UFCW	$36.04
Rate for Payer: TriWest Medicare	$8.48
Rate for Payer: United Healthcare Commercial	$30.32
Rate for Payer: United Healthcare Medicare	$8.48
Rate for Payer: United Healthcare New Mexico Commercial	$10.07
Rate for Payer: Veterans Affairs TRICARE	$8.40

36410 VENIPUNCTURE PHYSICIAN

Facility

$77.00

Service Code	CPT 36410
Hospital Charge Code	22282907
Hospital Revenue Code	450
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Arizona Complete Health Allwell	$12.32
Rate for Payer: Banner UC Health Medicare	$12.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$52.36
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9.07
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.32
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$53.90
Rate for Payer: Devoted Health Medicare	$13.86
Rate for Payer: Humana of AZ Medicare	$12.32
Rate for Payer: Mercy Care Medicaid	$9.07
Rate for Payer: NaphCare Correctional Healthcare	$9.07
Rate for Payer: Southwest Service Administrators UFCW	$52.36
Rate for Payer: TriWest Medicare	$12.32
Rate for Payer: United Healthcare Commercial	$44.04
Rate for Payer: United Healthcare Medicare	$12.32
Rate for Payer: United Healthcare New Mexico Commercial	$14.63
Rate for Payer: Veterans Affairs TRICARE	$12.20

36410 VENIPUNCTURE PHYSICIAN

Facility

$77.00

Service Code	CPT 36410
Hospital Charge Code	22282907
Hospital Revenue Code	450
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Cash Price	$61.60

36420 IV CUTDOWN<1Y

Facility

$310.00

Service Code	CPT 36420
Hospital Charge Code	22282908
Hospital Revenue Code	450
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Cash Price	$248.00

36420 IV CUTDOWN<1Y

Facility

$310.00

Service Code	CPT 36420
Hospital Charge Code	22282908
Hospital Revenue Code	450
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Arizona Complete Health Allwell	$49.60
Rate for Payer: Banner UC Health Medicare	$49.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$210.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$49.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.60
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: Devoted Health Medicare	$55.80
Rate for Payer: Humana of AZ Medicare	$49.60
Rate for Payer: Seven Corners Travel Insurance	$205.86
Rate for Payer: Southwest Service Administrators UFCW	$210.80
Rate for Payer: TriWest Medicare	$49.60
Rate for Payer: United Healthcare Commercial	$177.32
Rate for Payer: United Healthcare Medicare	$49.60
Rate for Payer: United Healthcare New Mexico Commercial	$58.90
Rate for Payer: Veterans Affairs TRICARE	$49.10

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	$174.60
Max. Negotiated Rate	$174.60
Rate for Payer: Aetna of AZ Commercial	$174.60
Rate for Payer: Cash Price	$155.20

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	$30.73
Max. Negotiated Rate	$691.20
Rate for Payer: Aetna of AZ Commercial	$174.60
Rate for Payer: Arizona Complete Health Allwell	$31.04
Rate for Payer: Banner UC Health Medicare	$31.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$131.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.04
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: Devoted Health Medicare	$34.92
Rate for Payer: Humana of AZ Medicare	$31.04
Rate for Payer: Seven Corners Travel Insurance	$691.20
Rate for Payer: Southwest Service Administrators UFCW	$131.92
Rate for Payer: TriWest Medicare	$31.04
Rate for Payer: United Healthcare Commercial	$110.97
Rate for Payer: United Healthcare Medicare	$31.04
Rate for Payer: United Healthcare New Mexico Commercial	$36.86
Rate for Payer: Veterans Affairs TRICARE	$30.73

36430 BLOOD PRODUCT TRANSFUSION

Facility

$908.00

Service Code	CPT 36430
Hospital Charge Code	22282910
Hospital Revenue Code	391
Min. Negotiated Rate	$817.20
Max. Negotiated Rate	$817.20
Rate for Payer: Aetna of AZ Commercial	$817.20
Rate for Payer: Cash Price	$726.40

36430 BLOOD PRODUCT TRANSFUSION

Facility

$908.00

Service Code	CPT 36430
Hospital Charge Code	22282910
Hospital Revenue Code	391
Min. Negotiated Rate	$143.83
Max. Negotiated Rate	$817.20
Rate for Payer: Aetna of AZ Commercial	$817.20
Rate for Payer: Arizona Complete Health Allwell	$145.28
Rate for Payer: Banner UC Health Medicare	$145.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$617.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$145.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$145.28
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: Devoted Health Medicare	$163.44
Rate for Payer: Humana of AZ Medicare	$145.28
Rate for Payer: Seven Corners Travel Insurance	$682.62
Rate for Payer: Southwest Service Administrators UFCW	$617.44
Rate for Payer: TriWest Medicare	$145.28
Rate for Payer: United Healthcare Commercial	$519.38
Rate for Payer: United Healthcare Medicare	$145.28
Rate for Payer: Veterans Affairs TRICARE	$143.83

36510 UMBIL VEIN CATH

Facility

$233.00

Service Code	CPT 36510
Hospital Charge Code	22282911
Hospital Revenue Code	450
Min. Negotiated Rate	$34.17
Max. Negotiated Rate	$209.70
Rate for Payer: Aetna of AZ Commercial	$209.70
Rate for Payer: Arizona Complete Health Allwell	$37.28
Rate for Payer: Banner UC Health Medicare	$37.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$158.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34.17
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$37.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$37.28
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: Devoted Health Medicare	$41.94
Rate for Payer: Humana of AZ Medicare	$37.28
Rate for Payer: Mercy Care Medicaid	$34.17
Rate for Payer: NaphCare Correctional Healthcare	$34.17
Rate for Payer: Southwest Service Administrators UFCW	$158.44
Rate for Payer: TriWest Medicare	$37.28
Rate for Payer: United Healthcare Commercial	$133.28
Rate for Payer: United Healthcare Medicare	$37.28
Rate for Payer: United Healthcare New Mexico Commercial	$44.27
Rate for Payer: Veterans Affairs TRICARE	$36.91

36510 UMBIL VEIN CATH

Facility

$233.00

Service Code	CPT 36510
Hospital Charge Code	22282911
Hospital Revenue Code	450
Min. Negotiated Rate	$209.70
Max. Negotiated Rate	$209.70
Rate for Payer: Aetna of AZ Commercial	$209.70
Rate for Payer: Cash Price	$186.40

36550 THROMBOLYTIC AGENT

Facility

$91.00

Service Code	CPT 36550
Hospital Charge Code	22282912
Hospital Revenue Code	450
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Cash Price	$72.80

Know your out-of-pocket cost for care.

All Charges