Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	$22.65
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Arizona Complete Health Allwell	$22.88
Rate for Payer: Banner UC Health Medicare	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.88
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Devoted Health Medicare	$25.74
Rate for Payer: Humana of AZ Medicare	$22.88
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$97.24
Rate for Payer: TriWest Medicare	$22.88
Rate for Payer: United Healthcare Commercial	$81.80
Rate for Payer: United Healthcare Medicare	$22.88
Rate for Payer: United Healthcare New Mexico Commercial	$27.17
Rate for Payer: Veterans Affairs TRICARE	$22.65

NEEDLE INTERSTIM

Facility

$184.00

Hospital Charge Code	22354867
Hospital Revenue Code	270
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Cash Price	$147.20

NEEDLE INTERSTIM

Facility

$184.00

Hospital Charge Code	22354867
Hospital Revenue Code	270
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Arizona Complete Health Allwell	$29.44
Rate for Payer: Banner UC Health Medicare	$29.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.44
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cigna of AZ Commercial	$128.80
Rate for Payer: Devoted Health Medicare	$33.12
Rate for Payer: Humana of AZ Medicare	$29.44
Rate for Payer: Southwest Service Administrators UFCW	$125.12
Rate for Payer: TriWest Medicare	$29.44
Rate for Payer: United Healthcare Commercial	$105.25
Rate for Payer: United Healthcare Medicare	$29.44
Rate for Payer: Veterans Affairs TRICARE	$29.15

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	$113.40
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Cash Price	$100.80

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	$19.53
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$113.40
Rate for Payer: Arizona Complete Health Allwell	$20.16
Rate for Payer: Banner UC Health Medicare	$20.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$85.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19.53
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.16
Rate for Payer: Cash Price	$100.80
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: Devoted Health Medicare	$22.68
Rate for Payer: Humana of AZ Medicare	$20.16
Rate for Payer: Mercy Care Medicaid	$19.53
Rate for Payer: NaphCare Correctional Healthcare	$19.53
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$85.68
Rate for Payer: TriWest Medicare	$20.16
Rate for Payer: United Healthcare Commercial	$3,373.00
Rate for Payer: United Healthcare Medicare	$20.16
Rate for Payer: Veterans Affairs TRICARE	$19.96

Neisseria gonorrhoeae NAA LC

Facility

$412.00

Service Code	CPT 87591
Hospital Charge Code	7486632
Hospital Revenue Code	306
Min. Negotiated Rate	$370.80
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Cash Price	$329.60

Neisseria gonorrhoeae NAA LC

Facility

$412.00

Service Code	CPT 87591
Hospital Charge Code	7486632
Hospital Revenue Code	306
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna of AZ Commercial	$370.80
Rate for Payer: Arizona Complete Health Allwell	$65.92
Rate for Payer: Banner UC Health Medicare	$65.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$280.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.92
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cash Price	$329.60
Rate for Payer: Cigna of AZ Commercial	$267.80
Rate for Payer: Devoted Health Medicare	$74.16
Rate for Payer: Humana of AZ Medicare	$65.92
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$280.16
Rate for Payer: TriWest Medicare	$65.92
Rate for Payer: United Healthcare Commercial	$235.66
Rate for Payer: United Healthcare Medicare	$65.92
Rate for Payer: Veterans Affairs TRICARE	$65.26

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: Arizona Complete Health Allwell	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.49
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.12
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna of AZ Commercial	$0.47
Rate for Payer: Devoted Health Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Southwest Service Administrators UFCW	$0.49
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: United Healthcare Commercial	$0.41
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: Veterans Affairs TRICARE	$0.11

neomycin 500 mg Tab [CQCH]

Facility

$0.72

Service Code	NDC 39822031005
Hospital Charge Code	105933687
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna of AZ Commercial	$0.65
Rate for Payer: Cash Price	$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: Blue Cross Blue Shield of Arizona Health Choice	$27,689.17
Rate for Payer: Mercy Care Medicaid	$27,689.17
Rate for Payer: NaphCare Correctional Healthcare	$27,689.17

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: Blue Cross Blue Shield of Arizona Health Choice	$3,680.25
Rate for Payer: Mercy Care Medicaid	$3,680.25
Rate for Payer: NaphCare Correctional Healthcare	$3,680.25

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: Blue Cross Blue Shield of Arizona Health Choice	$72,106.73
Rate for Payer: Mercy Care Medicaid	$72,106.73
Rate for Payer: NaphCare Correctional Healthcare	$72,106.73

Neonatal Aftercare

Facility

$3,680.25

Service Code	APR-DRG 8631
Hospital Charge Code	APRDRG8632
Min. Negotiated Rate	$3,680.25
Max. Negotiated Rate	$3,680.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,680.25
Rate for Payer: Mercy Care Medicaid	$3,680.25
Rate for Payer: NaphCare Correctional Healthcare	$3,680.25

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: Blue Cross Blue Shield of Arizona Health Choice	$27,689.17
Rate for Payer: Mercy Care Medicaid	$27,689.17
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$72,106.73
Rate for Payer: Mercy Care Medicaid	$72,106.73
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$10,314.79
Rate for Payer: Mercy Care Medicaid	$10,314.79
Rate for Payer: NaphCare Correctional Healthcare	$10,314.79

Neonatal Aftercare

Facility

$27,689.17

Service Code	APR-DRG 8633
Hospital Charge Code	APRDRG8632
Min. Negotiated Rate	$27,689.17
Max. Negotiated Rate	$27,689.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,689.17
Rate for Payer: Mercy Care Medicaid	$27,689.17
Rate for Payer: NaphCare Correctional Healthcare	$27,689.17

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: Blue Cross Blue Shield of Arizona Health Choice	$27,689.17
Rate for Payer: Mercy Care Medicaid	$27,689.17
Rate for Payer: NaphCare Correctional Healthcare	$27,689.17

Neonatal Aftercare

Facility

$3,680.25

Service Code	APR-DRG 8631
Hospital Charge Code	APRDRG8631
Min. Negotiated Rate	$3,680.25
Max. Negotiated Rate	$3,680.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,680.25
Rate for Payer: Mercy Care Medicaid	$3,680.25
Rate for Payer: NaphCare Correctional Healthcare	$3,680.25

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: Blue Cross Blue Shield of Arizona Health Choice	$10,314.79
Rate for Payer: Mercy Care Medicaid	$10,314.79
Rate for Payer: NaphCare Correctional Healthcare	$10,314.79

Neonatal Aftercare

Facility

$10,314.79

Service Code	APR-DRG 8632
Hospital Charge Code	APRDRG8633
Min. Negotiated Rate	$10,314.79
Max. Negotiated Rate	$10,314.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,314.79
Rate for Payer: Mercy Care Medicaid	$10,314.79
Rate for Payer: NaphCare Correctional Healthcare	$10,314.79

Neonatal Aftercare

Facility

$3,680.25

Service Code	APR-DRG 8631
Hospital Charge Code	APRDRG8634
Min. Negotiated Rate	$3,680.25
Max. Negotiated Rate	$3,680.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,680.25
Rate for Payer: Mercy Care Medicaid	$3,680.25
Rate for Payer: NaphCare Correctional Healthcare	$3,680.25

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: Blue Cross Blue Shield of Arizona Health Choice	$72,106.73
Rate for Payer: Mercy Care Medicaid	$72,106.73
Rate for Payer: NaphCare Correctional Healthcare	$72,106.73

Neonatal Aftercare

Facility

$10,314.79

Service Code	APR-DRG 8632
Hospital Charge Code	APRDRG8632
Min. Negotiated Rate	$10,314.79
Max. Negotiated Rate	$10,314.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,314.79
Rate for Payer: Mercy Care Medicaid	$10,314.79
Rate for Payer: NaphCare Correctional Healthcare	$10,314.79

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: Blue Cross Blue Shield of Arizona Health Choice	$72,106.73
Rate for Payer: Mercy Care Medicaid	$72,106.73
Rate for Payer: NaphCare Correctional Healthcare	$72,106.73

Know your out-of-pocket cost for care.

All Charges