Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB 3-0 GS-22

Facility

$43.00

Hospital Charge Code	22355450
Hospital Revenue Code	270
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of AZ Commercial	$38.70
Rate for Payer: Bisbee Police All Plans	$11.18
Rate for Payer: Cash Price	$34.40
Rate for Payer: Self Pay Self Pay	$34.40

SUTURE POLYSORB 3-0 GS-22

Facility

$43.00

Hospital Charge Code	22355450
Hospital Revenue Code	270
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna of AZ Commercial	$38.70
Rate for Payer: Aetna of AZ Medicare	$12.04
Rate for Payer: Allwell Medicare	$6.45
Rate for Payer: Amerigroup Medicare	$6.45
Rate for Payer: APIPA Medicare/Medicaid	$16.06
Rate for Payer: AZCH Complete Medicare	$6.45
Rate for Payer: Banner UC Health Medicare	$6.45
Rate for Payer: Bisbee Police All Plans	$11.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.24
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cigna of AZ Commercial	$30.10
Rate for Payer: Copperpoint Commercial	$10.64
Rate for Payer: Health Net of AZ Commercial	$25.80
Rate for Payer: Health Net of AZ Medicare	$12.04
Rate for Payer: Humana of AZ Medicare	$6.45
Rate for Payer: Self Pay Self Pay	$34.40
Rate for Payer: TriWest Medicare	$6.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.74

SUTURE POLYSORB 5-0 C-13

Facility

$67.00

Hospital Charge Code	22354173
Hospital Revenue Code	270
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.05
Rate for Payer: Amerigroup Medicare	$10.05
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.05
Rate for Payer: Banner UC Health Medicare	$10.05
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.05
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

SUTURE POLYSORB 5-0 C-13

Facility

$67.00

Hospital Charge Code	22354173
Hospital Revenue Code	270
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

SUTURE PROLENE 0 CT-1

Facility

$253.00

Hospital Charge Code	22355189
Hospital Revenue Code	270
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of AZ Commercial	$227.70
Rate for Payer: Aetna of AZ Medicare	$70.84
Rate for Payer: Allwell Medicare	$37.95
Rate for Payer: Amerigroup Medicare	$37.95
Rate for Payer: APIPA Medicare/Medicaid	$94.50
Rate for Payer: AZCH Complete Medicare	$37.95
Rate for Payer: Banner UC Health Medicare	$37.95
Rate for Payer: Bisbee Police All Plans	$65.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$172.04
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cigna of AZ Commercial	$177.10
Rate for Payer: Copperpoint Commercial	$62.62
Rate for Payer: Health Net of AZ Commercial	$151.80
Rate for Payer: Health Net of AZ Medicare	$70.84
Rate for Payer: Humana of AZ Medicare	$37.95
Rate for Payer: Self Pay Self Pay	$202.40
Rate for Payer: TriWest Medicare	$37.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$147.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.54

SUTURE PROLENE 0 CT-1

Facility

$253.00

Hospital Charge Code	22355189
Hospital Revenue Code	270
Min. Negotiated Rate	$65.78
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna of AZ Commercial	$227.70
Rate for Payer: Bisbee Police All Plans	$65.78
Rate for Payer: Cash Price	$202.40
Rate for Payer: Self Pay Self Pay	$202.40

SUTURE PROLENE 0 CT-2

Facility

$62.00

Hospital Charge Code	22355448
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 PROLENE 0 CT-2

Facility

$62.00

Hospital Charge Code	22355448
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 PROLENE 0 CT-2 SURGIPRO

Facility

$54.00

Hospital Charge Code	22355479
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

SUTURE PROLENE 0 CT-2 SURGIPRO

Facility

$54.00

Hospital Charge Code	22355479
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
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	$8.10
Rate for Payer: Amerigroup Medicare	$8.10
Rate for Payer: APIPA Medicare/Medicaid	$20.17
Rate for Payer: AZCH Complete Medicare	$8.10
Rate for Payer: Banner UC Health Medicare	$8.10
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	$13.36
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	$8.10
Rate for Payer: Self Pay Self Pay	$43.20
Rate for Payer: TriWest Medicare	$8.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$31.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.72

SUTURE PROLENE 1-0 CTX

Facility

$15.00

Hospital Charge Code	22355470
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Aetna of AZ Medicare	$4.20
Rate for Payer: Allwell Medicare	$2.25
Rate for Payer: Amerigroup Medicare	$2.25
Rate for Payer: APIPA Medicare/Medicaid	$5.60
Rate for Payer: AZCH Complete Medicare	$2.25
Rate for Payer: Banner UC Health Medicare	$2.25
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of AZ Commercial	$10.50
Rate for Payer: Copperpoint Commercial	$3.71
Rate for Payer: Health Net of AZ Commercial	$9.00
Rate for Payer: Health Net of AZ Medicare	$4.20
Rate for Payer: Humana of AZ Medicare	$2.25
Rate for Payer: Self Pay Self Pay	$12.00
Rate for Payer: TriWest Medicare	$2.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.70

SUTURE PROLENE 1-0 CTX

Facility

$15.00

Hospital Charge Code	22355470
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of AZ Commercial	$13.50
Rate for Payer: Bisbee Police All Plans	$3.90
Rate for Payer: Cash Price	$12.00
Rate for Payer: Self Pay Self Pay	$12.00

SUTURE PROLENE 2-0 CT-2

Facility

$17.00

Hospital Charge Code	22355469
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 PROLENE 2-0 CT-2

Facility

$17.00

Hospital Charge Code	22355469
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

SUTURE PROLENE 2-0 FS

Facility

$67.00

Hospital Charge Code	22355474
Hospital Revenue Code	270
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

SUTURE PROLENE 2-0 FS

Facility

$67.00

Hospital Charge Code	22355474
Hospital Revenue Code	270
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.05
Rate for Payer: Amerigroup Medicare	$10.05
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.05
Rate for Payer: Banner UC Health Medicare	$10.05
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.05
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

SUTURE PROLENE 3-0 FS-2

Facility

$18.00

Hospital Charge Code	22355132
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.70
Rate for Payer: Amerigroup Medicare	$2.70
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.70
Rate for Payer: Banner UC Health Medicare	$2.70
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.70
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

SUTURE PROLENE 3-0 FS-2

Facility

$18.00

Hospital Charge Code	22355132
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

SUTURE PROLENE 3-0 RB-1

Facility

$71.00

Hospital Charge Code	22355475
Hospital Revenue Code	270
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

SUTURE PROLENE 3-0 RB-1

Facility

$71.00

Hospital Charge Code	22355475
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$10.65
Rate for Payer: Amerigroup Medicare	$10.65
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$10.65
Rate for Payer: Banner UC Health Medicare	$10.65
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$10.65
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$10.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

SUTURE PROLENE 3-0 SH

Facility

$69.00

Hospital Charge Code	22355449
Hospital Revenue Code	270
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$10.35
Rate for Payer: Amerigroup Medicare	$10.35
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$10.35
Rate for Payer: Banner UC Health Medicare	$10.35
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$48.30
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$10.35
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$10.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

SUTURE PROLENE 3-0 SH

Facility

$69.00

Hospital Charge Code	22355449
Hospital Revenue Code	270
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

SUTURE PROLENE 4-0 FS-1

Facility

$69.00

Hospital Charge Code	22355473
Hospital Revenue Code	270
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$10.35
Rate for Payer: Amerigroup Medicare	$10.35
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$10.35
Rate for Payer: Banner UC Health Medicare	$10.35
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$48.30
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$10.35
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$10.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

SUTURE PROLENE 4-0 FS-1

Facility

$69.00

Hospital Charge Code	22355473
Hospital Revenue Code	270
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

SUTURE PROLENE 4-0 FS-2

Facility

$18.00

Hospital Charge Code	22355133
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.70
Rate for Payer: Amerigroup Medicare	$2.70
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.70
Rate for Payer: Banner UC Health Medicare	$2.70
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.70
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

Know your out-of-pocket cost for care.

All Charges