Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

tocilizumab 200 mg/10 ml Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233011115
Hospital Revenue Code	250
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Arizona Complete Health Allwell	$20.61
Rate for Payer: Banner UC Health Medicare	$20.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.61
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.61
Rate for Payer: Cash Price	$103.04
Rate for Payer: Cash Price	$103.04
Rate for Payer: Cigna of AZ Commercial	$83.72
Rate for Payer: Devoted Health Medicare	$23.18
Rate for Payer: Humana of AZ Medicare	$20.61
Rate for Payer: Seven Corners Travel Insurance	$7.84
Rate for Payer: Southwest Service Administrators UFCW	$87.58
Rate for Payer: TriWest Medicare	$20.61
Rate for Payer: United Healthcare Commercial	$73.67
Rate for Payer: United Healthcare Medicare	$20.61
Rate for Payer: Veterans Affairs TRICARE	$20.40

tocilizumab 80 mg/4 mL Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233007748
Hospital Revenue Code	250
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Arizona Complete Health Allwell	$20.61
Rate for Payer: Banner UC Health Medicare	$20.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.58
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.61
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.61
Rate for Payer: Cash Price	$103.04
Rate for Payer: Cash Price	$103.04
Rate for Payer: Cigna of AZ Commercial	$83.72
Rate for Payer: Devoted Health Medicare	$23.18
Rate for Payer: Humana of AZ Medicare	$20.61
Rate for Payer: Seven Corners Travel Insurance	$7.84
Rate for Payer: Southwest Service Administrators UFCW	$87.58
Rate for Payer: TriWest Medicare	$20.61
Rate for Payer: United Healthcare Commercial	$73.67
Rate for Payer: United Healthcare Medicare	$20.61
Rate for Payer: Veterans Affairs TRICARE	$20.40

tocilizumab 80 mg/4 mL Sol[CQCH]

Facility

$128.80

Service Code	HCPCS J3262
Hospital Charge Code	233007748
Hospital Revenue Code	250
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$115.92
Rate for Payer: Aetna of AZ Commercial	$115.92
Rate for Payer: Cash Price	$103.04

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56
Rate for Payer: NaphCare Correctional Healthcare	$3,787.56

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0973
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56
Rate for Payer: NaphCare Correctional Healthcare	$3,787.56

Tonsil And Adenoid Procedures

Facility

$17,184.30

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG0973
Min. Negotiated Rate	$17,184.30
Max. Negotiated Rate	$17,184.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,184.30
Rate for Payer: Mercy Care Medicaid	$17,184.30
Rate for Payer: NaphCare Correctional Healthcare	$17,184.30

Tonsil And Adenoid Procedures

Facility

$17,184.30

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$17,184.30
Max. Negotiated Rate	$17,184.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,184.30
Rate for Payer: Mercy Care Medicaid	$17,184.30
Rate for Payer: NaphCare Correctional Healthcare	$17,184.30

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0973
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68
Rate for Payer: NaphCare Correctional Healthcare	$9,659.68

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0973
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12
Rate for Payer: NaphCare Correctional Healthcare	$5,522.12

Tonsil And Adenoid Procedures

Facility

$17,184.30

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$17,184.30
Max. Negotiated Rate	$17,184.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,184.30
Rate for Payer: Mercy Care Medicaid	$17,184.30
Rate for Payer: NaphCare Correctional Healthcare	$17,184.30

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12
Rate for Payer: NaphCare Correctional Healthcare	$5,522.12

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0974
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68
Rate for Payer: NaphCare Correctional Healthcare	$9,659.68

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56
Rate for Payer: NaphCare Correctional Healthcare	$3,787.56

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0971
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12
Rate for Payer: NaphCare Correctional Healthcare	$5,522.12

Tonsil And Adenoid Procedures

Facility

$3,787.56

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG0971
Min. Negotiated Rate	$3,787.56
Max. Negotiated Rate	$3,787.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,787.56
Rate for Payer: Mercy Care Medicaid	$3,787.56
Rate for Payer: NaphCare Correctional Healthcare	$3,787.56

Tonsil And Adenoid Procedures

Facility

$17,184.30

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG0971
Min. Negotiated Rate	$17,184.30
Max. Negotiated Rate	$17,184.30
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,184.30
Rate for Payer: Mercy Care Medicaid	$17,184.30
Rate for Payer: NaphCare Correctional Healthcare	$17,184.30

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0971
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68
Rate for Payer: NaphCare Correctional Healthcare	$9,659.68

Tonsil And Adenoid Procedures

Facility

$5,522.12

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$5,522.12
Max. Negotiated Rate	$5,522.12
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,522.12
Rate for Payer: Mercy Care Medicaid	$5,522.12
Rate for Payer: NaphCare Correctional Healthcare	$5,522.12

Tonsil And Adenoid Procedures

Facility

$9,659.68

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG0972
Min. Negotiated Rate	$9,659.68
Max. Negotiated Rate	$9,659.68
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,659.68
Rate for Payer: Mercy Care Medicaid	$9,659.68
Rate for Payer: NaphCare Correctional Healthcare	$9,659.68

TONSIL DAVIS NEEDLES

Facility

$22.03

Hospital Charge Code	27485971
Hospital Revenue Code	270
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$19.83
Rate for Payer: Aetna of AZ Commercial	$19.83
Rate for Payer: Cash Price	$17.62

TONSIL DAVIS NEEDLES

Facility

$22.03

Hospital Charge Code	27485971
Hospital Revenue Code	270
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$19.83
Rate for Payer: Aetna of AZ Commercial	$19.83
Rate for Payer: Arizona Complete Health Allwell	$3.52
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$14.98
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$3.52
Rate for Payer: Cash Price	$17.62
Rate for Payer: Cigna of AZ Commercial	$15.42
Rate for Payer: Devoted Health Medicare	$3.97
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Southwest Service Administrators UFCW	$14.98
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: United Healthcare Commercial	$12.60
Rate for Payer: United Healthcare Medicare	$3.52
Rate for Payer: Veterans Affairs TRICARE	$3.49

topiramate 200 mg Tab [CQCH]

Facility

$0.48

Service Code	NDC 68084034521
Hospital Charge Code	105944129
Hospital Revenue Code	251
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of AZ Commercial	$0.43
Rate for Payer: Cash Price	$0.38

topiramate 200 mg Tab [CQCH]

Facility

$0.48

Service Code	NDC 68084034521
Hospital Charge Code	105944129
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna of AZ Commercial	$0.43
Rate for Payer: Arizona Complete Health Allwell	$0.08
Rate for Payer: Banner UC Health Medicare	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.08
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of AZ Commercial	$0.31
Rate for Payer: Devoted Health Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.08
Rate for Payer: Southwest Service Administrators UFCW	$0.33
Rate for Payer: TriWest Medicare	$0.08
Rate for Payer: United Healthcare Commercial	$0.27
Rate for Payer: United Healthcare Medicare	$0.08
Rate for Payer: Veterans Affairs TRICARE	$0.08

topiramate 25 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 68084034201
Hospital Charge Code	105944064
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.07
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.06
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

topiramate 25 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 68084034201
Hospital Charge Code	105944064
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Cash Price	$0.09

Know your out-of-pocket cost for care.

All Charges