Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL RAPIDE 2-0 SH VR417

Facility

$26.00

Hospital Charge Code	22355183
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SUTURE VICRYL RAPIDE 3-0 CT-1 VR944

Facility

$23.00

Hospital Charge Code	22355196
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 VICRYL RAPIDE 3-0 CT-1 VR944

Facility

$23.00

Hospital Charge Code	22355196
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 VICRYL RAPIDE 3-0 SH VR416

Facility

$26.00

Hospital Charge Code	22355195
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SUTURE VICRYL RAPIDE 3-0 SH VR416

Facility

$26.00

Hospital Charge Code	22355195
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

SUTURE VICRYL UNDYED COATED 2-0SH

Facility

$52.00

Hospital Charge Code	27450511
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of AZ Commercial	$46.80
Rate for Payer: Aetna of AZ Medicare	$14.56
Rate for Payer: Allwell Medicare	$7.80
Rate for Payer: Amerigroup Medicare	$7.80
Rate for Payer: APIPA Medicare/Medicaid	$19.42
Rate for Payer: AZCH Complete Medicare	$7.80
Rate for Payer: Banner UC Health Medicare	$7.80
Rate for Payer: Bisbee Police All Plans	$13.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$35.36
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cigna of AZ Commercial	$36.40
Rate for Payer: Copperpoint Commercial	$12.87
Rate for Payer: Health Net of AZ Commercial	$31.20
Rate for Payer: Health Net of AZ Medicare	$14.56
Rate for Payer: Humana of AZ Medicare	$7.80
Rate for Payer: Self Pay Self Pay	$41.60
Rate for Payer: TriWest Medicare	$7.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$30.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.36

SUTURE VICRYL UNDYED COATED 2-0SH

Facility

$52.00

Hospital Charge Code	27450511
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of AZ Commercial	$46.80
Rate for Payer: Bisbee Police All Plans	$13.52
Rate for Payer: Cash Price	$41.60
Rate for Payer: Self Pay Self Pay	$41.60

SVN CUP WITH TUBING

Facility

$9.00

Hospital Charge Code	22355588
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

SVN CUP WITH TUBING

Facility

$9.00

Hospital Charge Code	22355588
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: AHCCCS Medicaid	$9,069.80
Rate for Payer: Allwell Medicaid	$9,069.80
Rate for Payer: AZCH Complete Medicaid	$9,069.80
Rate for Payer: Banner UC Health Medicaid	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80

Syncope And Collapse

Facility

$5,625.23

Service Code	APR-DRG 2043
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$5,625.23
Max. Negotiated Rate	$5,625.23
Rate for Payer: AHCCCS Medicaid	$5,625.23
Rate for Payer: Allwell Medicaid	$5,625.23
Rate for Payer: AZCH Complete Medicaid	$5,625.23
Rate for Payer: Banner UC Health Medicaid	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23

Syncope And Collapse

Facility

$5,625.23

Service Code	APR-DRG 2043
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$5,625.23
Max. Negotiated Rate	$5,625.23
Rate for Payer: AHCCCS Medicaid	$5,625.23
Rate for Payer: Allwell Medicaid	$5,625.23
Rate for Payer: AZCH Complete Medicaid	$5,625.23
Rate for Payer: Banner UC Health Medicaid	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: AHCCCS Medicaid	$3,955.90
Rate for Payer: Allwell Medicaid	$3,955.90
Rate for Payer: AZCH Complete Medicaid	$3,955.90
Rate for Payer: Banner UC Health Medicaid	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: AHCCCS Medicaid	$9,069.80
Rate for Payer: Allwell Medicaid	$9,069.80
Rate for Payer: AZCH Complete Medicaid	$9,069.80
Rate for Payer: Banner UC Health Medicaid	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: AHCCCS Medicaid	$3,955.90
Rate for Payer: Allwell Medicaid	$3,955.90
Rate for Payer: AZCH Complete Medicaid	$3,955.90
Rate for Payer: Banner UC Health Medicaid	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: AHCCCS Medicaid	$9,069.80
Rate for Payer: Allwell Medicaid	$9,069.80
Rate for Payer: AZCH Complete Medicaid	$9,069.80
Rate for Payer: Banner UC Health Medicaid	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80

Syncope And Collapse

Facility

$5,625.23

Service Code	APR-DRG 2043
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$5,625.23
Max. Negotiated Rate	$5,625.23
Rate for Payer: AHCCCS Medicaid	$5,625.23
Rate for Payer: Allwell Medicaid	$5,625.23
Rate for Payer: AZCH Complete Medicaid	$5,625.23
Rate for Payer: Banner UC Health Medicaid	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23

Syncope And Collapse

Facility

$5,625.23

Service Code	APR-DRG 2043
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$5,625.23
Max. Negotiated Rate	$5,625.23
Rate for Payer: AHCCCS Medicaid	$5,625.23
Rate for Payer: Allwell Medicaid	$5,625.23
Rate for Payer: AZCH Complete Medicaid	$5,625.23
Rate for Payer: Banner UC Health Medicaid	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23

Syncope And Collapse

Facility

$9,069.80

Service Code	APR-DRG 2044
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$9,069.80
Max. Negotiated Rate	$9,069.80
Rate for Payer: AHCCCS Medicaid	$9,069.80
Rate for Payer: Allwell Medicaid	$9,069.80
Rate for Payer: AZCH Complete Medicaid	$9,069.80
Rate for Payer: Banner UC Health Medicaid	$9,069.80
Rate for Payer: Mercy Care Medicaid	$9,069.80

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: AHCCCS Medicaid	$4,438.46
Rate for Payer: Allwell Medicaid	$4,438.46
Rate for Payer: AZCH Complete Medicaid	$4,438.46
Rate for Payer: Banner UC Health Medicaid	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2044
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: AHCCCS Medicaid	$3,955.90
Rate for Payer: Allwell Medicaid	$3,955.90
Rate for Payer: AZCH Complete Medicaid	$3,955.90
Rate for Payer: Banner UC Health Medicaid	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2041
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: AHCCCS Medicaid	$4,438.46
Rate for Payer: Allwell Medicaid	$4,438.46
Rate for Payer: AZCH Complete Medicaid	$4,438.46
Rate for Payer: Banner UC Health Medicaid	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: AHCCCS Medicaid	$4,438.46
Rate for Payer: Allwell Medicaid	$4,438.46
Rate for Payer: AZCH Complete Medicaid	$4,438.46
Rate for Payer: Banner UC Health Medicaid	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46

Syncope And Collapse

Facility

$4,438.46

Service Code	APR-DRG 2042
Hospital Charge Code	APRDRG2043
Min. Negotiated Rate	$4,438.46
Max. Negotiated Rate	$4,438.46
Rate for Payer: AHCCCS Medicaid	$4,438.46
Rate for Payer: Allwell Medicaid	$4,438.46
Rate for Payer: AZCH Complete Medicaid	$4,438.46
Rate for Payer: Banner UC Health Medicaid	$4,438.46
Rate for Payer: Mercy Care Medicaid	$4,438.46

Syncope And Collapse

Facility

$3,955.90

Service Code	APR-DRG 2041
Hospital Charge Code	APRDRG2042
Min. Negotiated Rate	$3,955.90
Max. Negotiated Rate	$3,955.90
Rate for Payer: AHCCCS Medicaid	$3,955.90
Rate for Payer: Allwell Medicaid	$3,955.90
Rate for Payer: AZCH Complete Medicaid	$3,955.90
Rate for Payer: Banner UC Health Medicaid	$3,955.90
Rate for Payer: Mercy Care Medicaid	$3,955.90

Know your out-of-pocket cost for care.

All Charges