Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MYOSURE XL HYSTEROSCOPE TISSUE REMVL DEV

Facility

$3,673.00

Hospital Charge Code	22354783
Hospital Revenue Code	270
Min. Negotiated Rate	$550.95
Max. Negotiated Rate	$3,305.70
Rate for Payer: Aetna of AZ Commercial	$3,305.70
Rate for Payer: Aetna of AZ Medicare	$1,028.44
Rate for Payer: Allwell Medicare	$550.95
Rate for Payer: Amerigroup Medicare	$550.95
Rate for Payer: APIPA Medicare/Medicaid	$1,371.87
Rate for Payer: AZCH Complete Medicare	$550.95
Rate for Payer: Banner UC Health Medicare	$550.95
Rate for Payer: Bisbee Police All Plans	$954.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,497.64
Rate for Payer: Cash Price	$2,938.40
Rate for Payer: Cigna of AZ Commercial	$2,571.10
Rate for Payer: Copperpoint Commercial	$909.07
Rate for Payer: Health Net of AZ Commercial	$2,203.80
Rate for Payer: Health Net of AZ Medicare	$1,028.44
Rate for Payer: Humana of AZ Medicare	$550.95
Rate for Payer: Self Pay Self Pay	$2,938.40
Rate for Payer: TriWest Medicare	$550.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,141.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$661.14

MYOSURE XL HYSTEROSCOPE TISSUE REMVL DEV

Facility

$3,673.00

Hospital Charge Code	22354783
Hospital Revenue Code	270
Min. Negotiated Rate	$954.98
Max. Negotiated Rate	$3,305.70
Rate for Payer: Aetna of AZ Commercial	$3,305.70
Rate for Payer: Bisbee Police All Plans	$954.98
Rate for Payer: Cash Price	$2,938.40
Rate for Payer: Self Pay Self Pay	$2,938.40

naloxone 0.4 mg/ 1 mL Inj Sol [CQCH]

Facility

$12.78

Service Code	HCPCS J2310
Hospital Charge Code	105933490
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$19.58
Rate for Payer: Aetna of AZ Commercial	$11.50
Rate for Payer: Aetna of AZ Medicare	$3.58
Rate for Payer: AHCCCS Medicaid	$19.58
Rate for Payer: Allwell Medicaid	$19.58
Rate for Payer: Allwell Medicare	$1.92
Rate for Payer: Amerigroup Medicare	$1.92
Rate for Payer: APIPA Medicare/Medicaid	$4.77
Rate for Payer: AZCH Complete Medicaid	$19.58
Rate for Payer: AZCH Complete Medicare	$1.92
Rate for Payer: Banner UC Health Medicaid	$19.58
Rate for Payer: Banner UC Health Medicare	$1.92
Rate for Payer: Bisbee Police All Plans	$3.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.69
Rate for Payer: Cash Price	$10.22
Rate for Payer: Cash Price	$10.22
Rate for Payer: Cigna of AZ Commercial	$8.31
Rate for Payer: Copperpoint Commercial	$3.16
Rate for Payer: Health Net of AZ Commercial	$7.67
Rate for Payer: Health Net of AZ Medicare	$3.58
Rate for Payer: Humana of AZ Medicare	$1.92
Rate for Payer: Mercy Care Medicaid	$19.58
Rate for Payer: Self Pay Self Pay	$10.22
Rate for Payer: TriWest Medicare	$1.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.30

naloxone 0.4 mg/ 1 mL Inj Sol [CQCH]

Facility

$12.78

Service Code	HCPCS J2310
Hospital Charge Code	105933490
Hospital Revenue Code	250
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna of AZ Commercial	$11.50
Rate for Payer: Bisbee Police All Plans	$3.32
Rate for Payer: Cash Price	$10.22
Rate for Payer: Self Pay Self Pay	$10.22

naloxone 2 mg PFS [CQCH]

Facility

$24.89

Service Code	HCPCS J2310
Hospital Charge Code	105933415
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna of AZ Commercial	$22.40
Rate for Payer: Bisbee Police All Plans	$6.47
Rate for Payer: Cash Price	$19.91
Rate for Payer: Self Pay Self Pay	$19.91

naloxone 2 mg PFS [CQCH]

Facility

$24.89

Service Code	HCPCS J2310
Hospital Charge Code	105933415
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna of AZ Commercial	$22.40
Rate for Payer: Aetna of AZ Medicare	$6.97
Rate for Payer: AHCCCS Medicaid	$19.58
Rate for Payer: Allwell Medicaid	$19.58
Rate for Payer: Allwell Medicare	$3.73
Rate for Payer: Amerigroup Medicare	$3.73
Rate for Payer: APIPA Medicare/Medicaid	$9.30
Rate for Payer: AZCH Complete Medicaid	$19.58
Rate for Payer: AZCH Complete Medicare	$3.73
Rate for Payer: Banner UC Health Medicaid	$19.58
Rate for Payer: Banner UC Health Medicare	$3.73
Rate for Payer: Bisbee Police All Plans	$6.47
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.93
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cigna of AZ Commercial	$16.18
Rate for Payer: Copperpoint Commercial	$6.16
Rate for Payer: Health Net of AZ Commercial	$14.93
Rate for Payer: Health Net of AZ Medicare	$6.97
Rate for Payer: Humana of AZ Medicare	$3.73
Rate for Payer: Mercy Care Medicaid	$19.58
Rate for Payer: Self Pay Self Pay	$19.91
Rate for Payer: TriWest Medicare	$3.73
Rate for Payer: UnitedHealth Group of AZ Commercial	$14.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.48

naproxen 500 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 68084012701
Hospital Charge Code	105933620
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.12
Rate for Payer: Self Pay Self Pay	$0.12

naproxen 500 mg Tab [CQCH]

Facility

$0.15

Service Code	NDC 68084012701
Hospital Charge Code	105933620
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.09
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.12
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

NASAL AND ORAL CO2 CANNULA PED WITH O2

Facility

$74.00

Hospital Charge Code	27410392
Hospital Revenue Code	270
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Cash Price	$59.20
Rate for Payer: Self Pay Self Pay	$59.20

NASAL AND ORAL CO2 CANNULA PED WITH O2

Facility

$74.00

Hospital Charge Code	27410392
Hospital Revenue Code	270
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Aetna of AZ Medicare	$20.72
Rate for Payer: Allwell Medicare	$11.10
Rate for Payer: Amerigroup Medicare	$11.10
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.10
Rate for Payer: Banner UC Health Medicare	$11.10
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.32
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$51.80
Rate for Payer: Copperpoint Commercial	$18.32
Rate for Payer: Health Net of AZ Commercial	$44.40
Rate for Payer: Health Net of AZ Medicare	$20.72
Rate for Payer: Humana of AZ Medicare	$11.10
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

NASAL CATH EPISTAT II

Facility

$242.00

Hospital Charge Code	22354310
Hospital Revenue Code	270
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Cash Price	$193.60
Rate for Payer: Self Pay Self Pay	$193.60

NASAL CATH EPISTAT II

Facility

$242.00

Hospital Charge Code	22354310
Hospital Revenue Code	270
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Medicare	$67.76
Rate for Payer: Allwell Medicare	$36.30
Rate for Payer: Amerigroup Medicare	$36.30
Rate for Payer: APIPA Medicare/Medicaid	$90.39
Rate for Payer: AZCH Complete Medicare	$36.30
Rate for Payer: Banner UC Health Medicare	$36.30
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$164.56
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$169.40
Rate for Payer: Copperpoint Commercial	$59.90
Rate for Payer: Health Net of AZ Commercial	$145.20
Rate for Payer: Health Net of AZ Medicare	$67.76
Rate for Payer: Humana of AZ Medicare	$36.30
Rate for Payer: Self Pay Self Pay	$193.60
Rate for Payer: TriWest Medicare	$36.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.56

NCIRCLE HELICAL TIPLESS STONE EXTRACTOR

Facility

$1,388.00

Hospital Charge Code	22354220
Hospital Revenue Code	270
Min. Negotiated Rate	$208.20
Max. Negotiated Rate	$1,249.20
Rate for Payer: Aetna of AZ Commercial	$1,249.20
Rate for Payer: Aetna of AZ Medicare	$388.64
Rate for Payer: Allwell Medicare	$208.20
Rate for Payer: Amerigroup Medicare	$208.20
Rate for Payer: APIPA Medicare/Medicaid	$518.42
Rate for Payer: AZCH Complete Medicare	$208.20
Rate for Payer: Banner UC Health Medicare	$208.20
Rate for Payer: Bisbee Police All Plans	$360.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$943.84
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cigna of AZ Commercial	$971.60
Rate for Payer: Copperpoint Commercial	$343.53
Rate for Payer: Health Net of AZ Commercial	$832.80
Rate for Payer: Health Net of AZ Medicare	$388.64
Rate for Payer: Humana of AZ Medicare	$208.20
Rate for Payer: Self Pay Self Pay	$1,110.40
Rate for Payer: TriWest Medicare	$208.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$809.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$249.84

NCIRCLE HELICAL TIPLESS STONE EXTRACTOR

Facility

$1,388.00

Hospital Charge Code	22354220
Hospital Revenue Code	270
Min. Negotiated Rate	$360.88
Max. Negotiated Rate	$1,249.20
Rate for Payer: Aetna of AZ Commercial	$1,249.20
Rate for Payer: Bisbee Police All Plans	$360.88
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Self Pay Self Pay	$1,110.40

NCIRCLE TIPLESS STONE EXTRACTOR 1.5

Facility

$1,388.00

Hospital Charge Code	27748908
Hospital Revenue Code	270
Min. Negotiated Rate	$360.88
Max. Negotiated Rate	$1,249.20
Rate for Payer: Aetna of AZ Commercial	$1,249.20
Rate for Payer: Bisbee Police All Plans	$360.88
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Self Pay Self Pay	$1,110.40

NCIRCLE TIPLESS STONE EXTRACTOR 1.5

Facility

$1,388.00

Hospital Charge Code	27748908
Hospital Revenue Code	270
Min. Negotiated Rate	$208.20
Max. Negotiated Rate	$1,249.20
Rate for Payer: Aetna of AZ Commercial	$1,249.20
Rate for Payer: Aetna of AZ Medicare	$388.64
Rate for Payer: Allwell Medicare	$208.20
Rate for Payer: Amerigroup Medicare	$208.20
Rate for Payer: APIPA Medicare/Medicaid	$518.42
Rate for Payer: AZCH Complete Medicare	$208.20
Rate for Payer: Banner UC Health Medicare	$208.20
Rate for Payer: Bisbee Police All Plans	$360.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$943.84
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cigna of AZ Commercial	$971.60
Rate for Payer: Copperpoint Commercial	$343.53
Rate for Payer: Health Net of AZ Commercial	$832.80
Rate for Payer: Health Net of AZ Medicare	$388.64
Rate for Payer: Humana of AZ Medicare	$208.20
Rate for Payer: Self Pay Self Pay	$1,110.40
Rate for Payer: TriWest Medicare	$208.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$809.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$249.84

NDL SPINAL 18X3.5

Facility

$16.00

Hospital Charge Code	22355411
Hospital Revenue Code	270
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Aetna of AZ Medicare	$4.48
Rate for Payer: Allwell Medicare	$2.40
Rate for Payer: Amerigroup Medicare	$2.40
Rate for Payer: APIPA Medicare/Medicaid	$5.98
Rate for Payer: AZCH Complete Medicare	$2.40
Rate for Payer: Banner UC Health Medicare	$2.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$10.88
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Copperpoint Commercial	$3.96
Rate for Payer: Health Net of AZ Commercial	$9.60
Rate for Payer: Health Net of AZ Medicare	$4.48
Rate for Payer: Humana of AZ Medicare	$2.40
Rate for Payer: Self Pay Self Pay	$12.80
Rate for Payer: TriWest Medicare	$2.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.88

NDL SPINAL 18X3.5

Facility

$16.00

Hospital Charge Code	22355411
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Bisbee Police All Plans	$4.16
Rate for Payer: Cash Price	$12.80
Rate for Payer: Self Pay Self Pay	$12.80

NDL SPINAL 20GX3.5

Facility

$26.00

Hospital Charge Code	22355398
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

NDL SPINAL 20GX3.5

Facility

$26.00

Hospital Charge Code	22355398
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

NDL SPINAL 22GX3.5

Facility

$27.00

Hospital Charge Code	22355417
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Aetna of AZ Medicare	$7.56
Rate for Payer: Allwell Medicare	$4.05
Rate for Payer: Amerigroup Medicare	$4.05
Rate for Payer: APIPA Medicare/Medicaid	$10.08
Rate for Payer: AZCH Complete Medicare	$4.05
Rate for Payer: Banner UC Health Medicare	$4.05
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$18.36
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$18.90
Rate for Payer: Copperpoint Commercial	$6.68
Rate for Payer: Health Net of AZ Commercial	$16.20
Rate for Payer: Health Net of AZ Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$4.05
Rate for Payer: Self Pay Self Pay	$21.60
Rate for Payer: TriWest Medicare	$4.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.86

NDL SPINAL 22GX3.5

Facility

$27.00

Hospital Charge Code	22355417
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Cash Price	$21.60
Rate for Payer: Self Pay Self Pay	$21.60

NDL SPINAL 25GX3.5

Facility

$26.00

Hospital Charge Code	22355397
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

NDL SPINAL 25GX3.5

Facility

$26.00

Hospital Charge Code	22355397
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

NDL SPNL 20GX3.5 QUINCKE

Facility

$99.00

Hospital Charge Code	22354972
Hospital Revenue Code	270
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Cash Price	$79.20
Rate for Payer: Self Pay Self Pay	$79.20

Know your out-of-pocket cost for care.

All Charges