Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ENDOPOUCH RETRIEVER

Facility

$896.00

Hospital Charge Code	22560772
Hospital Revenue Code	272
Min. Negotiated Rate	$232.96
Max. Negotiated Rate	$806.40
Rate for Payer: Aetna of AZ Commercial	$806.40
Rate for Payer: Bisbee Police All Plans	$232.96
Rate for Payer: Cash Price	$716.80
Rate for Payer: Self Pay Self Pay	$716.80

Endoscopic linear cutter Reloads 35mm Standard

Facility

$791.00

Hospital Charge Code	22926414
Hospital Revenue Code	272
Min. Negotiated Rate	$118.65
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna of AZ Commercial	$711.90
Rate for Payer: Aetna of AZ Medicare	$221.48
Rate for Payer: Allwell Medicare	$118.65
Rate for Payer: Amerigroup Medicare	$118.65
Rate for Payer: APIPA Medicare/Medicaid	$295.44
Rate for Payer: AZCH Complete Medicare	$118.65
Rate for Payer: Banner UC Health Medicare	$118.65
Rate for Payer: Bisbee Police All Plans	$205.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$537.88
Rate for Payer: Cash Price	$632.80
Rate for Payer: Cigna of AZ Commercial	$553.70
Rate for Payer: Copperpoint Commercial	$195.77
Rate for Payer: Health Net of AZ Commercial	$474.60
Rate for Payer: Health Net of AZ Medicare	$221.48
Rate for Payer: Humana of AZ Medicare	$118.65
Rate for Payer: Self Pay Self Pay	$632.80
Rate for Payer: TriWest Medicare	$118.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$461.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$142.38

Endoscopic linear cutter Reloads 35mm Standard

Facility

$791.00

Hospital Charge Code	22926414
Hospital Revenue Code	272
Min. Negotiated Rate	$205.66
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna of AZ Commercial	$711.90
Rate for Payer: Bisbee Police All Plans	$205.66
Rate for Payer: Cash Price	$632.80
Rate for Payer: Self Pay Self Pay	$632.80

Endoscopic linear cutter Reloads 45mm VASCULAR THIN

Facility

$671.00

Hospital Charge Code	22926415
Hospital Revenue Code	272
Min. Negotiated Rate	$174.46
Max. Negotiated Rate	$603.90
Rate for Payer: Aetna of AZ Commercial	$603.90
Rate for Payer: Bisbee Police All Plans	$174.46
Rate for Payer: Cash Price	$536.80
Rate for Payer: Self Pay Self Pay	$536.80

Endoscopic linear cutter Reloads 45mm VASCULAR THIN

Facility

$671.00

Hospital Charge Code	22926415
Hospital Revenue Code	272
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$603.90
Rate for Payer: Aetna of AZ Commercial	$603.90
Rate for Payer: Aetna of AZ Medicare	$187.88
Rate for Payer: Allwell Medicare	$100.65
Rate for Payer: Amerigroup Medicare	$100.65
Rate for Payer: APIPA Medicare/Medicaid	$250.62
Rate for Payer: AZCH Complete Medicare	$100.65
Rate for Payer: Banner UC Health Medicare	$100.65
Rate for Payer: Bisbee Police All Plans	$174.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$456.28
Rate for Payer: Cash Price	$536.80
Rate for Payer: Cigna of AZ Commercial	$469.70
Rate for Payer: Copperpoint Commercial	$166.07
Rate for Payer: Health Net of AZ Commercial	$402.60
Rate for Payer: Health Net of AZ Medicare	$187.88
Rate for Payer: Humana of AZ Medicare	$100.65
Rate for Payer: Self Pay Self Pay	$536.80
Rate for Payer: TriWest Medicare	$100.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$391.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$120.78

ENDOSCOPIC PLANTAR FASCIOTOMY - Tech

Facility

$2,092.00

Service Code	CPT 29893
Hospital Charge Code	24043272
Hospital Revenue Code	360
Min. Negotiated Rate	$543.92
Max. Negotiated Rate	$1,882.80
Rate for Payer: Aetna of AZ Commercial	$1,882.80
Rate for Payer: Bisbee Police All Plans	$543.92
Rate for Payer: Cash Price	$1,673.60
Rate for Payer: Self Pay Self Pay	$1,673.60

ENDOSCOPIC PLANTAR FASCIOTOMY - Tech

Facility

$2,092.00

Service Code	CPT 29893
Hospital Charge Code	24043272
Hospital Revenue Code	360
Min. Negotiated Rate	$313.80
Max. Negotiated Rate	$4,104.08
Rate for Payer: Aetna of AZ Commercial	$1,882.80
Rate for Payer: Aetna of AZ Medicare	$585.76
Rate for Payer: AHCCCS Medicaid	$4,104.08
Rate for Payer: Allwell Medicaid	$4,104.08
Rate for Payer: Allwell Medicare	$313.80
Rate for Payer: Amerigroup Medicare	$313.80
Rate for Payer: APIPA Medicare/Medicaid	$781.36
Rate for Payer: AZCH Complete Medicaid	$4,104.08
Rate for Payer: AZCH Complete Medicare	$313.80
Rate for Payer: Banner UC Health Medicaid	$4,104.08
Rate for Payer: Banner UC Health Medicare	$313.80
Rate for Payer: Bisbee Police All Plans	$543.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,422.56
Rate for Payer: Cash Price	$1,673.60
Rate for Payer: Cash Price	$1,673.60
Rate for Payer: Cigna of AZ Commercial	$1,046.00
Rate for Payer: Copperpoint Commercial	$517.77
Rate for Payer: Health Net of AZ Commercial	$1,255.20
Rate for Payer: Health Net of AZ Medicare	$585.76
Rate for Payer: Humana of AZ Medicare	$313.80
Rate for Payer: Mercy Care Medicaid	$4,104.08
Rate for Payer: Self Pay Self Pay	$1,673.60
Rate for Payer: TriWest Medicare	$313.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$376.56

ENDOTRACHEAL TUBE BOUGIE PEDIATRIC 10FRX70CM

Facility

$59.00

Hospital Charge Code	27704488
Hospital Revenue Code	270
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Aetna of AZ Medicare	$16.52
Rate for Payer: Allwell Medicare	$8.85
Rate for Payer: Amerigroup Medicare	$8.85
Rate for Payer: APIPA Medicare/Medicaid	$22.04
Rate for Payer: AZCH Complete Medicare	$8.85
Rate for Payer: Banner UC Health Medicare	$8.85
Rate for Payer: Bisbee Police All Plans	$15.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.12
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cigna of AZ Commercial	$41.30
Rate for Payer: Copperpoint Commercial	$14.60
Rate for Payer: Health Net of AZ Commercial	$35.40
Rate for Payer: Health Net of AZ Medicare	$16.52
Rate for Payer: Humana of AZ Medicare	$8.85
Rate for Payer: Self Pay Self Pay	$47.20
Rate for Payer: TriWest Medicare	$8.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.62

ENDOTRACHEAL TUBE BOUGIE PEDIATRIC 10FRX70CM

Facility

$59.00

Hospital Charge Code	27704488
Hospital Revenue Code	270
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna of AZ Commercial	$53.10
Rate for Payer: Bisbee Police All Plans	$15.34
Rate for Payer: Cash Price	$47.20
Rate for Payer: Self Pay Self Pay	$47.20

enoxaparin 100 mg/mL SC [CQCH]

Facility

$7.31

Service Code	HCPCS J1650
Hospital Charge Code	108072705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$6.58
Rate for Payer: Aetna of AZ Commercial	$6.58
Rate for Payer: Aetna of AZ Medicare	$2.05
Rate for Payer: AHCCCS Medicaid	$1.54
Rate for Payer: Allwell Medicaid	$1.54
Rate for Payer: Allwell Medicare	$1.10
Rate for Payer: Amerigroup Medicare	$1.10
Rate for Payer: APIPA Medicare/Medicaid	$2.73
Rate for Payer: AZCH Complete Medicaid	$1.54
Rate for Payer: AZCH Complete Medicare	$1.10
Rate for Payer: Banner UC Health Medicaid	$1.54
Rate for Payer: Banner UC Health Medicare	$1.10
Rate for Payer: Bisbee Police All Plans	$1.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.97
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of AZ Commercial	$4.75
Rate for Payer: Copperpoint Commercial	$1.81
Rate for Payer: Health Net of AZ Commercial	$4.39
Rate for Payer: Health Net of AZ Medicare	$2.05
Rate for Payer: Humana of AZ Medicare	$1.10
Rate for Payer: Mercy Care Medicaid	$1.54
Rate for Payer: Self Pay Self Pay	$5.85
Rate for Payer: TriWest Medicare	$1.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.32

enoxaparin 100 mg/mL SC [CQCH]

Facility

$7.31

Service Code	HCPCS J1650
Hospital Charge Code	108072705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$6.58
Rate for Payer: Aetna of AZ Commercial	$6.58
Rate for Payer: Bisbee Police All Plans	$1.90
Rate for Payer: Cash Price	$5.85
Rate for Payer: Self Pay Self Pay	$5.85

enoxaparin 120 mg/0.8 mL SC [CQCH]

Facility

$10.68

Service Code	HCPCS J1650
Hospital Charge Code	108072834
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna of AZ Commercial	$9.61
Rate for Payer: Bisbee Police All Plans	$2.78
Rate for Payer: Cash Price	$8.55
Rate for Payer: Self Pay Self Pay	$8.54

enoxaparin 120 mg/0.8 mL SC [CQCH]

Facility

$10.68

Service Code	HCPCS J1650
Hospital Charge Code	108072834
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna of AZ Commercial	$9.61
Rate for Payer: Aetna of AZ Medicare	$2.99
Rate for Payer: AHCCCS Medicaid	$1.54
Rate for Payer: Allwell Medicaid	$1.54
Rate for Payer: Allwell Medicare	$1.60
Rate for Payer: Amerigroup Medicare	$1.60
Rate for Payer: APIPA Medicare/Medicaid	$3.99
Rate for Payer: AZCH Complete Medicaid	$1.54
Rate for Payer: AZCH Complete Medicare	$1.60
Rate for Payer: Banner UC Health Medicaid	$1.54
Rate for Payer: Banner UC Health Medicare	$1.60
Rate for Payer: Bisbee Police All Plans	$2.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.26
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cigna of AZ Commercial	$6.94
Rate for Payer: Copperpoint Commercial	$2.64
Rate for Payer: Health Net of AZ Commercial	$6.41
Rate for Payer: Health Net of AZ Medicare	$2.99
Rate for Payer: Humana of AZ Medicare	$1.60
Rate for Payer: Mercy Care Medicaid	$1.54
Rate for Payer: Self Pay Self Pay	$8.54
Rate for Payer: TriWest Medicare	$1.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.92

enoxaparin 30 mg/0.3 mL SC [CQCH]

Facility

$2.10

Service Code	HCPCS J1650
Hospital Charge Code	105920357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.89
Rate for Payer: Aetna of AZ Commercial	$1.89
Rate for Payer: Aetna of AZ Medicare	$0.59
Rate for Payer: AHCCCS Medicaid	$1.54
Rate for Payer: Allwell Medicaid	$1.54
Rate for Payer: Allwell Medicare	$0.32
Rate for Payer: Amerigroup Medicare	$0.32
Rate for Payer: APIPA Medicare/Medicaid	$0.78
Rate for Payer: AZCH Complete Medicaid	$1.54
Rate for Payer: AZCH Complete Medicare	$0.32
Rate for Payer: Banner UC Health Medicaid	$1.54
Rate for Payer: Banner UC Health Medicare	$0.32
Rate for Payer: Bisbee Police All Plans	$0.55
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.43
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cash Price	$1.68
Rate for Payer: Cigna of AZ Commercial	$1.36
Rate for Payer: Copperpoint Commercial	$0.52
Rate for Payer: Health Net of AZ Commercial	$1.26
Rate for Payer: Health Net of AZ Medicare	$0.59
Rate for Payer: Humana of AZ Medicare	$0.32
Rate for Payer: Mercy Care Medicaid	$1.54
Rate for Payer: Self Pay Self Pay	$1.68
Rate for Payer: TriWest Medicare	$0.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.38

enoxaparin 30 mg/0.3 mL SC [CQCH]

Facility

$2.10

Service Code	HCPCS J1650
Hospital Charge Code	105920357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.89
Rate for Payer: Aetna of AZ Commercial	$1.89
Rate for Payer: Bisbee Police All Plans	$0.55
Rate for Payer: Cash Price	$1.68
Rate for Payer: Self Pay Self Pay	$1.68

enoxaparin 40 mg/0.4 mL SC [CQCH]

Facility

$3.10

Service Code	HCPCS J1650
Hospital Charge Code	105920582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of AZ Commercial	$2.79
Rate for Payer: Aetna of AZ Medicare	$0.87
Rate for Payer: AHCCCS Medicaid	$1.54
Rate for Payer: Allwell Medicaid	$1.54
Rate for Payer: Allwell Medicare	$0.47
Rate for Payer: Amerigroup Medicare	$0.47
Rate for Payer: APIPA Medicare/Medicaid	$1.16
Rate for Payer: AZCH Complete Medicaid	$1.54
Rate for Payer: AZCH Complete Medicare	$0.47
Rate for Payer: Banner UC Health Medicaid	$1.54
Rate for Payer: Banner UC Health Medicare	$0.47
Rate for Payer: Bisbee Police All Plans	$0.81
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.11
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cigna of AZ Commercial	$2.02
Rate for Payer: Copperpoint Commercial	$0.77
Rate for Payer: Health Net of AZ Commercial	$1.86
Rate for Payer: Health Net of AZ Medicare	$0.87
Rate for Payer: Humana of AZ Medicare	$0.47
Rate for Payer: Mercy Care Medicaid	$1.54
Rate for Payer: Self Pay Self Pay	$2.48
Rate for Payer: TriWest Medicare	$0.47
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.56

enoxaparin 40 mg/0.4 mL SC [CQCH]

Facility

$3.10

Service Code	HCPCS J1650
Hospital Charge Code	105920582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of AZ Commercial	$2.79
Rate for Payer: Bisbee Police All Plans	$0.81
Rate for Payer: Cash Price	$2.48
Rate for Payer: Self Pay Self Pay	$2.48

enoxaparin 60 mg/0.6 mL SC [CQCH]

Facility

$4.40

Service Code	HCPCS J1650
Hospital Charge Code	105920507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna of AZ Commercial	$3.96
Rate for Payer: Aetna of AZ Medicare	$1.23
Rate for Payer: AHCCCS Medicaid	$1.54
Rate for Payer: Allwell Medicaid	$1.54
Rate for Payer: Allwell Medicare	$0.66
Rate for Payer: Amerigroup Medicare	$0.66
Rate for Payer: APIPA Medicare/Medicaid	$1.64
Rate for Payer: AZCH Complete Medicaid	$1.54
Rate for Payer: AZCH Complete Medicare	$0.66
Rate for Payer: Banner UC Health Medicaid	$1.54
Rate for Payer: Banner UC Health Medicare	$0.66
Rate for Payer: Bisbee Police All Plans	$1.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.99
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cigna of AZ Commercial	$2.86
Rate for Payer: Copperpoint Commercial	$1.09
Rate for Payer: Health Net of AZ Commercial	$2.64
Rate for Payer: Health Net of AZ Medicare	$1.23
Rate for Payer: Humana of AZ Medicare	$0.66
Rate for Payer: Mercy Care Medicaid	$1.54
Rate for Payer: Self Pay Self Pay	$3.52
Rate for Payer: TriWest Medicare	$0.66
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.79

enoxaparin 60 mg/0.6 mL SC [CQCH]

Facility

$4.40

Service Code	HCPCS J1650
Hospital Charge Code	105920507
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna of AZ Commercial	$3.96
Rate for Payer: Bisbee Police All Plans	$1.14
Rate for Payer: Cash Price	$3.52
Rate for Payer: Self Pay Self Pay	$3.52

enoxaparin 80 mg/0.8 mL SC [CQCH]

Facility

$5.63

Service Code	HCPCS J1650
Hospital Charge Code	105920432
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna of AZ Commercial	$5.07
Rate for Payer: Bisbee Police All Plans	$1.46
Rate for Payer: Cash Price	$4.50
Rate for Payer: Self Pay Self Pay	$4.50

enoxaparin 80 mg/0.8 mL SC [CQCH]

Facility

$5.63

Service Code	HCPCS J1650
Hospital Charge Code	105920432
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna of AZ Commercial	$5.07
Rate for Payer: Aetna of AZ Medicare	$1.58
Rate for Payer: AHCCCS Medicaid	$1.54
Rate for Payer: Allwell Medicaid	$1.54
Rate for Payer: Allwell Medicare	$0.84
Rate for Payer: Amerigroup Medicare	$0.84
Rate for Payer: APIPA Medicare/Medicaid	$2.10
Rate for Payer: AZCH Complete Medicaid	$1.54
Rate for Payer: AZCH Complete Medicare	$0.84
Rate for Payer: Banner UC Health Medicaid	$1.54
Rate for Payer: Banner UC Health Medicare	$0.84
Rate for Payer: Bisbee Police All Plans	$1.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.83
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of AZ Commercial	$3.66
Rate for Payer: Copperpoint Commercial	$1.39
Rate for Payer: Health Net of AZ Commercial	$3.38
Rate for Payer: Health Net of AZ Medicare	$1.58
Rate for Payer: Humana of AZ Medicare	$0.84
Rate for Payer: Mercy Care Medicaid	$1.54
Rate for Payer: Self Pay Self Pay	$4.50
Rate for Payer: TriWest Medicare	$0.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.01

ENSIZOR ENDOSCOPIC SCISSORS 235CM

Facility

$2,348.00

Hospital Charge Code	27758288
Hospital Revenue Code	270
Min. Negotiated Rate	$610.48
Max. Negotiated Rate	$2,113.20
Rate for Payer: Aetna of AZ Commercial	$2,113.20
Rate for Payer: Bisbee Police All Plans	$610.48
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Self Pay Self Pay	$1,878.40

ENSIZOR ENDOSCOPIC SCISSORS 235CM

Facility

$2,348.00

Hospital Charge Code	27758288
Hospital Revenue Code	270
Min. Negotiated Rate	$352.20
Max. Negotiated Rate	$2,113.20
Rate for Payer: Aetna of AZ Commercial	$2,113.20
Rate for Payer: Aetna of AZ Medicare	$657.44
Rate for Payer: Allwell Medicare	$352.20
Rate for Payer: Amerigroup Medicare	$352.20
Rate for Payer: APIPA Medicare/Medicaid	$876.98
Rate for Payer: AZCH Complete Medicare	$352.20
Rate for Payer: Banner UC Health Medicare	$352.20
Rate for Payer: Bisbee Police All Plans	$610.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,596.64
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cigna of AZ Commercial	$1,643.60
Rate for Payer: Copperpoint Commercial	$581.13
Rate for Payer: Health Net of AZ Commercial	$1,408.80
Rate for Payer: Health Net of AZ Medicare	$657.44
Rate for Payer: Humana of AZ Medicare	$352.20
Rate for Payer: Self Pay Self Pay	$1,878.40
Rate for Payer: TriWest Medicare	$352.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,368.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$422.64

entacapone 200 mg Tab [CQCH]

Facility

$2.42

Service Code	NDC 51079027303
Hospital Charge Code	105920659
Hospital Revenue Code	251
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna of AZ Commercial	$2.18
Rate for Payer: Bisbee Police All Plans	$0.63
Rate for Payer: Cash Price	$1.94
Rate for Payer: Self Pay Self Pay	$1.94

entacapone 200 mg Tab [CQCH]

Facility

$2.42

Service Code	NDC 51079027303
Hospital Charge Code	105920659
Hospital Revenue Code	251
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna of AZ Commercial	$2.18
Rate for Payer: Aetna of AZ Medicare	$0.68
Rate for Payer: Allwell Medicare	$0.36
Rate for Payer: Amerigroup Medicare	$0.36
Rate for Payer: APIPA Medicare/Medicaid	$0.90
Rate for Payer: AZCH Complete Medicare	$0.36
Rate for Payer: Banner UC Health Medicare	$0.36
Rate for Payer: Bisbee Police All Plans	$0.63
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.65
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cigna of AZ Commercial	$1.57
Rate for Payer: Copperpoint Commercial	$0.60
Rate for Payer: Health Net of AZ Commercial	$1.45
Rate for Payer: Health Net of AZ Medicare	$0.68
Rate for Payer: Humana of AZ Medicare	$0.36
Rate for Payer: Self Pay Self Pay	$1.94
Rate for Payer: TriWest Medicare	$0.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.44

Know your out-of-pocket cost for care.

All Charges