Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL 3-0 CT-1

Facility

$46.00

Hospital Charge Code	22355452
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 VICRYL 3-0 CT-1

Facility

$46.00

Hospital Charge Code	22355452
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 VICRYL 3-0 CT-2

Facility

$45.00

Hospital Charge Code	22355489
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 3-0 CT-2

Facility

$45.00

Hospital Charge Code	22355489
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 3-0 FS-1

Facility

$17.00

Hospital Charge Code	22355494
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 3-0 FS-1

Facility

$17.00

Hospital Charge Code	22355494
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 3-0 PS-2

Facility

$77.00

Hospital Charge Code	22355178
Hospital Revenue Code	270
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Cash Price	$61.60
Rate for Payer: Self Pay Self Pay	$61.60

SUTURE VICRYL 3-0 PS-2

Facility

$77.00

Hospital Charge Code	22355178
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$69.30
Rate for Payer: Aetna of AZ Commercial	$69.30
Rate for Payer: Aetna of AZ Medicare	$21.56
Rate for Payer: Allwell Medicare	$11.55
Rate for Payer: Amerigroup Medicare	$11.55
Rate for Payer: APIPA Medicare/Medicaid	$28.76
Rate for Payer: AZCH Complete Medicare	$11.55
Rate for Payer: Banner UC Health Medicare	$11.55
Rate for Payer: Bisbee Police All Plans	$20.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$52.36
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cigna of AZ Commercial	$53.90
Rate for Payer: Copperpoint Commercial	$19.06
Rate for Payer: Health Net of AZ Commercial	$46.20
Rate for Payer: Health Net of AZ Medicare	$21.56
Rate for Payer: Humana of AZ Medicare	$11.55
Rate for Payer: Self Pay Self Pay	$61.60
Rate for Payer: TriWest Medicare	$11.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.86

SUTURE VICRYL 3-0 SH

Facility

$45.00

Hospital Charge Code	22355482
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 3-0 SH

Facility

$45.00

Hospital Charge Code	22355482
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 3-0 SPAK TIES

Facility

$160.00

Hospital Charge Code	22355374
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Aetna of AZ Medicare	$44.80
Rate for Payer: Allwell Medicare	$24.00
Rate for Payer: Amerigroup Medicare	$24.00
Rate for Payer: APIPA Medicare/Medicaid	$59.76
Rate for Payer: AZCH Complete Medicare	$24.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.80
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cigna of AZ Commercial	$112.00
Rate for Payer: Copperpoint Commercial	$39.60
Rate for Payer: Health Net of AZ Commercial	$96.00
Rate for Payer: Health Net of AZ Medicare	$44.80
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Self Pay Self Pay	$128.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$93.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.80

SUTURE VICRYL 3-0 SPAK TIES

Facility

$160.00

Hospital Charge Code	22355374
Hospital Revenue Code	270
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of AZ Commercial	$144.00
Rate for Payer: Bisbee Police All Plans	$41.60
Rate for Payer: Cash Price	$128.00
Rate for Payer: Self Pay Self Pay	$128.00

SUTURE VICRYL 4-0 FS-1

Facility

$61.00

Hospital Charge Code	22355493
Hospital Revenue Code	270
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Aetna of AZ Medicare	$17.08
Rate for Payer: Allwell Medicare	$9.15
Rate for Payer: Amerigroup Medicare	$9.15
Rate for Payer: APIPA Medicare/Medicaid	$22.78
Rate for Payer: AZCH Complete Medicare	$9.15
Rate for Payer: Banner UC Health Medicare	$9.15
Rate for Payer: Bisbee Police All Plans	$15.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$41.48
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Copperpoint Commercial	$15.10
Rate for Payer: Health Net of AZ Commercial	$36.60
Rate for Payer: Health Net of AZ Medicare	$17.08
Rate for Payer: Humana of AZ Medicare	$9.15
Rate for Payer: Self Pay Self Pay	$48.80
Rate for Payer: TriWest Medicare	$9.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$35.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.98

SUTURE VICRYL 4-0 FS-1

Facility

$61.00

Hospital Charge Code	22355493
Hospital Revenue Code	270
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Bisbee Police All Plans	$15.86
Rate for Payer: Cash Price	$48.80
Rate for Payer: Self Pay Self Pay	$48.80

SUTURE VICRYL 4-0 P3

Facility

$107.00

Hospital Charge Code	22355202
Hospital Revenue Code	270
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Aetna of AZ Medicare	$29.96
Rate for Payer: Allwell Medicare	$16.05
Rate for Payer: Amerigroup Medicare	$16.05
Rate for Payer: APIPA Medicare/Medicaid	$39.96
Rate for Payer: AZCH Complete Medicare	$16.05
Rate for Payer: Banner UC Health Medicare	$16.05
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.76
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$74.90
Rate for Payer: Copperpoint Commercial	$26.48
Rate for Payer: Health Net of AZ Commercial	$64.20
Rate for Payer: Health Net of AZ Medicare	$29.96
Rate for Payer: Humana of AZ Medicare	$16.05
Rate for Payer: Self Pay Self Pay	$85.60
Rate for Payer: TriWest Medicare	$16.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.26

SUTURE VICRYL 4-0 P3

Facility

$107.00

Hospital Charge Code	22355202
Hospital Revenue Code	270
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Cash Price	$85.60
Rate for Payer: Self Pay Self Pay	$85.60

SUTURE VICRYL 4-0 PS-2

Facility

$101.00

Hospital Charge Code	22355495
Hospital Revenue Code	270
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Aetna of AZ Medicare	$28.28
Rate for Payer: Allwell Medicare	$15.15
Rate for Payer: Amerigroup Medicare	$15.15
Rate for Payer: APIPA Medicare/Medicaid	$37.72
Rate for Payer: AZCH Complete Medicare	$15.15
Rate for Payer: Banner UC Health Medicare	$15.15
Rate for Payer: Bisbee Police All Plans	$26.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.68
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$70.70
Rate for Payer: Copperpoint Commercial	$25.00
Rate for Payer: Health Net of AZ Commercial	$60.60
Rate for Payer: Health Net of AZ Medicare	$28.28
Rate for Payer: Humana of AZ Medicare	$15.15
Rate for Payer: Self Pay Self Pay	$80.80
Rate for Payer: TriWest Medicare	$15.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.18

SUTURE VICRYL 4-0 PS-2

Facility

$101.00

Hospital Charge Code	22355495
Hospital Revenue Code	270
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Bisbee Police All Plans	$26.26
Rate for Payer: Cash Price	$80.80
Rate for Payer: Self Pay Self Pay	$80.80

SUTURE VICRYL 4-0 SH

Facility

$45.00

Hospital Charge Code	22355481
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 4-0 SH

Facility

$45.00

Hospital Charge Code	22355481
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 6-0 P-1

Facility

$102.00

Hospital Charge Code	22355199
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Cash Price	$81.60
Rate for Payer: Self Pay Self Pay	$81.60

SUTURE VICRYL 6-0 P-1

Facility

$102.00

Hospital Charge Code	22355199
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Aetna of AZ Medicare	$28.56
Rate for Payer: Allwell Medicare	$15.30
Rate for Payer: Amerigroup Medicare	$15.30
Rate for Payer: APIPA Medicare/Medicaid	$38.10
Rate for Payer: AZCH Complete Medicare	$15.30
Rate for Payer: Banner UC Health Medicare	$15.30
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$69.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cigna of AZ Commercial	$71.40
Rate for Payer: Copperpoint Commercial	$25.24
Rate for Payer: Health Net of AZ Commercial	$61.20
Rate for Payer: Health Net of AZ Medicare	$28.56
Rate for Payer: Humana of AZ Medicare	$15.30
Rate for Payer: Self Pay Self Pay	$81.60
Rate for Payer: TriWest Medicare	$15.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$59.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.36

SUTURE VICRYL PLUS 2-0 BACT

Facility

$18.00

Hospital Charge Code	22355460
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 VICRYL PLUS 2-0 BACT

Facility

$18.00

Hospital Charge Code	22355460
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 VICRYL RAPIDE 2-0 SH VR417

Facility

$26.00

Hospital Charge Code	22355183
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

Know your out-of-pocket cost for care.

All Charges