Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	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

$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

$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

$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

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

$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	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

$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

$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	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

$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

$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

$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

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

raltegravir 400 mgTab [CQCH]

Facility

$23.26

Service Code	NDC 6022761
Hospital Charge Code	105939295
Hospital Revenue Code	251
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$20.93
Rate for Payer: Aetna of AZ Commercial	$20.93
Rate for Payer: Aetna of AZ Medicare	$6.51
Rate for Payer: Allwell Medicare	$3.72
Rate for Payer: Amerigroup Medicare	$3.72
Rate for Payer: APIPA Medicare/Medicaid	$8.69
Rate for Payer: AZCH Complete Medicare	$3.72
Rate for Payer: Banner UC Health Medicare	$3.72
Rate for Payer: Bisbee Police All Plans	$6.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.82
Rate for Payer: Cash Price	$18.61
Rate for Payer: Cigna of AZ Commercial	$15.12
Rate for Payer: Copperpoint Commercial	$5.76
Rate for Payer: Health Net of AZ Commercial	$13.96
Rate for Payer: Health Net of AZ Medicare	$6.51
Rate for Payer: Humana of AZ Medicare	$3.72
Rate for Payer: Self Pay Self Pay	$18.61
Rate for Payer: TriWest Medicare	$3.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.19

RAM NASAL OXYGEN CANNULA INFANT

Facility

$95.00

Hospital Charge Code	27554771
Hospital Revenue Code	270
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Cash Price	$76.00
Rate for Payer: Self Pay Self Pay	$76.00

RAM NASAL OXYGEN CANNULA INFANT

Facility

$95.00

Hospital Charge Code	27554771
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Aetna of AZ Medicare	$26.60
Rate for Payer: Allwell Medicare	$15.20
Rate for Payer: Amerigroup Medicare	$15.20
Rate for Payer: APIPA Medicare/Medicaid	$35.48
Rate for Payer: AZCH Complete Medicare	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$64.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Copperpoint Commercial	$23.51
Rate for Payer: Health Net of AZ Commercial	$57.00
Rate for Payer: Health Net of AZ Medicare	$26.60
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Self Pay Self Pay	$76.00
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.10

RAM NASAL OXYGEN CANNULA NEWBORN

Facility

$95.00

Hospital Charge Code	27554772
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Aetna of AZ Medicare	$26.60
Rate for Payer: Allwell Medicare	$15.20
Rate for Payer: Amerigroup Medicare	$15.20
Rate for Payer: APIPA Medicare/Medicaid	$35.48
Rate for Payer: AZCH Complete Medicare	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$64.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Copperpoint Commercial	$23.51
Rate for Payer: Health Net of AZ Commercial	$57.00
Rate for Payer: Health Net of AZ Medicare	$26.60
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Self Pay Self Pay	$76.00
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.10

RAM NASAL OXYGEN CANNULA NEWBORN

Facility

$95.00

Hospital Charge Code	27554772
Hospital Revenue Code	270
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Cash Price	$76.00
Rate for Payer: Self Pay Self Pay	$76.00

RAM NASAL OXYGEN CANNULA PREMMIE

Facility

$95.00

Hospital Charge Code	27554770
Hospital Revenue Code	270
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Cash Price	$76.00
Rate for Payer: Self Pay Self Pay	$76.00

RAM NASAL OXYGEN CANNULA PREMMIE

Facility

$95.00

Hospital Charge Code	27554770
Hospital Revenue Code	270
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Aetna of AZ Medicare	$26.60
Rate for Payer: Allwell Medicare	$15.20
Rate for Payer: Amerigroup Medicare	$15.20
Rate for Payer: APIPA Medicare/Medicaid	$35.48
Rate for Payer: AZCH Complete Medicare	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$64.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Copperpoint Commercial	$23.51
Rate for Payer: Health Net of AZ Commercial	$57.00
Rate for Payer: Health Net of AZ Medicare	$26.60
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Self Pay Self Pay	$76.00
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.10

ravulizumab 100 mg/mL Sol[CQCH]

Facility

$2,134.67

Service Code	HCPCS J1303
Hospital Charge Code	212945258
Hospital Revenue Code	250
Min. Negotiated Rate	$341.55
Max. Negotiated Rate	$1,921.20
Rate for Payer: Aetna of AZ Commercial	$1,921.20
Rate for Payer: Aetna of AZ Medicare	$597.71
Rate for Payer: Allwell Medicare	$341.55
Rate for Payer: Amerigroup Medicare	$341.55
Rate for Payer: APIPA Medicare/Medicaid	$797.30
Rate for Payer: AZCH Complete Medicare	$341.55
Rate for Payer: Banner UC Health Medicare	$341.55
Rate for Payer: Bisbee Police All Plans	$555.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,451.58
Rate for Payer: Cash Price	$1,707.73
Rate for Payer: Cigna of AZ Commercial	$1,387.54
Rate for Payer: Copperpoint Commercial	$528.33
Rate for Payer: Health Net of AZ Commercial	$1,280.80
Rate for Payer: Health Net of AZ Medicare	$597.71
Rate for Payer: Humana of AZ Medicare	$341.55
Rate for Payer: Self Pay Self Pay	$1,707.74
Rate for Payer: TriWest Medicare	$341.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,244.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$384.24

Know your out-of-pocket cost for care.

All Charges