Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

NCIRCLE TIPLESS STONE EXTRACTOR 1.5

Facility

$1,388.00

Hospital Charge Code	27748908
Hospital Revenue Code	270
Min. Negotiated Rate	$222.08
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	$222.08
Rate for Payer: Amerigroup Medicare	$222.08
Rate for Payer: APIPA Medicare/Medicaid	$518.42
Rate for Payer: AZCH Complete Medicare	$222.08
Rate for Payer: Banner UC Health Medicare	$222.08
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	$222.08
Rate for Payer: Self Pay Self Pay	$1,110.40
Rate for Payer: TriWest Medicare	$222.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$809.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$249.84

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

NDL SPINAL 20GX3.5

Facility

$26.00

Hospital Charge Code	22355398
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
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	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
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	$6.43
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	$4.16
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

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 25GX3.5

Facility

$26.00

Hospital Charge Code	22355397
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
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	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
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	$6.43
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	$4.16
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$4.16
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

NDL SPNL 20GX3.5 QUINCKE

Facility

$99.00

Hospital Charge Code	22354972
Hospital Revenue Code	270
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$89.10
Rate for Payer: Aetna of AZ Commercial	$89.10
Rate for Payer: Aetna of AZ Medicare	$27.72
Rate for Payer: Allwell Medicare	$15.84
Rate for Payer: Amerigroup Medicare	$15.84
Rate for Payer: APIPA Medicare/Medicaid	$36.98
Rate for Payer: AZCH Complete Medicare	$15.84
Rate for Payer: Banner UC Health Medicare	$15.84
Rate for Payer: Bisbee Police All Plans	$25.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$67.32
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of AZ Commercial	$69.30
Rate for Payer: Copperpoint Commercial	$24.50
Rate for Payer: Health Net of AZ Commercial	$59.40
Rate for Payer: Health Net of AZ Medicare	$27.72
Rate for Payer: Humana of AZ Medicare	$15.84
Rate for Payer: Self Pay Self Pay	$79.20
Rate for Payer: TriWest Medicare	$15.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.82

NEB HANDHELD

Facility

$11.00

Hospital Charge Code	22355590
Hospital Revenue Code	270
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Cash Price	$8.80
Rate for Payer: Self Pay Self Pay	$8.80

NEB HANDHELD

Facility

$11.00

Hospital Charge Code	22355590
Hospital Revenue Code	270
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Aetna of AZ Medicare	$3.08
Rate for Payer: Allwell Medicare	$1.76
Rate for Payer: Amerigroup Medicare	$1.76
Rate for Payer: APIPA Medicare/Medicaid	$4.11
Rate for Payer: AZCH Complete Medicare	$1.76
Rate for Payer: Banner UC Health Medicare	$1.76
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.48
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Copperpoint Commercial	$2.72
Rate for Payer: Health Net of AZ Commercial	$6.60
Rate for Payer: Health Net of AZ Medicare	$3.08
Rate for Payer: Humana of AZ Medicare	$1.76
Rate for Payer: Self Pay Self Pay	$8.80
Rate for Payer: TriWest Medicare	$1.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.98

NEB HAND INITIAL SETUP

Facility

$258.00

Service Code	CPT 94664
Hospital Charge Code	3230233
Hospital Revenue Code	410
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

NEB HAND INITIAL SETUP

Facility

$258.00

Service Code	CPT 94664
Hospital Charge Code	3230233
Hospital Revenue Code	410
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: AHCCCS Medicaid	$136.21
Rate for Payer: Allwell Medicaid	$136.21
Rate for Payer: Allwell Medicare	$41.28
Rate for Payer: Amerigroup Medicare	$41.28
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicaid	$136.21
Rate for Payer: AZCH Complete Medicare	$41.28
Rate for Payer: Banner UC Health Medicaid	$136.21
Rate for Payer: Banner UC Health Medicare	$41.28
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$180.60
Rate for Payer: Copperpoint Commercial	$63.85
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$41.28
Rate for Payer: Mercy Care Medicaid	$136.21
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$41.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

nebivolol 5 mg Tab [CQCH]

Facility

$4.44

Service Code	NDC 456140530
Hospital Charge Code	110528057
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of AZ Commercial	$4.00
Rate for Payer: Bisbee Police All Plans	$1.15
Rate for Payer: Cash Price	$3.55
Rate for Payer: Self Pay Self Pay	$3.55

nebivolol 5 mg Tab [CQCH]

Facility

$4.44

Service Code	NDC 456140530
Hospital Charge Code	110528057
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of AZ Commercial	$4.00
Rate for Payer: Aetna of AZ Medicare	$1.24
Rate for Payer: Allwell Medicare	$0.71
Rate for Payer: Amerigroup Medicare	$0.71
Rate for Payer: APIPA Medicare/Medicaid	$1.66
Rate for Payer: AZCH Complete Medicare	$0.71
Rate for Payer: Banner UC Health Medicare	$0.71
Rate for Payer: Bisbee Police All Plans	$1.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.02
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cigna of AZ Commercial	$2.89
Rate for Payer: Copperpoint Commercial	$1.10
Rate for Payer: Health Net of AZ Commercial	$2.66
Rate for Payer: Health Net of AZ Medicare	$1.24
Rate for Payer: Humana of AZ Medicare	$0.71
Rate for Payer: Self Pay Self Pay	$3.55
Rate for Payer: TriWest Medicare	$0.71
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.80

NEB KIT HOUR LONG

Facility

$38.00

Hospital Charge Code	22355407
Hospital Revenue Code	270
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Aetna of AZ Medicare	$10.64
Rate for Payer: Allwell Medicare	$6.08
Rate for Payer: Amerigroup Medicare	$6.08
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.84
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Copperpoint Commercial	$9.40
Rate for Payer: Health Net of AZ Commercial	$22.80
Rate for Payer: Health Net of AZ Medicare	$10.64
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

NEB KIT HOUR LONG

Facility

$38.00

Hospital Charge Code	22355407
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

NEB KIT, SVN

Facility

$9.00

Hospital Charge Code	22355578
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

NEB KIT, SVN

Facility

$9.00

Hospital Charge Code	22355578
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

NEBULIZER ADAPTOR KIT NEONATAL

Facility

$19.10

Hospital Charge Code	27755357
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna of AZ Commercial	$17.19
Rate for Payer: Aetna of AZ Medicare	$5.35
Rate for Payer: Allwell Medicare	$3.06
Rate for Payer: Amerigroup Medicare	$3.06
Rate for Payer: APIPA Medicare/Medicaid	$7.13
Rate for Payer: AZCH Complete Medicare	$3.06
Rate for Payer: Banner UC Health Medicare	$3.06
Rate for Payer: Bisbee Police All Plans	$4.97
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.99
Rate for Payer: Cash Price	$15.28
Rate for Payer: Cigna of AZ Commercial	$13.37
Rate for Payer: Copperpoint Commercial	$4.73
Rate for Payer: Health Net of AZ Commercial	$11.46
Rate for Payer: Health Net of AZ Medicare	$5.35
Rate for Payer: Humana of AZ Medicare	$3.06
Rate for Payer: Self Pay Self Pay	$15.28
Rate for Payer: TriWest Medicare	$3.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.44

NEBULIZER ADAPTOR KIT NEONATAL

Facility

$19.10

Hospital Charge Code	27755357
Hospital Revenue Code	270
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna of AZ Commercial	$17.19
Rate for Payer: Bisbee Police All Plans	$4.97
Rate for Payer: Cash Price	$15.28
Rate for Payer: Self Pay Self Pay	$15.28

NEBULIZER PEDIATRIC W PACIFIER

Facility

$55.00

Hospital Charge Code	23811353
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

NEBULIZER PEDIATRIC W PACIFIER

Facility

$55.00

Hospital Charge Code	23811353
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

NEEDLE BIOPSY 14Gx4.5 SOFT TISS

Facility

$222.00

Hospital Charge Code	22354955
Hospital Revenue Code	270
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Aetna of AZ Medicare	$62.16
Rate for Payer: Allwell Medicare	$35.52
Rate for Payer: Amerigroup Medicare	$35.52
Rate for Payer: APIPA Medicare/Medicaid	$82.92
Rate for Payer: AZCH Complete Medicare	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$150.96
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$155.40
Rate for Payer: Copperpoint Commercial	$54.95
Rate for Payer: Health Net of AZ Commercial	$133.20
Rate for Payer: Health Net of AZ Medicare	$62.16
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Self Pay Self Pay	$177.60
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$129.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.96

NEEDLE BIOPSY 14Gx4.5 SOFT TISS

Facility

$222.00

Hospital Charge Code	22354955
Hospital Revenue Code	270
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Bisbee Police All Plans	$57.72
Rate for Payer: Cash Price	$177.60
Rate for Payer: Self Pay Self Pay	$177.60

NEEDLE BIOPSY MAGNUM 18X25

Facility

$156.00

Hospital Charge Code	22354931
Hospital Revenue Code	270
Min. Negotiated Rate	$40.56
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Cash Price	$124.80
Rate for Payer: Self Pay Self Pay	$124.80

Know your out-of-pocket cost for care.

All Charges