Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CATH FOLEY 24FR 5CC 2-WAY ST

Facility

$75.00

Hospital Charge Code	22355139
Hospital Revenue Code	270
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Arizona Complete Health Allwell	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$51.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Devoted Health Medicare	$13.50
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Southwest Service Administrators UFCW	$51.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: United Healthcare Commercial	$42.90
Rate for Payer: United Healthcare Medicare	$12.00
Rate for Payer: Veterans Affairs TRICARE	$11.88

CATH FOLEY 24FR 5CC 2-WAY ST

Facility

$75.00

Hospital Charge Code	22355139
Hospital Revenue Code	270
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Cash Price	$60.00

CATH FOLEY 26FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355152
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

CATH FOLEY 26FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355152
Hospital Revenue Code	270
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Cash Price	$77.60

CATH FOLEY 28FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355155
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

CATH FOLEY 28FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355155
Hospital Revenue Code	270
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Cash Price	$77.60

CATH FOLEY 28FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355164
Hospital Revenue Code	270
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

CATH FOLEY 28FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355164
Hospital Revenue Code	270
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

CATH FOLEY 30CC 18FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355168
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

CATH FOLEY 30CC 18FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355168
Hospital Revenue Code	270
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

CATH FOLEY 30CC 18FR 3 WAY SILICONE

Facility

$64.25

Hospital Charge Code	27796434
Hospital Revenue Code	270
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna of AZ Commercial	$57.83
Rate for Payer: Cash Price	$51.40

CATH FOLEY 30CC 18FR 3 WAY SILICONE

Facility

$64.25

Hospital Charge Code	27796434
Hospital Revenue Code	270
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna of AZ Commercial	$57.83
Rate for Payer: Arizona Complete Health Allwell	$10.28
Rate for Payer: Banner UC Health Medicare	$10.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$43.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.28
Rate for Payer: Cash Price	$51.40
Rate for Payer: Cigna of AZ Commercial	$44.98
Rate for Payer: Devoted Health Medicare	$11.56
Rate for Payer: Humana of AZ Medicare	$10.28
Rate for Payer: Southwest Service Administrators UFCW	$43.69
Rate for Payer: TriWest Medicare	$10.28
Rate for Payer: United Healthcare Commercial	$36.75
Rate for Payer: United Healthcare Medicare	$10.28
Rate for Payer: Veterans Affairs TRICARE	$10.18

CATH FOLEY 30CC 20FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355169
Hospital Revenue Code	270
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

CATH FOLEY 30CC 20FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355169
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

CATH FOLEY 30CC 20FR 3-WAY ST

Facility

$54.00

Hospital Charge Code	22355148
Hospital Revenue Code	270
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Arizona Complete Health Allwell	$8.64
Rate for Payer: Banner UC Health Medicare	$8.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.64
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of AZ Commercial	$37.80
Rate for Payer: Devoted Health Medicare	$9.72
Rate for Payer: Humana of AZ Medicare	$8.64
Rate for Payer: Southwest Service Administrators UFCW	$36.72
Rate for Payer: TriWest Medicare	$8.64
Rate for Payer: United Healthcare Commercial	$30.89
Rate for Payer: United Healthcare Medicare	$8.64
Rate for Payer: Veterans Affairs TRICARE	$8.55

CATH FOLEY 30CC 20FR 3-WAY ST

Facility

$54.00

Hospital Charge Code	22355148
Hospital Revenue Code	270
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Cash Price	$43.20

CATH FOLEY 30CC 22FR 3-WAY

Facility

$49.00

Hospital Charge Code	22355187
Hospital Revenue Code	270
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Arizona Complete Health Allwell	$7.84
Rate for Payer: Banner UC Health Medicare	$7.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$33.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.84
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$34.30
Rate for Payer: Devoted Health Medicare	$8.82
Rate for Payer: Humana of AZ Medicare	$7.84
Rate for Payer: Southwest Service Administrators UFCW	$33.32
Rate for Payer: TriWest Medicare	$7.84
Rate for Payer: United Healthcare Commercial	$28.03
Rate for Payer: United Healthcare Medicare	$7.84
Rate for Payer: Veterans Affairs TRICARE	$7.76

CATH FOLEY 30CC 22FR 3-WAY

Facility

$49.00

Hospital Charge Code	22355187
Hospital Revenue Code	270
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Cash Price	$39.20

CATH FOLEY 30CC 22FR 3 WAY SILICONE

Facility

$25.60

Hospital Charge Code	27796436
Hospital Revenue Code	270
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna of AZ Commercial	$23.04
Rate for Payer: Arizona Complete Health Allwell	$4.10
Rate for Payer: Banner UC Health Medicare	$4.10
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.41
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.10
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.10
Rate for Payer: Cash Price	$20.48
Rate for Payer: Cigna of AZ Commercial	$17.92
Rate for Payer: Devoted Health Medicare	$4.61
Rate for Payer: Humana of AZ Medicare	$4.10
Rate for Payer: Southwest Service Administrators UFCW	$17.41
Rate for Payer: TriWest Medicare	$4.10
Rate for Payer: United Healthcare Commercial	$14.64
Rate for Payer: United Healthcare Medicare	$4.10
Rate for Payer: Veterans Affairs TRICARE	$4.06

CATH FOLEY 30CC 22FR 3 WAY SILICONE

Facility

$25.60

Hospital Charge Code	27796436
Hospital Revenue Code	270
Min. Negotiated Rate	$23.04
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna of AZ Commercial	$23.04
Rate for Payer: Cash Price	$20.48

CATH FOLEY 30CC 24FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355167
Hospital Revenue Code	270
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

CATH FOLEY 30CC 24FR 3-WAY

Facility

$71.00

Hospital Charge Code	22355167
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

CATH FOLEY 30CC 26FR 3-WAY

Facility

$158.00

Hospital Charge Code	22355181
Hospital Revenue Code	270
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Cash Price	$126.40

CATH FOLEY 30CC 26FR 3-WAY

Facility

$158.00

Hospital Charge Code	22355181
Hospital Revenue Code	270
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$142.20
Rate for Payer: Aetna of AZ Commercial	$142.20
Rate for Payer: Arizona Complete Health Allwell	$25.28
Rate for Payer: Banner UC Health Medicare	$25.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$107.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$25.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$25.28
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cigna of AZ Commercial	$110.60
Rate for Payer: Devoted Health Medicare	$28.44
Rate for Payer: Humana of AZ Medicare	$25.28
Rate for Payer: Southwest Service Administrators UFCW	$107.44
Rate for Payer: TriWest Medicare	$25.28
Rate for Payer: United Healthcare Commercial	$90.38
Rate for Payer: United Healthcare Medicare	$25.28
Rate for Payer: Veterans Affairs TRICARE	$25.03

CATH FOLEY 30FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355153
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Arizona Complete Health Allwell	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$65.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.52
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Devoted Health Medicare	$17.46
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Southwest Service Administrators UFCW	$65.96
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: United Healthcare Commercial	$55.48
Rate for Payer: United Healthcare Medicare	$15.52
Rate for Payer: Veterans Affairs TRICARE	$15.36

Know your out-of-pocket cost for care.

All Charges