Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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: 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

$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: 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	APRDRG6921
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

$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: 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

$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: 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

$35,017.95

Service Code	MSDRG 849
Min. Negotiated Rate	$35,017.95
Max. Negotiated Rate	$35,017.95
Rate for Payer: Seven Corners Travel Insurance	$35,017.95

raltegravir 400 mgTab [CQCH]

Facility

$23.26

Service Code	NDC 6022761
Hospital Charge Code	105939295
Hospital Revenue Code	251
Min. Negotiated Rate	$20.93
Max. Negotiated Rate	$20.93
Rate for Payer: Aetna of AZ Commercial	$20.93
Rate for Payer: Cash Price	$18.61

raltegravir 400 mgTab [CQCH]

Facility

$23.26

Service Code	NDC 6022761
Hospital Charge Code	105939295
Hospital Revenue Code	251
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$20.93
Rate for Payer: Aetna of AZ Commercial	$20.93
Rate for Payer: Arizona Complete Health Allwell	$3.72
Rate for Payer: Banner UC Health Medicare	$3.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$15.82
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.72
Rate for Payer: Cash Price	$18.61
Rate for Payer: Cigna of AZ Commercial	$15.12
Rate for Payer: Devoted Health Medicare	$4.19
Rate for Payer: Humana of AZ Medicare	$3.72
Rate for Payer: Southwest Service Administrators UFCW	$15.82
Rate for Payer: TriWest Medicare	$3.72
Rate for Payer: United Healthcare Commercial	$13.30
Rate for Payer: United Healthcare Medicare	$3.72
Rate for Payer: Veterans Affairs TRICARE	$3.68

RAM NASAL OXYGEN CANNULA INFANT

Facility

$95.00

Hospital Charge Code	27554771
Hospital Revenue Code	270
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Cash Price	$76.00

RAM NASAL OXYGEN CANNULA INFANT

Facility

$95.00

Hospital Charge Code	27554771
Hospital Revenue Code	270
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Arizona Complete Health Allwell	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$64.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.20
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Devoted Health Medicare	$17.10
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Southwest Service Administrators UFCW	$64.60
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: United Healthcare Commercial	$54.34
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: Veterans Affairs TRICARE	$15.05

RAM NASAL OXYGEN CANNULA NEWBORN

Facility

$95.00

Hospital Charge Code	27554772
Hospital Revenue Code	270
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Cash Price	$76.00

RAM NASAL OXYGEN CANNULA NEWBORN

Facility

$95.00

Hospital Charge Code	27554772
Hospital Revenue Code	270
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Arizona Complete Health Allwell	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$64.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.20
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Devoted Health Medicare	$17.10
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Southwest Service Administrators UFCW	$64.60
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: United Healthcare Commercial	$54.34
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: Veterans Affairs TRICARE	$15.05

RAM NASAL OXYGEN CANNULA PREMMIE

Facility

$95.00

Hospital Charge Code	27554770
Hospital Revenue Code	270
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Cash Price	$76.00

RAM NASAL OXYGEN CANNULA PREMMIE

Facility

$95.00

Hospital Charge Code	27554770
Hospital Revenue Code	270
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Arizona Complete Health Allwell	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$64.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.20
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$66.50
Rate for Payer: Devoted Health Medicare	$17.10
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Southwest Service Administrators UFCW	$64.60
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: United Healthcare Commercial	$54.34
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: Veterans Affairs TRICARE	$15.05

Rapid Strep POC

Facility

$33.00

Service Code	CPT 87880
Hospital Charge Code	684345
Hospital Revenue Code	521
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Cash Price	$26.40

Rapid Strep POC

Facility

$33.00

Service Code	CPT 87880
Hospital Charge Code	684345
Hospital Revenue Code	521
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Arizona Complete Health Allwell	$5.28
Rate for Payer: Banner UC Health Medicare	$5.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$22.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.28
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Devoted Health Medicare	$5.94
Rate for Payer: Humana of AZ Medicare	$5.28
Rate for Payer: Seven Corners Travel Insurance	$23.97
Rate for Payer: Southwest Service Administrators UFCW	$22.44
Rate for Payer: TriWest Medicare	$5.28
Rate for Payer: United Healthcare Commercial	$18.88
Rate for Payer: United Healthcare Medicare	$5.28
Rate for Payer: Veterans Affairs TRICARE	$5.23

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	$1,921.20
Max. Negotiated Rate	$1,921.20
Rate for Payer: Aetna of AZ Commercial	$1,921.20
Rate for Payer: Cash Price	$1,707.73

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	$329.03
Max. Negotiated Rate	$1,921.20
Rate for Payer: Aetna of AZ Commercial	$1,921.20
Rate for Payer: Arizona Complete Health Allwell	$341.55
Rate for Payer: Banner UC Health Medicare	$341.55
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,451.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$341.55
Rate for Payer: Care1st Health Plan Arizona Medicare	$341.55
Rate for Payer: Cash Price	$1,707.73
Rate for Payer: Cash Price	$1,707.73
Rate for Payer: Cigna of AZ Commercial	$1,387.54
Rate for Payer: Devoted Health Medicare	$384.24
Rate for Payer: Humana of AZ Medicare	$341.55
Rate for Payer: Seven Corners Travel Insurance	$329.03
Rate for Payer: Southwest Service Administrators UFCW	$1,451.58
Rate for Payer: TriWest Medicare	$341.55
Rate for Payer: United Healthcare Commercial	$1,221.03
Rate for Payer: United Healthcare Medicare	$341.55
Rate for Payer: Veterans Affairs TRICARE	$338.13

RBC CP2D AS3 500 LR

Facility

$755.00

Service Code	HCPCS P9016
Hospital Charge Code	857613
Hospital Revenue Code	390
Min. Negotiated Rate	$679.50
Max. Negotiated Rate	$679.50
Rate for Payer: Aetna of AZ Commercial	$679.50
Rate for Payer: Cash Price	$604.00

RBC CP2D AS3 500 LR

Facility

$755.00

Service Code	HCPCS P9016
Hospital Charge Code	857613
Hospital Revenue Code	390
Min. Negotiated Rate	$119.59
Max. Negotiated Rate	$679.50
Rate for Payer: Aetna of AZ Commercial	$679.50
Rate for Payer: Arizona Complete Health Allwell	$120.80
Rate for Payer: Banner UC Health Medicare	$120.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$513.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$120.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$120.80
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cigna of AZ Commercial	$490.75
Rate for Payer: Devoted Health Medicare	$135.90
Rate for Payer: Humana of AZ Medicare	$120.80
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$513.40
Rate for Payer: TriWest Medicare	$120.80
Rate for Payer: United Healthcare Commercial	$431.86
Rate for Payer: United Healthcare Medicare	$120.80
Rate for Payer: Veterans Affairs TRICARE	$119.59

RBC CP2D AS3 500 LR Irr

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857635
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

RBC CP2D AS3 500 LR Irr

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857635
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

RBC CPD 500 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857651
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

RBC CPD 500 LR

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857651
Hospital Revenue Code	390
Min. Negotiated Rate	$126.56
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Arizona Complete Health Allwell	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$543.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$127.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$127.84
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Seven Corners Travel Insurance	$280.04
Rate for Payer: Southwest Service Administrators UFCW	$543.32
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: United Healthcare Commercial	$457.03
Rate for Payer: United Healthcare Medicare	$127.84
Rate for Payer: Veterans Affairs TRICARE	$126.56

RBC CPD 500 LR Irr

Facility

$799.00

Service Code	HCPCS P9016
Hospital Charge Code	857652
Hospital Revenue Code	390
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Cash Price	$639.20

Know your out-of-pocket cost for care.

All Charges