Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

DRAPE LAPAROSCOPY PACK

Facility

$395.00

Hospital Charge Code	22354239
Hospital Revenue Code	270
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Aetna of AZ Medicare	$110.60
Rate for Payer: Allwell Medicare	$59.25
Rate for Payer: Amerigroup Medicare	$59.25
Rate for Payer: APIPA Medicare/Medicaid	$147.53
Rate for Payer: AZCH Complete Medicare	$59.25
Rate for Payer: Banner UC Health Medicare	$59.25
Rate for Payer: Bisbee Police All Plans	$102.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$268.60
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cigna of AZ Commercial	$276.50
Rate for Payer: Copperpoint Commercial	$97.76
Rate for Payer: Health Net of AZ Commercial	$237.00
Rate for Payer: Health Net of AZ Medicare	$110.60
Rate for Payer: Humana of AZ Medicare	$59.25
Rate for Payer: Self Pay Self Pay	$316.00
Rate for Payer: TriWest Medicare	$59.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$230.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.10

DRAPE LAPAROSCOPY PACK

Facility

$395.00

Hospital Charge Code	22354239
Hospital Revenue Code	270
Min. Negotiated Rate	$102.70
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Bisbee Police All Plans	$102.70
Rate for Payer: Cash Price	$316.00
Rate for Payer: Self Pay Self Pay	$316.00

DRAPE LAPAROTOMY

Facility

$37.00

Hospital Charge Code	22355293
Hospital Revenue Code	271
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of AZ Commercial	$33.30
Rate for Payer: Aetna of AZ Medicare	$10.36
Rate for Payer: Allwell Medicare	$5.55
Rate for Payer: Amerigroup Medicare	$5.55
Rate for Payer: APIPA Medicare/Medicaid	$13.82
Rate for Payer: AZCH Complete Medicare	$5.55
Rate for Payer: Banner UC Health Medicare	$5.55
Rate for Payer: Bisbee Police All Plans	$9.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.16
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cigna of AZ Commercial	$25.90
Rate for Payer: Copperpoint Commercial	$9.16
Rate for Payer: Health Net of AZ Commercial	$22.20
Rate for Payer: Health Net of AZ Medicare	$10.36
Rate for Payer: Humana of AZ Medicare	$5.55
Rate for Payer: Self Pay Self Pay	$29.60
Rate for Payer: TriWest Medicare	$5.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$21.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.66

DRAPE LAPAROTOMY

Facility

$37.00

Hospital Charge Code	22355293
Hospital Revenue Code	271
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna of AZ Commercial	$33.30
Rate for Payer: Bisbee Police All Plans	$9.62
Rate for Payer: Cash Price	$29.60
Rate for Payer: Self Pay Self Pay	$29.60

DRAPE PELVIC

Facility

$97.00

Hospital Charge Code	22926417
Hospital Revenue Code	272
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

DRAPE PELVIC

Facility

$97.00

Hospital Charge Code	22926417
Hospital Revenue Code	272
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$14.55
Rate for Payer: Amerigroup Medicare	$14.55
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$14.55
Rate for Payer: Banner UC Health Medicare	$14.55
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$14.55
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$14.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

DRAPE UNDER BUTTOCK W/FLUID COLLECTION

Facility

$23.00

Hospital Charge Code	22355540
Hospital Revenue Code	270
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Aetna of AZ Medicare	$6.44
Rate for Payer: Allwell Medicare	$3.45
Rate for Payer: Amerigroup Medicare	$3.45
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.45
Rate for Payer: Banner UC Health Medicare	$3.45
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.64
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Copperpoint Commercial	$5.69
Rate for Payer: Health Net of AZ Commercial	$13.80
Rate for Payer: Health Net of AZ Medicare	$6.44
Rate for Payer: Humana of AZ Medicare	$3.45
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.14

DRAPE UNDER BUTTOCK W/FLUID COLLECTION

Facility

$23.00

Hospital Charge Code	22355540
Hospital Revenue Code	270
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Cash Price	$18.40
Rate for Payer: Self Pay Self Pay	$18.40

DRESSING COLLAGEN PURACOL PLUS AG 4X4

Facility

$109.00

Hospital Charge Code	27571812
Hospital Revenue Code	272
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$16.35
Rate for Payer: Amerigroup Medicare	$16.35
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$16.35
Rate for Payer: Banner UC Health Medicare	$16.35
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$16.35
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$16.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

DRESSING COLLAGEN PURACOL PLUS AG 4X4

Facility

$109.00

Hospital Charge Code	27571812
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

DRESSING COLLAGEN PURACOL PLUS AG 4X4

Facility

$109.00

Hospital Charge Code	23359342
Hospital Revenue Code	272
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: Allwell Medicare	$16.35
Rate for Payer: Amerigroup Medicare	$16.35
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$16.35
Rate for Payer: Banner UC Health Medicare	$16.35
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$76.30
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$16.35
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$16.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

DRESSING COLLAGEN PURACOL PLUS AG 4X4

Facility

$109.00

Hospital Charge Code	23359342
Hospital Revenue Code	272
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

DRESSING MEPITEL SILICONE 3X4

Facility

$29.00

Hospital Charge Code	27569974
Hospital Revenue Code	270
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Aetna of AZ Medicare	$8.12
Rate for Payer: Allwell Medicare	$4.35
Rate for Payer: Amerigroup Medicare	$4.35
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.35
Rate for Payer: Banner UC Health Medicare	$4.35
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$20.30
Rate for Payer: Copperpoint Commercial	$7.18
Rate for Payer: Health Net of AZ Commercial	$17.40
Rate for Payer: Health Net of AZ Medicare	$8.12
Rate for Payer: Humana of AZ Medicare	$4.35
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.22

DRESSING MEPITEL SILICONE 3X4

Facility

$29.00

Hospital Charge Code	23770583
Hospital Revenue Code	270
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Aetna of AZ Medicare	$8.12
Rate for Payer: Allwell Medicare	$4.35
Rate for Payer: Amerigroup Medicare	$4.35
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.35
Rate for Payer: Banner UC Health Medicare	$4.35
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$20.30
Rate for Payer: Copperpoint Commercial	$7.18
Rate for Payer: Health Net of AZ Commercial	$17.40
Rate for Payer: Health Net of AZ Medicare	$8.12
Rate for Payer: Humana of AZ Medicare	$4.35
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.22

DRESSING MEPITEL SILICONE 3X4

Facility

$29.00

Hospital Charge Code	23770583
Hospital Revenue Code	270
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

DRESSING MEPITEL SILICONE 3X4

Facility

$29.00

Hospital Charge Code	27569974
Hospital Revenue Code	270
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

DRESSING STRATASORB COMP 4X10

Facility

$10.00

Hospital Charge Code	27449661
Hospital Revenue Code	270
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of AZ Commercial	$9.00
Rate for Payer: Aetna of AZ Medicare	$2.80
Rate for Payer: Allwell Medicare	$1.50
Rate for Payer: Amerigroup Medicare	$1.50
Rate for Payer: APIPA Medicare/Medicaid	$3.74
Rate for Payer: AZCH Complete Medicare	$1.50
Rate for Payer: Banner UC Health Medicare	$1.50
Rate for Payer: Bisbee Police All Plans	$2.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.80
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cigna of AZ Commercial	$7.00
Rate for Payer: Copperpoint Commercial	$2.48
Rate for Payer: Health Net of AZ Commercial	$6.00
Rate for Payer: Health Net of AZ Medicare	$2.80
Rate for Payer: Humana of AZ Medicare	$1.50
Rate for Payer: Self Pay Self Pay	$8.00
Rate for Payer: TriWest Medicare	$1.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.80

DRESSING STRATASORB COMP 4X10

Facility

$10.00

Hospital Charge Code	27449661
Hospital Revenue Code	270
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of AZ Commercial	$9.00
Rate for Payer: Bisbee Police All Plans	$2.60
Rate for Payer: Cash Price	$8.00
Rate for Payer: Self Pay Self Pay	$8.00

DRILL AO D 2.0MM

Facility

$1,510.00

Hospital Charge Code	24415637
Hospital Revenue Code	270
Min. Negotiated Rate	$392.60
Max. Negotiated Rate	$1,359.00
Rate for Payer: Aetna of AZ Commercial	$1,359.00
Rate for Payer: Bisbee Police All Plans	$392.60
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Self Pay Self Pay	$1,208.00

DRILL AO D 2.0MM

Facility

$1,510.00

Hospital Charge Code	24415637
Hospital Revenue Code	270
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$1,359.00
Rate for Payer: Aetna of AZ Commercial	$1,359.00
Rate for Payer: Aetna of AZ Medicare	$422.80
Rate for Payer: Allwell Medicare	$226.50
Rate for Payer: Amerigroup Medicare	$226.50
Rate for Payer: APIPA Medicare/Medicaid	$563.98
Rate for Payer: AZCH Complete Medicare	$226.50
Rate for Payer: Banner UC Health Medicare	$226.50
Rate for Payer: Bisbee Police All Plans	$392.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,026.80
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cigna of AZ Commercial	$1,057.00
Rate for Payer: Copperpoint Commercial	$373.72
Rate for Payer: Health Net of AZ Commercial	$906.00
Rate for Payer: Health Net of AZ Medicare	$422.80
Rate for Payer: Humana of AZ Medicare	$226.50
Rate for Payer: Self Pay Self Pay	$1,208.00
Rate for Payer: TriWest Medicare	$226.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$880.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$271.80

DRSG ACTICOAT 7 4X5 IN.

Facility

$116.00

Hospital Charge Code	22354838
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

DRSG ACTICOAT 7 4X5 IN.

Facility

$116.00

Hospital Charge Code	22354838
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

DRSG ALGINATE AQUACEL 4X4.7

Facility

$53.00

Hospital Charge Code	22354975
Hospital Revenue Code	270
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Cash Price	$42.40
Rate for Payer: Self Pay Self Pay	$42.40

DRSG ALGINATE AQUACEL 4X4.7

Facility

$53.00

Hospital Charge Code	22354975
Hospital Revenue Code	270
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Aetna of AZ Medicare	$14.84
Rate for Payer: Allwell Medicare	$7.95
Rate for Payer: Amerigroup Medicare	$7.95
Rate for Payer: APIPA Medicare/Medicaid	$19.80
Rate for Payer: AZCH Complete Medicare	$7.95
Rate for Payer: Banner UC Health Medicare	$7.95
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$36.04
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Copperpoint Commercial	$13.12
Rate for Payer: Health Net of AZ Commercial	$31.80
Rate for Payer: Health Net of AZ Medicare	$14.84
Rate for Payer: Humana of AZ Medicare	$7.95
Rate for Payer: Self Pay Self Pay	$42.40
Rate for Payer: TriWest Medicare	$7.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$30.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.54

Know your out-of-pocket cost for care.

All Charges