Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ROCKER SWITCH SMOKE EVAC PENCIL UNCOATED

Facility

$1,410.00

Hospital Charge Code	27773153
Hospital Revenue Code	270
Min. Negotiated Rate	$223.34
Max. Negotiated Rate	$1,269.00
Rate for Payer: Aetna of AZ Commercial	$1,269.00
Rate for Payer: Arizona Complete Health Allwell	$225.60
Rate for Payer: Banner UC Health Medicare	$225.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$958.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$225.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$225.60
Rate for Payer: Cash Price	$1,128.00
Rate for Payer: Cigna of AZ Commercial	$987.00
Rate for Payer: Devoted Health Medicare	$253.80
Rate for Payer: Humana of AZ Medicare	$225.60
Rate for Payer: Southwest Service Administrators UFCW	$958.80
Rate for Payer: TriWest Medicare	$225.60
Rate for Payer: United Healthcare Commercial	$806.52
Rate for Payer: United Healthcare Medicare	$225.60
Rate for Payer: Veterans Affairs TRICARE	$223.34

ROCKER SWITCH SMOKE EVAC PENCIL UNCOATED

Facility

$1,410.00

Hospital Charge Code	27773153
Hospital Revenue Code	270
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$1,269.00
Rate for Payer: Aetna of AZ Commercial	$1,269.00
Rate for Payer: Cash Price	$1,128.00

Rocky Mtn Spotted Fever, IgM LC

Facility

$226.00

Service Code	CPT 86757
Hospital Charge Code	1285661
Hospital Revenue Code	302
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Arizona Complete Health Allwell	$36.16
Rate for Payer: Banner UC Health Medicare	$36.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$153.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.16
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cigna of AZ Commercial	$146.90
Rate for Payer: Devoted Health Medicare	$40.68
Rate for Payer: Humana of AZ Medicare	$36.16
Rate for Payer: Seven Corners Travel Insurance	$28.06
Rate for Payer: Southwest Service Administrators UFCW	$153.68
Rate for Payer: TriWest Medicare	$36.16
Rate for Payer: United Healthcare Commercial	$129.27
Rate for Payer: United Healthcare Medicare	$36.16
Rate for Payer: Veterans Affairs TRICARE	$35.80

Rocky Mtn Spotted Fever, IgM LC

Facility

$226.00

Service Code	CPT 86757
Hospital Charge Code	1285661
Hospital Revenue Code	302
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Cash Price	$180.80

Rocky Mtn Spotted Fev, IgG, Qn LC

Facility

$226.00

Service Code	CPT 86757
Hospital Charge Code	1285665
Hospital Revenue Code	302
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Cash Price	$180.80

Rocky Mtn Spotted Fev, IgG, Qn LC

Facility

$226.00

Service Code	CPT 86757
Hospital Charge Code	1285665
Hospital Revenue Code	302
Min. Negotiated Rate	$28.06
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Arizona Complete Health Allwell	$36.16
Rate for Payer: Banner UC Health Medicare	$36.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$153.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.16
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cigna of AZ Commercial	$146.90
Rate for Payer: Devoted Health Medicare	$40.68
Rate for Payer: Humana of AZ Medicare	$36.16
Rate for Payer: Seven Corners Travel Insurance	$28.06
Rate for Payer: Southwest Service Administrators UFCW	$153.68
Rate for Payer: TriWest Medicare	$36.16
Rate for Payer: United Healthcare Commercial	$129.27
Rate for Payer: United Healthcare Medicare	$36.16
Rate for Payer: Veterans Affairs TRICARE	$35.80

rocuronium 100 mg/10 mL inj Sol [CQCH]

Facility

$0.35

Service Code	NDC 55150022610
Hospital Charge Code	108079385
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Arizona Complete Health Allwell	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.06
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.06
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Devoted Health Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Southwest Service Administrators UFCW	$0.24
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: United Healthcare Commercial	$0.20
Rate for Payer: United Healthcare Medicare	$0.06
Rate for Payer: Veterans Affairs TRICARE	$0.06

rocuronium 100 mg/10 mL inj Sol [CQCH]

Facility

$0.35

Service Code	NDC 55150022610
Hospital Charge Code	108079385
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Cash Price	$0.28

romiPLOStim 125 mcg REC[CQCH]

Facility

$1,032.35

Service Code	HCPCS J2796
Hospital Charge Code	189610323
Hospital Revenue Code	251
Min. Negotiated Rate	$163.52
Max. Negotiated Rate	$929.12
Rate for Payer: Aetna of AZ Commercial	$929.12
Rate for Payer: Arizona Complete Health Allwell	$165.18
Rate for Payer: Banner UC Health Medicare	$165.18
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$702.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$165.18
Rate for Payer: Care1st Health Plan Arizona Medicare	$165.18
Rate for Payer: Cash Price	$825.88
Rate for Payer: Cigna of AZ Commercial	$671.03
Rate for Payer: Devoted Health Medicare	$185.82
Rate for Payer: Humana of AZ Medicare	$165.18
Rate for Payer: Southwest Service Administrators UFCW	$702.00
Rate for Payer: TriWest Medicare	$165.18
Rate for Payer: United Healthcare Commercial	$590.50
Rate for Payer: United Healthcare Medicare	$165.18
Rate for Payer: Veterans Affairs TRICARE	$163.52

romiPLOStim 125 mcg REC[CQCH]

Facility

$1,032.35

Service Code	HCPCS J2796
Hospital Charge Code	189610323
Hospital Revenue Code	251
Min. Negotiated Rate	$929.12
Max. Negotiated Rate	$929.12
Rate for Payer: Aetna of AZ Commercial	$929.12
Rate for Payer: Cash Price	$825.88

romiPLOStim 250 mcg REC[CQCH]

Facility

$2,064.68

Service Code	HCPCS J2796
Hospital Charge Code	189307178
Hospital Revenue Code	251
Min. Negotiated Rate	$327.05
Max. Negotiated Rate	$1,858.21
Rate for Payer: Aetna of AZ Commercial	$1,858.21
Rate for Payer: Arizona Complete Health Allwell	$330.35
Rate for Payer: Banner UC Health Medicare	$330.35
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,403.98
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$330.35
Rate for Payer: Care1st Health Plan Arizona Medicare	$330.35
Rate for Payer: Cash Price	$1,651.74
Rate for Payer: Cigna of AZ Commercial	$1,342.04
Rate for Payer: Devoted Health Medicare	$371.64
Rate for Payer: Humana of AZ Medicare	$330.35
Rate for Payer: Southwest Service Administrators UFCW	$1,403.98
Rate for Payer: TriWest Medicare	$330.35
Rate for Payer: United Healthcare Commercial	$1,181.00
Rate for Payer: United Healthcare Medicare	$330.35
Rate for Payer: Veterans Affairs TRICARE	$327.05

romiPLOStim 250 mcg REC[CQCH]

Facility

$2,064.68

Service Code	HCPCS J2796
Hospital Charge Code	189307178
Hospital Revenue Code	251
Min. Negotiated Rate	$1,858.21
Max. Negotiated Rate	$1,858.21
Rate for Payer: Aetna of AZ Commercial	$1,858.21
Rate for Payer: Cash Price	$1,651.74

ROOM/BED: Extended Recovery

Facility

$53.00

Hospital Charge Code	2091602
Hospital Revenue Code	710
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Arizona Complete Health Allwell	$8.48
Rate for Payer: Banner UC Health Medicare	$8.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.48
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Devoted Health Medicare	$9.54
Rate for Payer: Humana of AZ Medicare	$8.48
Rate for Payer: Southwest Service Administrators UFCW	$36.04
Rate for Payer: TriWest Medicare	$8.48
Rate for Payer: United Healthcare Commercial	$30.32
Rate for Payer: United Healthcare Medicare	$8.48
Rate for Payer: United Healthcare New Mexico Commercial	$10.07
Rate for Payer: Veterans Affairs TRICARE	$8.40

ROOM/BED: Extended Recovery

Facility

$53.00

Hospital Charge Code	2091602
Hospital Revenue Code	710
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Cash Price	$42.40

ROOM/BED: Observation

Facility

$104.00

Service Code	HCPCS G0378
Hospital Charge Code	1101857
Hospital Revenue Code	762
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: Cigna of AZ Commercial	$72.80
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Humana of AZ Medicare	$16.64
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: United Healthcare New Mexico Commercial	$19.76
Rate for Payer: Veterans Affairs TRICARE	$16.47

ROOM/BED: Observation

Facility

$104.00

Service Code	HCPCS G0378
Hospital Charge Code	1101857
Hospital Revenue Code	762
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

ROOM/BED: Semi Private

Facility

$2,500.00

Hospital Charge Code	867361
Hospital Revenue Code	120
Min. Negotiated Rate	$1,434.00
Max. Negotiated Rate	$3,918.00
Rate for Payer: Aetna of AZ Commercial	$2,250.00
Rate for Payer: Arizona Complete Health Allwell	$3,918.00
Rate for Payer: Banner UC Health Medicare	$3,918.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,700.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3,918.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$3,918.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cigna of AZ Commercial	$1,700.00
Rate for Payer: Devoted Health Medicare	$1,434.00
Rate for Payer: Humana of AZ Medicare	$3,918.00
Rate for Payer: Southwest Service Administrators UFCW	$1,700.00
Rate for Payer: TriWest Medicare	$3,918.00
Rate for Payer: United Healthcare Commercial	$1,978.00
Rate for Payer: United Healthcare Medicare	$3,918.00
Rate for Payer: United Healthcare New Mexico Commercial	$2,238.00
Rate for Payer: Veterans Affairs TRICARE	$3,839.64

ROOM/BED: Swingbed

Facility

$2,500.00

Hospital Charge Code	11805353
Hospital Revenue Code	120
Min. Negotiated Rate	$1,434.00
Max. Negotiated Rate	$3,338.00
Rate for Payer: Aetna of AZ Commercial	$2,250.00
Rate for Payer: Arizona Complete Health Allwell	$3,338.00
Rate for Payer: Banner UC Health Medicare	$3,338.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,700.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3,338.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$3,338.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cigna of AZ Commercial	$1,700.00
Rate for Payer: Devoted Health Medicare	$1,434.00
Rate for Payer: Humana of AZ Medicare	$3,338.00
Rate for Payer: Southwest Service Administrators UFCW	$1,700.00
Rate for Payer: TriWest Medicare	$3,338.00
Rate for Payer: United Healthcare Commercial	$1,978.00
Rate for Payer: United Healthcare Medicare	$3,338.00
Rate for Payer: United Healthcare New Mexico Commercial	$1,940.00
Rate for Payer: Veterans Affairs TRICARE	$3,271.24

rOPINIRole 0.5 mg Tab [CQCH]

Facility

$0.09

Service Code	NDC 43547026910
Hospital Charge Code	105939910
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

rOPINIRole 0.5 mg Tab [CQCH]

Facility

$0.09

Service Code	NDC 43547026910
Hospital Charge Code	105939910
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

ropivacaine HCl, 0.5%, 20 ml

Facility

$4.26

Service Code	NDC 63323028627
Hospital Charge Code	135066287
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna of AZ Commercial	$3.83
Rate for Payer: Arizona Complete Health Allwell	$0.68
Rate for Payer: Banner UC Health Medicare	$0.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.90
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.68
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cigna of AZ Commercial	$2.77
Rate for Payer: Devoted Health Medicare	$0.77
Rate for Payer: Humana of AZ Medicare	$0.68
Rate for Payer: Southwest Service Administrators UFCW	$2.90
Rate for Payer: TriWest Medicare	$0.68
Rate for Payer: United Healthcare Commercial	$2.44
Rate for Payer: United Healthcare Medicare	$0.68
Rate for Payer: Veterans Affairs TRICARE	$0.67

ropivacaine HCl, 0.5%, 20 ml

Facility

$4.26

Service Code	NDC 63323028627
Hospital Charge Code	135066287
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna of AZ Commercial	$3.83
Rate for Payer: Cash Price	$3.41

Rotatable Small Oval Snare Medium Stiffness

Facility

$213.00

Hospital Charge Code	22926473
Hospital Revenue Code	272
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Arizona Complete Health Allwell	$34.08
Rate for Payer: Banner UC Health Medicare	$34.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$144.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.08
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cigna of AZ Commercial	$149.10
Rate for Payer: Devoted Health Medicare	$38.34
Rate for Payer: Humana of AZ Medicare	$34.08
Rate for Payer: Southwest Service Administrators UFCW	$144.84
Rate for Payer: TriWest Medicare	$34.08
Rate for Payer: United Healthcare Commercial	$121.84
Rate for Payer: United Healthcare Medicare	$34.08
Rate for Payer: Veterans Affairs TRICARE	$33.74

Rotatable Small Oval Snare Medium Stiffness

Facility

$213.00

Hospital Charge Code	22926473
Hospital Revenue Code	272
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Cash Price	$170.40

ROTATIONS MORCELLATOR 4.8MM WL 355MM

Facility

$5,257.15

Hospital Charge Code	27839759
Hospital Revenue Code	270
Min. Negotiated Rate	$4,731.44
Max. Negotiated Rate	$4,731.44
Rate for Payer: Aetna of AZ Commercial	$4,731.44
Rate for Payer: Cash Price	$4,205.72

Know your out-of-pocket cost for care.

All Charges