Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

NDL SPNL 20GX3.5 QUINCKE

Facility

$99.00

Hospital Charge Code	22354972
Hospital Revenue Code	270
Min. Negotiated Rate	$14.85
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	$14.85
Rate for Payer: Amerigroup Medicare	$14.85
Rate for Payer: APIPA Medicare/Medicaid	$36.98
Rate for Payer: AZCH Complete Medicare	$14.85
Rate for Payer: Banner UC Health Medicare	$14.85
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	$14.85
Rate for Payer: Self Pay Self Pay	$79.20
Rate for Payer: TriWest Medicare	$14.85
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	$1.65
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	$1.65
Rate for Payer: Amerigroup Medicare	$1.65
Rate for Payer: APIPA Medicare/Medicaid	$4.11
Rate for Payer: AZCH Complete Medicare	$1.65
Rate for Payer: Banner UC Health Medicare	$1.65
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	$1.65
Rate for Payer: Self Pay Self Pay	$8.80
Rate for Payer: TriWest Medicare	$1.65
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

$191.00

Service Code	CPT 94664
Hospital Charge Code	3230233
Hospital Revenue Code	410
Min. Negotiated Rate	$49.66
Max. Negotiated Rate	$171.90
Rate for Payer: Aetna of AZ Commercial	$171.90
Rate for Payer: Bisbee Police All Plans	$49.66
Rate for Payer: Cash Price	$152.80
Rate for Payer: Self Pay Self Pay	$152.80

NEB HAND INITIAL SETUP

Facility

$191.00

Service Code	CPT 94664
Hospital Charge Code	3230233
Hospital Revenue Code	410
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$272.42
Rate for Payer: Aetna of AZ Commercial	$171.90
Rate for Payer: Aetna of AZ Medicare	$53.48
Rate for Payer: AHCCCS Medicaid	$272.42
Rate for Payer: Allwell Medicaid	$272.42
Rate for Payer: Allwell Medicare	$28.65
Rate for Payer: Amerigroup Medicare	$28.65
Rate for Payer: APIPA Medicare/Medicaid	$71.34
Rate for Payer: AZCH Complete Medicaid	$272.42
Rate for Payer: AZCH Complete Medicare	$28.65
Rate for Payer: Banner UC Health Medicaid	$272.42
Rate for Payer: Banner UC Health Medicare	$28.65
Rate for Payer: Bisbee Police All Plans	$49.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$129.88
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cigna of AZ Commercial	$133.70
Rate for Payer: Copperpoint Commercial	$47.27
Rate for Payer: Health Net of AZ Commercial	$114.60
Rate for Payer: Health Net of AZ Medicare	$53.48
Rate for Payer: Humana of AZ Medicare	$28.65
Rate for Payer: Mercy Care Medicaid	$272.42
Rate for Payer: Self Pay Self Pay	$152.80
Rate for Payer: TriWest Medicare	$28.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$111.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.38

nebivolol 5 mg Tab [CQCH]

Facility

$4.44

Service Code	NDC 456140530
Hospital Charge Code	110528057
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
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	$0.67
Rate for Payer: Amerigroup Medicare	$0.67
Rate for Payer: APIPA Medicare/Medicaid	$1.66
Rate for Payer: AZCH Complete Medicare	$0.67
Rate for Payer: Banner UC Health Medicare	$0.67
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	$0.67
Rate for Payer: Self Pay Self Pay	$3.55
Rate for Payer: TriWest Medicare	$0.67
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.80

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

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 HOUR LONG

Facility

$38.00

Hospital Charge Code	22355407
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
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	$5.70
Rate for Payer: Amerigroup Medicare	$5.70
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$5.70
Rate for Payer: Banner UC Health Medicare	$5.70
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	$5.70
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$5.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

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

NEB KIT, SVN

Facility

$9.00

Hospital Charge Code	22355578
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
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	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
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	$1.35
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

NEBULIZER ADAPTOR KIT NEONATAL

Facility

$20.00

Hospital Charge Code	27755357
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Cash Price	$16.00
Rate for Payer: Self Pay Self Pay	$16.00

NEBULIZER ADAPTOR KIT NEONATAL

Facility

$20.00

Hospital Charge Code	27755357
Hospital Revenue Code	270
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of AZ Commercial	$18.00
Rate for Payer: Aetna of AZ Medicare	$5.60
Rate for Payer: Allwell Medicare	$3.00
Rate for Payer: Amerigroup Medicare	$3.00
Rate for Payer: APIPA Medicare/Medicaid	$7.47
Rate for Payer: AZCH Complete Medicare	$3.00
Rate for Payer: Banner UC Health Medicare	$3.00
Rate for Payer: Bisbee Police All Plans	$5.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cigna of AZ Commercial	$14.00
Rate for Payer: Copperpoint Commercial	$4.95
Rate for Payer: Health Net of AZ Commercial	$12.00
Rate for Payer: Health Net of AZ Medicare	$5.60
Rate for Payer: Humana of AZ Medicare	$3.00
Rate for Payer: Self Pay Self Pay	$16.00
Rate for Payer: TriWest Medicare	$3.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.60

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

NEBULIZER PEDIATRIC W PACIFIER

Facility

$55.00

Hospital Charge Code	23811353
Hospital Revenue Code	270
Min. Negotiated Rate	$8.25
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	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicare	$8.25
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	$8.25
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

NEEDLE 18GX1.5IN BLUNT FILL

Facility

$2,664.00

Hospital Charge Code	23351654
Hospital Revenue Code	270
Min. Negotiated Rate	$399.60
Max. Negotiated Rate	$2,397.60
Rate for Payer: Aetna of AZ Commercial	$2,397.60
Rate for Payer: Aetna of AZ Medicare	$745.92
Rate for Payer: Allwell Medicare	$399.60
Rate for Payer: Amerigroup Medicare	$399.60
Rate for Payer: APIPA Medicare/Medicaid	$995.00
Rate for Payer: AZCH Complete Medicare	$399.60
Rate for Payer: Banner UC Health Medicare	$399.60
Rate for Payer: Bisbee Police All Plans	$692.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,811.52
Rate for Payer: Cash Price	$2,131.20
Rate for Payer: Cigna of AZ Commercial	$1,864.80
Rate for Payer: Copperpoint Commercial	$659.34
Rate for Payer: Health Net of AZ Commercial	$1,598.40
Rate for Payer: Health Net of AZ Medicare	$745.92
Rate for Payer: Humana of AZ Medicare	$399.60
Rate for Payer: Self Pay Self Pay	$2,131.20
Rate for Payer: TriWest Medicare	$399.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,553.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$479.52

NEEDLE 18GX1.5IN BLUNT FILL

Facility

$2,664.00

Hospital Charge Code	23351654
Hospital Revenue Code	270
Min. Negotiated Rate	$692.64
Max. Negotiated Rate	$2,397.60
Rate for Payer: Aetna of AZ Commercial	$2,397.60
Rate for Payer: Bisbee Police All Plans	$692.64
Rate for Payer: Cash Price	$2,131.20
Rate for Payer: Self Pay Self Pay	$2,131.20

NEEDLE BIOPSY 14Gx4.5 SOFT TISS

Facility

$222.00

Hospital Charge Code	22354955
Hospital Revenue Code	270
Min. Negotiated Rate	$33.30
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	$33.30
Rate for Payer: Amerigroup Medicare	$33.30
Rate for Payer: APIPA Medicare/Medicaid	$82.92
Rate for Payer: AZCH Complete Medicare	$33.30
Rate for Payer: Banner UC Health Medicare	$33.30
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	$54.94
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	$33.30
Rate for Payer: Self Pay Self Pay	$177.60
Rate for Payer: TriWest Medicare	$33.30
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

NEEDLE BIOPSY MAGNUM 18X25

Facility

$156.00

Hospital Charge Code	22354931
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Aetna of AZ Medicare	$43.68
Rate for Payer: Allwell Medicare	$23.40
Rate for Payer: Amerigroup Medicare	$23.40
Rate for Payer: APIPA Medicare/Medicaid	$58.27
Rate for Payer: AZCH Complete Medicare	$23.40
Rate for Payer: Banner UC Health Medicare	$23.40
Rate for Payer: Bisbee Police All Plans	$40.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$106.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cigna of AZ Commercial	$109.20
Rate for Payer: Copperpoint Commercial	$38.61
Rate for Payer: Health Net of AZ Commercial	$93.60
Rate for Payer: Health Net of AZ Medicare	$43.68
Rate for Payer: Humana of AZ Medicare	$23.40
Rate for Payer: Self Pay Self Pay	$124.80
Rate for Payer: TriWest Medicare	$23.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.08

NEEDLE FASCIAL INCISING 18G/4.5CM COOK

Facility

$155.00

Hospital Charge Code	22354211
Hospital Revenue Code	270
Min. Negotiated Rate	$40.30
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Cash Price	$124.00
Rate for Payer: Self Pay Self Pay	$124.00

NEEDLE FASCIAL INCISING 18G/4.5CM COOK

Facility

$155.00

Hospital Charge Code	22354211
Hospital Revenue Code	270
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Aetna of AZ Medicare	$43.40
Rate for Payer: Allwell Medicare	$23.25
Rate for Payer: Amerigroup Medicare	$23.25
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$23.25
Rate for Payer: Banner UC Health Medicare	$23.25
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$105.40
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Copperpoint Commercial	$38.36
Rate for Payer: Health Net of AZ Commercial	$93.00
Rate for Payer: Health Net of AZ Medicare	$43.40
Rate for Payer: Humana of AZ Medicare	$23.25
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$23.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

NEEDLE GRIPPER

Facility

$27.00

Hospital Charge Code	22354524
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

NEEDLE GRIPPER

Facility

$27.00

Hospital Charge Code	22354524
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

Know your out-of-pocket cost for care.

All Charges