Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ceFAZolin 2 gm REC [CQCH]

Facility

$4.28

Service Code	HCPCS J0690
Hospital Charge Code	213338088
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna of AZ Commercial	$3.85
Rate for Payer: Cash Price	$3.42

cefdinir 125 mg/5 mL REC[CQCH]

Facility

$0.09

Service Code	NDC 16714039202
Hospital Charge Code	160942771
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Cash Price	$0.07

cefdinir 125 mg/5 mL REC[CQCH]

Facility

$0.09

Service Code	NDC 16714039202
Hospital Charge Code	160942771
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
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	$0.06
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	$0.06
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.06
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

cefdinir 300 mg Cap [CQCH]

Facility

$1.92

Service Code	NDC 16714039102
Hospital Charge Code	107734593
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Aetna of AZ Commercial	$1.73
Rate for Payer: Cash Price	$1.54

cefdinir 300 mg Cap [CQCH]

Facility

$1.92

Service Code	NDC 16714039102
Hospital Charge Code	107734593
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$1.73
Rate for Payer: Aetna of AZ Commercial	$1.73
Rate for Payer: Arizona Complete Health Allwell	$0.31
Rate for Payer: Banner UC Health Medicare	$0.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.31
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.31
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.31
Rate for Payer: Cash Price	$1.54
Rate for Payer: Cigna of AZ Commercial	$1.25
Rate for Payer: Devoted Health Medicare	$0.35
Rate for Payer: Humana of AZ Medicare	$0.31
Rate for Payer: Southwest Service Administrators UFCW	$1.31
Rate for Payer: TriWest Medicare	$0.31
Rate for Payer: United Healthcare Commercial	$1.10
Rate for Payer: United Healthcare Medicare	$0.31
Rate for Payer: Veterans Affairs TRICARE	$0.30

cefepime 1 gm Inj [CQCH]

Facility

$3.96

Service Code	HCPCS J0692
Hospital Charge Code	105914993
Hospital Revenue Code	250
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of AZ Commercial	$3.56
Rate for Payer: Cash Price	$3.17

cefepime 1 gm Inj [CQCH]

Facility

$3.96

Service Code	HCPCS J0692
Hospital Charge Code	105914993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of AZ Commercial	$3.56
Rate for Payer: Arizona Complete Health Allwell	$0.63
Rate for Payer: Banner UC Health Medicare	$0.63
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.63
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.63
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cigna of AZ Commercial	$2.57
Rate for Payer: Devoted Health Medicare	$0.71
Rate for Payer: Humana of AZ Medicare	$0.63
Rate for Payer: Southwest Service Administrators UFCW	$2.69
Rate for Payer: TriWest Medicare	$0.63
Rate for Payer: United Healthcare Commercial	$2.27
Rate for Payer: United Healthcare Medicare	$0.63
Rate for Payer: Veterans Affairs TRICARE	$0.63

cefepime 2 gm Inj [CQCH]

Facility

$9.03

Service Code	HCPCS J0692
Hospital Charge Code	105914920
Hospital Revenue Code	250
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$8.13
Rate for Payer: Aetna of AZ Commercial	$8.13
Rate for Payer: Cash Price	$7.22

cefepime 2 gm Inj [CQCH]

Facility

$9.03

Service Code	HCPCS J0692
Hospital Charge Code	105914920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$8.13
Rate for Payer: Aetna of AZ Commercial	$8.13
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	$6.14
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	$7.22
Rate for Payer: Cigna of AZ Commercial	$5.87
Rate for Payer: Devoted Health Medicare	$1.63
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Southwest Service Administrators UFCW	$6.14
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: United Healthcare Commercial	$5.17
Rate for Payer: United Healthcare Medicare	$1.44
Rate for Payer: Veterans Affairs TRICARE	$1.43

cefOXitin 1 gm Inj [CQCH]

Facility

$3.63

Service Code	HCPCS J0694
Hospital Charge Code	105915139
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna of AZ Commercial	$3.27
Rate for Payer: Arizona Complete Health Allwell	$0.58
Rate for Payer: Banner UC Health Medicare	$0.58
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.47
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.58
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.58
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cigna of AZ Commercial	$2.36
Rate for Payer: Devoted Health Medicare	$0.65
Rate for Payer: Humana of AZ Medicare	$0.58
Rate for Payer: Southwest Service Administrators UFCW	$2.47
Rate for Payer: TriWest Medicare	$0.58
Rate for Payer: United Healthcare Commercial	$2.08
Rate for Payer: United Healthcare Medicare	$0.58
Rate for Payer: Veterans Affairs TRICARE	$0.57

cefOXitin 1 gm Inj [CQCH]

Facility

$3.63

Service Code	HCPCS J0694
Hospital Charge Code	105915139
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna of AZ Commercial	$3.27
Rate for Payer: Cash Price	$2.90

cefOXitin 2 gm Inj [CQCH]

Facility

$5.41

Service Code	HCPCS J0694
Hospital Charge Code	105915066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$4.87
Rate for Payer: Aetna of AZ Commercial	$4.87
Rate for Payer: Arizona Complete Health Allwell	$0.87
Rate for Payer: Banner UC Health Medicare	$0.87
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.87
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.87
Rate for Payer: Cash Price	$4.33
Rate for Payer: Cigna of AZ Commercial	$3.52
Rate for Payer: Devoted Health Medicare	$0.97
Rate for Payer: Humana of AZ Medicare	$0.87
Rate for Payer: Southwest Service Administrators UFCW	$3.68
Rate for Payer: TriWest Medicare	$0.87
Rate for Payer: United Healthcare Commercial	$3.09
Rate for Payer: United Healthcare Medicare	$0.87
Rate for Payer: Veterans Affairs TRICARE	$0.86

cefOXitin 2 gm Inj [CQCH]

Facility

$5.41

Service Code	HCPCS J0694
Hospital Charge Code	105915066
Hospital Revenue Code	250
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$4.87
Rate for Payer: Aetna of AZ Commercial	$4.87
Rate for Payer: Cash Price	$4.33

cefTAZidime 1 gm REC[CQCH]

Facility

$2.97

Service Code	HCPCS J0713
Hospital Charge Code	141532362
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna of AZ Commercial	$2.67
Rate for Payer: Arizona Complete Health Allwell	$0.48
Rate for Payer: Banner UC Health Medicare	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.48
Rate for Payer: Cash Price	$2.38
Rate for Payer: Cigna of AZ Commercial	$1.93
Rate for Payer: Devoted Health Medicare	$0.53
Rate for Payer: Humana of AZ Medicare	$0.48
Rate for Payer: Southwest Service Administrators UFCW	$2.02
Rate for Payer: TriWest Medicare	$0.48
Rate for Payer: United Healthcare Commercial	$1.70
Rate for Payer: United Healthcare Medicare	$0.48
Rate for Payer: Veterans Affairs TRICARE	$0.47

cefTAZidime 1 gm REC[CQCH]

Facility

$2.97

Service Code	HCPCS J0713
Hospital Charge Code	141532362
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna of AZ Commercial	$2.67
Rate for Payer: Cash Price	$2.38

cefTRIAXone 1 gm Inj [CQCH]

Facility

$2.77

Service Code	HCPCS J0696
Hospital Charge Code	105915652
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$2.49
Rate for Payer: Aetna of AZ Commercial	$2.49
Rate for Payer: Cash Price	$2.21

cefTRIAXone 1 gm Inj [CQCH]

Facility

$2.77

Service Code	HCPCS J0696
Hospital Charge Code	105915652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$2.49
Rate for Payer: Aetna of AZ Commercial	$2.49
Rate for Payer: Arizona Complete Health Allwell	$0.44
Rate for Payer: Banner UC Health Medicare	$0.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.44
Rate for Payer: Cash Price	$2.21
Rate for Payer: Cigna of AZ Commercial	$1.80
Rate for Payer: Devoted Health Medicare	$0.50
Rate for Payer: Humana of AZ Medicare	$0.44
Rate for Payer: Southwest Service Administrators UFCW	$1.88
Rate for Payer: TriWest Medicare	$0.44
Rate for Payer: United Healthcare Commercial	$1.58
Rate for Payer: United Healthcare Medicare	$0.44
Rate for Payer: Veterans Affairs TRICARE	$0.44

cefTRIAXone 2 gm Inj [CQCH]

Facility

$2.13

Service Code	HCPCS J0696
Hospital Charge Code	105915506
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of AZ Commercial	$1.92
Rate for Payer: Cash Price	$1.70

cefTRIAXone 2 gm Inj [CQCH]

Facility

$2.13

Service Code	HCPCS J0696
Hospital Charge Code	105915506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of AZ Commercial	$1.92
Rate for Payer: Arizona Complete Health Allwell	$0.34
Rate for Payer: Banner UC Health Medicare	$0.34
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.45
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.34
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.34
Rate for Payer: Cash Price	$1.70
Rate for Payer: Cigna of AZ Commercial	$1.38
Rate for Payer: Devoted Health Medicare	$0.38
Rate for Payer: Humana of AZ Medicare	$0.34
Rate for Payer: Southwest Service Administrators UFCW	$1.45
Rate for Payer: TriWest Medicare	$0.34
Rate for Payer: United Healthcare Commercial	$1.22
Rate for Payer: United Healthcare Medicare	$0.34
Rate for Payer: Veterans Affairs TRICARE	$0.34

cefTRIAXone 500 mg Inj [CQCH]

Facility

$0.92

Service Code	HCPCS J0696
Hospital Charge Code	105915433
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of AZ Commercial	$0.83
Rate for Payer: Arizona Complete Health Allwell	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.63
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.15
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.15
Rate for Payer: Cash Price	$0.74
Rate for Payer: Cigna of AZ Commercial	$0.60
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Southwest Service Administrators UFCW	$0.63
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: United Healthcare Commercial	$0.53
Rate for Payer: United Healthcare Medicare	$0.15
Rate for Payer: Veterans Affairs TRICARE	$0.15

cefTRIAXone 500 mg Inj [CQCH]

Facility

$0.92

Service Code	HCPCS J0696
Hospital Charge Code	105915433
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna of AZ Commercial	$0.83
Rate for Payer: Cash Price	$0.74

cefTRIAXone INJ : 1 GM VIAL

Facility

$35.00

Hospital Charge Code	22331184
Hospital Revenue Code	250
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Cash Price	$28.00

cefTRIAXone INJ : 1 GM VIAL

Facility

$35.00

Hospital Charge Code	22331184
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna of AZ Commercial	$31.50
Rate for Payer: Arizona Complete Health Allwell	$5.60
Rate for Payer: Banner UC Health Medicare	$5.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$23.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.60
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cigna of AZ Commercial	$22.75
Rate for Payer: Devoted Health Medicare	$6.30
Rate for Payer: Humana of AZ Medicare	$5.60
Rate for Payer: Southwest Service Administrators UFCW	$23.80
Rate for Payer: TriWest Medicare	$5.60
Rate for Payer: United Healthcare Commercial	$20.02
Rate for Payer: United Healthcare Medicare	$5.60
Rate for Payer: Veterans Affairs TRICARE	$5.54

cefuroxime 250 mg Tab [CQCH]

Facility

$1.65

Service Code	NDC 16714040002
Hospital Charge Code	105915725
Hospital Revenue Code	251
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of AZ Commercial	$1.49
Rate for Payer: Cash Price	$1.32

cefuroxime 250 mg Tab [CQCH]

Facility

$1.65

Service Code	NDC 16714040002
Hospital Charge Code	105915725
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.49
Rate for Payer: Aetna of AZ Commercial	$1.49
Rate for Payer: Arizona Complete Health Allwell	$0.26
Rate for Payer: Banner UC Health Medicare	$0.26
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.26
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.26
Rate for Payer: Cash Price	$1.32
Rate for Payer: Cigna of AZ Commercial	$1.07
Rate for Payer: Devoted Health Medicare	$0.30
Rate for Payer: Humana of AZ Medicare	$0.26
Rate for Payer: Southwest Service Administrators UFCW	$1.12
Rate for Payer: TriWest Medicare	$0.26
Rate for Payer: United Healthcare Commercial	$0.94
Rate for Payer: United Healthcare Medicare	$0.26
Rate for Payer: Veterans Affairs TRICARE	$0.26

Know your out-of-pocket cost for care.

All Charges