Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Venous Blood Gas..

Facility

$309.00

Service Code	CPT 82803
Hospital Charge Code	22040456
Hospital Revenue Code	301
Min. Negotiated Rate	$278.10
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Cash Price	$247.20

Venous Blood Gas...

Facility

$338.00

Service Code	CPT 82803
Hospital Charge Code	23122859
Hospital Revenue Code	301
Min. Negotiated Rate	$304.20
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Cash Price	$270.40

Venous Blood Gas...

Facility

$338.00

Service Code	CPT 82803
Hospital Charge Code	23122859
Hospital Revenue Code	301
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Arizona Complete Health Allwell	$54.08
Rate for Payer: Banner UC Health Medicare	$54.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$229.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$54.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$54.08
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cigna of AZ Commercial	$219.70
Rate for Payer: Devoted Health Medicare	$60.84
Rate for Payer: Humana of AZ Medicare	$54.08
Rate for Payer: Seven Corners Travel Insurance	$37.80
Rate for Payer: Southwest Service Administrators UFCW	$229.84
Rate for Payer: TriWest Medicare	$54.08
Rate for Payer: United Healthcare Commercial	$193.34
Rate for Payer: United Healthcare Medicare	$54.08
Rate for Payer: Veterans Affairs TRICARE	$53.54

Venous Draw Charge

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	2240048
Hospital Revenue Code	300
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Arizona Complete Health Allwell	$5.76
Rate for Payer: Banner UC Health Medicare	$5.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$24.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.76
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of AZ Commercial	$23.40
Rate for Payer: Devoted Health Medicare	$6.48
Rate for Payer: Humana of AZ Medicare	$5.76
Rate for Payer: Seven Corners Travel Insurance	$13.54
Rate for Payer: Southwest Service Administrators UFCW	$24.48
Rate for Payer: TriWest Medicare	$5.76
Rate for Payer: United Healthcare Commercial	$20.59
Rate for Payer: United Healthcare Medicare	$5.76
Rate for Payer: Veterans Affairs TRICARE	$5.70

Venous Draw Charge

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	2240048
Hospital Revenue Code	300
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Cash Price	$28.80

Ventilator Services Initial

Facility

$2,336.00

Service Code	CPT 94002
Hospital Charge Code	1886947
Hospital Revenue Code	410
Min. Negotiated Rate	$370.02
Max. Negotiated Rate	$2,102.40
Rate for Payer: Aetna of AZ Commercial	$2,102.40
Rate for Payer: Arizona Complete Health Allwell	$373.76
Rate for Payer: Banner UC Health Medicare	$373.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,588.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$373.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$373.76
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Cash Price	$1,868.80
Rate for Payer: Cigna of AZ Commercial	$1,635.20
Rate for Payer: Devoted Health Medicare	$420.48
Rate for Payer: Humana of AZ Medicare	$373.76
Rate for Payer: Seven Corners Travel Insurance	$955.88
Rate for Payer: Southwest Service Administrators UFCW	$1,588.48
Rate for Payer: TriWest Medicare	$373.76
Rate for Payer: United Healthcare Commercial	$1,336.19
Rate for Payer: United Healthcare Medicare	$373.76
Rate for Payer: United Healthcare New Mexico Commercial	$443.84
Rate for Payer: Veterans Affairs TRICARE	$370.02

Ventilator Services Initial

Facility

$2,336.00

Service Code	CPT 94002
Hospital Charge Code	1886947
Hospital Revenue Code	410
Min. Negotiated Rate	$2,102.40
Max. Negotiated Rate	$2,102.40
Rate for Payer: Aetna of AZ Commercial	$2,102.40
Rate for Payer: Cash Price	$1,868.80

Ventricular Shunt Procedures

Facility

$18,163.45

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG0221
Min. Negotiated Rate	$18,163.45
Max. Negotiated Rate	$18,163.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,163.45
Rate for Payer: Mercy Care Medicaid	$18,163.45
Rate for Payer: NaphCare Correctional Healthcare	$18,163.45

Ventricular Shunt Procedures

Facility

$11,077.21

Service Code	APR-DRG 0222
Hospital Charge Code	APRDRG0222
Min. Negotiated Rate	$11,077.21
Max. Negotiated Rate	$11,077.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,077.21
Rate for Payer: Mercy Care Medicaid	$11,077.21
Rate for Payer: NaphCare Correctional Healthcare	$11,077.21

Ventricular Shunt Procedures

Facility

$18,163.45

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG0222
Min. Negotiated Rate	$18,163.45
Max. Negotiated Rate	$18,163.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,163.45
Rate for Payer: Mercy Care Medicaid	$18,163.45
Rate for Payer: NaphCare Correctional Healthcare	$18,163.45

Ventricular Shunt Procedures

Facility

$40,079.40

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG0221
Min. Negotiated Rate	$40,079.40
Max. Negotiated Rate	$40,079.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40,079.40
Rate for Payer: Mercy Care Medicaid	$40,079.40
Rate for Payer: NaphCare Correctional Healthcare	$40,079.40

Ventricular Shunt Procedures

Facility

$18,163.45

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG0223
Min. Negotiated Rate	$18,163.45
Max. Negotiated Rate	$18,163.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,163.45
Rate for Payer: Mercy Care Medicaid	$18,163.45
Rate for Payer: NaphCare Correctional Healthcare	$18,163.45

Ventricular Shunt Procedures

Facility

$11,077.21

Service Code	APR-DRG 0222
Hospital Charge Code	APRDRG0223
Min. Negotiated Rate	$11,077.21
Max. Negotiated Rate	$11,077.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,077.21
Rate for Payer: Mercy Care Medicaid	$11,077.21
Rate for Payer: NaphCare Correctional Healthcare	$11,077.21

Ventricular Shunt Procedures

Facility

$11,077.21

Service Code	APR-DRG 0222
Hospital Charge Code	APRDRG0221
Min. Negotiated Rate	$11,077.21
Max. Negotiated Rate	$11,077.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,077.21
Rate for Payer: Mercy Care Medicaid	$11,077.21
Rate for Payer: NaphCare Correctional Healthcare	$11,077.21

Ventricular Shunt Procedures

Facility

$40,079.40

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG0224
Min. Negotiated Rate	$40,079.40
Max. Negotiated Rate	$40,079.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40,079.40
Rate for Payer: Mercy Care Medicaid	$40,079.40
Rate for Payer: NaphCare Correctional Healthcare	$40,079.40

Ventricular Shunt Procedures

Facility

$11,077.21

Service Code	APR-DRG 0222
Hospital Charge Code	APRDRG0224
Min. Negotiated Rate	$11,077.21
Max. Negotiated Rate	$11,077.21
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,077.21
Rate for Payer: Mercy Care Medicaid	$11,077.21
Rate for Payer: NaphCare Correctional Healthcare	$11,077.21

Ventricular Shunt Procedures

Facility

$8,652.47

Service Code	APR-DRG 0221
Hospital Charge Code	APRDRG0224
Min. Negotiated Rate	$8,652.47
Max. Negotiated Rate	$8,652.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,652.47
Rate for Payer: Mercy Care Medicaid	$8,652.47
Rate for Payer: NaphCare Correctional Healthcare	$8,652.47

Ventricular Shunt Procedures

Facility

$40,079.40

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG0223
Min. Negotiated Rate	$40,079.40
Max. Negotiated Rate	$40,079.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40,079.40
Rate for Payer: Mercy Care Medicaid	$40,079.40
Rate for Payer: NaphCare Correctional Healthcare	$40,079.40

Ventricular Shunt Procedures

Facility

$18,163.45

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG0224
Min. Negotiated Rate	$18,163.45
Max. Negotiated Rate	$18,163.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,163.45
Rate for Payer: Mercy Care Medicaid	$18,163.45
Rate for Payer: NaphCare Correctional Healthcare	$18,163.45

Ventricular Shunt Procedures

Facility

$8,652.47

Service Code	APR-DRG 0221
Hospital Charge Code	APRDRG0221
Min. Negotiated Rate	$8,652.47
Max. Negotiated Rate	$8,652.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,652.47
Rate for Payer: Mercy Care Medicaid	$8,652.47
Rate for Payer: NaphCare Correctional Healthcare	$8,652.47

Ventricular Shunt Procedures

Facility

$8,652.47

Service Code	APR-DRG 0221
Hospital Charge Code	APRDRG0222
Min. Negotiated Rate	$8,652.47
Max. Negotiated Rate	$8,652.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,652.47
Rate for Payer: Mercy Care Medicaid	$8,652.47
Rate for Payer: NaphCare Correctional Healthcare	$8,652.47

Ventricular Shunt Procedures

Facility

$40,079.40

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG0222
Min. Negotiated Rate	$40,079.40
Max. Negotiated Rate	$40,079.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40,079.40
Rate for Payer: Mercy Care Medicaid	$40,079.40
Rate for Payer: NaphCare Correctional Healthcare	$40,079.40

Ventricular Shunt Procedures

Facility

$8,652.47

Service Code	APR-DRG 0221
Hospital Charge Code	APRDRG0223
Min. Negotiated Rate	$8,652.47
Max. Negotiated Rate	$8,652.47
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,652.47
Rate for Payer: Mercy Care Medicaid	$8,652.47
Rate for Payer: NaphCare Correctional Healthcare	$8,652.47

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$27,541.36

Service Code	MSDRG 032
Min. Negotiated Rate	$27,541.36
Max. Negotiated Rate	$27,541.36
Rate for Payer: Seven Corners Travel Insurance	$27,541.36

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$57,906.62

Service Code	MSDRG 031
Min. Negotiated Rate	$57,906.62
Max. Negotiated Rate	$57,906.62
Rate for Payer: Seven Corners Travel Insurance	$57,906.62

Know your out-of-pocket cost for care.

All Charges