Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL 0 OS-6

Facility

$19.00

Hospital Charge Code	22355483
Hospital Revenue Code	270
Min. Negotiated Rate	$3.04
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	$3.04
Rate for Payer: Amerigroup Medicare	$3.04
Rate for Payer: APIPA Medicare/Medicaid	$7.10
Rate for Payer: AZCH Complete Medicare	$3.04
Rate for Payer: Banner UC Health Medicare	$3.04
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	$3.04
Rate for Payer: Self Pay Self Pay	$15.20
Rate for Payer: TriWest Medicare	$3.04
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	$15.52
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	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
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	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
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	$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 VICRYL 0 UR-6

Facility

$15.00

Hospital Charge Code	22355496
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
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	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.60
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
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	$2.40
Rate for Payer: Self Pay Self Pay	$12.00
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.70

SUTURE VICRYL 1-0 CT-1

Facility

$84.00

Hospital Charge Code	22355458
Hospital Revenue Code	270
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Cash Price	$67.20
Rate for Payer: Self Pay Self Pay	$67.20

SUTURE VICRYL 1-0 CT-1

Facility

$84.00

Hospital Charge Code	22355458
Hospital Revenue Code	270
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Aetna of AZ Medicare	$23.52
Rate for Payer: Allwell Medicare	$13.44
Rate for Payer: Amerigroup Medicare	$13.44
Rate for Payer: APIPA Medicare/Medicaid	$31.37
Rate for Payer: AZCH Complete Medicare	$13.44
Rate for Payer: Banner UC Health Medicare	$13.44
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.12
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$58.80
Rate for Payer: Copperpoint Commercial	$20.79
Rate for Payer: Health Net of AZ Commercial	$50.40
Rate for Payer: Health Net of AZ Medicare	$23.52
Rate for Payer: Humana of AZ Medicare	$13.44
Rate for Payer: Self Pay Self Pay	$67.20
Rate for Payer: TriWest Medicare	$13.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.12

SUTURE VICRYL 2-0 27-IN SH

Facility

$69.00

Hospital Charge Code	22355204
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 VICRYL 2-0 27-IN SH

Facility

$69.00

Hospital Charge Code	22355204
Hospital Revenue Code	270
Min. Negotiated Rate	$11.04
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	$11.04
Rate for Payer: Amerigroup Medicare	$11.04
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
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	$11.04
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

SUTURE VICRYL 2-0 CP-1

Facility

$14.00

Hospital Charge Code	22355454
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 VICRYL 2-0 CP-1

Facility

$14.00

Hospital Charge Code	22355454
Hospital Revenue Code	270
Min. Negotiated Rate	$2.24
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	$2.24
Rate for Payer: Amerigroup Medicare	$2.24
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.24
Rate for Payer: Banner UC Health Medicare	$2.24
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	$2.24
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

SUTURE VICRYL 2-0 CT-1

Facility

$13.00

Hospital Charge Code	22355490
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

SUTURE VICRYL 2-0 CT-1

Facility

$13.00

Hospital Charge Code	22355490
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

SUTURE VICRYL 2-0 CT-1 CR8

Facility

$223.00

Hospital Charge Code	22355201
Hospital Revenue Code	270
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$200.70
Rate for Payer: Aetna of AZ Commercial	$200.70
Rate for Payer: Aetna of AZ Medicare	$62.44
Rate for Payer: Allwell Medicare	$35.68
Rate for Payer: Amerigroup Medicare	$35.68
Rate for Payer: APIPA Medicare/Medicaid	$83.29
Rate for Payer: AZCH Complete Medicare	$35.68
Rate for Payer: Banner UC Health Medicare	$35.68
Rate for Payer: Bisbee Police All Plans	$57.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$151.64
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cigna of AZ Commercial	$156.10
Rate for Payer: Copperpoint Commercial	$55.19
Rate for Payer: Health Net of AZ Commercial	$133.80
Rate for Payer: Health Net of AZ Medicare	$62.44
Rate for Payer: Humana of AZ Medicare	$35.68
Rate for Payer: Self Pay Self Pay	$178.40
Rate for Payer: TriWest Medicare	$35.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$130.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.14

SUTURE VICRYL 2-0 CT-1 CR8

Facility

$223.00

Hospital Charge Code	22355201
Hospital Revenue Code	270
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$200.70
Rate for Payer: Aetna of AZ Commercial	$200.70
Rate for Payer: Bisbee Police All Plans	$57.98
Rate for Payer: Cash Price	$178.40
Rate for Payer: Self Pay Self Pay	$178.40

SUTURE VICRYL 2-0 CT-2

Facility

$46.00

Hospital Charge Code	22355491
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
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	$7.36
Rate for Payer: Amerigroup Medicare	$7.36
Rate for Payer: APIPA Medicare/Medicaid	$17.18
Rate for Payer: AZCH Complete Medicare	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
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	$7.36
Rate for Payer: Self Pay Self Pay	$36.80
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.28

SUTURE VICRYL 2-0 CT-2

Facility

$46.00

Hospital Charge Code	22355491
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 2-0 CT-3

Facility

$13.00

Hospital Charge Code	22355480
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Cash Price	$10.40
Rate for Payer: Self Pay Self Pay	$10.40

SUTURE VICRYL 2-0 CT-3

Facility

$13.00

Hospital Charge Code	22355480
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna of AZ Commercial	$11.70
Rate for Payer: Aetna of AZ Medicare	$3.64
Rate for Payer: Allwell Medicare	$2.08
Rate for Payer: Amerigroup Medicare	$2.08
Rate for Payer: APIPA Medicare/Medicaid	$4.86
Rate for Payer: AZCH Complete Medicare	$2.08
Rate for Payer: Banner UC Health Medicare	$2.08
Rate for Payer: Bisbee Police All Plans	$3.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.84
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna of AZ Commercial	$9.10
Rate for Payer: Copperpoint Commercial	$3.22
Rate for Payer: Health Net of AZ Commercial	$7.80
Rate for Payer: Health Net of AZ Medicare	$3.64
Rate for Payer: Humana of AZ Medicare	$2.08
Rate for Payer: Self Pay Self Pay	$10.40
Rate for Payer: TriWest Medicare	$2.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.34

SUTURE VICRYL 2-0 SH

Facility

$44.00

Hospital Charge Code	22355455
Hospital Revenue Code	270
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

SUTURE VICRYL 2-0 SH

Facility

$44.00

Hospital Charge Code	22355455
Hospital Revenue Code	270
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$7.04
Rate for Payer: Amerigroup Medicare	$7.04
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$7.04
Rate for Payer: Banner UC Health Medicare	$7.04
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$30.80
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$7.04
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$7.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

SUTURE VICRYL 2-0 SPAK TIES

Facility

$55.00

Hospital Charge Code	22355363
Hospital Revenue Code	270
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.80
Rate for Payer: Amerigroup Medicare	$8.80
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

SUTURE VICRYL 2-0 SPAK TIES

Facility

$55.00

Hospital Charge Code	22355363
Hospital Revenue Code	270
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

SUTURE VICRYL 3-0 12-18 SPAK TIES

Facility

$65.00

Hospital Charge Code	22355369
Hospital Revenue Code	270
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

SUTURE VICRYL 3-0 12-18 SPAK TIES

Facility

$65.00

Hospital Charge Code	22355369
Hospital Revenue Code	270
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Know your out-of-pocket cost for care.

All Charges