Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Supplies

Facility

$805.00

Hospital Charge Code	22528823
Hospital Revenue Code	270
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$724.50
Rate for Payer: Aetna of AZ Commercial	$724.50
Rate for Payer: Bisbee Police All Plans	$209.30
Rate for Payer: Cash Price	$644.00
Rate for Payer: Self Pay Self Pay	$644.00

Supplies

Facility

$2,099.00

Hospital Charge Code	22528809
Hospital Revenue Code	270
Min. Negotiated Rate	$545.74
Max. Negotiated Rate	$1,889.10
Rate for Payer: Aetna of AZ Commercial	$1,889.10
Rate for Payer: Bisbee Police All Plans	$545.74
Rate for Payer: Cash Price	$1,679.20
Rate for Payer: Self Pay Self Pay	$1,679.20

Supplies

Facility

$1,029.00

Hospital Charge Code	22528829
Hospital Revenue Code	270
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$926.10
Rate for Payer: Aetna of AZ Commercial	$926.10
Rate for Payer: Aetna of AZ Medicare	$288.12
Rate for Payer: Allwell Medicare	$154.35
Rate for Payer: Amerigroup Medicare	$154.35
Rate for Payer: APIPA Medicare/Medicaid	$384.33
Rate for Payer: AZCH Complete Medicare	$154.35
Rate for Payer: Banner UC Health Medicare	$154.35
Rate for Payer: Bisbee Police All Plans	$267.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$699.72
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cigna of AZ Commercial	$720.30
Rate for Payer: Copperpoint Commercial	$254.68
Rate for Payer: Health Net of AZ Commercial	$617.40
Rate for Payer: Health Net of AZ Medicare	$288.12
Rate for Payer: Humana of AZ Medicare	$154.35
Rate for Payer: Self Pay Self Pay	$823.20
Rate for Payer: TriWest Medicare	$154.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$599.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$185.22

Supplies

Facility

$805.00

Hospital Charge Code	22528827
Hospital Revenue Code	270
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$724.50
Rate for Payer: Aetna of AZ Commercial	$724.50
Rate for Payer: Aetna of AZ Medicare	$225.40
Rate for Payer: Allwell Medicare	$120.75
Rate for Payer: Amerigroup Medicare	$120.75
Rate for Payer: APIPA Medicare/Medicaid	$300.67
Rate for Payer: AZCH Complete Medicare	$120.75
Rate for Payer: Banner UC Health Medicare	$120.75
Rate for Payer: Bisbee Police All Plans	$209.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$547.40
Rate for Payer: Cash Price	$644.00
Rate for Payer: Cigna of AZ Commercial	$563.50
Rate for Payer: Copperpoint Commercial	$199.24
Rate for Payer: Health Net of AZ Commercial	$483.00
Rate for Payer: Health Net of AZ Medicare	$225.40
Rate for Payer: Humana of AZ Medicare	$120.75
Rate for Payer: Self Pay Self Pay	$644.00
Rate for Payer: TriWest Medicare	$120.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$469.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.90

Supplies

Facility

$3,066.00

Hospital Charge Code	22528815
Hospital Revenue Code	270
Min. Negotiated Rate	$459.90
Max. Negotiated Rate	$2,759.40
Rate for Payer: Aetna of AZ Commercial	$2,759.40
Rate for Payer: Aetna of AZ Medicare	$858.48
Rate for Payer: Allwell Medicare	$459.90
Rate for Payer: Amerigroup Medicare	$459.90
Rate for Payer: APIPA Medicare/Medicaid	$1,145.15
Rate for Payer: AZCH Complete Medicare	$459.90
Rate for Payer: Banner UC Health Medicare	$459.90
Rate for Payer: Bisbee Police All Plans	$797.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,084.88
Rate for Payer: Cash Price	$2,452.80
Rate for Payer: Cigna of AZ Commercial	$2,146.20
Rate for Payer: Copperpoint Commercial	$758.84
Rate for Payer: Health Net of AZ Commercial	$1,839.60
Rate for Payer: Health Net of AZ Medicare	$858.48
Rate for Payer: Humana of AZ Medicare	$459.90
Rate for Payer: Self Pay Self Pay	$2,452.80
Rate for Payer: TriWest Medicare	$459.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,787.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$551.88

Supplies SLING DESARA

Facility

$3,297.00

Hospital Charge Code	22528819
Hospital Revenue Code	270
Min. Negotiated Rate	$494.55
Max. Negotiated Rate	$2,967.30
Rate for Payer: Aetna of AZ Commercial	$2,967.30
Rate for Payer: Aetna of AZ Medicare	$923.16
Rate for Payer: Allwell Medicare	$494.55
Rate for Payer: Amerigroup Medicare	$494.55
Rate for Payer: APIPA Medicare/Medicaid	$1,231.43
Rate for Payer: AZCH Complete Medicare	$494.55
Rate for Payer: Banner UC Health Medicare	$494.55
Rate for Payer: Bisbee Police All Plans	$857.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,241.96
Rate for Payer: Cash Price	$2,637.60
Rate for Payer: Cigna of AZ Commercial	$2,307.90
Rate for Payer: Copperpoint Commercial	$816.01
Rate for Payer: Health Net of AZ Commercial	$1,978.20
Rate for Payer: Health Net of AZ Medicare	$923.16
Rate for Payer: Humana of AZ Medicare	$494.55
Rate for Payer: Self Pay Self Pay	$2,637.60
Rate for Payer: TriWest Medicare	$494.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,922.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$593.46

Supplies SLING DESARA

Facility

$3,297.00

Hospital Charge Code	22528819
Hospital Revenue Code	270
Min. Negotiated Rate	$857.22
Max. Negotiated Rate	$2,967.30
Rate for Payer: Aetna of AZ Commercial	$2,967.30
Rate for Payer: Bisbee Police All Plans	$857.22
Rate for Payer: Cash Price	$2,637.60
Rate for Payer: Self Pay Self Pay	$2,637.60

SUPPORTER ADULT LG

Facility

$88.00

Hospital Charge Code	22354192
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Aetna of AZ Medicare	$24.64
Rate for Payer: Allwell Medicare	$13.20
Rate for Payer: Amerigroup Medicare	$13.20
Rate for Payer: APIPA Medicare/Medicaid	$32.87
Rate for Payer: AZCH Complete Medicare	$13.20
Rate for Payer: Banner UC Health Medicare	$13.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$61.60
Rate for Payer: Copperpoint Commercial	$21.78
Rate for Payer: Health Net of AZ Commercial	$52.80
Rate for Payer: Health Net of AZ Medicare	$24.64
Rate for Payer: Humana of AZ Medicare	$13.20
Rate for Payer: Self Pay Self Pay	$70.40
Rate for Payer: TriWest Medicare	$13.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.84

SUPPORTER ADULT LG

Facility

$88.00

Hospital Charge Code	22354192
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Cash Price	$70.40
Rate for Payer: Self Pay Self Pay	$70.40

SUPPORTER ADULT MED

Facility

$26.00

Hospital Charge Code	22354191
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

SUPPORTER ADULT MED

Facility

$26.00

Hospital Charge Code	22354191
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

SUPPORTER ADULT SMALL

Facility

$88.00

Hospital Charge Code	22354190
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Cash Price	$70.40
Rate for Payer: Self Pay Self Pay	$70.40

SUPPORTER ADULT SMALL

Facility

$88.00

Hospital Charge Code	22354190
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Aetna of AZ Medicare	$24.64
Rate for Payer: Allwell Medicare	$13.20
Rate for Payer: Amerigroup Medicare	$13.20
Rate for Payer: APIPA Medicare/Medicaid	$32.87
Rate for Payer: AZCH Complete Medicare	$13.20
Rate for Payer: Banner UC Health Medicare	$13.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$61.60
Rate for Payer: Copperpoint Commercial	$21.78
Rate for Payer: Health Net of AZ Commercial	$52.80
Rate for Payer: Health Net of AZ Medicare	$24.64
Rate for Payer: Humana of AZ Medicare	$13.20
Rate for Payer: Self Pay Self Pay	$70.40
Rate for Payer: TriWest Medicare	$13.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.84

SUPPORTER ADULT XL

Facility

$42.00

Hospital Charge Code	22354193
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.30
Rate for Payer: Amerigroup Medicare	$6.30
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.30
Rate for Payer: Banner UC Health Medicare	$6.30
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.40
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.30
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

SUPPORTER ADULT XL

Facility

$42.00

Hospital Charge Code	22354193
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

SURECLIP 11MM REPOSITIONABLE

Facility

$718.00

Hospital Charge Code	23152396
Hospital Revenue Code	272
Min. Negotiated Rate	$107.70
Max. Negotiated Rate	$646.20
Rate for Payer: Aetna of AZ Commercial	$646.20
Rate for Payer: Aetna of AZ Medicare	$201.04
Rate for Payer: Allwell Medicare	$107.70
Rate for Payer: Amerigroup Medicare	$107.70
Rate for Payer: APIPA Medicare/Medicaid	$268.17
Rate for Payer: AZCH Complete Medicare	$107.70
Rate for Payer: Banner UC Health Medicare	$107.70
Rate for Payer: Bisbee Police All Plans	$186.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$488.24
Rate for Payer: Cash Price	$574.40
Rate for Payer: Cigna of AZ Commercial	$502.60
Rate for Payer: Copperpoint Commercial	$177.70
Rate for Payer: Health Net of AZ Commercial	$430.80
Rate for Payer: Health Net of AZ Medicare	$201.04
Rate for Payer: Humana of AZ Medicare	$107.70
Rate for Payer: Self Pay Self Pay	$574.40
Rate for Payer: TriWest Medicare	$107.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$418.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.24

SURECLIP 11MM REPOSITIONABLE

Facility

$718.00

Hospital Charge Code	23152396
Hospital Revenue Code	272
Min. Negotiated Rate	$186.68
Max. Negotiated Rate	$646.20
Rate for Payer: Aetna of AZ Commercial	$646.20
Rate for Payer: Bisbee Police All Plans	$186.68
Rate for Payer: Cash Price	$574.40
Rate for Payer: Self Pay Self Pay	$574.40

SUREFIX TI SCREW CAP 18MM

Facility

$2,085.25

Hospital Charge Code	27595624
Hospital Revenue Code	270
Min. Negotiated Rate	$312.79
Max. Negotiated Rate	$1,876.72
Rate for Payer: Aetna of AZ Commercial	$1,876.72
Rate for Payer: Aetna of AZ Medicare	$583.87
Rate for Payer: Allwell Medicare	$312.79
Rate for Payer: Amerigroup Medicare	$312.79
Rate for Payer: APIPA Medicare/Medicaid	$778.84
Rate for Payer: AZCH Complete Medicare	$312.79
Rate for Payer: Banner UC Health Medicare	$312.79
Rate for Payer: Bisbee Police All Plans	$542.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,417.97
Rate for Payer: Cash Price	$1,668.20
Rate for Payer: Cigna of AZ Commercial	$1,459.68
Rate for Payer: Copperpoint Commercial	$516.10
Rate for Payer: Health Net of AZ Commercial	$1,251.15
Rate for Payer: Health Net of AZ Medicare	$583.87
Rate for Payer: Humana of AZ Medicare	$312.79
Rate for Payer: Self Pay Self Pay	$1,668.20
Rate for Payer: TriWest Medicare	$312.79
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,215.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$375.34

SUREFIX TI SCREW CAP 18MM

Facility

$2,085.25

Hospital Charge Code	27595624
Hospital Revenue Code	270
Min. Negotiated Rate	$542.16
Max. Negotiated Rate	$1,876.72
Rate for Payer: Aetna of AZ Commercial	$1,876.72
Rate for Payer: Bisbee Police All Plans	$542.16
Rate for Payer: Cash Price	$1,668.20
Rate for Payer: Self Pay Self Pay	$1,668.20

SURESEAL

Facility

$76.00

Hospital Charge Code	27750226
Hospital Revenue Code	270
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

SURESEAL

Facility

$76.00

Hospital Charge Code	27750226
Hospital Revenue Code	270
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$11.40
Rate for Payer: Amerigroup Medicare	$11.40
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$11.40
Rate for Payer: Banner UC Health Medicare	$11.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$53.20
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$11.40
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$11.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

SURE SEAL VALVE

Facility

$111.00

Hospital Charge Code	22354974
Hospital Revenue Code	270
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Cash Price	$88.80
Rate for Payer: Self Pay Self Pay	$88.80

SURE SEAL VALVE

Facility

$111.00

Hospital Charge Code	22354974
Hospital Revenue Code	270
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Aetna of AZ Medicare	$31.08
Rate for Payer: Allwell Medicare	$16.65
Rate for Payer: Amerigroup Medicare	$16.65
Rate for Payer: APIPA Medicare/Medicaid	$41.46
Rate for Payer: AZCH Complete Medicare	$16.65
Rate for Payer: Banner UC Health Medicare	$16.65
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$75.48
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cigna of AZ Commercial	$77.70
Rate for Payer: Copperpoint Commercial	$27.47
Rate for Payer: Health Net of AZ Commercial	$66.60
Rate for Payer: Health Net of AZ Medicare	$31.08
Rate for Payer: Humana of AZ Medicare	$16.65
Rate for Payer: Self Pay Self Pay	$88.80
Rate for Payer: TriWest Medicare	$16.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$64.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.98

SURGICAL GOWN LG

Facility

$17.00

Hospital Charge Code	22549514
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of AZ Commercial	$15.30
Rate for Payer: Aetna of AZ Medicare	$4.76
Rate for Payer: Allwell Medicare	$2.55
Rate for Payer: Amerigroup Medicare	$2.55
Rate for Payer: APIPA Medicare/Medicaid	$6.35
Rate for Payer: AZCH Complete Medicare	$2.55
Rate for Payer: Banner UC Health Medicare	$2.55
Rate for Payer: Bisbee Police All Plans	$4.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$11.56
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cigna of AZ Commercial	$11.90
Rate for Payer: Copperpoint Commercial	$4.21
Rate for Payer: Health Net of AZ Commercial	$10.20
Rate for Payer: Health Net of AZ Medicare	$4.76
Rate for Payer: Humana of AZ Medicare	$2.55
Rate for Payer: Self Pay Self Pay	$13.60
Rate for Payer: TriWest Medicare	$2.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.06

SURGICAL GOWN LG

Facility

$17.00

Hospital Charge Code	22549514
Hospital Revenue Code	272
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$15.30
Rate for Payer: Aetna of AZ Commercial	$15.30
Rate for Payer: Bisbee Police All Plans	$4.42
Rate for Payer: Cash Price	$13.60
Rate for Payer: Self Pay Self Pay	$13.60

Know your out-of-pocket cost for care.

All Charges