Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Neonate With Ecmo

Facility

$261,126.31

Service Code	APR-DRG 5834
Hospital Charge Code	APRDRG5834
Min. Negotiated Rate	$261,126.31
Max. Negotiated Rate	$261,126.31
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$261,126.31
Rate for Payer: Mercy Care Medicaid	$261,126.31
Rate for Payer: NaphCare Correctional Healthcare	$261,126.31

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$19,074.72

Service Code	MSDRG 794
Min. Negotiated Rate	$19,074.72
Max. Negotiated Rate	$19,074.72
Rate for Payer: Seven Corners Travel Insurance	$19,074.72

neostigmine 5 mg/ 10 mL Inj Sol [CQCH]

Facility

$1.83

Service Code	HCPCS J2710
Hospital Charge Code	105933754
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Aetna of AZ Commercial	$1.65
Rate for Payer: Cash Price	$1.47

neostigmine 5 mg/ 10 mL Inj Sol [CQCH]

Facility

$1.83

Service Code	HCPCS J2710
Hospital Charge Code	105933754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.65
Rate for Payer: Aetna of AZ Commercial	$1.65
Rate for Payer: Arizona Complete Health Allwell	$0.29
Rate for Payer: Banner UC Health Medicare	$0.29
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.29
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.29
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna of AZ Commercial	$1.19
Rate for Payer: Devoted Health Medicare	$0.33
Rate for Payer: Humana of AZ Medicare	$0.29
Rate for Payer: Southwest Service Administrators UFCW	$1.24
Rate for Payer: TriWest Medicare	$0.29
Rate for Payer: United Healthcare Commercial	$1.05
Rate for Payer: United Healthcare Medicare	$0.29
Rate for Payer: Veterans Affairs TRICARE	$0.29

NEO TEE RESUSCITATOR INFANT

Facility

$101.00

Hospital Charge Code	22562183
Hospital Revenue Code	272
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Arizona Complete Health Allwell	$16.16
Rate for Payer: Banner UC Health Medicare	$16.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$68.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.16
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cigna of AZ Commercial	$70.70
Rate for Payer: Devoted Health Medicare	$18.18
Rate for Payer: Humana of AZ Medicare	$16.16
Rate for Payer: Southwest Service Administrators UFCW	$68.68
Rate for Payer: TriWest Medicare	$16.16
Rate for Payer: United Healthcare Commercial	$57.77
Rate for Payer: United Healthcare Medicare	$16.16
Rate for Payer: Veterans Affairs TRICARE	$16.00

NEO TEE RESUSCITATOR INFANT

Facility

$101.00

Hospital Charge Code	22562183
Hospital Revenue Code	272
Min. Negotiated Rate	$90.90
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna of AZ Commercial	$90.90
Rate for Payer: Cash Price	$80.80

NEOTRACT UROLIFT SYSTEM

Facility

$2,663.00

Hospital Charge Code	23458651
Hospital Revenue Code	272
Min. Negotiated Rate	$421.82
Max. Negotiated Rate	$2,396.70
Rate for Payer: Aetna of AZ Commercial	$2,396.70
Rate for Payer: Arizona Complete Health Allwell	$426.08
Rate for Payer: Banner UC Health Medicare	$426.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,810.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$426.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$426.08
Rate for Payer: Cash Price	$2,130.40
Rate for Payer: Cigna of AZ Commercial	$1,864.10
Rate for Payer: Devoted Health Medicare	$479.34
Rate for Payer: Humana of AZ Medicare	$426.08
Rate for Payer: Southwest Service Administrators UFCW	$1,810.84
Rate for Payer: TriWest Medicare	$426.08
Rate for Payer: United Healthcare Commercial	$1,523.24
Rate for Payer: United Healthcare Medicare	$426.08
Rate for Payer: Veterans Affairs TRICARE	$421.82

NEOTRACT UROLIFT SYSTEM

Facility

$2,663.00

Hospital Charge Code	23458651
Hospital Revenue Code	272
Min. Negotiated Rate	$2,396.70
Max. Negotiated Rate	$2,396.70
Rate for Payer: Aetna of AZ Commercial	$2,396.70
Rate for Payer: Cash Price	$2,130.40

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87
Rate for Payer: NaphCare Correctional Healthcare	$9,501.87

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$4,672.03
Max. Negotiated Rate	$4,672.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,672.03
Rate for Payer: Mercy Care Medicaid	$4,672.03
Rate for Payer: NaphCare Correctional Healthcare	$4,672.03

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$4,672.03
Max. Negotiated Rate	$4,672.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,672.03
Rate for Payer: Mercy Care Medicaid	$4,672.03
Rate for Payer: NaphCare Correctional Healthcare	$4,672.03

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95
Rate for Payer: NaphCare Correctional Healthcare	$3,229.95

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18
Rate for Payer: NaphCare Correctional Healthcare	$22,136.18

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$4,672.03
Max. Negotiated Rate	$4,672.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,672.03
Rate for Payer: Mercy Care Medicaid	$4,672.03
Rate for Payer: NaphCare Correctional Healthcare	$4,672.03

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18
Rate for Payer: NaphCare Correctional Healthcare	$22,136.18

Nephritis And Nephrosis

Facility

$4,672.03

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$4,672.03
Max. Negotiated Rate	$4,672.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,672.03
Rate for Payer: Mercy Care Medicaid	$4,672.03
Rate for Payer: NaphCare Correctional Healthcare	$4,672.03

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95
Rate for Payer: NaphCare Correctional Healthcare	$3,229.95

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18
Rate for Payer: NaphCare Correctional Healthcare	$22,136.18

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87
Rate for Payer: NaphCare Correctional Healthcare	$9,501.87

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4622
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95
Rate for Payer: NaphCare Correctional Healthcare	$3,229.95

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87
Rate for Payer: NaphCare Correctional Healthcare	$9,501.87

Nephritis And Nephrosis

Facility

$22,136.18

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG4624
Min. Negotiated Rate	$22,136.18
Max. Negotiated Rate	$22,136.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,136.18
Rate for Payer: Mercy Care Medicaid	$22,136.18
Rate for Payer: NaphCare Correctional Healthcare	$22,136.18

Nephritis And Nephrosis

Facility

$9,501.87

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG4623
Min. Negotiated Rate	$9,501.87
Max. Negotiated Rate	$9,501.87
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,501.87
Rate for Payer: Mercy Care Medicaid	$9,501.87
Rate for Payer: NaphCare Correctional Healthcare	$9,501.87

Nephritis And Nephrosis

Facility

$3,229.95

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG4621
Min. Negotiated Rate	$3,229.95
Max. Negotiated Rate	$3,229.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,229.95
Rate for Payer: Mercy Care Medicaid	$3,229.95
Rate for Payer: NaphCare Correctional Healthcare	$3,229.95

NERVE TEASING PREPARATIONS

Facility

$1,084.00

Service Code	CPT 88362
Hospital Charge Code	22545742
Hospital Revenue Code	310
Min. Negotiated Rate	$975.60
Max. Negotiated Rate	$975.60
Rate for Payer: Aetna of AZ Commercial	$975.60
Rate for Payer: Cash Price	$867.20

Know your out-of-pocket cost for care.

All Charges