Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE CHROMIC 2-0 FS-1

Facility

$90.00

Hospital Charge Code	22355464
Hospital Revenue Code	270
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

SUTURE CHROMIC 2-0 MH

Facility

$88.00

Hospital Charge Code	22355487
Hospital Revenue Code	270
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Arizona Complete Health Allwell	$14.08
Rate for Payer: Banner UC Health Medicare	$14.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$59.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.08
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$61.60
Rate for Payer: Devoted Health Medicare	$15.84
Rate for Payer: Humana of AZ Medicare	$14.08
Rate for Payer: Southwest Service Administrators UFCW	$59.84
Rate for Payer: TriWest Medicare	$14.08
Rate for Payer: United Healthcare Commercial	$50.34
Rate for Payer: United Healthcare Medicare	$14.08
Rate for Payer: Veterans Affairs TRICARE	$13.94

SUTURE CHROMIC 2-0 MH

Facility

$88.00

Hospital Charge Code	22355487
Hospital Revenue Code	270
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Cash Price	$70.40

SUTURE CHROMIC 2-0 SH

Facility

$86.00

Hospital Charge Code	22355486
Hospital Revenue Code	270
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Cash Price	$68.80

SUTURE CHROMIC 2-0 SH

Facility

$86.00

Hospital Charge Code	22355486
Hospital Revenue Code	270
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Arizona Complete Health Allwell	$13.76
Rate for Payer: Banner UC Health Medicare	$13.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$58.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.76
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cigna of AZ Commercial	$60.20
Rate for Payer: Devoted Health Medicare	$15.48
Rate for Payer: Humana of AZ Medicare	$13.76
Rate for Payer: Southwest Service Administrators UFCW	$58.48
Rate for Payer: TriWest Medicare	$13.76
Rate for Payer: United Healthcare Commercial	$49.19
Rate for Payer: United Healthcare Medicare	$13.76
Rate for Payer: Veterans Affairs TRICARE	$13.62

SUTURE CHROMIC 2-0 UR-5

Facility

$108.00

Hospital Charge Code	22355502
Hospital Revenue Code	270
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Arizona Complete Health Allwell	$17.28
Rate for Payer: Banner UC Health Medicare	$17.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$73.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.28
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of AZ Commercial	$75.60
Rate for Payer: Devoted Health Medicare	$19.44
Rate for Payer: Humana of AZ Medicare	$17.28
Rate for Payer: Southwest Service Administrators UFCW	$73.44
Rate for Payer: TriWest Medicare	$17.28
Rate for Payer: United Healthcare Commercial	$61.78
Rate for Payer: United Healthcare Medicare	$17.28
Rate for Payer: Veterans Affairs TRICARE	$17.11

SUTURE CHROMIC 2-0 UR-5

Facility

$108.00

Hospital Charge Code	22355502
Hospital Revenue Code	270
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Aetna of AZ Commercial	$97.20
Rate for Payer: Cash Price	$86.40

SUTURE CHROMIC 3-0 CT-1 982H

Facility

$129.00

Hospital Charge Code	22355457
Hospital Revenue Code	270
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$90.30
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: Veterans Affairs TRICARE	$20.43

SUTURE CHROMIC 3-0 CT-1 982H

Facility

$129.00

Hospital Charge Code	22355457
Hospital Revenue Code	270
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Cash Price	$103.20

SUTURE CHROMIC 3-0 SH

Facility

$86.00

Hospital Charge Code	22355485
Hospital Revenue Code	270
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Cash Price	$68.80

SUTURE CHROMIC 3-0 SH

Facility

$86.00

Hospital Charge Code	22355485
Hospital Revenue Code	270
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Arizona Complete Health Allwell	$13.76
Rate for Payer: Banner UC Health Medicare	$13.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$58.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.76
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cigna of AZ Commercial	$60.20
Rate for Payer: Devoted Health Medicare	$15.48
Rate for Payer: Humana of AZ Medicare	$13.76
Rate for Payer: Southwest Service Administrators UFCW	$58.48
Rate for Payer: TriWest Medicare	$13.76
Rate for Payer: United Healthcare Commercial	$49.19
Rate for Payer: United Healthcare Medicare	$13.76
Rate for Payer: Veterans Affairs TRICARE	$13.62

SUTURE CHROMIC 4-0 SH

Facility

$90.00

Hospital Charge Code	22355484
Hospital Revenue Code	270
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

SUTURE CHROMIC 4-0 SH

Facility

$90.00

Hospital Charge Code	22355484
Hospital Revenue Code	270
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

SUTURE CHROMIC 4-0 V-20

Facility

$58.00

Hospital Charge Code	22355488
Hospital Revenue Code	270
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Arizona Complete Health Allwell	$9.28
Rate for Payer: Banner UC Health Medicare	$9.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$39.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.28
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Devoted Health Medicare	$10.44
Rate for Payer: Humana of AZ Medicare	$9.28
Rate for Payer: Southwest Service Administrators UFCW	$39.44
Rate for Payer: TriWest Medicare	$9.28
Rate for Payer: United Healthcare Commercial	$33.18
Rate for Payer: United Healthcare Medicare	$9.28
Rate for Payer: Veterans Affairs TRICARE	$9.19

SUTURE CHROMIC 4-0 V-20

Facility

$58.00

Hospital Charge Code	22355488
Hospital Revenue Code	270
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Cash Price	$46.40

SUTURE CHROMIC 5-0 RB-1

Facility

$23.00

Hospital Charge Code	22355501
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Arizona Complete Health Allwell	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$15.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.68
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Devoted Health Medicare	$4.14
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Southwest Service Administrators UFCW	$15.64
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: United Healthcare Commercial	$13.16
Rate for Payer: United Healthcare Medicare	$3.68
Rate for Payer: Veterans Affairs TRICARE	$3.64

SUTURE CHROMIC 5-0 RB-1

Facility

$23.00

Hospital Charge Code	22355501
Hospital Revenue Code	270
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Cash Price	$18.40

SUTURE CHROMIC 6-0 PS-3 1635G

Facility

$46.00

Hospital Charge Code	22355192
Hospital Revenue Code	270
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Cash Price	$36.80

SUTURE CHROMIC 6-0 PS-3 1635G

Facility

$46.00

Hospital Charge Code	22355192
Hospital Revenue Code	270
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Arizona Complete Health Allwell	$7.36
Rate for Payer: Banner UC Health Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$31.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.36
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cigna of AZ Commercial	$32.20
Rate for Payer: Devoted Health Medicare	$8.28
Rate for Payer: Humana of AZ Medicare	$7.36
Rate for Payer: Southwest Service Administrators UFCW	$31.28
Rate for Payer: TriWest Medicare	$7.36
Rate for Payer: United Healthcare Commercial	$26.31
Rate for Payer: United Healthcare Medicare	$7.36
Rate for Payer: Veterans Affairs TRICARE	$7.29

SUTURE ETHIBOND 2-0 18

Facility

$116.00

Hospital Charge Code	22355185
Hospital Revenue Code	270
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Arizona Complete Health Allwell	$18.56
Rate for Payer: Banner UC Health Medicare	$18.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$78.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.56
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cigna of AZ Commercial	$81.20
Rate for Payer: Devoted Health Medicare	$20.88
Rate for Payer: Humana of AZ Medicare	$18.56
Rate for Payer: Southwest Service Administrators UFCW	$78.88
Rate for Payer: TriWest Medicare	$18.56
Rate for Payer: United Healthcare Commercial	$66.35
Rate for Payer: United Healthcare Medicare	$18.56
Rate for Payer: Veterans Affairs TRICARE	$18.37

SUTURE ETHIBOND 2-0 18

Facility

$116.00

Hospital Charge Code	22355185
Hospital Revenue Code	270
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$104.40
Rate for Payer: Aetna of AZ Commercial	$104.40
Rate for Payer: Cash Price	$92.80

SUTURE ETHIBOND 2-0 CT-1

Facility

$48.00

Hospital Charge Code	22355503
Hospital Revenue Code	270
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Cash Price	$38.40

SUTURE ETHIBOND 2-0 CT-1

Facility

$48.00

Hospital Charge Code	22355503
Hospital Revenue Code	270
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Arizona Complete Health Allwell	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.68
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Devoted Health Medicare	$8.64
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Southwest Service Administrators UFCW	$32.64
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: United Healthcare Commercial	$27.46
Rate for Payer: United Healthcare Medicare	$7.68
Rate for Payer: Veterans Affairs TRICARE	$7.60

SUTURE ETHIBOND 2 0 SH

Facility

$31.44

Hospital Charge Code	27895522
Hospital Revenue Code	270
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna of AZ Commercial	$28.30
Rate for Payer: Arizona Complete Health Allwell	$5.03
Rate for Payer: Banner UC Health Medicare	$5.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$21.38
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.03
Rate for Payer: Cash Price	$25.15
Rate for Payer: Cigna of AZ Commercial	$22.01
Rate for Payer: Devoted Health Medicare	$5.66
Rate for Payer: Humana of AZ Medicare	$5.03
Rate for Payer: Southwest Service Administrators UFCW	$21.38
Rate for Payer: TriWest Medicare	$5.03
Rate for Payer: United Healthcare Commercial	$17.98
Rate for Payer: United Healthcare Medicare	$5.03
Rate for Payer: Veterans Affairs TRICARE	$4.98

SUTURE ETHIBOND 2 0 SH

Facility

$31.44

Hospital Charge Code	27895522
Hospital Revenue Code	270
Min. Negotiated Rate	$28.30
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna of AZ Commercial	$28.30
Rate for Payer: Cash Price	$25.15

Know your out-of-pocket cost for care.

All Charges