Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CATH IV - ANGIO 24GX3/4 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355560
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 LEG BAND

Facility

$26.00

Service Code	CPT A5114
Hospital Charge Code	22354281
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

CATH LEG BAND

Facility

$26.00

Service Code	CPT A5114
Hospital Charge Code	22354281
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: AHCCCS Medicaid	$16.12
Rate for Payer: Allwell Medicaid	$16.12
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicaid	$16.12
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicaid	$16.12
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Mercy Care Medicaid	$16.12
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

CATH PICC 2 LUMEN

Facility

$622.00

Hospital Charge Code	22354943
Hospital Revenue Code	270
Min. Negotiated Rate	$161.72
Max. Negotiated Rate	$559.80
Rate for Payer: Aetna of AZ Commercial	$559.80
Rate for Payer: Bisbee Police All Plans	$161.72
Rate for Payer: Cash Price	$497.60
Rate for Payer: Self Pay Self Pay	$497.60

CATH PICC 2 LUMEN

Facility

$622.00

Hospital Charge Code	22354943
Hospital Revenue Code	270
Min. Negotiated Rate	$93.30
Max. Negotiated Rate	$559.80
Rate for Payer: Aetna of AZ Commercial	$559.80
Rate for Payer: Aetna of AZ Medicare	$174.16
Rate for Payer: Allwell Medicare	$93.30
Rate for Payer: Amerigroup Medicare	$93.30
Rate for Payer: APIPA Medicare/Medicaid	$232.32
Rate for Payer: AZCH Complete Medicare	$93.30
Rate for Payer: Banner UC Health Medicare	$93.30
Rate for Payer: Bisbee Police All Plans	$161.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$422.96
Rate for Payer: Cash Price	$497.60
Rate for Payer: Cigna of AZ Commercial	$435.40
Rate for Payer: Copperpoint Commercial	$153.94
Rate for Payer: Health Net of AZ Commercial	$373.20
Rate for Payer: Health Net of AZ Medicare	$174.16
Rate for Payer: Humana of AZ Medicare	$93.30
Rate for Payer: Self Pay Self Pay	$497.60
Rate for Payer: TriWest Medicare	$93.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$362.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$111.96

CATH PLUG

Facility

$30.00

Hospital Charge Code	22355775
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

CATH PLUG

Facility

$30.00

Hospital Charge Code	22355775
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

CATH PORT-A-CATH 6F

Facility

$4,174.00

Hospital Charge Code	22354244
Hospital Revenue Code	270
Min. Negotiated Rate	$1,085.24
Max. Negotiated Rate	$3,756.60
Rate for Payer: Aetna of AZ Commercial	$3,756.60
Rate for Payer: Bisbee Police All Plans	$1,085.24
Rate for Payer: Cash Price	$3,339.20
Rate for Payer: Self Pay Self Pay	$3,339.20

CATH PORT-A-CATH 6F

Facility

$4,174.00

Hospital Charge Code	22354244
Hospital Revenue Code	270
Min. Negotiated Rate	$626.10
Max. Negotiated Rate	$3,756.60
Rate for Payer: Aetna of AZ Commercial	$3,756.60
Rate for Payer: Aetna of AZ Medicare	$1,168.72
Rate for Payer: Allwell Medicare	$626.10
Rate for Payer: Amerigroup Medicare	$626.10
Rate for Payer: APIPA Medicare/Medicaid	$1,558.99
Rate for Payer: AZCH Complete Medicare	$626.10
Rate for Payer: Banner UC Health Medicare	$626.10
Rate for Payer: Bisbee Police All Plans	$1,085.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,838.32
Rate for Payer: Cash Price	$3,339.20
Rate for Payer: Cigna of AZ Commercial	$2,921.80
Rate for Payer: Copperpoint Commercial	$1,033.06
Rate for Payer: Health Net of AZ Commercial	$2,504.40
Rate for Payer: Health Net of AZ Medicare	$1,168.72
Rate for Payer: Humana of AZ Medicare	$626.10
Rate for Payer: Self Pay Self Pay	$3,339.20
Rate for Payer: TriWest Medicare	$626.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,433.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$751.32

CATH RED ROBIN 10F

Facility

$47.00

Hospital Charge Code	22355170
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

CATH RED ROBIN 10F

Facility

$47.00

Hospital Charge Code	22355170
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

CATH RED ROBIN 12F

Facility

$47.00

Hospital Charge Code	22355171
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

CATH RED ROBIN 12F

Facility

$47.00

Hospital Charge Code	22355171
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

CATH RED ROBIN 14F

Facility

$26.00

Hospital Charge Code	22355123
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

CATH RED ROBIN 14F

Facility

$26.00

Hospital Charge Code	22355123
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

CATH RED ROBIN 16F

Facility

$44.00

Hospital Charge Code	22355124
Hospital Revenue Code	270
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

CATH RED ROBIN 16F

Facility

$44.00

Hospital Charge Code	22355124
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$6.60
Rate for Payer: Amerigroup Medicare	$6.60
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$6.60
Rate for Payer: Banner UC Health Medicare	$6.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$6.60
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$6.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

CATH RED ROBIN 18F

Facility

$47.00

Hospital Charge Code	22355125
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

CATH RED ROBIN 18F

Facility

$47.00

Hospital Charge Code	22355125
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

CATH RED ROBIN 20F

Facility

$47.00

Hospital Charge Code	22355180
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

CATH RED ROBIN 20F

Facility

$47.00

Hospital Charge Code	22355180
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

CATH RED ROBIN 8F

Facility

$47.00

Hospital Charge Code	22355188
Hospital Revenue Code	270
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$32.90
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

CATH RED ROBIN 8F

Facility

$47.00

Hospital Charge Code	22355188
Hospital Revenue Code	270
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

CATH SET SUPRAPUBIC INTRUDER

Facility

$455.00

Hospital Charge Code	22354288
Hospital Revenue Code	270
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna of AZ Commercial	$409.50
Rate for Payer: Aetna of AZ Medicare	$127.40
Rate for Payer: Allwell Medicare	$68.25
Rate for Payer: Amerigroup Medicare	$68.25
Rate for Payer: APIPA Medicare/Medicaid	$169.94
Rate for Payer: AZCH Complete Medicare	$68.25
Rate for Payer: Banner UC Health Medicare	$68.25
Rate for Payer: Bisbee Police All Plans	$118.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$309.40
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cigna of AZ Commercial	$318.50
Rate for Payer: Copperpoint Commercial	$112.61
Rate for Payer: Health Net of AZ Commercial	$273.00
Rate for Payer: Health Net of AZ Medicare	$127.40
Rate for Payer: Humana of AZ Medicare	$68.25
Rate for Payer: Self Pay Self Pay	$364.00
Rate for Payer: TriWest Medicare	$68.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$265.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$81.90

CATH SET SUPRAPUBIC INTRUDER

Facility

$455.00

Hospital Charge Code	22354288
Hospital Revenue Code	270
Min. Negotiated Rate	$118.30
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna of AZ Commercial	$409.50
Rate for Payer: Bisbee Police All Plans	$118.30
Rate for Payer: Cash Price	$364.00
Rate for Payer: Self Pay Self Pay	$364.00

Know your out-of-pocket cost for care.

All Charges