Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

DRAIN HEMO 1/4-INCH X-LARGE

Facility

$225.00

Hospital Charge Code	22354952
Hospital Revenue Code	270
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Aetna of AZ Medicare	$63.00
Rate for Payer: Allwell Medicare	$33.75
Rate for Payer: Amerigroup Medicare	$33.75
Rate for Payer: APIPA Medicare/Medicaid	$84.04
Rate for Payer: AZCH Complete Medicare	$33.75
Rate for Payer: Banner UC Health Medicare	$33.75
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$153.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna of AZ Commercial	$157.50
Rate for Payer: Copperpoint Commercial	$55.69
Rate for Payer: Health Net of AZ Commercial	$135.00
Rate for Payer: Health Net of AZ Medicare	$63.00
Rate for Payer: Humana of AZ Medicare	$33.75
Rate for Payer: Self Pay Self Pay	$180.00
Rate for Payer: TriWest Medicare	$33.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$131.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.50

DRAIN HEMO 1/4-INCH X-LARGE

Facility

$225.00

Hospital Charge Code	22354952
Hospital Revenue Code	270
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Cash Price	$180.00
Rate for Payer: Self Pay Self Pay	$180.00

DRAIN HEMO 1/8-INCH MEDIUM

Facility

$66.00

Hospital Charge Code	22354963
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Aetna of AZ Medicare	$18.48
Rate for Payer: Allwell Medicare	$9.90
Rate for Payer: Amerigroup Medicare	$9.90
Rate for Payer: APIPA Medicare/Medicaid	$24.65
Rate for Payer: AZCH Complete Medicare	$9.90
Rate for Payer: Banner UC Health Medicare	$9.90
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.88
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$46.20
Rate for Payer: Copperpoint Commercial	$16.34
Rate for Payer: Health Net of AZ Commercial	$39.60
Rate for Payer: Health Net of AZ Medicare	$18.48
Rate for Payer: Humana of AZ Medicare	$9.90
Rate for Payer: Self Pay Self Pay	$52.80
Rate for Payer: TriWest Medicare	$9.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$38.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.88

DRAIN HEMO 1/8-INCH MEDIUM

Facility

$66.00

Hospital Charge Code	22354963
Hospital Revenue Code	270
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Bisbee Police All Plans	$17.16
Rate for Payer: Cash Price	$52.80
Rate for Payer: Self Pay Self Pay	$52.80

DRAIN HEMO 3/16-INCH LARGE

Facility

$225.00

Hospital Charge Code	22354950
Hospital Revenue Code	270
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Cash Price	$180.00
Rate for Payer: Self Pay Self Pay	$180.00

DRAIN HEMO 3/16-INCH LARGE

Facility

$225.00

Hospital Charge Code	22354950
Hospital Revenue Code	270
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Aetna of AZ Medicare	$63.00
Rate for Payer: Allwell Medicare	$33.75
Rate for Payer: Amerigroup Medicare	$33.75
Rate for Payer: APIPA Medicare/Medicaid	$84.04
Rate for Payer: AZCH Complete Medicare	$33.75
Rate for Payer: Banner UC Health Medicare	$33.75
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$153.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna of AZ Commercial	$157.50
Rate for Payer: Copperpoint Commercial	$55.69
Rate for Payer: Health Net of AZ Commercial	$135.00
Rate for Payer: Health Net of AZ Medicare	$63.00
Rate for Payer: Humana of AZ Medicare	$33.75
Rate for Payer: Self Pay Self Pay	$180.00
Rate for Payer: TriWest Medicare	$33.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$131.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.50

DRAIN HEMO 3/32-INCH SMALL

Facility

$70.00

Hospital Charge Code	22354949
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Aetna of AZ Medicare	$19.60
Rate for Payer: Allwell Medicare	$10.50
Rate for Payer: Amerigroup Medicare	$10.50
Rate for Payer: APIPA Medicare/Medicaid	$26.14
Rate for Payer: AZCH Complete Medicare	$10.50
Rate for Payer: Banner UC Health Medicare	$10.50
Rate for Payer: Bisbee Police All Plans	$18.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$47.60
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cigna of AZ Commercial	$49.00
Rate for Payer: Copperpoint Commercial	$17.32
Rate for Payer: Health Net of AZ Commercial	$42.00
Rate for Payer: Health Net of AZ Medicare	$19.60
Rate for Payer: Humana of AZ Medicare	$10.50
Rate for Payer: Self Pay Self Pay	$56.00
Rate for Payer: TriWest Medicare	$10.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.60

DRAIN HEMO 3/32-INCH SMALL

Facility

$70.00

Hospital Charge Code	22354949
Hospital Revenue Code	270
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Bisbee Police All Plans	$18.20
Rate for Payer: Cash Price	$56.00
Rate for Payer: Self Pay Self Pay	$56.00

DRAIN JP FLAT SUCT 10MM

Facility

$106.00

Hospital Charge Code	22354938
Hospital Revenue Code	270
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$15.90
Rate for Payer: Amerigroup Medicare	$15.90
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$15.90
Rate for Payer: Banner UC Health Medicare	$15.90
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$74.20
Rate for Payer: Copperpoint Commercial	$26.24
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$15.90
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$15.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

DRAIN JP FLAT SUCT 10MM

Facility

$106.00

Hospital Charge Code	22354938
Hospital Revenue Code	270
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

DRAIN JP FLAT SUCT 7MM

Facility

$106.00

Hospital Charge Code	22354937
Hospital Revenue Code	270
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$15.90
Rate for Payer: Amerigroup Medicare	$15.90
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$15.90
Rate for Payer: Banner UC Health Medicare	$15.90
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$74.20
Rate for Payer: Copperpoint Commercial	$26.24
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$15.90
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$15.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

DRAIN JP FLAT SUCT 7MM

Facility

$106.00

Hospital Charge Code	22354937
Hospital Revenue Code	270
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

DRAIN JP SUCT RESRV

Facility

$116.00

Hospital Charge Code	22355431
Hospital Revenue Code	270
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Cash Price	$92.80
Rate for Payer: Self Pay Self Pay	$92.80

DRAIN JP SUCT RESRV

Facility

$116.00

Hospital Charge Code	22355431
Hospital Revenue Code	270
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Aetna of AZ Medicare	$32.48
Rate for Payer: Allwell Medicare	$17.40
Rate for Payer: Amerigroup Medicare	$17.40
Rate for Payer: APIPA Medicare/Medicaid	$43.33
Rate for Payer: AZCH Complete Medicare	$17.40
Rate for Payer: Banner UC Health Medicare	$17.40
Rate for Payer: Bisbee Police All Plans	$30.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.88
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$81.20
Rate for Payer: Copperpoint Commercial	$28.71
Rate for Payer: Health Net of AZ Commercial	$69.60
Rate for Payer: Health Net of AZ Medicare	$32.48
Rate for Payer: Humana of AZ Medicare	$17.40
Rate for Payer: Self Pay Self Pay	$92.80
Rate for Payer: TriWest Medicare	$17.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.88

DRAPE BASIC PK V

Facility

$54.00

Hospital Charge Code	22354911
Hospital Revenue Code	270
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Bisbee Police All Plans	$14.04
Rate for Payer: Cash Price	$43.20
Rate for Payer: Self Pay Self Pay	$43.20

DRAPE BASIC PK V

Facility

$54.00

Hospital Charge Code	22354911
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna of AZ Commercial	$48.60
Rate for Payer: Aetna of AZ Medicare	$15.12
Rate for Payer: Allwell Medicare	$8.10
Rate for Payer: Amerigroup Medicare	$8.10
Rate for Payer: APIPA Medicare/Medicaid	$20.17
Rate for Payer: AZCH Complete Medicare	$8.10
Rate for Payer: Banner UC Health Medicare	$8.10
Rate for Payer: Bisbee Police All Plans	$14.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$36.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of AZ Commercial	$37.80
Rate for Payer: Copperpoint Commercial	$13.36
Rate for Payer: Health Net of AZ Commercial	$32.40
Rate for Payer: Health Net of AZ Medicare	$15.12
Rate for Payer: Humana of AZ Medicare	$8.10
Rate for Payer: Self Pay Self Pay	$43.20
Rate for Payer: TriWest Medicare	$8.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$31.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.72

DRAPE C ARM COVER

Facility

$81.00

Hospital Charge Code	22355316
Hospital Revenue Code	270
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$72.90
Rate for Payer: Aetna of AZ Commercial	$72.90
Rate for Payer: Aetna of AZ Medicare	$22.68
Rate for Payer: Allwell Medicare	$12.15
Rate for Payer: Amerigroup Medicare	$12.15
Rate for Payer: APIPA Medicare/Medicaid	$30.25
Rate for Payer: AZCH Complete Medicare	$12.15
Rate for Payer: Banner UC Health Medicare	$12.15
Rate for Payer: Bisbee Police All Plans	$21.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.08
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cigna of AZ Commercial	$56.70
Rate for Payer: Copperpoint Commercial	$20.05
Rate for Payer: Health Net of AZ Commercial	$48.60
Rate for Payer: Health Net of AZ Medicare	$22.68
Rate for Payer: Humana of AZ Medicare	$12.15
Rate for Payer: Self Pay Self Pay	$64.80
Rate for Payer: TriWest Medicare	$12.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.58

DRAPE C ARM COVER

Facility

$81.00

Hospital Charge Code	22355316
Hospital Revenue Code	270
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$72.90
Rate for Payer: Aetna of AZ Commercial	$72.90
Rate for Payer: Bisbee Police All Plans	$21.06
Rate for Payer: Cash Price	$64.80
Rate for Payer: Self Pay Self Pay	$64.80

DRAPE CLEAR U-DRAPE

Facility

$26.00

Hospital Charge Code	22354921
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

DRAPE CLEAR U-DRAPE

Facility

$26.00

Hospital Charge Code	22354921
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

DRAPE, CLOSED CAMERA SYSTEM 9X96

Facility

$35.00

Hospital Charge Code	22926411
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Aetna of AZ Medicare	$9.80
Rate for Payer: Allwell Medicare	$5.25
Rate for Payer: Amerigroup Medicare	$5.25
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.25
Rate for Payer: Banner UC Health Medicare	$5.25
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$23.80
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$24.50
Rate for Payer: Copperpoint Commercial	$8.66
Rate for Payer: Health Net of AZ Commercial	$21.00
Rate for Payer: Health Net of AZ Medicare	$9.80
Rate for Payer: Humana of AZ Medicare	$5.25
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

DRAPE, CLOSED CAMERA SYSTEM 9X96

Facility

$35.00

Hospital Charge Code	22926411
Hospital Revenue Code	272
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Bisbee Police All Plans	$9.10
Rate for Payer: Cash Price	$28.00
Rate for Payer: Self Pay Self Pay	$28.00

DRAPE EXTREMITY

Facility

$33.00

Hospital Charge Code	22355294
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

DRAPE EXTREMITY

Facility

$33.00

Hospital Charge Code	22355294
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$4.95
Rate for Payer: Amerigroup Medicare	$4.95
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$4.95
Rate for Payer: Banner UC Health Medicare	$4.95
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$4.95
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$4.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

DRAPE INCISE IOBAN 13X13-IN (36CM)

Facility

$68.00

Hospital Charge Code	22354969
Hospital Revenue Code	270
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna of AZ Commercial	$61.20
Rate for Payer: Aetna of AZ Medicare	$19.04
Rate for Payer: Allwell Medicare	$10.20
Rate for Payer: Amerigroup Medicare	$10.20
Rate for Payer: APIPA Medicare/Medicaid	$25.40
Rate for Payer: AZCH Complete Medicare	$10.20
Rate for Payer: Banner UC Health Medicare	$10.20
Rate for Payer: Bisbee Police All Plans	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.24
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cigna of AZ Commercial	$47.60
Rate for Payer: Copperpoint Commercial	$16.83
Rate for Payer: Health Net of AZ Commercial	$40.80
Rate for Payer: Health Net of AZ Medicare	$19.04
Rate for Payer: Humana of AZ Medicare	$10.20
Rate for Payer: Self Pay Self Pay	$54.40
Rate for Payer: TriWest Medicare	$10.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.24

Know your out-of-pocket cost for care.

All Charges