Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

rabies immune globulin, human 300 units/mL 1 mL Sol[CQCH]

Facility

$646.31

Service Code	NDC 13533031801
Hospital Charge Code	142368685
Hospital Revenue Code	250
Min. Negotiated Rate	$102.38
Max. Negotiated Rate	$581.68
Rate for Payer: Aetna of AZ Commercial	$581.68
Rate for Payer: Arizona Complete Health Allwell	$103.41
Rate for Payer: Banner UC Health Medicare	$103.41
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$439.49
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$103.41
Rate for Payer: Care1st Health Plan Arizona Medicare	$103.41
Rate for Payer: Cash Price	$517.05
Rate for Payer: Cigna of AZ Commercial	$420.10
Rate for Payer: Devoted Health Medicare	$116.34
Rate for Payer: Humana of AZ Medicare	$103.41
Rate for Payer: Southwest Service Administrators UFCW	$439.49
Rate for Payer: TriWest Medicare	$103.41
Rate for Payer: United Healthcare Commercial	$369.69
Rate for Payer: United Healthcare Medicare	$103.41
Rate for Payer: Veterans Affairs TRICARE	$102.38

rabies immune globulin, human 300 units/mL 1 mL Sol[CQCH]

Facility

$646.31

Service Code	NDC 13533031801
Hospital Charge Code	142368685
Hospital Revenue Code	250
Min. Negotiated Rate	$581.68
Max. Negotiated Rate	$581.68
Rate for Payer: Aetna of AZ Commercial	$581.68
Rate for Payer: Cash Price	$517.05

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	$511.88
Max. Negotiated Rate	$2,908.39
Rate for Payer: Aetna of AZ Commercial	$2,908.39
Rate for Payer: Arizona Complete Health Allwell	$517.05
Rate for Payer: Banner UC Health Medicare	$517.05
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,197.45
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$517.05
Rate for Payer: Care1st Health Plan Arizona Medicare	$517.05
Rate for Payer: Cash Price	$2,585.24
Rate for Payer: Cigna of AZ Commercial	$2,100.51
Rate for Payer: Devoted Health Medicare	$581.68
Rate for Payer: Humana of AZ Medicare	$517.05
Rate for Payer: Southwest Service Administrators UFCW	$2,197.45
Rate for Payer: TriWest Medicare	$517.05
Rate for Payer: United Healthcare Commercial	$1,848.45
Rate for Payer: United Healthcare Medicare	$517.05
Rate for Payer: Veterans Affairs TRICARE	$511.88

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	$2,908.39
Max. Negotiated Rate	$2,908.39
Rate for Payer: Aetna of AZ Commercial	$2,908.39
Rate for Payer: Cash Price	$2,585.24

Rabies Neut. Abs Titrat. (RFFIT) LC

Facility

$104.00

Service Code	CPT 86382
Hospital Charge Code	22617332
Hospital Revenue Code	300
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Cash Price	$83.20

Rabies Neut. Abs Titrat. (RFFIT) LC

Facility

$104.00

Service Code	CPT 86382
Hospital Charge Code	22617332
Hospital Revenue Code	300
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Arizona Complete Health Allwell	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$70.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.64
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$67.60
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Seven Corners Travel Insurance	$24.52
Rate for Payer: Southwest Service Administrators UFCW	$70.72
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: United Healthcare Commercial	$59.49
Rate for Payer: United Healthcare Medicare	$16.64
Rate for Payer: Veterans Affairs TRICARE	$16.47

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	$5.96
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna of AZ Commercial	$5.96
Rate for Payer: Cash Price	$5.30

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	$1.05
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna of AZ Commercial	$5.96
Rate for Payer: Arizona Complete Health Allwell	$1.06
Rate for Payer: Banner UC Health Medicare	$1.06
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4.50
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1.06
Rate for Payer: Care1st Health Plan Arizona Medicare	$1.06
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cigna of AZ Commercial	$4.30
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Humana of AZ Medicare	$1.06
Rate for Payer: Southwest Service Administrators UFCW	$4.50
Rate for Payer: TriWest Medicare	$1.06
Rate for Payer: United Healthcare Commercial	$3.79
Rate for Payer: United Healthcare Medicare	$1.06
Rate for Payer: Veterans Affairs TRICARE	$1.05

RADIAL JAW LARGE

Facility

$107.10

Hospital Charge Code	28137182
Hospital Revenue Code	270
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna of AZ Commercial	$96.39
Rate for Payer: Cash Price	$85.68

RADIAL JAW LARGE

Facility

$107.10

Hospital Charge Code	28137182
Hospital Revenue Code	270
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna of AZ Commercial	$96.39
Rate for Payer: Arizona Complete Health Allwell	$17.14
Rate for Payer: Banner UC Health Medicare	$17.14
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.83
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.14
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.14
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cigna of AZ Commercial	$74.97
Rate for Payer: Devoted Health Medicare	$19.28
Rate for Payer: Humana of AZ Medicare	$17.14
Rate for Payer: Southwest Service Administrators UFCW	$72.83
Rate for Payer: TriWest Medicare	$17.14
Rate for Payer: United Healthcare Commercial	$61.26
Rate for Payer: United Healthcare Medicare	$17.14
Rate for Payer: Veterans Affairs TRICARE	$16.96

RADIAL JAW STANDARD

Facility

$145.65

Hospital Charge Code	28137183
Hospital Revenue Code	270
Min. Negotiated Rate	$131.09
Max. Negotiated Rate	$131.09
Rate for Payer: Aetna of AZ Commercial	$131.09
Rate for Payer: Cash Price	$116.52

RADIAL JAW STANDARD

Facility

$145.65

Hospital Charge Code	28137183
Hospital Revenue Code	270
Min. Negotiated Rate	$23.07
Max. Negotiated Rate	$131.09
Rate for Payer: Aetna of AZ Commercial	$131.09
Rate for Payer: Arizona Complete Health Allwell	$23.30
Rate for Payer: Banner UC Health Medicare	$23.30
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$99.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.30
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.30
Rate for Payer: Cash Price	$116.52
Rate for Payer: Cigna of AZ Commercial	$101.95
Rate for Payer: Devoted Health Medicare	$26.22
Rate for Payer: Humana of AZ Medicare	$23.30
Rate for Payer: Southwest Service Administrators UFCW	$99.04
Rate for Payer: TriWest Medicare	$23.30
Rate for Payer: United Healthcare Commercial	$83.31
Rate for Payer: United Healthcare Medicare	$23.30
Rate for Payer: Veterans Affairs TRICARE	$23.07

Radiology Misc

Facility

$862.00

Service Code	CPT 93971 RT
Hospital Charge Code	22828024
Hospital Revenue Code	921
Min. Negotiated Rate	$136.54
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Arizona Complete Health Allwell	$137.92
Rate for Payer: Banner UC Health Medicare	$137.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$586.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$137.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$137.92
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cigna of AZ Commercial	$603.40
Rate for Payer: Devoted Health Medicare	$155.16
Rate for Payer: Humana of AZ Medicare	$137.92
Rate for Payer: Southwest Service Administrators UFCW	$586.16
Rate for Payer: TriWest Medicare	$137.92
Rate for Payer: United Healthcare Commercial	$493.06
Rate for Payer: United Healthcare Medicare	$137.92
Rate for Payer: United Healthcare New Mexico Commercial	$163.78
Rate for Payer: Veterans Affairs TRICARE	$136.54

Radiology Misc

Facility

$862.00

Service Code	CPT 93971 RT
Hospital Charge Code	22828024
Hospital Revenue Code	921
Min. Negotiated Rate	$775.80
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Cash Price	$689.60

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: Blue Cross Blue Shield of Arizona Health Choice	$16,027.69
Rate for Payer: Mercy Care Medicaid	$16,027.69
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61
Rate for Payer: NaphCare Correctional Healthcare	$25,806.61

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: Blue Cross Blue Shield of Arizona Health Choice	$16,027.69
Rate for Payer: Mercy Care Medicaid	$16,027.69
Rate for Payer: NaphCare Correctional Healthcare	$16,027.69

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: Blue Cross Blue Shield of Arizona Health Choice	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$5,319.42
Rate for Payer: Mercy Care Medicaid	$5,319.42
Rate for Payer: NaphCare Correctional Healthcare	$5,319.42

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: Blue Cross Blue Shield of Arizona Health Choice	$9,793.65
Rate for Payer: Mercy Care Medicaid	$9,793.65
Rate for Payer: NaphCare Correctional Healthcare	$9,793.65

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: Blue Cross Blue Shield of Arizona Health Choice	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$9,793.65
Rate for Payer: Mercy Care Medicaid	$9,793.65
Rate for Payer: NaphCare Correctional Healthcare	$9,793.65

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: Blue Cross Blue Shield of Arizona Health Choice	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61
Rate for Payer: NaphCare Correctional Healthcare	$25,806.61

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: Blue Cross Blue Shield of Arizona Health Choice	$25,806.61
Rate for Payer: Mercy Care Medicaid	$25,806.61
Rate for Payer: NaphCare Correctional Healthcare	$25,806.61

Know your out-of-pocket cost for care.

All Charges