Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Catecholamines, Plasma LC

Facility

$384.00

Service Code	CPT 82384
Hospital Charge Code	2029228
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Aetna of AZ Medicare	$107.52
Rate for Payer: AHCCCS Medicaid	$25.25
Rate for Payer: Allwell Medicaid	$25.25
Rate for Payer: Allwell Medicare	$57.60
Rate for Payer: Amerigroup Medicare	$57.60
Rate for Payer: APIPA Medicare/Medicaid	$143.42
Rate for Payer: AZCH Complete Medicaid	$25.25
Rate for Payer: AZCH Complete Medicare	$57.60
Rate for Payer: Banner UC Health Medicaid	$25.25
Rate for Payer: Banner UC Health Medicare	$57.60
Rate for Payer: Bisbee Police All Plans	$99.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$261.12
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cigna of AZ Commercial	$249.60
Rate for Payer: Copperpoint Commercial	$95.04
Rate for Payer: Health Net of AZ Commercial	$230.40
Rate for Payer: Health Net of AZ Medicare	$107.52
Rate for Payer: Humana of AZ Medicare	$57.60
Rate for Payer: Mercy Care Medicaid	$25.25
Rate for Payer: Self Pay Self Pay	$307.20
Rate for Payer: TriWest Medicare	$57.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$223.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$69.12

Catecholamines, Plasma LC

Facility

$384.00

Service Code	CPT 82384
Hospital Charge Code	2029228
Hospital Revenue Code	301
Min. Negotiated Rate	$99.84
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Bisbee Police All Plans	$99.84
Rate for Payer: Cash Price	$307.20
Rate for Payer: Self Pay Self Pay	$307.20

Catecholamines,Ur.,Free,24 Hr LC

Facility

$328.00

Service Code	CPT 82384
Hospital Charge Code	2029235
Hospital Revenue Code	301
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$295.20
Rate for Payer: Aetna of AZ Commercial	$295.20
Rate for Payer: Bisbee Police All Plans	$85.28
Rate for Payer: Cash Price	$262.40
Rate for Payer: Self Pay Self Pay	$262.40

Catecholamines,Ur.,Free,24 Hr LC

Facility

$328.00

Service Code	CPT 82384
Hospital Charge Code	2029235
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$295.20
Rate for Payer: Aetna of AZ Commercial	$295.20
Rate for Payer: Aetna of AZ Medicare	$91.84
Rate for Payer: AHCCCS Medicaid	$25.25
Rate for Payer: Allwell Medicaid	$25.25
Rate for Payer: Allwell Medicare	$49.20
Rate for Payer: Amerigroup Medicare	$49.20
Rate for Payer: APIPA Medicare/Medicaid	$122.51
Rate for Payer: AZCH Complete Medicaid	$25.25
Rate for Payer: AZCH Complete Medicare	$49.20
Rate for Payer: Banner UC Health Medicaid	$25.25
Rate for Payer: Banner UC Health Medicare	$49.20
Rate for Payer: Bisbee Police All Plans	$85.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$223.04
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cigna of AZ Commercial	$213.20
Rate for Payer: Copperpoint Commercial	$81.18
Rate for Payer: Health Net of AZ Commercial	$196.80
Rate for Payer: Health Net of AZ Medicare	$91.84
Rate for Payer: Humana of AZ Medicare	$49.20
Rate for Payer: Mercy Care Medicaid	$25.25
Rate for Payer: Self Pay Self Pay	$262.40
Rate for Payer: TriWest Medicare	$49.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$191.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.04

CATH, CLOSED SUCTION,14FR,DBL, ETT,24HR

Facility

$61.00

Hospital Charge Code	23028277
Hospital Revenue Code	272
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Bisbee Police All Plans	$15.86
Rate for Payer: Cash Price	$48.80
Rate for Payer: Self Pay Self Pay	$48.80

CATH, CLOSED SUCTION,14FR,DBL, ETT,24HR

Facility

$61.00

Hospital Charge Code	23028277
Hospital Revenue Code	272
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Aetna of AZ Medicare	$17.08
Rate for Payer: Allwell Medicare	$9.15
Rate for Payer: Amerigroup Medicare	$9.15
Rate for Payer: APIPA Medicare/Medicaid	$22.78
Rate for Payer: AZCH Complete Medicare	$9.15
Rate for Payer: Banner UC Health Medicare	$9.15
Rate for Payer: Bisbee Police All Plans	$15.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$41.48
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Copperpoint Commercial	$15.10
Rate for Payer: Health Net of AZ Commercial	$36.60
Rate for Payer: Health Net of AZ Medicare	$17.08
Rate for Payer: Humana of AZ Medicare	$9.15
Rate for Payer: Self Pay Self Pay	$48.80
Rate for Payer: TriWest Medicare	$9.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$35.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.98

CATH COUDE TIEMANN 12F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355182
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CATH COUDE TIEMANN 12F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355182
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$57.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: AHCCCS Medicaid	$57.20
Rate for Payer: Allwell Medicaid	$57.20
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicaid	$57.20
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicaid	$57.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Mercy Care Medicaid	$57.20
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CATH COUDE TIEMANN 14F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355162
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$57.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: AHCCCS Medicaid	$57.20
Rate for Payer: Allwell Medicaid	$57.20
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicaid	$57.20
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicaid	$57.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Mercy Care Medicaid	$57.20
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CATH COUDE TIEMANN 14F

Facility

$48.00

Service Code	CPT A4340
Hospital Charge Code	22355162
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CATH COUDE TIEMANN 16F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355163
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$57.20
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: AHCCCS Medicaid	$57.20
Rate for Payer: Allwell Medicaid	$57.20
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	$57.20
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicaid	$57.20
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	$57.20
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 COUDE TIEMANN 16F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355163
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 COUDE TIEMANN 18F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355105
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$57.20
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: AHCCCS Medicaid	$57.20
Rate for Payer: Allwell Medicaid	$57.20
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	$57.20
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicaid	$57.20
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	$57.20
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 COUDE TIEMANN 18F

Facility

$26.00

Service Code	CPT A4340
Hospital Charge Code	22355105
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 COUDE TIEMANN 20F

Facility

$180.00

Service Code	CPT A4340
Hospital Charge Code	22355135
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

CATH COUDE TIEMANN 20F

Facility

$180.00

Service Code	CPT A4340
Hospital Charge Code	22355135
Hospital Revenue Code	270
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: AHCCCS Medicaid	$57.20
Rate for Payer: Allwell Medicaid	$57.20
Rate for Payer: Allwell Medicare	$27.00
Rate for Payer: Amerigroup Medicare	$27.00
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicaid	$57.20
Rate for Payer: AZCH Complete Medicare	$27.00
Rate for Payer: Banner UC Health Medicaid	$57.20
Rate for Payer: Banner UC Health Medicare	$27.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$126.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$27.00
Rate for Payer: Mercy Care Medicaid	$57.20
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$27.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

CATHETER, FOLEY, 16FR, 5ML, SIL-ELASTOMER

Facility

$26.00

Hospital Charge Code	22355214
Hospital Revenue Code	272
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

CATHETER, FOLEY, 16FR, 5ML, SIL-ELASTOMER

Facility

$26.00

Hospital Charge Code	22355214
Hospital Revenue Code	272
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

CATHETER FOLEY 20FR 30ML SIL-ELASTOMER

Facility

$22.00

Hospital Charge Code	23321242
Hospital Revenue Code	272
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Cash Price	$17.60
Rate for Payer: Self Pay Self Pay	$17.60

CATHETER FOLEY 20FR 30ML SIL-ELASTOMER

Facility

$22.00

Hospital Charge Code	23321242
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Aetna of AZ Medicare	$6.16
Rate for Payer: Allwell Medicare	$3.30
Rate for Payer: Amerigroup Medicare	$3.30
Rate for Payer: APIPA Medicare/Medicaid	$8.22
Rate for Payer: AZCH Complete Medicare	$3.30
Rate for Payer: Banner UC Health Medicare	$3.30
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.96
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$15.40
Rate for Payer: Copperpoint Commercial	$5.44
Rate for Payer: Health Net of AZ Commercial	$13.20
Rate for Payer: Health Net of AZ Medicare	$6.16
Rate for Payer: Humana of AZ Medicare	$3.30
Rate for Payer: Self Pay Self Pay	$17.60
Rate for Payer: TriWest Medicare	$3.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.96

CATHETER FOLEY ALL-SILICONE 22FR 30ML

Facility

$27.00

Hospital Charge Code	23321244
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Cash Price	$21.60
Rate for Payer: Self Pay Self Pay	$21.60

CATHETER FOLEY ALL-SILICONE 22FR 30ML

Facility

$27.00

Hospital Charge Code	23321244
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Aetna of AZ Medicare	$7.56
Rate for Payer: Allwell Medicare	$4.05
Rate for Payer: Amerigroup Medicare	$4.05
Rate for Payer: APIPA Medicare/Medicaid	$10.08
Rate for Payer: AZCH Complete Medicare	$4.05
Rate for Payer: Banner UC Health Medicare	$4.05
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$18.36
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$18.90
Rate for Payer: Copperpoint Commercial	$6.68
Rate for Payer: Health Net of AZ Commercial	$16.20
Rate for Payer: Health Net of AZ Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$4.05
Rate for Payer: Self Pay Self Pay	$21.60
Rate for Payer: TriWest Medicare	$4.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.86

CATHETER FOLEY COUDE 16FR 5CC 2-WAY

Facility

$48.00

Hospital Charge Code	23359343
Hospital Revenue Code	272
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CATHETER FOLEY COUDE 16FR 5CC 2-WAY

Facility

$48.00

Hospital Charge Code	23359343
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CATHETER FOLEY COUDE 18FR 5ML 2 WAY

Facility

$86.00

Hospital Charge Code	23758407
Hospital Revenue Code	270
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Bisbee Police All Plans	$22.36
Rate for Payer: Cash Price	$68.80
Rate for Payer: Self Pay Self Pay	$68.80

Know your out-of-pocket cost for care.

All Charges