Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE CHROMIC 4-0 V-20

Facility

$58.00

Hospital Charge Code	22355488
Hospital Revenue Code	270
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Cash Price	$46.40
Rate for Payer: Self Pay Self Pay	$46.40

SUTURE CHROMIC 4-0 V-20

Facility

$58.00

Hospital Charge Code	22355488
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$8.70
Rate for Payer: Amerigroup Medicare	$8.70
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$8.70
Rate for Payer: Banner UC Health Medicare	$8.70
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$8.70
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$8.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

SUTURE CHROMIC 5-0 RB-1

Facility

$23.00

Hospital Charge Code	22355501
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

SUTURE CHROMIC 5-0 RB-1

Facility

$23.00

Hospital Charge Code	22355501
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

SUTURE CHROMIC 6-0 PS-3 1635G

Facility

$46.00

Hospital Charge Code	22355192
Hospital Revenue Code	270
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Aetna of AZ Medicare	$12.88
Rate for Payer: Allwell Medicare	$6.90
Rate for Payer: Amerigroup Medicare	$6.90
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$6.90
Rate for Payer: Banner UC Health Medicare	$6.90
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.28
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Copperpoint Commercial	$11.38
Rate for Payer: Health Net of AZ Commercial	$27.60
Rate for Payer: Health Net of AZ Medicare	$12.88
Rate for Payer: Humana of AZ Medicare	$6.90
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$6.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

SUTURE CHROMIC 6-0 PS-3 1635G

Facility

$46.00

Hospital Charge Code	22355192
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

SUTURE ETHIBOND 2-0 18

Facility

$116.00

Hospital Charge Code	22355185
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

SUTURE ETHIBOND 2-0 18

Facility

$116.00

Hospital Charge Code	22355185
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

SUTURE ETHIBOND 2-0 CT-1

Facility

$48.00

Hospital Charge Code	22355503
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

SUTURE ETHIBOND 2-0 CT-1

Facility

$48.00

Hospital Charge Code	22355503
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

SUTURE ETHIBOND EXCEL 1-0 OS-4

Facility

$25.00

Hospital Charge Code	22355504
Hospital Revenue Code	270
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Aetna of AZ Medicare	$7.00
Rate for Payer: Allwell Medicare	$3.75
Rate for Payer: Amerigroup Medicare	$3.75
Rate for Payer: APIPA Medicare/Medicaid	$9.34
Rate for Payer: AZCH Complete Medicare	$3.75
Rate for Payer: Banner UC Health Medicare	$3.75
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cigna of AZ Commercial	$17.50
Rate for Payer: Copperpoint Commercial	$6.19
Rate for Payer: Health Net of AZ Commercial	$15.00
Rate for Payer: Health Net of AZ Medicare	$7.00
Rate for Payer: Humana of AZ Medicare	$3.75
Rate for Payer: Self Pay Self Pay	$20.00
Rate for Payer: TriWest Medicare	$3.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.50

SUTURE ETHIBOND EXCEL 1-0 OS-4

Facility

$25.00

Hospital Charge Code	22355504
Hospital Revenue Code	270
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of AZ Commercial	$22.50
Rate for Payer: Bisbee Police All Plans	$6.50
Rate for Payer: Cash Price	$20.00
Rate for Payer: Self Pay Self Pay	$20.00

SUTURE ETHIBOND EXCEL 1-0 OS-8

Facility

$74.00

Hospital Charge Code	22355505
Hospital Revenue Code	270
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Aetna of AZ Medicare	$20.72
Rate for Payer: Allwell Medicare	$11.10
Rate for Payer: Amerigroup Medicare	$11.10
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.10
Rate for Payer: Banner UC Health Medicare	$11.10
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.32
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$51.80
Rate for Payer: Copperpoint Commercial	$18.32
Rate for Payer: Health Net of AZ Commercial	$44.40
Rate for Payer: Health Net of AZ Medicare	$20.72
Rate for Payer: Humana of AZ Medicare	$11.10
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

SUTURE ETHIBOND EXCEL 1-0 OS-8

Facility

$74.00

Hospital Charge Code	22355505
Hospital Revenue Code	270
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Cash Price	$59.20
Rate for Payer: Self Pay Self Pay	$59.20

SUTURE ETHILON 2-0 FS

Facility

$48.00

Hospital Charge Code	22355465
Hospital Revenue Code	270
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

SUTURE ETHILON 2-0 FS

Facility

$48.00

Hospital Charge Code	22355465
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

SUTURE ETHILON 2-0 FSL

Facility

$13.00

Hospital Charge Code	22355446
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

SUTURE ETHILON 2-0 FSL

Facility

$13.00

Hospital Charge Code	22355446
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$1.95
Rate for Payer: Amerigroup Medicare	$1.95
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$1.95
Rate for Payer: Banner UC Health Medicare	$1.95
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$1.95
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$1.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

SUTURE ETHILON 3-0 FSL

Facility

$14.00

Hospital Charge Code	22355445
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Cash Price	$11.20
Rate for Payer: Self Pay Self Pay	$11.20

SUTURE ETHILON 3-0 FSL

Facility

$14.00

Hospital Charge Code	22355445
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Aetna of AZ Medicare	$3.92
Rate for Payer: Allwell Medicare	$2.10
Rate for Payer: Amerigroup Medicare	$2.10
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.10
Rate for Payer: Banner UC Health Medicare	$2.10
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$9.52
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Copperpoint Commercial	$3.46
Rate for Payer: Health Net of AZ Commercial	$8.40
Rate for Payer: Health Net of AZ Medicare	$3.92
Rate for Payer: Humana of AZ Medicare	$2.10
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

SUTURE ETHILON 4-0 C-14

Facility

$40.00

Hospital Charge Code	22355499
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of AZ Commercial	$36.00
Rate for Payer: Aetna of AZ Medicare	$11.20
Rate for Payer: Allwell Medicare	$6.00
Rate for Payer: Amerigroup Medicare	$6.00
Rate for Payer: APIPA Medicare/Medicaid	$14.94
Rate for Payer: AZCH Complete Medicare	$6.00
Rate for Payer: Banner UC Health Medicare	$6.00
Rate for Payer: Bisbee Police All Plans	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.20
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cigna of AZ Commercial	$28.00
Rate for Payer: Copperpoint Commercial	$9.90
Rate for Payer: Health Net of AZ Commercial	$24.00
Rate for Payer: Health Net of AZ Medicare	$11.20
Rate for Payer: Humana of AZ Medicare	$6.00
Rate for Payer: Self Pay Self Pay	$32.00
Rate for Payer: TriWest Medicare	$6.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.20

SUTURE ETHILON 4-0 C-14

Facility

$40.00

Hospital Charge Code	22355499
Hospital Revenue Code	270
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of AZ Commercial	$36.00
Rate for Payer: Bisbee Police All Plans	$10.40
Rate for Payer: Cash Price	$32.00
Rate for Payer: Self Pay Self Pay	$32.00

SUTURE ETHILON 4-0 FS-1

Facility

$14.00

Hospital Charge Code	22355444
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Aetna of AZ Medicare	$3.92
Rate for Payer: Allwell Medicare	$2.10
Rate for Payer: Amerigroup Medicare	$2.10
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.10
Rate for Payer: Banner UC Health Medicare	$2.10
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$9.52
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Copperpoint Commercial	$3.46
Rate for Payer: Health Net of AZ Commercial	$8.40
Rate for Payer: Health Net of AZ Medicare	$3.92
Rate for Payer: Humana of AZ Medicare	$2.10
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

SUTURE ETHILON 4-0 FS-1

Facility

$14.00

Hospital Charge Code	22355444
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Cash Price	$11.20
Rate for Payer: Self Pay Self Pay	$11.20

SUTURE ETHILON 4-0 FS-2

Facility

$17.00

Hospital Charge Code	22355127
Hospital Revenue Code	270
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