Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

nebivolol 5 mg Tab [CQCH]

Facility

$4.44

Service Code	NDC 456140530
Hospital Charge Code	110528057
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of AZ Commercial	$4.00
Rate for Payer: Arizona Complete Health Allwell	$0.71
Rate for Payer: Banner UC Health Medicare	$0.71
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.71
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.71
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cigna of AZ Commercial	$2.89
Rate for Payer: Devoted Health Medicare	$0.80
Rate for Payer: Humana of AZ Medicare	$0.71
Rate for Payer: Southwest Service Administrators UFCW	$3.02
Rate for Payer: TriWest Medicare	$0.71
Rate for Payer: United Healthcare Commercial	$2.54
Rate for Payer: United Healthcare Medicare	$0.71
Rate for Payer: Veterans Affairs TRICARE	$0.70

nebivolol 5 mg Tab [CQCH]

Facility

$4.44

Service Code	NDC 456140530
Hospital Charge Code	110528057
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna of AZ Commercial	$4.00
Rate for Payer: Cash Price	$3.55

NEB KIT HOUR LONG

Facility

$38.00

Hospital Charge Code	22355407
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Arizona Complete Health Allwell	$6.08
Rate for Payer: Banner UC Health Medicare	$6.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$25.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.08
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Devoted Health Medicare	$6.84
Rate for Payer: Humana of AZ Medicare	$6.08
Rate for Payer: Southwest Service Administrators UFCW	$25.84
Rate for Payer: TriWest Medicare	$6.08
Rate for Payer: United Healthcare Commercial	$21.74
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: Veterans Affairs TRICARE	$6.02

NEB KIT HOUR LONG

Facility

$38.00

Hospital Charge Code	22355407
Hospital Revenue Code	270
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Cash Price	$30.40

NEB KIT, SVN

Facility

$9.00

Hospital Charge Code	22355578
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Arizona Complete Health Allwell	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.44
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.12
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.15
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

NEB KIT, SVN

Facility

$9.00

Hospital Charge Code	22355578
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Cash Price	$7.20

NEBULIZER ADAPTOR KIT NEONATAL

Facility

$19.10

Hospital Charge Code	27755357
Hospital Revenue Code	270
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna of AZ Commercial	$17.19
Rate for Payer: Arizona Complete Health Allwell	$3.06
Rate for Payer: Banner UC Health Medicare	$3.06
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.99
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.06
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.06
Rate for Payer: Cash Price	$15.28
Rate for Payer: Cigna of AZ Commercial	$13.37
Rate for Payer: Devoted Health Medicare	$3.44
Rate for Payer: Humana of AZ Medicare	$3.06
Rate for Payer: Southwest Service Administrators UFCW	$12.99
Rate for Payer: TriWest Medicare	$3.06
Rate for Payer: United Healthcare Commercial	$10.93
Rate for Payer: United Healthcare Medicare	$3.06
Rate for Payer: Veterans Affairs TRICARE	$3.03

NEBULIZER ADAPTOR KIT NEONATAL

Facility

$19.10

Hospital Charge Code	27755357
Hospital Revenue Code	270
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna of AZ Commercial	$17.19
Rate for Payer: Cash Price	$15.28

NEBULIZER PEDIATRIC W PACIFIER

Facility

$55.00

Hospital Charge Code	23811353
Hospital Revenue Code	270
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

NEBULIZER PEDIATRIC W PACIFIER

Facility

$55.00

Hospital Charge Code	23811353
Hospital Revenue Code	270
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

NEEDLE BIOPSY 14Gx4.5 SOFT TISS

Facility

$222.00

Hospital Charge Code	22354955
Hospital Revenue Code	270
Min. Negotiated Rate	$35.16
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Arizona Complete Health Allwell	$35.52
Rate for Payer: Banner UC Health Medicare	$35.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$150.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.52
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cigna of AZ Commercial	$155.40
Rate for Payer: Devoted Health Medicare	$39.96
Rate for Payer: Humana of AZ Medicare	$35.52
Rate for Payer: Southwest Service Administrators UFCW	$150.96
Rate for Payer: TriWest Medicare	$35.52
Rate for Payer: United Healthcare Commercial	$126.98
Rate for Payer: United Healthcare Medicare	$35.52
Rate for Payer: Veterans Affairs TRICARE	$35.16

NEEDLE BIOPSY 14Gx4.5 SOFT TISS

Facility

$222.00

Hospital Charge Code	22354955
Hospital Revenue Code	270
Min. Negotiated Rate	$199.80
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna of AZ Commercial	$199.80
Rate for Payer: Cash Price	$177.60

NEEDLE BIOPSY MAGNUM 18X25

Facility

$156.00

Hospital Charge Code	22354931
Hospital Revenue Code	270
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Arizona Complete Health Allwell	$24.96
Rate for Payer: Banner UC Health Medicare	$24.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$106.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.96
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cigna of AZ Commercial	$109.20
Rate for Payer: Devoted Health Medicare	$28.08
Rate for Payer: Humana of AZ Medicare	$24.96
Rate for Payer: Southwest Service Administrators UFCW	$106.08
Rate for Payer: TriWest Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$89.23
Rate for Payer: United Healthcare Medicare	$24.96
Rate for Payer: Veterans Affairs TRICARE	$24.71

NEEDLE BIOPSY MAGNUM 18X25

Facility

$156.00

Hospital Charge Code	22354931
Hospital Revenue Code	270
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna of AZ Commercial	$140.40
Rate for Payer: Cash Price	$124.80

NEEDLE BIOPSY OF LIVER THROUGH SKIN

Facility

$600.00

Service Code	CPT 47000
Hospital Charge Code	28286993
Hospital Revenue Code	314
Min. Negotiated Rate	$55.77
Max. Negotiated Rate	$2,555.47
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Arizona Complete Health Allwell	$96.00
Rate for Payer: Banner UC Health Medicare	$96.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$408.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$210.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$96.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$55.77
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cigna of AZ Commercial	$390.00
Rate for Payer: Devoted Health Medicare	$108.00
Rate for Payer: Humana of AZ Medicare	$96.00
Rate for Payer: Mercy Care Medicaid	$210.60
Rate for Payer: NaphCare Correctional Healthcare	$210.60
Rate for Payer: Seven Corners Travel Insurance	$2,555.47
Rate for Payer: Southwest Service Administrators UFCW	$408.00
Rate for Payer: TriWest Medicare	$96.00
Rate for Payer: United Healthcare Commercial	$343.20
Rate for Payer: United Healthcare Medicare	$96.00
Rate for Payer: Veterans Affairs TRICARE	$95.04

NEEDLE BIOPSY OF LIVER THROUGH SKIN

Facility

$600.00

Service Code	CPT 47000
Hospital Charge Code	28286993
Hospital Revenue Code	314
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna of AZ Commercial	$540.00
Rate for Payer: Cash Price	$480.00

NEEDLE FASCIAL INCISING 18G/4.5CM COOK

Facility

$155.00

Hospital Charge Code	22354211
Hospital Revenue Code	270
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.80
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: Veterans Affairs TRICARE	$24.55

NEEDLE FASCIAL INCISING 18G/4.5CM COOK

Facility

$155.00

Hospital Charge Code	22354211
Hospital Revenue Code	270
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

NEEDLE GRIPPER PORTACATH PLUS

Facility

$60.00

Hospital Charge Code	23635911
Hospital Revenue Code	270
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: Veterans Affairs TRICARE	$9.50

NEEDLE GRIPPER PORTACATH PLUS

Facility

$60.00

Hospital Charge Code	23635911
Hospital Revenue Code	270
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

NEEDLE GUIDE ENDOCAVITY

Facility

$71.00

Hospital Charge Code	22355364
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Arizona Complete Health Allwell	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$48.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.36
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Humana of AZ Medicare	$11.36
Rate for Payer: Southwest Service Administrators UFCW	$48.28
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: United Healthcare Commercial	$40.61
Rate for Payer: United Healthcare Medicare	$11.36
Rate for Payer: Veterans Affairs TRICARE	$11.25

NEEDLE GUIDE ENDOCAVITY

Facility

$71.00

Hospital Charge Code	22355364
Hospital Revenue Code	270
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Cash Price	$56.80

Needle Insertion without injection 1 or 2 musles

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	24197496
Hospital Revenue Code	420
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Arizona Complete Health Allwell	$9.28
Rate for Payer: Banner UC Health Medicare	$9.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$39.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.28
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Devoted Health Medicare	$10.44
Rate for Payer: Humana of AZ Medicare	$9.28
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$39.44
Rate for Payer: TriWest Medicare	$9.28
Rate for Payer: United Healthcare Commercial	$33.18
Rate for Payer: United Healthcare Medicare	$9.28
Rate for Payer: United Healthcare New Mexico Commercial	$11.02
Rate for Payer: Veterans Affairs TRICARE	$9.19

Needle Insertion without injection 1 or 2 musles

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	24197496
Hospital Revenue Code	420
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Cash Price	$46.40

Needle insertion without injection 3 or more muscles

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	24197497
Hospital Revenue Code	420
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Cash Price	$114.40

Know your out-of-pocket cost for care.

All Charges