Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CATH FOLEY 30FR 30CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355153
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 30FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355166
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 30FR 5CC 2-WAY ST

Facility

$62.00

Hospital Charge Code	22355166
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 3WAY

Facility

$20.00

Service Code	HCPCS A4346
Hospital Charge Code	22355161
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Cash Price	$16.00

CATH FOLEY 3WAY

Facility

$20.00

Service Code	HCPCS A4346
Hospital Charge Code	22355161
Hospital Revenue Code	270
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Arizona Complete Health Allwell	$3.20
Rate for Payer: Banner UC Health Medicare	$3.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$13.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Devoted Health Medicare	$3.60
Rate for Payer: Humana of AZ Medicare	$3.20
Rate for Payer: Southwest Service Administrators UFCW	$13.60
Rate for Payer: TriWest Medicare	$3.20
Rate for Payer: United Healthcare Commercial	$11.44
Rate for Payer: United Healthcare Medicare	$3.20
Rate for Payer: Veterans Affairs TRICARE	$3.17

CATH FOLEY 6FR 3CC 2-WAY

Facility

$69.00

Hospital Charge Code	22355179
Hospital Revenue Code	270
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Arizona Complete Health Allwell	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$46.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.04
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$48.30
Rate for Payer: Devoted Health Medicare	$12.42
Rate for Payer: Humana of AZ Medicare	$11.04
Rate for Payer: Southwest Service Administrators UFCW	$46.92
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: United Healthcare Commercial	$39.47
Rate for Payer: United Healthcare Medicare	$11.04
Rate for Payer: Veterans Affairs TRICARE	$10.93

CATH FOLEY 6FR 3CC 2-WAY

Facility

$69.00

Hospital Charge Code	22355179
Hospital Revenue Code	270
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Cash Price	$55.20

CATH FOLEY 8FR 3CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355147
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 8FR 3CC 2-WAY ST

Facility

$97.00

Hospital Charge Code	22355147
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 FREEDOM

Facility

$13.00

Hospital Charge Code	22355707
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Cash Price	$10.40

CATH FREEDOM

Facility

$13.00

Hospital Charge Code	22355707
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Arizona Complete Health Allwell	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.08
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Devoted Health Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Southwest Service Administrators UFCW	$8.84
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: United Healthcare Commercial	$7.44
Rate for Payer: United Healthcare Medicare	$2.08
Rate for Payer: Veterans Affairs TRICARE	$2.06

CATH IMPLANTABLE PORT X-PORT

Facility

$1,902.00

Hospital Charge Code	22354157
Hospital Revenue Code	270
Min. Negotiated Rate	$301.28
Max. Negotiated Rate	$1,711.80
Rate for Payer: Aetna of AZ Commercial	$1,711.80
Rate for Payer: Arizona Complete Health Allwell	$304.32
Rate for Payer: Banner UC Health Medicare	$304.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,293.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$304.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$304.32
Rate for Payer: Cash Price	$1,521.60
Rate for Payer: Cigna of AZ Commercial	$1,331.40
Rate for Payer: Devoted Health Medicare	$342.36
Rate for Payer: Humana of AZ Medicare	$304.32
Rate for Payer: Southwest Service Administrators UFCW	$1,293.36
Rate for Payer: TriWest Medicare	$304.32
Rate for Payer: United Healthcare Commercial	$1,087.94
Rate for Payer: United Healthcare Medicare	$304.32
Rate for Payer: Veterans Affairs TRICARE	$301.28

CATH IMPLANTABLE PORT X-PORT

Facility

$1,902.00

Hospital Charge Code	22354157
Hospital Revenue Code	270
Min. Negotiated Rate	$1,711.80
Max. Negotiated Rate	$1,711.80
Rate for Payer: Aetna of AZ Commercial	$1,711.80
Rate for Payer: Cash Price	$1,521.60

CATH INFANT KIT

Facility

$11.00

Hospital Charge Code	22355580
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Cash Price	$8.80

CATH INFANT KIT

Facility

$11.00

Hospital Charge Code	22355580
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Arizona Complete Health Allwell	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$7.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.76
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Devoted Health Medicare	$1.98
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Southwest Service Administrators UFCW	$7.48
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: United Healthcare Commercial	$6.29
Rate for Payer: United Healthcare Medicare	$1.76
Rate for Payer: Veterans Affairs TRICARE	$1.74

CATH IV - ANGIO 14GX1.75 INSYTE AUTO

Facility

$13.00

Hospital Charge Code	22355565
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Arizona Complete Health Allwell	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.08
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Devoted Health Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Southwest Service Administrators UFCW	$8.84
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: United Healthcare Commercial	$7.44
Rate for Payer: United Healthcare Medicare	$2.08
Rate for Payer: Veterans Affairs TRICARE	$2.06

CATH IV - ANGIO 14GX1.75 INSYTE AUTO

Facility

$13.00

Hospital Charge Code	22355565
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Cash Price	$10.40

CATH IV - ANGIO 16GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355564
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

CATH IV - ANGIO 16GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355564
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

CATH IV - ANGIO 18GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355563
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

CATH IV - ANGIO 18GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355563
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

CATH IV - ANGIO 20GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355562
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

CATH IV - ANGIO 20GX1.16 INSYTE AUTO

Facility

$12.00

Hospital Charge Code	22355562
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

CATH IV - ANGIO 22GX1 INSYTE AUTO LF

Facility

$12.00

Hospital Charge Code	22355561
Hospital Revenue Code	272
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Arizona Complete Health Allwell	$1.92
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.92
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cigna of AZ Commercial	$8.40
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Southwest Service Administrators UFCW	$8.16
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: United Healthcare Commercial	$6.86
Rate for Payer: United Healthcare Medicare	$1.92
Rate for Payer: Veterans Affairs TRICARE	$1.90

CATH IV - ANGIO 22GX1 INSYTE AUTO LF

Facility

$12.00

Hospital Charge Code	22355561
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna of AZ Commercial	$10.80
Rate for Payer: Cash Price	$9.60

Know your out-of-pocket cost for care.

All Charges