Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

rabies immune globulin, human 300 units/mL 5 mL Sol[CQCH]

Facility

$3,231.55

Service Code	NDC 13533031805
Hospital Charge Code	135027576
Hospital Revenue Code	250
Min. Negotiated Rate	$484.73
Max. Negotiated Rate	$2,908.40
Rate for Payer: Aetna of AZ Commercial	$2,908.40
Rate for Payer: Aetna of AZ Medicare	$904.83
Rate for Payer: Allwell Medicare	$484.73
Rate for Payer: Amerigroup Medicare	$484.73
Rate for Payer: APIPA Medicare/Medicaid	$1,206.98
Rate for Payer: AZCH Complete Medicare	$484.73
Rate for Payer: Banner UC Health Medicare	$484.73
Rate for Payer: Bisbee Police All Plans	$840.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,197.45
Rate for Payer: Cash Price	$2,585.24
Rate for Payer: Cigna of AZ Commercial	$2,100.51
Rate for Payer: Copperpoint Commercial	$799.81
Rate for Payer: Health Net of AZ Commercial	$1,938.93
Rate for Payer: Health Net of AZ Medicare	$904.83
Rate for Payer: Humana of AZ Medicare	$484.73
Rate for Payer: Self Pay Self Pay	$2,585.24
Rate for Payer: TriWest Medicare	$484.73
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,883.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$581.68

rabies immune globulin, human 300 units/mL 5 mL Sol[CQCH]

Facility

$3,231.55

Service Code	NDC 13533031805
Hospital Charge Code	135027576
Hospital Revenue Code	250
Min. Negotiated Rate	$840.20
Max. Negotiated Rate	$2,908.40
Rate for Payer: Aetna of AZ Commercial	$2,908.40
Rate for Payer: Bisbee Police All Plans	$840.20
Rate for Payer: Cash Price	$2,585.24
Rate for Payer: Self Pay Self Pay	$2,585.24

Rabies Neut. Abs Titrat. (RFFIT) LC

Facility

$109.00

Service Code	CPT 86382
Hospital Charge Code	22617332
Hospital Revenue Code	300
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Aetna of AZ Medicare	$30.52
Rate for Payer: AHCCCS Medicaid	$16.91
Rate for Payer: Allwell Medicaid	$16.91
Rate for Payer: Allwell Medicare	$16.35
Rate for Payer: Amerigroup Medicare	$16.35
Rate for Payer: APIPA Medicare/Medicaid	$40.71
Rate for Payer: AZCH Complete Medicaid	$16.91
Rate for Payer: AZCH Complete Medicare	$16.35
Rate for Payer: Banner UC Health Medicaid	$16.91
Rate for Payer: Banner UC Health Medicare	$16.35
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.12
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cigna of AZ Commercial	$70.85
Rate for Payer: Copperpoint Commercial	$26.98
Rate for Payer: Health Net of AZ Commercial	$65.40
Rate for Payer: Health Net of AZ Medicare	$30.52
Rate for Payer: Humana of AZ Medicare	$16.35
Rate for Payer: Mercy Care Medicaid	$16.91
Rate for Payer: Self Pay Self Pay	$87.20
Rate for Payer: TriWest Medicare	$16.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$63.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.62

Rabies Neut. Abs Titrat. (RFFIT) LC

Facility

$109.00

Service Code	CPT 86382
Hospital Charge Code	22617332
Hospital Revenue Code	300
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna of AZ Commercial	$98.10
Rate for Payer: Bisbee Police All Plans	$28.34
Rate for Payer: Cash Price	$87.20
Rate for Payer: Self Pay Self Pay	$87.20

racepinephrine 2.25% Inh Sol UD [CQCH]

Facility

$6.62

Service Code	NDC 487278401
Hospital Charge Code	105939234
Hospital Revenue Code	251
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna of AZ Commercial	$5.96
Rate for Payer: Aetna of AZ Medicare	$1.85
Rate for Payer: Allwell Medicare	$0.99
Rate for Payer: Amerigroup Medicare	$0.99
Rate for Payer: APIPA Medicare/Medicaid	$2.47
Rate for Payer: AZCH Complete Medicare	$0.99
Rate for Payer: Banner UC Health Medicare	$0.99
Rate for Payer: Bisbee Police All Plans	$1.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.50
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cigna of AZ Commercial	$4.30
Rate for Payer: Copperpoint Commercial	$1.64
Rate for Payer: Health Net of AZ Commercial	$3.97
Rate for Payer: Health Net of AZ Medicare	$1.85
Rate for Payer: Humana of AZ Medicare	$0.99
Rate for Payer: Self Pay Self Pay	$5.30
Rate for Payer: TriWest Medicare	$0.99
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.19

racepinephrine 2.25% Inh Sol UD [CQCH]

Facility

$6.62

Service Code	NDC 487278401
Hospital Charge Code	105939234
Hospital Revenue Code	251
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna of AZ Commercial	$5.96
Rate for Payer: Bisbee Police All Plans	$1.72
Rate for Payer: Cash Price	$5.30
Rate for Payer: Self Pay Self Pay	$5.30

Radiology Misc

Facility

$862.00

Service Code	CPT 93971 RT
Hospital Charge Code	22828024
Hospital Revenue Code	921
Min. Negotiated Rate	$224.12
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Cash Price	$689.60
Rate for Payer: Self Pay Self Pay	$689.60

Radiology Misc

Facility

$862.00

Service Code	CPT 93971 RT
Hospital Charge Code	22828024
Hospital Revenue Code	921
Min. Negotiated Rate	$129.30
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Aetna of AZ Medicare	$241.36
Rate for Payer: Allwell Medicare	$129.30
Rate for Payer: Amerigroup Medicare	$129.30
Rate for Payer: APIPA Medicare/Medicaid	$321.96
Rate for Payer: AZCH Complete Medicare	$129.30
Rate for Payer: Banner UC Health Medicare	$129.30
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$586.16
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cigna of AZ Commercial	$603.40
Rate for Payer: Copperpoint Commercial	$213.34
Rate for Payer: Health Net of AZ Commercial	$517.20
Rate for Payer: Health Net of AZ Medicare	$241.36
Rate for Payer: Humana of AZ Medicare	$129.30
Rate for Payer: Self Pay Self Pay	$689.60
Rate for Payer: TriWest Medicare	$129.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$502.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.16

Radiotherapy

Facility

$16,027.69

Service Code	APR-DRG 6923
Hospital Charge Code	APRDRG6922
Min. Negotiated Rate	$16,027.69
Max. Negotiated Rate	$16,027.69
Rate for Payer: AHCCCS Medicaid	$16,027.69
Rate for Payer: Allwell Medicaid	$16,027.69
Rate for Payer: AZCH Complete Medicaid	$16,027.69
Rate for Payer: Banner UC Health Medicaid	$16,027.69
Rate for Payer: Mercy Care Medicaid	$16,027.69

Radiotherapy

Facility

$25,806.61

Service Code	APR-DRG 6924
Hospital Charge Code	APRDRG6921
Min. Negotiated Rate	$25,806.61
Max. Negotiated Rate	$25,806.61
Rate for Payer: AHCCCS Medicaid	$25,806.61
Rate for Payer: Allwell Medicaid	$25,806.61
Rate for Payer: AZCH Complete Medicaid	$25,806.61
Rate for Payer: Banner UC Health Medicaid	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61

Radiotherapy

Facility

$5,319.42

Service Code	APR-DRG 6921
Hospital Charge Code	APRDRG6921
Min. Negotiated Rate	$5,319.42
Max. Negotiated Rate	$5,319.42
Rate for Payer: AHCCCS Medicaid	$5,319.42
Rate for Payer: Allwell Medicaid	$5,319.42
Rate for Payer: AZCH Complete Medicaid	$5,319.42
Rate for Payer: Banner UC Health Medicaid	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42

Radiotherapy

Facility

$5,319.42

Service Code	APR-DRG 6921
Hospital Charge Code	APRDRG6922
Min. Negotiated Rate	$5,319.42
Max. Negotiated Rate	$5,319.42
Rate for Payer: AHCCCS Medicaid	$5,319.42
Rate for Payer: Allwell Medicaid	$5,319.42
Rate for Payer: AZCH Complete Medicaid	$5,319.42
Rate for Payer: Banner UC Health Medicaid	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42

Radiotherapy

Facility

$25,806.61

Service Code	APR-DRG 6924
Hospital Charge Code	APRDRG6922
Min. Negotiated Rate	$25,806.61
Max. Negotiated Rate	$25,806.61
Rate for Payer: AHCCCS Medicaid	$25,806.61
Rate for Payer: Allwell Medicaid	$25,806.61
Rate for Payer: AZCH Complete Medicaid	$25,806.61
Rate for Payer: Banner UC Health Medicaid	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61

Radiotherapy

Facility

$9,793.65

Service Code	APR-DRG 6922
Hospital Charge Code	APRDRG6922
Min. Negotiated Rate	$9,793.65
Max. Negotiated Rate	$9,793.65
Rate for Payer: AHCCCS Medicaid	$9,793.65
Rate for Payer: Allwell Medicaid	$9,793.65
Rate for Payer: AZCH Complete Medicaid	$9,793.65
Rate for Payer: Banner UC Health Medicaid	$9,793.65
Rate for Payer: Mercy Care Medicaid	$9,793.65

Radiotherapy

Facility

$5,319.42

Service Code	APR-DRG 6921
Hospital Charge Code	APRDRG6923
Min. Negotiated Rate	$5,319.42
Max. Negotiated Rate	$5,319.42
Rate for Payer: AHCCCS Medicaid	$5,319.42
Rate for Payer: Allwell Medicaid	$5,319.42
Rate for Payer: AZCH Complete Medicaid	$5,319.42
Rate for Payer: Banner UC Health Medicaid	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42

Radiotherapy

Facility

$16,027.69

Service Code	APR-DRG 6923
Hospital Charge Code	APRDRG6923
Min. Negotiated Rate	$16,027.69
Max. Negotiated Rate	$16,027.69
Rate for Payer: AHCCCS Medicaid	$16,027.69
Rate for Payer: Allwell Medicaid	$16,027.69
Rate for Payer: AZCH Complete Medicaid	$16,027.69
Rate for Payer: Banner UC Health Medicaid	$16,027.69
Rate for Payer: Mercy Care Medicaid	$16,027.69

Radiotherapy

Facility

$9,793.65

Service Code	APR-DRG 6922
Hospital Charge Code	APRDRG6924
Min. Negotiated Rate	$9,793.65
Max. Negotiated Rate	$9,793.65
Rate for Payer: AHCCCS Medicaid	$9,793.65
Rate for Payer: Allwell Medicaid	$9,793.65
Rate for Payer: AZCH Complete Medicaid	$9,793.65
Rate for Payer: Banner UC Health Medicaid	$9,793.65
Rate for Payer: Mercy Care Medicaid	$9,793.65

Radiotherapy

Facility

$16,027.69

Service Code	APR-DRG 6923
Hospital Charge Code	APRDRG6924
Min. Negotiated Rate	$16,027.69
Max. Negotiated Rate	$16,027.69
Rate for Payer: AHCCCS Medicaid	$16,027.69
Rate for Payer: Allwell Medicaid	$16,027.69
Rate for Payer: AZCH Complete Medicaid	$16,027.69
Rate for Payer: Banner UC Health Medicaid	$16,027.69
Rate for Payer: Mercy Care Medicaid	$16,027.69

Radiotherapy

Facility

$9,793.65

Service Code	APR-DRG 6922
Hospital Charge Code	APRDRG6921
Min. Negotiated Rate	$9,793.65
Max. Negotiated Rate	$9,793.65
Rate for Payer: AHCCCS Medicaid	$9,793.65
Rate for Payer: Allwell Medicaid	$9,793.65
Rate for Payer: AZCH Complete Medicaid	$9,793.65
Rate for Payer: Banner UC Health Medicaid	$9,793.65
Rate for Payer: Mercy Care Medicaid	$9,793.65

Radiotherapy

Facility

$25,806.61

Service Code	APR-DRG 6924
Hospital Charge Code	APRDRG6924
Min. Negotiated Rate	$25,806.61
Max. Negotiated Rate	$25,806.61
Rate for Payer: AHCCCS Medicaid	$25,806.61
Rate for Payer: Allwell Medicaid	$25,806.61
Rate for Payer: AZCH Complete Medicaid	$25,806.61
Rate for Payer: Banner UC Health Medicaid	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61

Radiotherapy

Facility

$9,793.65

Service Code	APR-DRG 6922
Hospital Charge Code	APRDRG6923
Min. Negotiated Rate	$9,793.65
Max. Negotiated Rate	$9,793.65
Rate for Payer: AHCCCS Medicaid	$9,793.65
Rate for Payer: Allwell Medicaid	$9,793.65
Rate for Payer: AZCH Complete Medicaid	$9,793.65
Rate for Payer: Banner UC Health Medicaid	$9,793.65
Rate for Payer: Mercy Care Medicaid	$9,793.65

Radiotherapy

Facility

$16,027.69

Service Code	APR-DRG 6923
Hospital Charge Code	APRDRG6921
Min. Negotiated Rate	$16,027.69
Max. Negotiated Rate	$16,027.69
Rate for Payer: AHCCCS Medicaid	$16,027.69
Rate for Payer: Allwell Medicaid	$16,027.69
Rate for Payer: AZCH Complete Medicaid	$16,027.69
Rate for Payer: Banner UC Health Medicaid	$16,027.69
Rate for Payer: Mercy Care Medicaid	$16,027.69

Radiotherapy

Facility

$25,806.61

Service Code	APR-DRG 6924
Hospital Charge Code	APRDRG6923
Min. Negotiated Rate	$25,806.61
Max. Negotiated Rate	$25,806.61
Rate for Payer: AHCCCS Medicaid	$25,806.61
Rate for Payer: Allwell Medicaid	$25,806.61
Rate for Payer: AZCH Complete Medicaid	$25,806.61
Rate for Payer: Banner UC Health Medicaid	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61

Radiotherapy

Facility

$5,319.42

Service Code	APR-DRG 6921
Hospital Charge Code	APRDRG6924
Min. Negotiated Rate	$5,319.42
Max. Negotiated Rate	$5,319.42
Rate for Payer: AHCCCS Medicaid	$5,319.42
Rate for Payer: Allwell Medicaid	$5,319.42
Rate for Payer: AZCH Complete Medicaid	$5,319.42
Rate for Payer: Banner UC Health Medicaid	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42

raltegravir 400 mgTab [CQCH]

Facility

$23.26

Service Code	NDC 6022761
Hospital Charge Code	105939295
Hospital Revenue Code	251
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$20.93
Rate for Payer: Aetna of AZ Commercial	$20.93
Rate for Payer: Bisbee Police All Plans	$6.05
Rate for Payer: Cash Price	$18.61
Rate for Payer: Self Pay Self Pay	$18.61

Know your out-of-pocket cost for care.

All Charges