Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

NEEDLE BIOPSY MAGNUM 18X25

Facility

$156.00

Hospital Charge Code	22354931
Hospital Revenue Code	270
Min. Negotiated Rate	$24.96
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	$24.96
Rate for Payer: Amerigroup Medicare	$24.96
Rate for Payer: APIPA Medicare/Medicaid	$58.27
Rate for Payer: AZCH Complete Medicare	$24.96
Rate for Payer: Banner UC Health Medicare	$24.96
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	$24.96
Rate for Payer: Self Pay Self Pay	$124.80
Rate for Payer: TriWest Medicare	$24.96
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	$24.80
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	$24.80
Rate for Payer: Amerigroup Medicare	$24.80
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
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	$24.80
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

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 GRIPPER PORTACATH PLUS

Facility

$60.00

Hospital Charge Code	23635911
Hospital Revenue Code	270
Min. Negotiated Rate	$9.60
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	$9.60
Rate for Payer: Amerigroup Medicare	$9.60
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
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	$9.60
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

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 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	$11.36
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	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
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	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

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	$29.44
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	$29.44
Rate for Payer: Amerigroup Medicare	$29.44
Rate for Payer: APIPA Medicare/Medicaid	$68.72
Rate for Payer: AZCH Complete Medicare	$29.44
Rate for Payer: Banner UC Health Medicare	$29.44
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	$29.44
Rate for Payer: Self Pay Self Pay	$147.20
Rate for Payer: TriWest Medicare	$29.44
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	$20.16
Max. Negotiated Rate	$130.17
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Aetna of AZ Medicare	$35.28
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$20.16
Rate for Payer: Amerigroup Medicare	$20.16
Rate for Payer: APIPA Medicare/Medicaid	$47.06
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$20.16
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$20.16
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	$20.16
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$100.80
Rate for Payer: TriWest Medicare	$20.16
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

$412.00

Service Code	CPT 87591
Hospital Charge Code	7486632
Hospital Revenue Code	306
Min. Negotiated Rate	$107.12
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Bisbee Police All Plans	$107.12
Rate for Payer: Cash Price	$329.60
Rate for Payer: Self Pay Self Pay	$329.60

Neisseria gonorrhoeae NAA LC

Facility

$412.00

Service Code	CPT 87591
Hospital Charge Code	7486632
Hospital Revenue Code	306
Min. Negotiated Rate	$65.92
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Aetna of AZ Medicare	$115.36
Rate for Payer: Allwell Medicare	$65.92
Rate for Payer: Amerigroup Medicare	$65.92
Rate for Payer: APIPA Medicare/Medicaid	$153.88
Rate for Payer: AZCH Complete Medicare	$65.92
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Bisbee Police All Plans	$107.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$280.16
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cigna of AZ Commercial	$267.80
Rate for Payer: Copperpoint Commercial	$101.97
Rate for Payer: Health Net of AZ Commercial	$247.20
Rate for Payer: Health Net of AZ Medicare	$115.36
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Self Pay Self Pay	$329.60
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$240.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$74.16

neomycin 500 mg Tab [CQCH]

Facility

$0.72

Service Code	NDC 39822031005
Hospital Charge Code	105933687
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
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	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.27
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
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	$0.12
Rate for Payer: Self Pay Self Pay	$0.58
Rate for Payer: TriWest Medicare	$0.12
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	APRDRG8634
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	APRDRG8631
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	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

$10,314.79

Service Code	APR-DRG 8632
Hospital Charge Code	APRDRG8631
Min. Negotiated Rate	$10,314.79
Max. Negotiated Rate	$10,314.79
Rate for Payer: AHCCCS Medicaid	$10,314.79
Rate for Payer: Allwell Medicaid	$10,314.79
Rate for Payer: AZCH Complete Medicaid	$10,314.79
Rate for Payer: Banner UC Health Medicaid	$10,314.79
Rate for Payer: Mercy Care Medicaid	$10,314.79

Neonatal Aftercare

Facility

$3,680.25

Service Code	APR-DRG 8631
Hospital Charge Code	APRDRG8633
Min. Negotiated Rate	$3,680.25
Max. Negotiated Rate	$3,680.25
Rate for Payer: AHCCCS Medicaid	$3,680.25
Rate for Payer: Allwell Medicaid	$3,680.25
Rate for Payer: AZCH Complete Medicaid	$3,680.25
Rate for Payer: Banner UC Health Medicaid	$3,680.25
Rate for Payer: Mercy Care Medicaid	$3,680.25

Neonatal Aftercare

Facility

$72,106.73

Service Code	APR-DRG 8634
Hospital Charge Code	APRDRG8633
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

$10,314.79

Service Code	APR-DRG 8632
Hospital Charge Code	APRDRG8634
Min. Negotiated Rate	$10,314.79
Max. Negotiated Rate	$10,314.79
Rate for Payer: AHCCCS Medicaid	$10,314.79
Rate for Payer: Allwell Medicaid	$10,314.79
Rate for Payer: AZCH Complete Medicaid	$10,314.79
Rate for Payer: Banner UC Health Medicaid	$10,314.79
Rate for Payer: Mercy Care Medicaid	$10,314.79

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

Neonatal Aftercare

Facility

$72,106.73

Service Code	APR-DRG 8634
Hospital Charge Code	APRDRG8634
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

Know your out-of-pocket cost for care.

All Charges