Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CATH FOLEY 28FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355164
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

CATH FOLEY 28FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355164
Hospital Revenue Code	270
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

CATH FOLEY 30CC 18FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355168
Hospital Revenue Code	270
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

CATH FOLEY 30CC 18FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355168
Hospital Revenue Code	270
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

CATH FOLEY 30CC 18FR 3 WAY SILICONE

Facility

$64.25

Hospital Charge Code	27796434
Hospital Revenue Code	270
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna of AZ Commercial	$57.83
Rate for Payer: Bisbee Police All Plans	$16.70
Rate for Payer: Cash Price	$51.40
Rate for Payer: Self Pay Self Pay	$51.40

CATH FOLEY 30CC 18FR 3 WAY SILICONE

Facility

$64.25

Hospital Charge Code	27796434
Hospital Revenue Code	270
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna of AZ Commercial	$57.83
Rate for Payer: Aetna of AZ Medicare	$17.99
Rate for Payer: Allwell Medicare	$10.28
Rate for Payer: Amerigroup Medicare	$10.28
Rate for Payer: APIPA Medicare/Medicaid	$24.00
Rate for Payer: AZCH Complete Medicare	$10.28
Rate for Payer: Banner UC Health Medicare	$10.28
Rate for Payer: Bisbee Police All Plans	$16.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43.69
Rate for Payer: Cash Price	$51.40
Rate for Payer: Cigna of AZ Commercial	$44.98
Rate for Payer: Copperpoint Commercial	$15.90
Rate for Payer: Health Net of AZ Commercial	$38.55
Rate for Payer: Health Net of AZ Medicare	$17.99
Rate for Payer: Humana of AZ Medicare	$10.28
Rate for Payer: Self Pay Self Pay	$51.40
Rate for Payer: TriWest Medicare	$10.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.56

CATH FOLEY 30CC 20FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355169
Hospital Revenue Code	270
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

CATH FOLEY 30CC 20FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355169
Hospital Revenue Code	270
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

CATH FOLEY 30CC 20FR 3-WAY ST

Facility

$54.00

Hospital Charge Code	22355148
Hospital Revenue Code	270
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Bisbee Police All Plans	$14.04
Rate for Payer: Cash Price	$43.20
Rate for Payer: Self Pay Self Pay	$43.20

CATH FOLEY 30CC 20FR 3-WAY ST

Facility

$54.00

Hospital Charge Code	22355148
Hospital Revenue Code	270
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Aetna of AZ Medicare	$15.12
Rate for Payer: Allwell Medicare	$8.64
Rate for Payer: Amerigroup Medicare	$8.64
Rate for Payer: APIPA Medicare/Medicaid	$20.17
Rate for Payer: AZCH Complete Medicare	$8.64
Rate for Payer: Banner UC Health Medicare	$8.64
Rate for Payer: Bisbee Police All Plans	$14.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$36.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of AZ Commercial	$37.80
Rate for Payer: Copperpoint Commercial	$13.37
Rate for Payer: Health Net of AZ Commercial	$32.40
Rate for Payer: Health Net of AZ Medicare	$15.12
Rate for Payer: Humana of AZ Medicare	$8.64
Rate for Payer: Self Pay Self Pay	$43.20
Rate for Payer: TriWest Medicare	$8.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$31.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.72

CATH FOLEY 30CC 22FR 3-WAY

Facility

$49.00

Hospital Charge Code	22355187
Hospital Revenue Code	270
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Aetna of AZ Medicare	$13.72
Rate for Payer: Allwell Medicare	$7.84
Rate for Payer: Amerigroup Medicare	$7.84
Rate for Payer: APIPA Medicare/Medicaid	$18.30
Rate for Payer: AZCH Complete Medicare	$7.84
Rate for Payer: Banner UC Health Medicare	$7.84
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$33.32
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$34.30
Rate for Payer: Copperpoint Commercial	$12.13
Rate for Payer: Health Net of AZ Commercial	$29.40
Rate for Payer: Health Net of AZ Medicare	$13.72
Rate for Payer: Humana of AZ Medicare	$7.84
Rate for Payer: Self Pay Self Pay	$39.20
Rate for Payer: TriWest Medicare	$7.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.82

CATH FOLEY 30CC 22FR 3-WAY

Facility

$49.00

Hospital Charge Code	22355187
Hospital Revenue Code	270
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Self Pay Self Pay	$39.20

CATH FOLEY 30CC 22FR 3 WAY SILICONE

Facility

$25.60

Hospital Charge Code	27796436
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna of AZ Commercial	$23.04
Rate for Payer: Aetna of AZ Medicare	$7.17
Rate for Payer: Allwell Medicare	$4.10
Rate for Payer: Amerigroup Medicare	$4.10
Rate for Payer: APIPA Medicare/Medicaid	$9.56
Rate for Payer: AZCH Complete Medicare	$4.10
Rate for Payer: Banner UC Health Medicare	$4.10
Rate for Payer: Bisbee Police All Plans	$6.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.41
Rate for Payer: Cash Price	$20.48
Rate for Payer: Cigna of AZ Commercial	$17.92
Rate for Payer: Copperpoint Commercial	$6.34
Rate for Payer: Health Net of AZ Commercial	$15.36
Rate for Payer: Health Net of AZ Medicare	$7.17
Rate for Payer: Humana of AZ Medicare	$4.10
Rate for Payer: Self Pay Self Pay	$20.48
Rate for Payer: TriWest Medicare	$4.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.61

CATH FOLEY 30CC 22FR 3 WAY SILICONE

Facility

$25.60

Hospital Charge Code	27796436
Hospital Revenue Code	270
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna of AZ Commercial	$23.04
Rate for Payer: Bisbee Police All Plans	$6.66
Rate for Payer: Cash Price	$20.48
Rate for Payer: Self Pay Self Pay	$20.48

CATH FOLEY 30CC 24FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355167
Hospital Revenue Code	270
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

CATH FOLEY 30CC 24FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355167
Hospital Revenue Code	270
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

CATH FOLEY 30CC 26FR 3-WAY

Facility

$158.00

Hospital Charge Code	22355181
Hospital Revenue Code	270
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Aetna of AZ Medicare	$44.24
Rate for Payer: Allwell Medicare	$25.28
Rate for Payer: Amerigroup Medicare	$25.28
Rate for Payer: APIPA Medicare/Medicaid	$59.01
Rate for Payer: AZCH Complete Medicare	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$107.44
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$110.60
Rate for Payer: Copperpoint Commercial	$39.10
Rate for Payer: Health Net of AZ Commercial	$94.80
Rate for Payer: Health Net of AZ Medicare	$44.24
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Self Pay Self Pay	$126.40
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.44

CATH FOLEY 30CC 26FR 3-WAY

Facility

$158.00

Hospital Charge Code	22355181
Hospital Revenue Code	270
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Bisbee Police All Plans	$41.08
Rate for Payer: Cash Price	$126.40
Rate for Payer: Self Pay Self Pay	$126.40

CATH FOLEY 30FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355153
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

CATH FOLEY 30FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355153
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

CATH FOLEY 30FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355166
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

CATH FOLEY 30FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355166
Hospital Revenue Code	270
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

CATH FOLEY 3WAY

Facility

$20.00

Service Code	CPT A4346
Hospital Charge Code	22355161
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

CATH FOLEY 3WAY

Facility

$20.00

Service Code	CPT A4346
Hospital Charge Code	22355161
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

CATH FOLEY 6FR 3CC 2-WAY

Facility

$69.00

Hospital Charge Code	22355179
Hospital Revenue Code	270
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

Know your out-of-pocket cost for care.

All Charges