Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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 3WAY

Facility

$20.00

Service Code	CPT A4346
Hospital Charge Code	22355161
Hospital Revenue Code	270
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$34.66
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: AHCCCS Medicaid	$34.66
Rate for Payer: Allwell Medicaid	$34.66
Rate for Payer: Allwell Medicare	$3.00
Rate for Payer: Amerigroup Medicare	$3.00
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicaid	$34.66
Rate for Payer: AZCH Complete Medicare	$3.00
Rate for Payer: Banner UC Health Medicaid	$34.66
Rate for Payer: Banner UC Health Medicare	$3.00
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: 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	$3.00
Rate for Payer: Mercy Care Medicaid	$34.66
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

CATH FOLEY 6FR 3CC 2-WAY

Facility

$69.00

Hospital Charge Code	22355179
Hospital Revenue Code	270
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$10.35
Rate for Payer: Amerigroup Medicare	$10.35
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$10.35
Rate for Payer: Banner UC Health Medicare	$10.35
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$48.30
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$10.35
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$10.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

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

CATH FOLEY 8FR 3CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355147
Hospital Revenue Code	270
Min. Negotiated Rate	$14.55
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	$14.55
Rate for Payer: Amerigroup Medicare	$14.55
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$14.55
Rate for Payer: Banner UC Health Medicare	$14.55
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	$14.55
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$14.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

CATH FOLEY 8FR 3CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355147
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 FREEDOM

Facility

$13.00

Hospital Charge Code	22355707
Hospital Revenue Code	270
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

CATH FREEDOM

Facility

$13.00

Hospital Charge Code	22355707
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
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	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
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	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

CATH IMPLANTABLE PORT X-PORT

Facility

$1,902.00

Hospital Charge Code	22354157
Hospital Revenue Code	270
Min. Negotiated Rate	$285.30
Max. Negotiated Rate	$1,711.80
Rate for Payer: Aetna of AZ Commercial	$1,711.80
Rate for Payer: Aetna of AZ Medicare	$532.56
Rate for Payer: Allwell Medicare	$285.30
Rate for Payer: Amerigroup Medicare	$285.30
Rate for Payer: APIPA Medicare/Medicaid	$710.40
Rate for Payer: AZCH Complete Medicare	$285.30
Rate for Payer: Banner UC Health Medicare	$285.30
Rate for Payer: Bisbee Police All Plans	$494.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,293.36
Rate for Payer: Cash Price	$1,521.60
Rate for Payer: Cigna of AZ Commercial	$1,331.40
Rate for Payer: Copperpoint Commercial	$470.74
Rate for Payer: Health Net of AZ Commercial	$1,141.20
Rate for Payer: Health Net of AZ Medicare	$532.56
Rate for Payer: Humana of AZ Medicare	$285.30
Rate for Payer: Self Pay Self Pay	$1,521.60
Rate for Payer: TriWest Medicare	$285.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,108.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$342.36

CATH IMPLANTABLE PORT X-PORT

Facility

$1,902.00

Hospital Charge Code	22354157
Hospital Revenue Code	270
Min. Negotiated Rate	$494.52
Max. Negotiated Rate	$1,711.80
Rate for Payer: Aetna of AZ Commercial	$1,711.80
Rate for Payer: Bisbee Police All Plans	$494.52
Rate for Payer: Cash Price	$1,521.60
Rate for Payer: Self Pay Self Pay	$1,521.60

CATH IMPLANTABLE POWERPORT

Facility

$1,511.00

Hospital Charge Code	22528805
Hospital Revenue Code	270
Min. Negotiated Rate	$392.86
Max. Negotiated Rate	$1,359.90
Rate for Payer: Aetna of AZ Commercial	$1,359.90
Rate for Payer: Bisbee Police All Plans	$392.86
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Self Pay Self Pay	$1,208.80

CATH IMPLANTABLE POWERPORT

Facility

$1,511.00

Hospital Charge Code	22528805
Hospital Revenue Code	270
Min. Negotiated Rate	$226.65
Max. Negotiated Rate	$1,359.90
Rate for Payer: Aetna of AZ Commercial	$1,359.90
Rate for Payer: Aetna of AZ Medicare	$423.08
Rate for Payer: Allwell Medicare	$226.65
Rate for Payer: Amerigroup Medicare	$226.65
Rate for Payer: APIPA Medicare/Medicaid	$564.36
Rate for Payer: AZCH Complete Medicare	$226.65
Rate for Payer: Banner UC Health Medicare	$226.65
Rate for Payer: Bisbee Police All Plans	$392.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,027.48
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Cigna of AZ Commercial	$1,057.70
Rate for Payer: Copperpoint Commercial	$373.97
Rate for Payer: Health Net of AZ Commercial	$906.60
Rate for Payer: Health Net of AZ Medicare	$423.08
Rate for Payer: Humana of AZ Medicare	$226.65
Rate for Payer: Self Pay Self Pay	$1,208.80
Rate for Payer: TriWest Medicare	$226.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$880.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$271.98

CATH INFANT KIT

Facility

$11.00

Hospital Charge Code	22355580
Hospital Revenue Code	270
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Aetna of AZ Medicare	$3.08
Rate for Payer: Allwell Medicare	$1.65
Rate for Payer: Amerigroup Medicare	$1.65
Rate for Payer: APIPA Medicare/Medicaid	$4.11
Rate for Payer: AZCH Complete Medicare	$1.65
Rate for Payer: Banner UC Health Medicare	$1.65
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.48
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Copperpoint Commercial	$2.72
Rate for Payer: Health Net of AZ Commercial	$6.60
Rate for Payer: Health Net of AZ Medicare	$3.08
Rate for Payer: Humana of AZ Medicare	$1.65
Rate for Payer: Self Pay Self Pay	$8.80
Rate for Payer: TriWest Medicare	$1.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.98

CATH INFANT KIT

Facility

$11.00

Hospital Charge Code	22355580
Hospital Revenue Code	270
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Cash Price	$8.80
Rate for Payer: Self Pay Self Pay	$8.80

CATH IV - ANGIO 14GX1.75 INSYTE AUTO

Facility

$13.00

Hospital Charge Code	22355565
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
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	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
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	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

CATH IV - ANGIO 14GX1.75 INSYTE AUTO

Facility

$13.00

Hospital Charge Code	22355565
Hospital Revenue Code	270
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

CATH IV - ANGIO 16GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355564
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CATH IV - ANGIO 16GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355564
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicare	$1.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.80
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CATH IV - ANGIO 18GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355563
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicare	$1.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.80
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CATH IV - ANGIO 18GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355563
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CATH IV - ANGIO 20GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355562
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicare	$1.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.80
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CATH IV - ANGIO 20GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355562
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CATH IV - ANGIO 22GX1 INSYTE AUTO LF

Facility

$12.00

Hospital Charge Code	22355561
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

CATH IV - ANGIO 22GX1 INSYTE AUTO LF

Facility

$12.00

Hospital Charge Code	22355561
Hospital Revenue Code	272
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Aetna of AZ Medicare	$3.36
Rate for Payer: Allwell Medicare	$1.80
Rate for Payer: Amerigroup Medicare	$1.80
Rate for Payer: APIPA Medicare/Medicaid	$4.48
Rate for Payer: AZCH Complete Medicare	$1.80
Rate for Payer: Banner UC Health Medicare	$1.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Copperpoint Commercial	$2.97
Rate for Payer: Health Net of AZ Commercial	$7.20
Rate for Payer: Health Net of AZ Medicare	$3.36
Rate for Payer: Humana of AZ Medicare	$1.80
Rate for Payer: Self Pay Self Pay	$9.60
Rate for Payer: TriWest Medicare	$1.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.16

CATH IV - ANGIO 24GX3/4 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355560
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Bisbee Police All Plans	$3.12
Rate for Payer: Cash Price	$9.60
Rate for Payer: Self Pay Self Pay	$9.60

Know your out-of-pocket cost for care.

All Charges