Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL 4-0 FS-1

Facility

$61.00

Hospital Charge Code	22355493
Hospital Revenue Code	270
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Arizona Complete Health Allwell	$9.76
Rate for Payer: Banner UC Health Medicare	$9.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$41.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.76
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cigna of AZ Commercial	$42.70
Rate for Payer: Devoted Health Medicare	$10.98
Rate for Payer: Humana of AZ Medicare	$9.76
Rate for Payer: Southwest Service Administrators UFCW	$41.48
Rate for Payer: TriWest Medicare	$9.76
Rate for Payer: United Healthcare Commercial	$34.89
Rate for Payer: United Healthcare Medicare	$9.76
Rate for Payer: Veterans Affairs TRICARE	$9.66

SUTURE VICRYL 4-0 FS-1

Facility

$61.00

Hospital Charge Code	22355493
Hospital Revenue Code	270
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna of AZ Commercial	$54.90
Rate for Payer: Cash Price	$48.80

SUTURE VICRYL 4-0 P3

Facility

$107.00

Hospital Charge Code	22355202
Hospital Revenue Code	270
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Arizona Complete Health Allwell	$17.12
Rate for Payer: Banner UC Health Medicare	$17.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.12
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$74.90
Rate for Payer: Devoted Health Medicare	$19.26
Rate for Payer: Humana of AZ Medicare	$17.12
Rate for Payer: Southwest Service Administrators UFCW	$72.76
Rate for Payer: TriWest Medicare	$17.12
Rate for Payer: United Healthcare Commercial	$61.20
Rate for Payer: United Healthcare Medicare	$17.12
Rate for Payer: Veterans Affairs TRICARE	$16.95

SUTURE VICRYL 4-0 P3

Facility

$107.00

Hospital Charge Code	22355202
Hospital Revenue Code	270
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Cash Price	$85.60

SUTURE VICRYL 4-0 PS-2

Facility

$101.00

Hospital Charge Code	22355495
Hospital Revenue Code	270
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Arizona Complete Health Allwell	$16.16
Rate for Payer: Banner UC Health Medicare	$16.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$68.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.16
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$70.70
Rate for Payer: Devoted Health Medicare	$18.18
Rate for Payer: Humana of AZ Medicare	$16.16
Rate for Payer: Southwest Service Administrators UFCW	$68.68
Rate for Payer: TriWest Medicare	$16.16
Rate for Payer: United Healthcare Commercial	$57.77
Rate for Payer: United Healthcare Medicare	$16.16
Rate for Payer: Veterans Affairs TRICARE	$16.00

SUTURE VICRYL 4-0 PS-2

Facility

$101.00

Hospital Charge Code	22355495
Hospital Revenue Code	270
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Cash Price	$80.80

SUTURE VICRYL 4-0 SH

Facility

$45.00

Hospital Charge Code	22355481
Hospital Revenue Code	270
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Cash Price	$36.00

SUTURE VICRYL 4-0 SH

Facility

$45.00

Hospital Charge Code	22355481
Hospital Revenue Code	270
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Arizona Complete Health Allwell	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$30.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Devoted Health Medicare	$8.10
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Southwest Service Administrators UFCW	$30.60
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: United Healthcare Commercial	$25.74
Rate for Payer: United Healthcare Medicare	$7.20
Rate for Payer: Veterans Affairs TRICARE	$7.13

SUTURE VICRYL 6-0 P-1

Facility

$102.00

Hospital Charge Code	22355199
Hospital Revenue Code	270
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Cash Price	$81.60

SUTURE VICRYL 6-0 P-1

Facility

$102.00

Hospital Charge Code	22355199
Hospital Revenue Code	270
Min. Negotiated Rate	$16.16
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Arizona Complete Health Allwell	$16.32
Rate for Payer: Banner UC Health Medicare	$16.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$69.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.32
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cigna of AZ Commercial	$71.40
Rate for Payer: Devoted Health Medicare	$18.36
Rate for Payer: Humana of AZ Medicare	$16.32
Rate for Payer: Southwest Service Administrators UFCW	$69.36
Rate for Payer: TriWest Medicare	$16.32
Rate for Payer: United Healthcare Commercial	$58.34
Rate for Payer: United Healthcare Medicare	$16.32
Rate for Payer: Veterans Affairs TRICARE	$16.16

SUTURE VICRYL PLUS 2-0 BACT

Facility

$18.00

Hospital Charge Code	22355460
Hospital Revenue Code	270
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Cash Price	$14.40

SUTURE VICRYL PLUS 2-0 BACT

Facility

$18.00

Hospital Charge Code	22355460
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Arizona Complete Health Allwell	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.88
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Devoted Health Medicare	$3.24
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Southwest Service Administrators UFCW	$12.24
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: United Healthcare Commercial	$10.30
Rate for Payer: United Healthcare Medicare	$2.88
Rate for Payer: Veterans Affairs TRICARE	$2.85

SUTURE VICRYL RAPIDE 2-0 SH VR417

Facility

$26.00

Hospital Charge Code	22355183
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

SUTURE VICRYL RAPIDE 2-0 SH VR417

Facility

$26.00

Hospital Charge Code	22355183
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

SUTURE VICRYL RAPIDE 3-0 CT-1 VR944

Facility

$23.00

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

Facility

$23.00

Hospital Charge Code	22355196
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 VICRYL RAPIDE 3-0 SH VR416

Facility

$26.00

Hospital Charge Code	22355195
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

SUTURE VICRYL RAPIDE 3-0 SH VR416

Facility

$26.00

Hospital Charge Code	22355195
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

SUTURE VICRYL UNDYED COATED 2-0SH

Facility

$52.00

Hospital Charge Code	27450511
Hospital Revenue Code	270
Min. Negotiated Rate	$8.24
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of AZ Commercial	$46.80
Rate for Payer: Arizona Complete Health Allwell	$8.32
Rate for Payer: Banner UC Health Medicare	$8.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$35.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.32
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cigna of AZ Commercial	$36.40
Rate for Payer: Devoted Health Medicare	$9.36
Rate for Payer: Humana of AZ Medicare	$8.32
Rate for Payer: Southwest Service Administrators UFCW	$35.36
Rate for Payer: TriWest Medicare	$8.32
Rate for Payer: United Healthcare Commercial	$29.74
Rate for Payer: United Healthcare Medicare	$8.32
Rate for Payer: Veterans Affairs TRICARE	$8.24

SUTURE VICRYL UNDYED COATED 2-0SH

Facility

$52.00

Hospital Charge Code	27450511
Hospital Revenue Code	270
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna of AZ Commercial	$46.80
Rate for Payer: Cash Price	$41.60

SVN CUP WITH TUBING

Facility

$9.00

Hospital Charge Code	22355588
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

SVN CUP WITH TUBING

Facility

$9.00

Hospital Charge Code	22355588
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

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: Blue Cross Blue Shield of Arizona Health Choice	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23
Rate for Payer: NaphCare Correctional Healthcare	$5,625.23

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: Blue Cross Blue Shield of Arizona Health Choice	$5,625.23
Rate for Payer: Mercy Care Medicaid	$5,625.23
Rate for Payer: NaphCare Correctional Healthcare	$5,625.23

Know your out-of-pocket cost for care.

All Charges