Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

nicotine 7 mg patch [CQCH]

Facility

$1.76

Service Code	NDC 49348014646
Hospital Charge Code	108075360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1.58
Rate for Payer: Aetna of AZ Commercial	$1.58
Rate for Payer: Arizona Complete Health Allwell	$0.28
Rate for Payer: Banner UC Health Medicare	$0.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.28
Rate for Payer: Cash Price	$1.41
Rate for Payer: Cigna of AZ Commercial	$1.14
Rate for Payer: Devoted Health Medicare	$0.32
Rate for Payer: Humana of AZ Medicare	$0.28
Rate for Payer: Southwest Service Administrators UFCW	$1.20
Rate for Payer: TriWest Medicare	$0.28
Rate for Payer: United Healthcare Commercial	$1.01
Rate for Payer: United Healthcare Medicare	$0.28
Rate for Payer: Veterans Affairs TRICARE	$0.28

nicotine 7 mg patch [CQCH]

Facility

$1.76

Service Code	NDC 49348014646
Hospital Charge Code	108075360
Hospital Revenue Code	251
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: Aetna of AZ Commercial	$1.58
Rate for Payer: Cash Price	$1.41

nitrofurantoin macrocrystals 100 mg Cap UD[CQCH]

Facility

$2.06

Service Code	NDC 60687048301
Hospital Charge Code	181685120
Hospital Revenue Code	251
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna of AZ Commercial	$1.85
Rate for Payer: Arizona Complete Health Allwell	$0.33
Rate for Payer: Banner UC Health Medicare	$0.33
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.33
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.33
Rate for Payer: Cash Price	$1.65
Rate for Payer: Cigna of AZ Commercial	$1.34
Rate for Payer: Devoted Health Medicare	$0.37
Rate for Payer: Humana of AZ Medicare	$0.33
Rate for Payer: Southwest Service Administrators UFCW	$1.40
Rate for Payer: TriWest Medicare	$0.33
Rate for Payer: United Healthcare Commercial	$1.18
Rate for Payer: United Healthcare Medicare	$0.33
Rate for Payer: Veterans Affairs TRICARE	$0.33

nitrofurantoin macrocrystals 100 mg Cap UD[CQCH]

Facility

$2.06

Service Code	NDC 60687048301
Hospital Charge Code	181685120
Hospital Revenue Code	251
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna of AZ Commercial	$1.85
Rate for Payer: Cash Price	$1.65

nitroglycerin 0.2 mg/hr patch [CQCH]

Facility

$0.46

Service Code	NDC 47781029703
Hospital Charge Code	105934020
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Arizona Complete Health Allwell	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.07
Rate for Payer: Cash Price	$0.37
Rate for Payer: Cigna of AZ Commercial	$0.30
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.31
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.26
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.07

nitroglycerin 0.2 mg/hr patch [CQCH]

Facility

$0.46

Service Code	NDC 47781029703
Hospital Charge Code	105934020
Hospital Revenue Code	251
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Cash Price	$0.37

nitroglycerin 0.4 mg/hr Patch [CQCH]

Facility

$0.49

Service Code	NDC 47781029803
Hospital Charge Code	105933959
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of AZ Commercial	$0.44
Rate for Payer: Arizona Complete Health Allwell	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.08
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of AZ Commercial	$0.32
Rate for Payer: Devoted Health Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Southwest Service Administrators UFCW	$0.33
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: United Healthcare Commercial	$0.28
Rate for Payer: United Healthcare Medicare	$0.08
Rate for Payer: Veterans Affairs TRICARE	$0.08

nitroglycerin 0.4 mg/hr Patch [CQCH]

Facility

$0.49

Service Code	NDC 47781029803
Hospital Charge Code	105933959
Hospital Revenue Code	251
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of AZ Commercial	$0.44
Rate for Payer: Cash Price	$0.39

nitroglycerin 0.4 mg sublingual Tab [CQCH]

Facility

$0.57

Service Code	NDC 68462063945
Hospital Charge Code	105934081
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.51
Rate for Payer: Aetna of AZ Commercial	$0.51
Rate for Payer: Arizona Complete Health Allwell	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.09
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.09
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of AZ Commercial	$0.37
Rate for Payer: Devoted Health Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Southwest Service Administrators UFCW	$0.39
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: United Healthcare Commercial	$0.33
Rate for Payer: United Healthcare Medicare	$0.09
Rate for Payer: Veterans Affairs TRICARE	$0.09

nitroglycerin 0.4 mg sublingual Tab [CQCH]

Facility

$0.57

Service Code	NDC 68462063945
Hospital Charge Code	105934081
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Aetna of AZ Commercial	$0.51
Rate for Payer: Cash Price	$0.45

nitroglycerin 200 mcg/ mL-250ml IV bottle [CQCH]

Facility

$0.08

Service Code	NDC 338104902
Hospital Charge Code	105934213
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.05
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

nitroglycerin 200 mcg/ mL-250ml IV bottle [CQCH]

Facility

$0.08

Service Code	NDC 338104902
Hospital Charge Code	105934213
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Cash Price	$0.07

nitroglycerin 2% Top Oint [CQCH]

Facility

$1.98

Service Code	NDC 281032608
Hospital Charge Code	105934148
Hospital Revenue Code	251
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of AZ Commercial	$1.78
Rate for Payer: Arizona Complete Health Allwell	$0.32
Rate for Payer: Banner UC Health Medicare	$0.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.35
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.32
Rate for Payer: Cash Price	$1.58
Rate for Payer: Cigna of AZ Commercial	$1.29
Rate for Payer: Devoted Health Medicare	$0.36
Rate for Payer: Humana of AZ Medicare	$0.32
Rate for Payer: Southwest Service Administrators UFCW	$1.35
Rate for Payer: TriWest Medicare	$0.32
Rate for Payer: United Healthcare Commercial	$1.13
Rate for Payer: United Healthcare Medicare	$0.32
Rate for Payer: Veterans Affairs TRICARE	$0.31

nitroglycerin 2% Top Oint [CQCH]

Facility

$1.98

Service Code	NDC 281032608
Hospital Charge Code	105934148
Hospital Revenue Code	251
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna of AZ Commercial	$1.78
Rate for Payer: Cash Price	$1.58

nitroprusside 50 mg/ 2 mL IV Sol [CQCH]

Facility

$18.60

Service Code	NDC 409302401
Hospital Charge Code	105934276
Hospital Revenue Code	251
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$16.74
Rate for Payer: Aetna of AZ Commercial	$16.74
Rate for Payer: Arizona Complete Health Allwell	$2.98
Rate for Payer: Banner UC Health Medicare	$2.98
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$12.65
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.98
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.98
Rate for Payer: Cash Price	$14.88
Rate for Payer: Cigna of AZ Commercial	$12.09
Rate for Payer: Devoted Health Medicare	$3.35
Rate for Payer: Humana of AZ Medicare	$2.98
Rate for Payer: Southwest Service Administrators UFCW	$12.65
Rate for Payer: TriWest Medicare	$2.98
Rate for Payer: United Healthcare Commercial	$10.64
Rate for Payer: United Healthcare Medicare	$2.98
Rate for Payer: Veterans Affairs TRICARE	$2.95

nitroprusside 50 mg/ 2 mL IV Sol [CQCH]

Facility

$18.60

Service Code	NDC 409302401
Hospital Charge Code	105934276
Hospital Revenue Code	251
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$16.74
Rate for Payer: Aetna of AZ Commercial	$16.74
Rate for Payer: Cash Price	$14.88

NMR LipoProfile LC

Facility

$217.00

Service Code	CPT 80061
Hospital Charge Code	2269488
Hospital Revenue Code	301
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Arizona Complete Health Allwell	$34.72
Rate for Payer: Banner UC Health Medicare	$34.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$147.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.72
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cigna of AZ Commercial	$141.05
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Humana of AZ Medicare	$34.72
Rate for Payer: Seven Corners Travel Insurance	$19.42
Rate for Payer: Southwest Service Administrators UFCW	$147.56
Rate for Payer: TriWest Medicare	$34.72
Rate for Payer: United Healthcare Commercial	$124.12
Rate for Payer: United Healthcare Medicare	$34.72
Rate for Payer: Veterans Affairs TRICARE	$34.37

NMR LipoProfile LC

Facility

$217.00

Service Code	CPT 80061
Hospital Charge Code	2269488
Hospital Revenue Code	301
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$195.30
Rate for Payer: Aetna of AZ Commercial	$195.30
Rate for Payer: Cash Price	$173.60

NOMOLINE HH AIRWAY ADAPTER INF NEO

Facility

$81.51

Hospital Charge Code	27816998
Hospital Revenue Code	270
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$73.36
Rate for Payer: Aetna of AZ Commercial	$73.36
Rate for Payer: Arizona Complete Health Allwell	$13.04
Rate for Payer: Banner UC Health Medicare	$13.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$55.43
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.04
Rate for Payer: Cash Price	$65.21
Rate for Payer: Cigna of AZ Commercial	$57.06
Rate for Payer: Devoted Health Medicare	$14.67
Rate for Payer: Humana of AZ Medicare	$13.04
Rate for Payer: Southwest Service Administrators UFCW	$55.43
Rate for Payer: TriWest Medicare	$13.04
Rate for Payer: United Healthcare Commercial	$46.62
Rate for Payer: United Healthcare Medicare	$13.04
Rate for Payer: Veterans Affairs TRICARE	$12.91

NOMOLINE HH AIRWAY ADAPTER INF NEO

Facility

$81.51

Hospital Charge Code	27816998
Hospital Revenue Code	270
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Aetna of AZ Commercial	$73.36
Rate for Payer: Cash Price	$65.21

NOMOLINE HH AIRWAY ADAPTER SET ADULT AND PED 7FT

Facility

$91.00

Hospital Charge Code	27476057
Hospital Revenue Code	270
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Arizona Complete Health Allwell	$14.56
Rate for Payer: Banner UC Health Medicare	$14.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.56
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$63.70
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Humana of AZ Medicare	$14.56
Rate for Payer: Southwest Service Administrators UFCW	$61.88
Rate for Payer: TriWest Medicare	$14.56
Rate for Payer: United Healthcare Commercial	$52.05
Rate for Payer: United Healthcare Medicare	$14.56
Rate for Payer: Veterans Affairs TRICARE	$14.41

NOMOLINE HH AIRWAY ADAPTER SET ADULT AND PED 7FT

Facility

$91.00

Hospital Charge Code	27476057
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Cash Price	$72.80

NOMOLINE HH NASAL ORAL CO2 CANNULA ADULT

Facility

$68.00

Hospital Charge Code	27548601
Hospital Revenue Code	270
Min. Negotiated Rate	$10.77
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna of AZ Commercial	$61.20
Rate for Payer: Arizona Complete Health Allwell	$10.88
Rate for Payer: Banner UC Health Medicare	$10.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$46.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.88
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cigna of AZ Commercial	$47.60
Rate for Payer: Devoted Health Medicare	$12.24
Rate for Payer: Humana of AZ Medicare	$10.88
Rate for Payer: Southwest Service Administrators UFCW	$46.24
Rate for Payer: TriWest Medicare	$10.88
Rate for Payer: United Healthcare Commercial	$38.90
Rate for Payer: United Healthcare Medicare	$10.88
Rate for Payer: Veterans Affairs TRICARE	$10.77

NOMOLINE HH NASAL ORAL CO2 CANNULA ADULT

Facility

$68.00

Hospital Charge Code	27548601
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna of AZ Commercial	$61.20
Rate for Payer: Cash Price	$54.40

NOMOLINE LH NASAL ORAL CO2 CANNUAL PED 7FT

Facility

$74.00

Hospital Charge Code	27476056
Hospital Revenue Code	270
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Cash Price	$59.20

Know your out-of-pocket cost for care.

All Charges