Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

NEEDLE GRIPPER PORTACATH PLUS

Facility

$60.00

Hospital Charge Code	23635911
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

NEEDLE GRIPPER PORTACATH PLUS

Facility

$60.00

Hospital Charge Code	23635911
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.00
Rate for Payer: Amerigroup Medicare	$9.00
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.00
Rate for Payer: Banner UC Health Medicare	$9.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.00
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

NEEDLE GUIDE ENDOCAVITY

Facility

$71.00

Hospital Charge Code	22355364
Hospital Revenue Code	270
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

NEEDLE GUIDE ENDOCAVITY

Facility

$71.00

Hospital Charge Code	22355364
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$10.65
Rate for Payer: Amerigroup Medicare	$10.65
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$10.65
Rate for Payer: Banner UC Health Medicare	$10.65
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$10.65
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$10.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

NEEDLE ILL ASPER EZ IO ADULT (25mm)

Facility

$546.00

Hospital Charge Code	22524460
Hospital Revenue Code	270
Min. Negotiated Rate	$141.96
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Bisbee Police All Plans	$141.96
Rate for Payer: Cash Price	$436.80
Rate for Payer: Self Pay Self Pay	$436.80

NEEDLE ILL ASPER EZ IO ADULT (25mm)

Facility

$546.00

Hospital Charge Code	22524460
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Aetna of AZ Medicare	$152.88
Rate for Payer: Allwell Medicare	$81.90
Rate for Payer: Amerigroup Medicare	$81.90
Rate for Payer: APIPA Medicare/Medicaid	$203.93
Rate for Payer: AZCH Complete Medicare	$81.90
Rate for Payer: Banner UC Health Medicare	$81.90
Rate for Payer: Bisbee Police All Plans	$141.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$371.28
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cigna of AZ Commercial	$382.20
Rate for Payer: Copperpoint Commercial	$135.14
Rate for Payer: Health Net of AZ Commercial	$327.60
Rate for Payer: Health Net of AZ Medicare	$152.88
Rate for Payer: Humana of AZ Medicare	$81.90
Rate for Payer: Self Pay Self Pay	$436.80
Rate for Payer: TriWest Medicare	$81.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$318.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$98.28

NEEDLE ILL ASPER EZ IO LONG (45mm)

Facility

$546.00

Hospital Charge Code	22524462
Hospital Revenue Code	270
Min. Negotiated Rate	$141.96
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Bisbee Police All Plans	$141.96
Rate for Payer: Cash Price	$436.80
Rate for Payer: Self Pay Self Pay	$436.80

NEEDLE ILL ASPER EZ IO LONG (45mm)

Facility

$546.00

Hospital Charge Code	22524462
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$491.40
Rate for Payer: Aetna of AZ Commercial	$491.40
Rate for Payer: Aetna of AZ Medicare	$152.88
Rate for Payer: Allwell Medicare	$81.90
Rate for Payer: Amerigroup Medicare	$81.90
Rate for Payer: APIPA Medicare/Medicaid	$203.93
Rate for Payer: AZCH Complete Medicare	$81.90
Rate for Payer: Banner UC Health Medicare	$81.90
Rate for Payer: Bisbee Police All Plans	$141.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$371.28
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cigna of AZ Commercial	$382.20
Rate for Payer: Copperpoint Commercial	$135.14
Rate for Payer: Health Net of AZ Commercial	$327.60
Rate for Payer: Health Net of AZ Medicare	$152.88
Rate for Payer: Humana of AZ Medicare	$81.90
Rate for Payer: Self Pay Self Pay	$436.80
Rate for Payer: TriWest Medicare	$81.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$318.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$98.28

NEEDLE ILL ASPER PED EZ IO (15mm)

Facility

$652.00

Hospital Charge Code	22524461
Hospital Revenue Code	270
Min. Negotiated Rate	$97.80
Max. Negotiated Rate	$586.80
Rate for Payer: Aetna of AZ Commercial	$586.80
Rate for Payer: Aetna of AZ Medicare	$182.56
Rate for Payer: Allwell Medicare	$97.80
Rate for Payer: Amerigroup Medicare	$97.80
Rate for Payer: APIPA Medicare/Medicaid	$243.52
Rate for Payer: AZCH Complete Medicare	$97.80
Rate for Payer: Banner UC Health Medicare	$97.80
Rate for Payer: Bisbee Police All Plans	$169.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$443.36
Rate for Payer: Cash Price	$521.60
Rate for Payer: Cigna of AZ Commercial	$456.40
Rate for Payer: Copperpoint Commercial	$161.37
Rate for Payer: Health Net of AZ Commercial	$391.20
Rate for Payer: Health Net of AZ Medicare	$182.56
Rate for Payer: Humana of AZ Medicare	$97.80
Rate for Payer: Self Pay Self Pay	$521.60
Rate for Payer: TriWest Medicare	$97.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$380.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$117.36

NEEDLE ILL ASPER PED EZ IO (15mm)

Facility

$652.00

Hospital Charge Code	22524461
Hospital Revenue Code	270
Min. Negotiated Rate	$169.52
Max. Negotiated Rate	$586.80
Rate for Payer: Aetna of AZ Commercial	$586.80
Rate for Payer: Bisbee Police All Plans	$169.52
Rate for Payer: Cash Price	$521.60
Rate for Payer: Self Pay Self Pay	$521.60

NEEDLE INJETAK ADJUSTABLE TIP 70CM

Facility

$239.00

Hospital Charge Code	22354772
Hospital Revenue Code	272
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Aetna of AZ Medicare	$66.92
Rate for Payer: Allwell Medicare	$35.85
Rate for Payer: Amerigroup Medicare	$35.85
Rate for Payer: APIPA Medicare/Medicaid	$89.27
Rate for Payer: AZCH Complete Medicare	$35.85
Rate for Payer: Banner UC Health Medicare	$35.85
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$162.52
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cigna of AZ Commercial	$167.30
Rate for Payer: Copperpoint Commercial	$59.15
Rate for Payer: Health Net of AZ Commercial	$143.40
Rate for Payer: Health Net of AZ Medicare	$66.92
Rate for Payer: Humana of AZ Medicare	$35.85
Rate for Payer: Self Pay Self Pay	$191.20
Rate for Payer: TriWest Medicare	$35.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.02

NEEDLE INJETAK ADJUSTABLE TIP 70CM

Facility

$239.00

Hospital Charge Code	22354772
Hospital Revenue Code	272
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Cash Price	$191.20
Rate for Payer: Self Pay Self Pay	$191.20

NEEDLE INSUFFLATION 15CM CONMED

Facility

$62.00

Hospital Charge Code	22355021
Hospital Revenue Code	272
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.30
Rate for Payer: Amerigroup Medicare	$9.30
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.30
Rate for Payer: Banner UC Health Medicare	$9.30
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.34
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.30
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

NEEDLE INSUFFLATION 15CM CONMED

Facility

$62.00

Hospital Charge Code	22355021
Hospital Revenue Code	272
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

NEEDLE INTERSTIM

Facility

$184.00

Hospital Charge Code	22354867
Hospital Revenue Code	270
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Bisbee Police All Plans	$47.84
Rate for Payer: Cash Price	$147.20
Rate for Payer: Self Pay Self Pay	$147.20

NEEDLE INTERSTIM

Facility

$184.00

Hospital Charge Code	22354867
Hospital Revenue Code	270
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Aetna of AZ Medicare	$51.52
Rate for Payer: Allwell Medicare	$27.60
Rate for Payer: Amerigroup Medicare	$27.60
Rate for Payer: APIPA Medicare/Medicaid	$68.72
Rate for Payer: AZCH Complete Medicare	$27.60
Rate for Payer: Banner UC Health Medicare	$27.60
Rate for Payer: Bisbee Police All Plans	$47.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.12
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cigna of AZ Commercial	$128.80
Rate for Payer: Copperpoint Commercial	$45.54
Rate for Payer: Health Net of AZ Commercial	$110.40
Rate for Payer: Health Net of AZ Medicare	$51.52
Rate for Payer: Humana of AZ Medicare	$27.60
Rate for Payer: Self Pay Self Pay	$147.20
Rate for Payer: TriWest Medicare	$27.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.12

NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAG

Facility

$126.00

Service Code	CPT 97605
Hospital Charge Code	24049287
Hospital Revenue Code	360
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$260.34
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Aetna of AZ Medicare	$35.28
Rate for Payer: AHCCCS Medicaid	$260.34
Rate for Payer: Allwell Medicaid	$260.34
Rate for Payer: Allwell Medicare	$18.90
Rate for Payer: Amerigroup Medicare	$18.90
Rate for Payer: APIPA Medicare/Medicaid	$47.06
Rate for Payer: AZCH Complete Medicaid	$260.34
Rate for Payer: AZCH Complete Medicare	$18.90
Rate for Payer: Banner UC Health Medicaid	$260.34
Rate for Payer: Banner UC Health Medicare	$18.90
Rate for Payer: Bisbee Police All Plans	$32.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$85.68
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Copperpoint Commercial	$31.18
Rate for Payer: Health Net of AZ Commercial	$75.60
Rate for Payer: Health Net of AZ Medicare	$35.28
Rate for Payer: Humana of AZ Medicare	$18.90
Rate for Payer: Mercy Care Medicaid	$260.34
Rate for Payer: Self Pay Self Pay	$100.80
Rate for Payer: TriWest Medicare	$18.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$73.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.68

NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAG

Facility

$126.00

Service Code	CPT 97605
Hospital Charge Code	24049287
Hospital Revenue Code	360
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Bisbee Police All Plans	$32.76
Rate for Payer: Cash Price	$100.80
Rate for Payer: Self Pay Self Pay	$100.80

Neisseria gonorrhoeae NAA LC

Facility

$434.00

Service Code	CPT 87591
Hospital Charge Code	7486632
Hospital Revenue Code	306
Min. Negotiated Rate	$112.84
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Bisbee Police All Plans	$112.84
Rate for Payer: Cash Price	$347.20
Rate for Payer: Self Pay Self Pay	$347.20

Neisseria gonorrhoeae NAA LC

Facility

$434.00

Service Code	CPT 87591
Hospital Charge Code	7486632
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$390.60
Rate for Payer: Aetna of AZ Commercial	$390.60
Rate for Payer: Aetna of AZ Medicare	$121.52
Rate for Payer: AHCCCS Medicaid	$35.09
Rate for Payer: Allwell Medicaid	$35.09
Rate for Payer: Allwell Medicare	$65.10
Rate for Payer: Amerigroup Medicare	$65.10
Rate for Payer: APIPA Medicare/Medicaid	$162.10
Rate for Payer: AZCH Complete Medicaid	$35.09
Rate for Payer: AZCH Complete Medicare	$65.10
Rate for Payer: Banner UC Health Medicaid	$35.09
Rate for Payer: Banner UC Health Medicare	$65.10
Rate for Payer: Bisbee Police All Plans	$112.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$295.12
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cigna of AZ Commercial	$282.10
Rate for Payer: Copperpoint Commercial	$107.42
Rate for Payer: Health Net of AZ Commercial	$260.40
Rate for Payer: Health Net of AZ Medicare	$121.52
Rate for Payer: Humana of AZ Medicare	$65.10
Rate for Payer: Mercy Care Medicaid	$35.09
Rate for Payer: Self Pay Self Pay	$347.20
Rate for Payer: TriWest Medicare	$65.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$253.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$78.12

neomycin 500 mg Tab [CQCH]

Facility

$0.72

Service Code	NDC 39822031005
Hospital Charge Code	105933687
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of AZ Commercial	$0.65
Rate for Payer: Aetna of AZ Medicare	$0.20
Rate for Payer: Allwell Medicare	$0.11
Rate for Payer: Amerigroup Medicare	$0.11
Rate for Payer: APIPA Medicare/Medicaid	$0.27
Rate for Payer: AZCH Complete Medicare	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Bisbee Police All Plans	$0.19
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.49
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna of AZ Commercial	$0.47
Rate for Payer: Copperpoint Commercial	$0.18
Rate for Payer: Health Net of AZ Commercial	$0.43
Rate for Payer: Health Net of AZ Medicare	$0.20
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Self Pay Self Pay	$0.58
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.13

neomycin 500 mg Tab [CQCH]

Facility

$0.72

Service Code	NDC 39822031005
Hospital Charge Code	105933687
Hospital Revenue Code	251
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of AZ Commercial	$0.65
Rate for Payer: Bisbee Police All Plans	$0.19
Rate for Payer: Cash Price	$0.58
Rate for Payer: Self Pay Self Pay	$0.58

Neonatal Aftercare

Facility

$27,689.17

Service Code	APR-DRG 8633
Hospital Charge Code	APRDRG8631
Min. Negotiated Rate	$27,689.17
Max. Negotiated Rate	$27,689.17
Rate for Payer: AHCCCS Medicaid	$27,689.17
Rate for Payer: Allwell Medicaid	$27,689.17
Rate for Payer: AZCH Complete Medicaid	$27,689.17
Rate for Payer: Banner UC Health Medicaid	$27,689.17
Rate for Payer: Mercy Care Medicaid	$27,689.17

Neonatal Aftercare

Facility

$72,106.73

Service Code	APR-DRG 8634
Hospital Charge Code	APRDRG8632
Min. Negotiated Rate	$72,106.73
Max. Negotiated Rate	$72,106.73
Rate for Payer: AHCCCS Medicaid	$72,106.73
Rate for Payer: Allwell Medicaid	$72,106.73
Rate for Payer: AZCH Complete Medicaid	$72,106.73
Rate for Payer: Banner UC Health Medicaid	$72,106.73
Rate for Payer: Mercy Care Medicaid	$72,106.73

Neonatal Aftercare

Facility

$27,689.17

Service Code	APR-DRG 8633
Hospital Charge Code	APRDRG8633
Min. Negotiated Rate	$27,689.17
Max. Negotiated Rate	$27,689.17
Rate for Payer: AHCCCS Medicaid	$27,689.17
Rate for Payer: Allwell Medicaid	$27,689.17
Rate for Payer: AZCH Complete Medicaid	$27,689.17
Rate for Payer: Banner UC Health Medicaid	$27,689.17
Rate for Payer: Mercy Care Medicaid	$27,689.17

Know your out-of-pocket cost for care.

All Charges