Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE SILK 2-0 TIES ONLY

Facility

$70.00

Hospital Charge Code	22355477
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Aetna of AZ Medicare	$19.60
Rate for Payer: Allwell Medicare	$10.50
Rate for Payer: Amerigroup Medicare	$10.50
Rate for Payer: APIPA Medicare/Medicaid	$26.14
Rate for Payer: AZCH Complete Medicare	$10.50
Rate for Payer: Banner UC Health Medicare	$10.50
Rate for Payer: Bisbee Police All Plans	$18.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$47.60
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cigna of AZ Commercial	$49.00
Rate for Payer: Copperpoint Commercial	$17.32
Rate for Payer: Health Net of AZ Commercial	$42.00
Rate for Payer: Health Net of AZ Medicare	$19.60
Rate for Payer: Humana of AZ Medicare	$10.50
Rate for Payer: Self Pay Self Pay	$56.00
Rate for Payer: TriWest Medicare	$10.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.60

SUTURE SILK 2-0 TIES ONLY

Facility

$70.00

Hospital Charge Code	22355477
Hospital Revenue Code	270
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of AZ Commercial	$63.00
Rate for Payer: Bisbee Police All Plans	$18.20
Rate for Payer: Cash Price	$56.00
Rate for Payer: Self Pay Self Pay	$56.00

SUTURE SILK 3-0 SH

Facility

$38.00

Hospital Charge Code	22355497
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Aetna of AZ Medicare	$10.64
Rate for Payer: Allwell Medicare	$5.70
Rate for Payer: Amerigroup Medicare	$5.70
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$5.70
Rate for Payer: Banner UC Health Medicare	$5.70
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.84
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Copperpoint Commercial	$9.40
Rate for Payer: Health Net of AZ Commercial	$22.80
Rate for Payer: Health Net of AZ Medicare	$10.64
Rate for Payer: Humana of AZ Medicare	$5.70
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$5.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

SUTURE SILK 3-0 SH

Facility

$38.00

Hospital Charge Code	22355497
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

SUTURE SILK 3-0 TIES ONLY

Facility

$72.00

Hospital Charge Code	22355476
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Aetna of AZ Medicare	$20.16
Rate for Payer: Allwell Medicare	$10.80
Rate for Payer: Amerigroup Medicare	$10.80
Rate for Payer: APIPA Medicare/Medicaid	$26.89
Rate for Payer: AZCH Complete Medicare	$10.80
Rate for Payer: Banner UC Health Medicare	$10.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Copperpoint Commercial	$17.82
Rate for Payer: Health Net of AZ Commercial	$43.20
Rate for Payer: Health Net of AZ Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$10.80
Rate for Payer: Self Pay Self Pay	$57.60
Rate for Payer: TriWest Medicare	$10.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.96

SUTURE SILK 3-0 TIES ONLY

Facility

$72.00

Hospital Charge Code	22355476
Hospital Revenue Code	270
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Cash Price	$57.60
Rate for Payer: Self Pay Self Pay	$57.60

SUTURE SILK 4-0 BB K881H

Facility

$54.00

Hospital Charge Code	22355456
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 SILK 4-0 BB K881H

Facility

$54.00

Hospital Charge Code	22355456
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 SURGICAL STEEL 2-0 FSLX

Facility

$57.00

Hospital Charge Code	22355177
Hospital Revenue Code	270
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

SUTURE SURGICAL STEEL 2-0 FSLX

Facility

$57.00

Hospital Charge Code	22355177
Hospital Revenue Code	270
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$8.55
Rate for Payer: Amerigroup Medicare	$8.55
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$8.55
Rate for Payer: Banner UC Health Medicare	$8.55
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$8.55
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$8.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

SUTURE VICRYL 0 CP-1

Facility

$17.00

Hospital Charge Code	22355453
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 VICRYL 0 CP-1

Facility

$17.00

Hospital Charge Code	22355453
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 VICRYL 0 CT-1 CR8

Facility

$210.00

Hospital Charge Code	22355200
Hospital Revenue Code	270
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of AZ Commercial	$189.00
Rate for Payer: Bisbee Police All Plans	$54.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Self Pay Self Pay	$168.00

SUTURE VICRYL 0 CT-1 CR8

Facility

$210.00

Hospital Charge Code	22355200
Hospital Revenue Code	270
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of AZ Commercial	$189.00
Rate for Payer: Aetna of AZ Medicare	$58.80
Rate for Payer: Allwell Medicare	$31.50
Rate for Payer: Amerigroup Medicare	$31.50
Rate for Payer: APIPA Medicare/Medicaid	$78.44
Rate for Payer: AZCH Complete Medicare	$31.50
Rate for Payer: Banner UC Health Medicare	$31.50
Rate for Payer: Bisbee Police All Plans	$54.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$142.80
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cigna of AZ Commercial	$147.00
Rate for Payer: Copperpoint Commercial	$51.98
Rate for Payer: Health Net of AZ Commercial	$126.00
Rate for Payer: Health Net of AZ Medicare	$58.80
Rate for Payer: Humana of AZ Medicare	$31.50
Rate for Payer: Self Pay Self Pay	$168.00
Rate for Payer: TriWest Medicare	$31.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$122.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.80

SUTURE VICRYL 0 CT-1 J260H

Facility

$16.00

Hospital Charge Code	22355459
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Cash Price	$12.80
Rate for Payer: Self Pay Self Pay	$12.80

SUTURE VICRYL 0 CT-1 J260H

Facility

$16.00

Hospital Charge Code	22355459
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

SUTURE VICRYL 0 CT-2

Facility

$45.00

Hospital Charge Code	22355492
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Cash Price	$36.00
Rate for Payer: Self Pay Self Pay	$36.00

SUTURE VICRYL 0 CT-2

Facility

$45.00

Hospital Charge Code	22355492
Hospital Revenue Code	270
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Aetna of AZ Medicare	$12.60
Rate for Payer: Allwell Medicare	$6.75
Rate for Payer: Amerigroup Medicare	$6.75
Rate for Payer: APIPA Medicare/Medicaid	$16.81
Rate for Payer: AZCH Complete Medicare	$6.75
Rate for Payer: Banner UC Health Medicare	$6.75
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Copperpoint Commercial	$11.14
Rate for Payer: Health Net of AZ Commercial	$27.00
Rate for Payer: Health Net of AZ Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$6.75
Rate for Payer: Self Pay Self Pay	$36.00
Rate for Payer: TriWest Medicare	$6.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.10

SUTURE VICRYL 0 ENDOLOOP

Facility

$268.00

Hospital Charge Code	22355191
Hospital Revenue Code	270
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Cash Price	$214.40
Rate for Payer: Self Pay Self Pay	$214.40

SUTURE VICRYL 0 ENDOLOOP

Facility

$268.00

Hospital Charge Code	22355191
Hospital Revenue Code	270
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Aetna of AZ Medicare	$75.04
Rate for Payer: Allwell Medicare	$40.20
Rate for Payer: Amerigroup Medicare	$40.20
Rate for Payer: APIPA Medicare/Medicaid	$100.10
Rate for Payer: AZCH Complete Medicare	$40.20
Rate for Payer: Banner UC Health Medicare	$40.20
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$182.24
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cigna of AZ Commercial	$187.60
Rate for Payer: Copperpoint Commercial	$66.33
Rate for Payer: Health Net of AZ Commercial	$160.80
Rate for Payer: Health Net of AZ Medicare	$75.04
Rate for Payer: Humana of AZ Medicare	$40.20
Rate for Payer: Self Pay Self Pay	$214.40
Rate for Payer: TriWest Medicare	$40.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$156.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.24

SUTURE VICRYL 0 OS-6

Facility

$19.00

Hospital Charge Code	22355483
Hospital Revenue Code	270
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Bisbee Police All Plans	$4.94
Rate for Payer: Cash Price	$15.20
Rate for Payer: Self Pay Self Pay	$15.20

SUTURE VICRYL 0 OS-6

Facility

$19.00

Hospital Charge Code	22355483
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Aetna of AZ Medicare	$5.32
Rate for Payer: Allwell Medicare	$2.85
Rate for Payer: Amerigroup Medicare	$2.85
Rate for Payer: APIPA Medicare/Medicaid	$7.10
Rate for Payer: AZCH Complete Medicare	$2.85
Rate for Payer: Banner UC Health Medicare	$2.85
Rate for Payer: Bisbee Police All Plans	$4.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.92
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of AZ Commercial	$13.30
Rate for Payer: Copperpoint Commercial	$4.70
Rate for Payer: Health Net of AZ Commercial	$11.40
Rate for Payer: Health Net of AZ Medicare	$5.32
Rate for Payer: Humana of AZ Medicare	$2.85
Rate for Payer: Self Pay Self Pay	$15.20
Rate for Payer: TriWest Medicare	$2.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.42

SUTURE VICRYL 0 SPAK TIES

Facility

$97.00

Hospital Charge Code	22355373
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

SUTURE VICRYL 0 SPAK TIES

Facility

$97.00

Hospital Charge Code	22355373
Hospital Revenue Code	270
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$14.55
Rate for Payer: Amerigroup Medicare	$14.55
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$14.55
Rate for Payer: Banner UC Health Medicare	$14.55
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$14.55
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$14.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

SUTURE VICRYL 0 UR-6

Facility

$15.00

Hospital Charge Code	22355496
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

Know your out-of-pocket cost for care.

All Charges