Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

KWIRE 100MM ONE BLUNT

Facility

$168.00

Hospital Charge Code	27341813
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Aetna of AZ Medicare	$47.04
Rate for Payer: Allwell Medicare	$25.20
Rate for Payer: Amerigroup Medicare	$25.20
Rate for Payer: APIPA Medicare/Medicaid	$62.75
Rate for Payer: AZCH Complete Medicare	$25.20
Rate for Payer: Banner UC Health Medicare	$25.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$114.24
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$117.60
Rate for Payer: Copperpoint Commercial	$41.58
Rate for Payer: Health Net of AZ Commercial	$100.80
Rate for Payer: Health Net of AZ Medicare	$47.04
Rate for Payer: Humana of AZ Medicare	$25.20
Rate for Payer: Self Pay Self Pay	$134.40
Rate for Payer: TriWest Medicare	$25.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$97.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.24

KWIRE 100MM ONE BLUNT

Facility

$168.00

Hospital Charge Code	27341813
Hospital Revenue Code	270
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Cash Price	$134.40
Rate for Payer: Self Pay Self Pay	$134.40

KWIRE SMOOTH DOUBLE POINTED

Facility

$186.00

Hospital Charge Code	27341815
Hospital Revenue Code	270
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: Allwell Medicare	$27.90
Rate for Payer: Amerigroup Medicare	$27.90
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicare	$27.90
Rate for Payer: Banner UC Health Medicare	$27.90
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$130.20
Rate for Payer: Copperpoint Commercial	$46.04
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$27.90
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$27.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

KWIRE SMOOTH DOUBLE POINTED

Facility

$186.00

Hospital Charge Code	27341815
Hospital Revenue Code	270
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Cash Price	$148.80
Rate for Payer: Self Pay Self Pay	$148.80

KWIRE SMOOTH DOUBLE TORCAR .45INX9IN

Facility

$41.00

Hospital Charge Code	24100618
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

KWIRE SMOOTH DOUBLE TORCAR .45INX9IN

Facility

$41.00

Hospital Charge Code	24100618
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

KWIRE SMOOTH DOUBLE TROCAR 035INX9IN

Facility

$41.00

Hospital Charge Code	24100620
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

KWIRE SMOOTH DOUBLE TROCAR 035INX9IN

Facility

$41.00

Hospital Charge Code	24100620
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

KWIRE SMOOTH DOUBLE TROCAR 062INX9IN

Facility

$41.00

Hospital Charge Code	24100619
Hospital Revenue Code	270
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.15
Rate for Payer: Amerigroup Medicare	$6.15
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.15
Rate for Payer: Banner UC Health Medicare	$6.15
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.15
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

KWIRE SMOOTH DOUBLE TROCAR 062INX9IN

Facility

$41.00

Hospital Charge Code	24100619
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

labetalol 100 mg Tab UD [CQCH]

Facility

$0.25

Service Code	NDC 51079092820
Hospital Charge Code	107742758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.20
Rate for Payer: Self Pay Self Pay	$0.20

labetalol 100 mg Tab UD [CQCH]

Facility

$0.25

Service Code	NDC 51079092820
Hospital Charge Code	107742758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Aetna of AZ Medicare	$0.07
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.09
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.17
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.15
Rate for Payer: Health Net of AZ Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.20
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

labetalol 5 mg/mL IV Sol [CQCH]

Facility

$0.11

Service Code	NDC 143932001
Hospital Charge Code	105927646
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: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.07
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

labetalol 5 mg/mL IV Sol [CQCH]

Facility

$0.11

Service Code	NDC 143932001
Hospital Charge Code	105927646
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.09
Rate for Payer: Self Pay Self Pay	$0.09

Lacosamide LC

Facility

$991.00

Service Code	CPT 80339
Hospital Charge Code	2087619
Hospital Revenue Code	301
Min. Negotiated Rate	$257.66
Max. Negotiated Rate	$891.90
Rate for Payer: Aetna of AZ Commercial	$891.90
Rate for Payer: Bisbee Police All Plans	$257.66
Rate for Payer: Cash Price	$792.80
Rate for Payer: Self Pay Self Pay	$792.80

Lacosamide LC

Facility

$991.00

Service Code	CPT 80339
Hospital Charge Code	2087619
Hospital Revenue Code	301
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$891.90
Rate for Payer: Aetna of AZ Commercial	$891.90
Rate for Payer: Aetna of AZ Medicare	$277.48
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$148.65
Rate for Payer: Amerigroup Medicare	$148.65
Rate for Payer: APIPA Medicare/Medicaid	$370.14
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$148.65
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$148.65
Rate for Payer: Bisbee Police All Plans	$257.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$673.88
Rate for Payer: Cash Price	$792.80
Rate for Payer: Cash Price	$792.80
Rate for Payer: Cigna of AZ Commercial	$644.15
Rate for Payer: Copperpoint Commercial	$245.27
Rate for Payer: Health Net of AZ Commercial	$594.60
Rate for Payer: Health Net of AZ Medicare	$277.48
Rate for Payer: Humana of AZ Medicare	$148.65
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$792.80
Rate for Payer: TriWest Medicare	$148.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$577.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$178.38

Lactate

Facility

$256.00

Service Code	CPT 83605
Hospital Charge Code	9578903
Hospital Revenue Code	301
Min. Negotiated Rate	$66.56
Max. Negotiated Rate	$230.40
Rate for Payer: Aetna of AZ Commercial	$230.40
Rate for Payer: Bisbee Police All Plans	$66.56
Rate for Payer: Cash Price	$204.80
Rate for Payer: Self Pay Self Pay	$204.80

Lactate

Facility

$256.00

Service Code	CPT 83605
Hospital Charge Code	9578903
Hospital Revenue Code	301
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$230.40
Rate for Payer: Aetna of AZ Commercial	$230.40
Rate for Payer: Aetna of AZ Medicare	$71.68
Rate for Payer: AHCCCS Medicaid	$11.57
Rate for Payer: Allwell Medicaid	$11.57
Rate for Payer: Allwell Medicare	$38.40
Rate for Payer: Amerigroup Medicare	$38.40
Rate for Payer: APIPA Medicare/Medicaid	$95.62
Rate for Payer: AZCH Complete Medicaid	$11.57
Rate for Payer: AZCH Complete Medicare	$38.40
Rate for Payer: Banner UC Health Medicaid	$11.57
Rate for Payer: Banner UC Health Medicare	$38.40
Rate for Payer: Bisbee Police All Plans	$66.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$174.08
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cigna of AZ Commercial	$166.40
Rate for Payer: Copperpoint Commercial	$63.36
Rate for Payer: Health Net of AZ Commercial	$153.60
Rate for Payer: Health Net of AZ Medicare	$71.68
Rate for Payer: Humana of AZ Medicare	$38.40
Rate for Payer: Mercy Care Medicaid	$11.57
Rate for Payer: Self Pay Self Pay	$204.80
Rate for Payer: TriWest Medicare	$38.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$149.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.08

Lactate Dehydrogenase

Facility

$73.00

Service Code	CPT 83615
Hospital Charge Code	633770
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Aetna of AZ Medicare	$20.44
Rate for Payer: AHCCCS Medicaid	$6.04
Rate for Payer: Allwell Medicaid	$6.04
Rate for Payer: Allwell Medicare	$10.95
Rate for Payer: Amerigroup Medicare	$10.95
Rate for Payer: APIPA Medicare/Medicaid	$27.27
Rate for Payer: AZCH Complete Medicaid	$6.04
Rate for Payer: AZCH Complete Medicare	$10.95
Rate for Payer: Banner UC Health Medicaid	$6.04
Rate for Payer: Banner UC Health Medicare	$10.95
Rate for Payer: Bisbee Police All Plans	$18.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$49.64
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cigna of AZ Commercial	$47.45
Rate for Payer: Copperpoint Commercial	$18.07
Rate for Payer: Health Net of AZ Commercial	$43.80
Rate for Payer: Health Net of AZ Medicare	$20.44
Rate for Payer: Humana of AZ Medicare	$10.95
Rate for Payer: Mercy Care Medicaid	$6.04
Rate for Payer: Self Pay Self Pay	$58.40
Rate for Payer: TriWest Medicare	$10.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$42.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.14

Lactate Dehydrogenase

Facility

$73.00

Service Code	CPT 83615
Hospital Charge Code	633770
Hospital Revenue Code	301
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Bisbee Police All Plans	$18.98
Rate for Payer: Cash Price	$58.40
Rate for Payer: Self Pay Self Pay	$58.40

Lactated Ringers IV Sol 1000 ml [CQCH]

Facility

$0.01

Service Code	HCPCS J7120
Hospital Charge Code	107734454
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Lactated Ringers IV Sol 1000 ml [CQCH]

Facility

$0.01

Service Code	HCPCS J7120
Hospital Charge Code	107734454
Hospital Revenue Code	258
Max. Negotiated Rate	$4.76
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: AHCCCS Medicaid	$4.76
Rate for Payer: Allwell Medicaid	$4.76
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicaid	$4.76
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicaid	$4.76
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Mercy Care Medicaid	$4.76
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Lactoferrin

Facility

$257.00

Service Code	CPT 83630
Hospital Charge Code	1853551
Hospital Revenue Code	301
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Bisbee Police All Plans	$66.82
Rate for Payer: Cash Price	$205.60
Rate for Payer: Self Pay Self Pay	$205.60

Lactoferrin

Facility

$257.00

Service Code	CPT 83630
Hospital Charge Code	1853551
Hospital Revenue Code	301
Min. Negotiated Rate	$19.70
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Aetna of AZ Medicare	$71.96
Rate for Payer: AHCCCS Medicaid	$19.70
Rate for Payer: Allwell Medicaid	$19.70
Rate for Payer: Allwell Medicare	$38.55
Rate for Payer: Amerigroup Medicare	$38.55
Rate for Payer: APIPA Medicare/Medicaid	$95.99
Rate for Payer: AZCH Complete Medicaid	$19.70
Rate for Payer: AZCH Complete Medicare	$38.55
Rate for Payer: Banner UC Health Medicaid	$19.70
Rate for Payer: Banner UC Health Medicare	$38.55
Rate for Payer: Bisbee Police All Plans	$66.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$174.76
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Copperpoint Commercial	$63.61
Rate for Payer: Health Net of AZ Commercial	$154.20
Rate for Payer: Health Net of AZ Medicare	$71.96
Rate for Payer: Humana of AZ Medicare	$38.55
Rate for Payer: Mercy Care Medicaid	$19.70
Rate for Payer: Self Pay Self Pay	$205.60
Rate for Payer: TriWest Medicare	$38.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$149.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.26

Lactoferrin, Fecal, Quant. LC

Facility

$245.00

Service Code	CPT 83631
Hospital Charge Code	22311197
Hospital Revenue Code	301
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Bisbee Police All Plans	$63.70
Rate for Payer: Cash Price	$196.00
Rate for Payer: Self Pay Self Pay	$196.00

Know your out-of-pocket cost for care.

All Charges