Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

DRAPE BASIC PK V

Facility

$54.00

Hospital Charge Code	22354911
Hospital Revenue Code	270
Min. Negotiated Rate	$8.64
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	$8.64
Rate for Payer: Amerigroup Medicare	$8.64
Rate for Payer: APIPA Medicare/Medicaid	$20.17
Rate for Payer: AZCH Complete Medicare	$8.64
Rate for Payer: Banner UC Health Medicare	$8.64
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	$13.37
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	$8.64
Rate for Payer: Self Pay Self Pay	$43.20
Rate for Payer: TriWest Medicare	$8.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$31.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.72

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 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 C ARM COVER

Facility

$81.00

Hospital Charge Code	22355316
Hospital Revenue Code	270
Min. Negotiated Rate	$12.96
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	$12.96
Rate for Payer: Amerigroup Medicare	$12.96
Rate for Payer: APIPA Medicare/Medicaid	$30.25
Rate for Payer: AZCH Complete Medicare	$12.96
Rate for Payer: Banner UC Health Medicare	$12.96
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	$12.96
Rate for Payer: Self Pay Self Pay	$64.80
Rate for Payer: TriWest Medicare	$12.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.58

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 CLEAR U-DRAPE

Facility

$26.00

Hospital Charge Code	22354921
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
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	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
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	$6.43
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	$4.16
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

DRAPE, CLOSED CAMERA SYSTEM 9X96

Facility

$35.00

Hospital Charge Code	22926411
Hospital Revenue Code	272
Min. Negotiated Rate	$5.60
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	$5.60
Rate for Payer: Amerigroup Medicare	$5.60
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.60
Rate for Payer: Banner UC Health Medicare	$5.60
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	$5.60
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.41
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	$5.28
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	$5.28
Rate for Payer: Amerigroup Medicare	$5.28
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
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	$5.28
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$5.28
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	$10.88
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	$10.88
Rate for Payer: Amerigroup Medicare	$10.88
Rate for Payer: APIPA Medicare/Medicaid	$25.40
Rate for Payer: AZCH Complete Medicare	$10.88
Rate for Payer: Banner UC Health Medicare	$10.88
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	$10.88
Rate for Payer: Self Pay Self Pay	$54.40
Rate for Payer: TriWest Medicare	$10.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.24

DRAPE INCISE IOBAN 13X13-IN (36CM)

Facility

$68.00

Hospital Charge Code	22354969
Hospital Revenue Code	270
Min. Negotiated Rate	$17.68
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna of AZ Commercial	$61.20
Rate for Payer: Bisbee Police All Plans	$17.68
Rate for Payer: Cash Price	$54.40
Rate for Payer: Self Pay Self Pay	$54.40

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 LAPAROSCOPY PACK

Facility

$395.00

Hospital Charge Code	22354239
Hospital Revenue Code	270
Min. Negotiated Rate	$63.20
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	$63.20
Rate for Payer: Amerigroup Medicare	$63.20
Rate for Payer: APIPA Medicare/Medicaid	$147.53
Rate for Payer: AZCH Complete Medicare	$63.20
Rate for Payer: Banner UC Health Medicare	$63.20
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	$63.20
Rate for Payer: Self Pay Self Pay	$316.00
Rate for Payer: TriWest Medicare	$63.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$230.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.10

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	$15.52
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	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
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	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
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	$3.68
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	$3.68
Rate for Payer: Amerigroup Medicare	$3.68
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
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	$3.68
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.68
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	$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	27571812
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
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	$17.44
Rate for Payer: Amerigroup Medicare	$17.44
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicare	$17.44
Rate for Payer: Banner UC Health Medicare	$17.44
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	$17.44
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$17.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

DRESSING MEPITEL SILICONE 3X4

Facility

$29.00

Hospital Charge Code	23770583
Hospital Revenue Code	270
Min. Negotiated Rate	$4.64
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	$4.64
Rate for Payer: Amerigroup Medicare	$4.64
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.64
Rate for Payer: Banner UC Health Medicare	$4.64
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	$4.64
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.64
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	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 MEPITEL SILICONE 3X4

Facility

$29.00

Hospital Charge Code	27569974
Hospital Revenue Code	270
Min. Negotiated Rate	$4.64
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	$4.64
Rate for Payer: Amerigroup Medicare	$4.64
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.64
Rate for Payer: Banner UC Health Medicare	$4.64
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	$4.64
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.64
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

Know your out-of-pocket cost for care.

All Charges