Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE ETHILON 4-0 FS-2

Facility

$17.00

Hospital Charge Code	22355127
Hospital Revenue Code	270
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

SUTURE ETHILON 4-0 PS-2

Facility

$24.00

Hospital Charge Code	22355461
Hospital Revenue Code	270
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Cash Price	$19.20
Rate for Payer: Self Pay Self Pay	$19.20

SUTURE ETHILON 4-0 PS-2

Facility

$24.00

Hospital Charge Code	22355461
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Aetna of AZ Medicare	$6.72
Rate for Payer: Allwell Medicare	$3.60
Rate for Payer: Amerigroup Medicare	$3.60
Rate for Payer: APIPA Medicare/Medicaid	$8.96
Rate for Payer: AZCH Complete Medicare	$3.60
Rate for Payer: Banner UC Health Medicare	$3.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.32
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Copperpoint Commercial	$5.94
Rate for Payer: Health Net of AZ Commercial	$14.40
Rate for Payer: Health Net of AZ Medicare	$6.72
Rate for Payer: Humana of AZ Medicare	$3.60
Rate for Payer: Self Pay Self Pay	$19.20
Rate for Payer: TriWest Medicare	$3.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.32

SUTURE ETHILON 5-0 C-2

Facility

$49.00

Hospital Charge Code	22355184
Hospital Revenue Code	270
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Aetna of AZ Medicare	$13.72
Rate for Payer: Allwell Medicare	$7.35
Rate for Payer: Amerigroup Medicare	$7.35
Rate for Payer: APIPA Medicare/Medicaid	$18.30
Rate for Payer: AZCH Complete Medicare	$7.35
Rate for Payer: Banner UC Health Medicare	$7.35
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$33.32
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$34.30
Rate for Payer: Copperpoint Commercial	$12.13
Rate for Payer: Health Net of AZ Commercial	$29.40
Rate for Payer: Health Net of AZ Medicare	$13.72
Rate for Payer: Humana of AZ Medicare	$7.35
Rate for Payer: Self Pay Self Pay	$39.20
Rate for Payer: TriWest Medicare	$7.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.82

SUTURE ETHILON 5-0 C-2

Facility

$49.00

Hospital Charge Code	22355184
Hospital Revenue Code	270
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Self Pay Self Pay	$39.20

SUTURE ETHILON 5-0 FS-2

Facility

$14.00

Hospital Charge Code	22355447
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 5-0 FS-2

Facility

$14.00

Hospital Charge Code	22355447
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 5-0 P-3

Facility

$24.00

Hospital Charge Code	22355129
Hospital Revenue Code	270
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Cash Price	$19.20
Rate for Payer: Self Pay Self Pay	$19.20

SUTURE ETHILON 5-0 P-3

Facility

$24.00

Hospital Charge Code	22355129
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Aetna of AZ Medicare	$6.72
Rate for Payer: Allwell Medicare	$3.60
Rate for Payer: Amerigroup Medicare	$3.60
Rate for Payer: APIPA Medicare/Medicaid	$8.96
Rate for Payer: AZCH Complete Medicare	$3.60
Rate for Payer: Banner UC Health Medicare	$3.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.32
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Copperpoint Commercial	$5.94
Rate for Payer: Health Net of AZ Commercial	$14.40
Rate for Payer: Health Net of AZ Medicare	$6.72
Rate for Payer: Humana of AZ Medicare	$3.60
Rate for Payer: Self Pay Self Pay	$19.20
Rate for Payer: TriWest Medicare	$3.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.32

SUTURE ETHILON 6-0 P-1

Facility

$50.00

Hospital Charge Code	22355128
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 ETHILON 6-0 P-1

Facility

$50.00

Hospital Charge Code	22355128
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 ETHILON 6-0 P-3

Facility

$93.00

Hospital Charge Code	22355198
Hospital Revenue Code	270
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Aetna of AZ Medicare	$26.04
Rate for Payer: Allwell Medicare	$13.95
Rate for Payer: Amerigroup Medicare	$13.95
Rate for Payer: APIPA Medicare/Medicaid	$34.74
Rate for Payer: AZCH Complete Medicare	$13.95
Rate for Payer: Banner UC Health Medicare	$13.95
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.24
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cigna of AZ Commercial	$65.10
Rate for Payer: Copperpoint Commercial	$23.02
Rate for Payer: Health Net of AZ Commercial	$55.80
Rate for Payer: Health Net of AZ Medicare	$26.04
Rate for Payer: Humana of AZ Medicare	$13.95
Rate for Payer: Self Pay Self Pay	$74.40
Rate for Payer: TriWest Medicare	$13.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.74

SUTURE ETHILON 6-0 P-3

Facility

$93.00

Hospital Charge Code	22355198
Hospital Revenue Code	270
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna of AZ Commercial	$83.70
Rate for Payer: Bisbee Police All Plans	$24.18
Rate for Payer: Cash Price	$74.40
Rate for Payer: Self Pay Self Pay	$74.40

SUTURE ETHILON MONO 2/0 BLK

Facility

$64.00

Hospital Charge Code	22754080
Hospital Revenue Code	272
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Cash Price	$51.20
Rate for Payer: Self Pay Self Pay	$51.20

SUTURE ETHILON MONO 2/0 BLK

Facility

$64.00

Hospital Charge Code	22754080
Hospital Revenue Code	272
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Aetna of AZ Medicare	$17.92
Rate for Payer: Allwell Medicare	$9.60
Rate for Payer: Amerigroup Medicare	$9.60
Rate for Payer: APIPA Medicare/Medicaid	$23.90
Rate for Payer: AZCH Complete Medicare	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43.52
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cigna of AZ Commercial	$44.80
Rate for Payer: Copperpoint Commercial	$15.84
Rate for Payer: Health Net of AZ Commercial	$38.40
Rate for Payer: Health Net of AZ Medicare	$17.92
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Self Pay Self Pay	$51.20
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.52

SUTURE MONOCRYL 4-0 PS-2

Facility

$32.00

Hospital Charge Code	23580266
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Cash Price	$25.60
Rate for Payer: Self Pay Self Pay	$25.60

SUTURE MONOCRYL 4-0 PS-2

Facility

$32.00

Hospital Charge Code	23580266
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of AZ Commercial	$28.80
Rate for Payer: Aetna of AZ Medicare	$8.96
Rate for Payer: Allwell Medicare	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.95
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Bisbee Police All Plans	$8.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21.76
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cigna of AZ Commercial	$22.40
Rate for Payer: Copperpoint Commercial	$7.92
Rate for Payer: Health Net of AZ Commercial	$19.20
Rate for Payer: Health Net of AZ Medicare	$8.96
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Self Pay Self Pay	$25.60
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$18.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.76

SUTURE MONOCRYL 4-0 PS-2 Y496G

Facility

$35.00

Hospital Charge Code	22355197
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
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	$5.25
Rate for Payer: Amerigroup Medicare	$5.25
Rate for Payer: APIPA Medicare/Medicaid	$13.07
Rate for Payer: AZCH Complete Medicare	$5.25
Rate for Payer: Banner UC Health Medicare	$5.25
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	$5.25
Rate for Payer: Self Pay Self Pay	$28.00
Rate for Payer: TriWest Medicare	$5.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.30

SUTURE MONOCRYL 4-0 PS-2 Y496G

Facility

$35.00

Hospital Charge Code	22355197
Hospital Revenue Code	270
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

SUTURE PDSII 0 CT-1

Facility

$62.00

Hospital Charge Code	22355506
Hospital Revenue Code	270
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

SUTURE PDSII 0 CT-1

Facility

$62.00

Hospital Charge Code	22355506
Hospital Revenue Code	270
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.30
Rate for Payer: Amerigroup Medicare	$9.30
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.30
Rate for Payer: Banner UC Health Medicare	$9.30
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.34
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.30
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

SUTURE PDSII 1-0 CT-1

Facility

$63.00

Hospital Charge Code	22355507
Hospital Revenue Code	270
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Aetna of AZ Medicare	$17.64
Rate for Payer: Allwell Medicare	$9.45
Rate for Payer: Amerigroup Medicare	$9.45
Rate for Payer: APIPA Medicare/Medicaid	$23.53
Rate for Payer: AZCH Complete Medicare	$9.45
Rate for Payer: Banner UC Health Medicare	$9.45
Rate for Payer: Bisbee Police All Plans	$16.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.84
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna of AZ Commercial	$44.10
Rate for Payer: Copperpoint Commercial	$15.59
Rate for Payer: Health Net of AZ Commercial	$37.80
Rate for Payer: Health Net of AZ Medicare	$17.64
Rate for Payer: Humana of AZ Medicare	$9.45
Rate for Payer: Self Pay Self Pay	$50.40
Rate for Payer: TriWest Medicare	$9.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.34

SUTURE PDSII 1-0 CT-1

Facility

$63.00

Hospital Charge Code	22355507
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Bisbee Police All Plans	$16.38
Rate for Payer: Cash Price	$50.40
Rate for Payer: Self Pay Self Pay	$50.40

SUTURE PLIABILIZED MONO BLK 4/0 18IN P-3

Facility

$78.00

Hospital Charge Code	23359341
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: Allwell Medicare	$11.70
Rate for Payer: Amerigroup Medicare	$11.70
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicare	$11.70
Rate for Payer: Banner UC Health Medicare	$11.70
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$11.70
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$11.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

SUTURE PLIABILIZED MONO BLK 4/0 18IN P-3

Facility

$78.00

Hospital Charge Code	23359341
Hospital Revenue Code	272
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

Know your out-of-pocket cost for care.

All Charges