Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ANES ANESTHESIA PRONE POSITION CHARGE BASE AND 1ST MINUTE

Facility

$591.00

Service Code	CPT 01992
Hospital Charge Code	22625272
Hospital Revenue Code	370
Min. Negotiated Rate	$531.90
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Cash Price	$472.80

ANES ANESTHESIA PRONE POSITION CHARGE BASE AND 1ST MINUTE

Facility

$591.00

Service Code	CPT 01992
Hospital Charge Code	22625272
Hospital Revenue Code	370
Min. Negotiated Rate	$93.61
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Arizona Complete Health Allwell	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$401.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$94.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$94.56
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Devoted Health Medicare	$106.38
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Southwest Service Administrators UFCW	$401.88
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: United Healthcare Commercial	$338.05
Rate for Payer: United Healthcare Medicare	$94.56
Rate for Payer: Veterans Affairs TRICARE	$93.61

ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT 1S

Facility

$9.00

Service Code	CPT 01382
Hospital Charge Code	22625273
Hospital Revenue Code	370
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT 1S

Facility

$9.00

Service Code	CPT 01382
Hospital Charge Code	22625273
Hospital Revenue Code	370
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT AD

Facility

$150.00

Service Code	CPT 01382
Hospital Charge Code	22625274
Hospital Revenue Code	370
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Cash Price	$120.00

ANES FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT AD

Facility

$150.00

Service Code	CPT 01382
Hospital Charge Code	22625274
Hospital Revenue Code	370
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Arizona Complete Health Allwell	$24.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cigna of AZ Commercial	$97.50
Rate for Payer: Devoted Health Medicare	$27.00
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Southwest Service Administrators UFCW	$102.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: United Healthcare Commercial	$85.80
Rate for Payer: United Healthcare Medicare	$24.00
Rate for Payer: Veterans Affairs TRICARE	$23.76

Anes Forearm Wrist and Hand Addtnl 0:30 charge

Facility

$298.00

Service Code	CPT 01810
Hospital Charge Code	23788219
Hospital Revenue Code	370
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Cash Price	$238.40

Anes Forearm Wrist and Hand Addtnl 0:30 charge

Facility

$298.00

Service Code	CPT 01810
Hospital Charge Code	23788219
Hospital Revenue Code	370
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Arizona Complete Health Allwell	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$202.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.68
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Devoted Health Medicare	$53.64
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Southwest Service Administrators UFCW	$202.64
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: United Healthcare Commercial	$170.46
Rate for Payer: United Healthcare Medicare	$47.68
Rate for Payer: Veterans Affairs TRICARE	$47.20

ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION 1ST 0:30

Facility

$591.00

Service Code	CPT 00532
Hospital Charge Code	22825334
Hospital Revenue Code	370
Min. Negotiated Rate	$531.90
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Cash Price	$472.80

ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION 1ST 0:30

Facility

$591.00

Service Code	CPT 00532
Hospital Charge Code	22825334
Hospital Revenue Code	370
Min. Negotiated Rate	$93.61
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Arizona Complete Health Allwell	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$401.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$94.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$94.56
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Devoted Health Medicare	$106.38
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Southwest Service Administrators UFCW	$401.88
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: United Healthcare Commercial	$338.05
Rate for Payer: United Healthcare Medicare	$94.56
Rate for Payer: Veterans Affairs TRICARE	$93.61

Anesthesia for Access to Central Venous Circulation Addtnl 0

Facility

$563.00

Service Code	CPT 00532
Hospital Charge Code	22825335
Hospital Revenue Code	370
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$506.70
Rate for Payer: Aetna of AZ Commercial	$506.70
Rate for Payer: Arizona Complete Health Allwell	$90.08
Rate for Payer: Banner UC Health Medicare	$90.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$382.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$90.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$90.08
Rate for Payer: Cash Price	$450.40
Rate for Payer: Cigna of AZ Commercial	$365.95
Rate for Payer: Devoted Health Medicare	$101.34
Rate for Payer: Humana of AZ Medicare	$90.08
Rate for Payer: Southwest Service Administrators UFCW	$382.84
Rate for Payer: TriWest Medicare	$90.08
Rate for Payer: United Healthcare Commercial	$322.04
Rate for Payer: United Healthcare Medicare	$90.08
Rate for Payer: Veterans Affairs TRICARE	$89.18

Anesthesia for Access to Central Venous Circulation Addtnl 0

Facility

$563.00

Service Code	CPT 00532
Hospital Charge Code	22825335
Hospital Revenue Code	370
Min. Negotiated Rate	$506.70
Max. Negotiated Rate	$506.70
Rate for Payer: Aetna of AZ Commercial	$506.70
Rate for Payer: Cash Price	$450.40

Anesthesia for transurethral procedures (including urethroCY

Facility

$9.00

Service Code	CPT 00918
Hospital Charge Code	22406156
Hospital Revenue Code	370
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

Anesthesia for transurethral procedures (including urethroCY

Facility

$9.00

Service Code	CPT 00918
Hospital Charge Code	22406156
Hospital Revenue Code	370
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

ANESTHESIA MASK

Facility

$8.00

Hospital Charge Code	22355433
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Cash Price	$6.40

ANESTHESIA MASK

Facility

$8.00

Hospital Charge Code	22355433
Hospital Revenue Code	270
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of AZ Commercial	$7.20
Rate for Payer: Arizona Complete Health Allwell	$1.28
Rate for Payer: Banner UC Health Medicare	$1.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$5.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.28
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna of AZ Commercial	$5.60
Rate for Payer: Devoted Health Medicare	$1.44
Rate for Payer: Humana of AZ Medicare	$1.28
Rate for Payer: Southwest Service Administrators UFCW	$5.44
Rate for Payer: TriWest Medicare	$1.28
Rate for Payer: United Healthcare Commercial	$4.58
Rate for Payer: United Healthcare Medicare	$1.28
Rate for Payer: Veterans Affairs TRICARE	$1.27

ANESTHESIA SET

Facility

$19.00

Hospital Charge Code	22355691
Hospital Revenue Code	270
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Cash Price	$15.20

ANESTHESIA SET

Facility

$19.00

Hospital Charge Code	22355691
Hospital Revenue Code	270
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Arizona Complete Health Allwell	$3.04
Rate for Payer: Banner UC Health Medicare	$3.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.04
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of AZ Commercial	$13.30
Rate for Payer: Devoted Health Medicare	$3.42
Rate for Payer: Humana of AZ Medicare	$3.04
Rate for Payer: Southwest Service Administrators UFCW	$12.92
Rate for Payer: TriWest Medicare	$3.04
Rate for Payer: United Healthcare Commercial	$10.87
Rate for Payer: United Healthcare Medicare	$3.04
Rate for Payer: Veterans Affairs TRICARE	$3.01

ANES TUBAL LIGATION TRANSECTION BASE

Facility

$591.00

Service Code	CPT 00851
Hospital Charge Code	3015527
Hospital Revenue Code	370
Min. Negotiated Rate	$531.90
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Cash Price	$472.80

ANES TUBAL LIGATION TRANSECTION BASE

Facility

$591.00

Service Code	CPT 00851
Hospital Charge Code	3015527
Hospital Revenue Code	370
Min. Negotiated Rate	$93.61
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Arizona Complete Health Allwell	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$401.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$94.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$94.56
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Devoted Health Medicare	$106.38
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Southwest Service Administrators UFCW	$401.88
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: United Healthcare Commercial	$338.05
Rate for Payer: United Healthcare Medicare	$94.56
Rate for Payer: Veterans Affairs TRICARE	$93.61

ANGINA PECTORIS

Facility

$9,249.33

Service Code	MSDRG 311
Min. Negotiated Rate	$9,249.33
Max. Negotiated Rate	$9,249.33
Rate for Payer: Seven Corners Travel Insurance	$9,249.33

Angina Pectoris And Coronary Atherosclerosis

Facility

$5,420.42

Service Code	APR-DRG 1983
Hospital Charge Code	APRDRG1981
Min. Negotiated Rate	$5,420.42
Max. Negotiated Rate	$5,420.42
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,420.42
Rate for Payer: Mercy Care Medicaid	$5,420.42
Rate for Payer: NaphCare Correctional Healthcare	$5,420.42

Angina Pectoris And Coronary Atherosclerosis

Facility

$3,483.85

Service Code	APR-DRG 1981
Hospital Charge Code	APRDRG1983
Min. Negotiated Rate	$3,483.85
Max. Negotiated Rate	$3,483.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,483.85
Rate for Payer: Mercy Care Medicaid	$3,483.85
Rate for Payer: NaphCare Correctional Healthcare	$3,483.85

Angina Pectoris And Coronary Atherosclerosis

Facility

$10,514.69

Service Code	APR-DRG 1984
Hospital Charge Code	APRDRG1984
Min. Negotiated Rate	$10,514.69
Max. Negotiated Rate	$10,514.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,514.69
Rate for Payer: Mercy Care Medicaid	$10,514.69
Rate for Payer: NaphCare Correctional Healthcare	$10,514.69

Angina Pectoris And Coronary Atherosclerosis

Facility

$10,514.69

Service Code	APR-DRG 1984
Hospital Charge Code	APRDRG1983
Min. Negotiated Rate	$10,514.69
Max. Negotiated Rate	$10,514.69
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,514.69
Rate for Payer: Mercy Care Medicaid	$10,514.69
Rate for Payer: NaphCare Correctional Healthcare	$10,514.69

Know your out-of-pocket cost for care.

All Charges