Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUSPENSORY MALE MED

Facility

$82.00

Hospital Charge Code	22354142
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

SUSPENSORY MALE SMALL

Facility

$82.00

Hospital Charge Code	22354141
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

SUSPENSORY MALE SMALL

Facility

$82.00

Hospital Charge Code	22354141
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$57.40
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

SUTURE, 1 36 CTD VIC UND BR CT-1

Facility

$59.00

Hospital Charge Code	23293575
Hospital Revenue Code	272
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Bisbee Police All Plans	$15.34
Rate for Payer: Cash Price	$47.20
Rate for Payer: Self Pay Self Pay	$47.20

SUTURE, 1 36 CTD VIC UND BR CT-1

Facility

$59.00

Hospital Charge Code	23293575
Hospital Revenue Code	272
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Aetna of AZ Medicare	$16.52
Rate for Payer: Allwell Medicare	$8.85
Rate for Payer: Amerigroup Medicare	$8.85
Rate for Payer: APIPA Medicare/Medicaid	$22.04
Rate for Payer: AZCH Complete Medicare	$8.85
Rate for Payer: Banner UC Health Medicare	$8.85
Rate for Payer: Bisbee Police All Plans	$15.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.12
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cigna of AZ Commercial	$41.30
Rate for Payer: Copperpoint Commercial	$14.60
Rate for Payer: Health Net of AZ Commercial	$35.40
Rate for Payer: Health Net of AZ Medicare	$16.52
Rate for Payer: Humana of AZ Medicare	$8.85
Rate for Payer: Self Pay Self Pay	$47.20
Rate for Payer: TriWest Medicare	$8.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.62

SUTURE CHROMIC 0 CT-1

Facility

$85.00

Hospital Charge Code	22355467
Hospital Revenue Code	270
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Aetna of AZ Medicare	$23.80
Rate for Payer: Allwell Medicare	$12.75
Rate for Payer: Amerigroup Medicare	$12.75
Rate for Payer: APIPA Medicare/Medicaid	$31.75
Rate for Payer: AZCH Complete Medicare	$12.75
Rate for Payer: Banner UC Health Medicare	$12.75
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.80
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cigna of AZ Commercial	$59.50
Rate for Payer: Copperpoint Commercial	$21.04
Rate for Payer: Health Net of AZ Commercial	$51.00
Rate for Payer: Health Net of AZ Medicare	$23.80
Rate for Payer: Humana of AZ Medicare	$12.75
Rate for Payer: Self Pay Self Pay	$68.00
Rate for Payer: TriWest Medicare	$12.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$49.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.30

SUTURE CHROMIC 0 CT-1

Facility

$85.00

Hospital Charge Code	22355467
Hospital Revenue Code	270
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Cash Price	$68.00
Rate for Payer: Self Pay Self Pay	$68.00

SUTURE CHROMIC 1-0 CT-1

Facility

$50.00

Hospital Charge Code	22355468
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of AZ Commercial	$45.00
Rate for Payer: Aetna of AZ Medicare	$14.00
Rate for Payer: Allwell Medicare	$7.50
Rate for Payer: Amerigroup Medicare	$7.50
Rate for Payer: APIPA Medicare/Medicaid	$18.68
Rate for Payer: AZCH Complete Medicare	$7.50
Rate for Payer: Banner UC Health Medicare	$7.50
Rate for Payer: Bisbee Police All Plans	$13.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cigna of AZ Commercial	$35.00
Rate for Payer: Copperpoint Commercial	$12.38
Rate for Payer: Health Net of AZ Commercial	$30.00
Rate for Payer: Health Net of AZ Medicare	$14.00
Rate for Payer: Humana of AZ Medicare	$7.50
Rate for Payer: Self Pay Self Pay	$40.00
Rate for Payer: TriWest Medicare	$7.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.00

SUTURE CHROMIC 1-0 CT-1

Facility

$50.00

Hospital Charge Code	22355468
Hospital Revenue Code	270
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of AZ Commercial	$45.00
Rate for Payer: Bisbee Police All Plans	$13.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Self Pay Self Pay	$40.00

SUTURE CHROMIC 1-0 CT-1 8 PK

Facility

$275.00

Hospital Charge Code	22355190
Hospital Revenue Code	270
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of AZ Commercial	$247.50
Rate for Payer: Bisbee Police All Plans	$71.50
Rate for Payer: Cash Price	$220.00
Rate for Payer: Self Pay Self Pay	$220.00

SUTURE CHROMIC 1-0 CT-1 8 PK

Facility

$275.00

Hospital Charge Code	22355190
Hospital Revenue Code	270
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna of AZ Commercial	$247.50
Rate for Payer: Aetna of AZ Medicare	$77.00
Rate for Payer: Allwell Medicare	$41.25
Rate for Payer: Amerigroup Medicare	$41.25
Rate for Payer: APIPA Medicare/Medicaid	$102.71
Rate for Payer: AZCH Complete Medicare	$41.25
Rate for Payer: Banner UC Health Medicare	$41.25
Rate for Payer: Bisbee Police All Plans	$71.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$187.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cigna of AZ Commercial	$192.50
Rate for Payer: Copperpoint Commercial	$68.06
Rate for Payer: Health Net of AZ Commercial	$165.00
Rate for Payer: Health Net of AZ Medicare	$77.00
Rate for Payer: Humana of AZ Medicare	$41.25
Rate for Payer: Self Pay Self Pay	$220.00
Rate for Payer: TriWest Medicare	$41.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$160.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$49.50

SUTURE CHROMIC 2-0 FS-1

Facility

$90.00

Hospital Charge Code	22355464
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

SUTURE CHROMIC 2-0 FS-1

Facility

$90.00

Hospital Charge Code	22355464
Hospital Revenue Code	270
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$13.50
Rate for Payer: Amerigroup Medicare	$13.50
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$13.50
Rate for Payer: Banner UC Health Medicare	$13.50
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$22.28
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$13.50
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$13.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

SUTURE CHROMIC 2-0 MH

Facility

$88.00

Hospital Charge Code	22355487
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

SUTURE CHROMIC 2-0 MH

Facility

$88.00

Hospital Charge Code	22355487
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

SUTURE CHROMIC 2-0 SH

Facility

$86.00

Hospital Charge Code	22355486
Hospital Revenue Code	270
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Aetna of AZ Medicare	$24.08
Rate for Payer: Allwell Medicare	$12.90
Rate for Payer: Amerigroup Medicare	$12.90
Rate for Payer: APIPA Medicare/Medicaid	$32.12
Rate for Payer: AZCH Complete Medicare	$12.90
Rate for Payer: Banner UC Health Medicare	$12.90
Rate for Payer: Bisbee Police All Plans	$22.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$58.48
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cigna of AZ Commercial	$60.20
Rate for Payer: Copperpoint Commercial	$21.28
Rate for Payer: Health Net of AZ Commercial	$51.60
Rate for Payer: Health Net of AZ Medicare	$24.08
Rate for Payer: Humana of AZ Medicare	$12.90
Rate for Payer: Self Pay Self Pay	$68.80
Rate for Payer: TriWest Medicare	$12.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.48

SUTURE CHROMIC 2-0 SH

Facility

$86.00

Hospital Charge Code	22355486
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

SUTURE CHROMIC 2-0 UR-5

Facility

$108.00

Hospital Charge Code	22355502
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Aetna of AZ Medicare	$30.24
Rate for Payer: Allwell Medicare	$16.20
Rate for Payer: Amerigroup Medicare	$16.20
Rate for Payer: APIPA Medicare/Medicaid	$40.34
Rate for Payer: AZCH Complete Medicare	$16.20
Rate for Payer: Banner UC Health Medicare	$16.20
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$73.44
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$75.60
Rate for Payer: Copperpoint Commercial	$26.73
Rate for Payer: Health Net of AZ Commercial	$64.80
Rate for Payer: Health Net of AZ Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$16.20
Rate for Payer: Self Pay Self Pay	$86.40
Rate for Payer: TriWest Medicare	$16.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.44

SUTURE CHROMIC 2-0 UR-5

Facility

$108.00

Hospital Charge Code	22355502
Hospital Revenue Code	270
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Bisbee Police All Plans	$28.08
Rate for Payer: Cash Price	$86.40
Rate for Payer: Self Pay Self Pay	$86.40

SUTURE CHROMIC 3-0 CT-1 982H

Facility

$129.00

Hospital Charge Code	22355457
Hospital Revenue Code	270
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Cash Price	$103.20
Rate for Payer: Self Pay Self Pay	$103.20

SUTURE CHROMIC 3-0 CT-1 982H

Facility

$129.00

Hospital Charge Code	22355457
Hospital Revenue Code	270
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Aetna of AZ Medicare	$36.12
Rate for Payer: Allwell Medicare	$19.35
Rate for Payer: Amerigroup Medicare	$19.35
Rate for Payer: APIPA Medicare/Medicaid	$48.18
Rate for Payer: AZCH Complete Medicare	$19.35
Rate for Payer: Banner UC Health Medicare	$19.35
Rate for Payer: Bisbee Police All Plans	$33.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$87.72
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$90.30
Rate for Payer: Copperpoint Commercial	$31.93
Rate for Payer: Health Net of AZ Commercial	$77.40
Rate for Payer: Health Net of AZ Medicare	$36.12
Rate for Payer: Humana of AZ Medicare	$19.35
Rate for Payer: Self Pay Self Pay	$103.20
Rate for Payer: TriWest Medicare	$19.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.22

SUTURE CHROMIC 3-0 SH

Facility

$86.00

Hospital Charge Code	22355485
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

SUTURE CHROMIC 3-0 SH

Facility

$86.00

Hospital Charge Code	22355485
Hospital Revenue Code	270
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Aetna of AZ Medicare	$24.08
Rate for Payer: Allwell Medicare	$12.90
Rate for Payer: Amerigroup Medicare	$12.90
Rate for Payer: APIPA Medicare/Medicaid	$32.12
Rate for Payer: AZCH Complete Medicare	$12.90
Rate for Payer: Banner UC Health Medicare	$12.90
Rate for Payer: Bisbee Police All Plans	$22.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$58.48
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cigna of AZ Commercial	$60.20
Rate for Payer: Copperpoint Commercial	$21.28
Rate for Payer: Health Net of AZ Commercial	$51.60
Rate for Payer: Health Net of AZ Medicare	$24.08
Rate for Payer: Humana of AZ Medicare	$12.90
Rate for Payer: Self Pay Self Pay	$68.80
Rate for Payer: TriWest Medicare	$12.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.48

SUTURE CHROMIC 4-0 SH

Facility

$90.00

Hospital Charge Code	22355484
Hospital Revenue Code	270
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$13.50
Rate for Payer: Amerigroup Medicare	$13.50
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$13.50
Rate for Payer: Banner UC Health Medicare	$13.50
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$22.28
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$13.50
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$13.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

SUTURE CHROMIC 4-0 SH

Facility

$90.00

Hospital Charge Code	22355484
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

Know your out-of-pocket cost for care.

All Charges