Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

KWIRE SMOOTH DOUBLE TROCAR 035INX9IN

Facility

$41.00

Hospital Charge Code	24100620
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
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	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
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	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
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	$6.56
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	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
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	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
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	$0.04
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 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 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

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

Lacosamide LC

Facility

$941.00

Service Code	CPT 80339
Hospital Charge Code	2087619
Hospital Revenue Code	301
Min. Negotiated Rate	$150.56
Max. Negotiated Rate	$846.90
Rate for Payer: Aetna of AZ Commercial	$846.90
Rate for Payer: Aetna of AZ Medicare	$263.48
Rate for Payer: Allwell Medicare	$150.56
Rate for Payer: Amerigroup Medicare	$150.56
Rate for Payer: APIPA Medicare/Medicaid	$351.46
Rate for Payer: AZCH Complete Medicare	$150.56
Rate for Payer: Banner UC Health Medicare	$150.56
Rate for Payer: Bisbee Police All Plans	$244.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$639.88
Rate for Payer: Cash Price	$752.80
Rate for Payer: Cigna of AZ Commercial	$611.65
Rate for Payer: Copperpoint Commercial	$232.90
Rate for Payer: Health Net of AZ Commercial	$564.60
Rate for Payer: Health Net of AZ Medicare	$263.48
Rate for Payer: Humana of AZ Medicare	$150.56
Rate for Payer: Self Pay Self Pay	$752.80
Rate for Payer: TriWest Medicare	$150.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$548.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$169.38

Lacosamide LC

Facility

$941.00

Service Code	CPT 80339
Hospital Charge Code	2087619
Hospital Revenue Code	301
Min. Negotiated Rate	$244.66
Max. Negotiated Rate	$846.90
Rate for Payer: Aetna of AZ Commercial	$846.90
Rate for Payer: Bisbee Police All Plans	$244.66
Rate for Payer: Cash Price	$752.80
Rate for Payer: Self Pay Self Pay	$752.80

Lactate

Facility

$243.00

Service Code	CPT 83605
Hospital Charge Code	9578903
Hospital Revenue Code	301
Min. Negotiated Rate	$38.88
Max. Negotiated Rate	$218.70
Rate for Payer: Aetna of AZ Commercial	$218.70
Rate for Payer: Aetna of AZ Medicare	$68.04
Rate for Payer: Allwell Medicare	$38.88
Rate for Payer: Amerigroup Medicare	$38.88
Rate for Payer: APIPA Medicare/Medicaid	$90.76
Rate for Payer: AZCH Complete Medicare	$38.88
Rate for Payer: Banner UC Health Medicare	$38.88
Rate for Payer: Bisbee Police All Plans	$63.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$165.24
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cigna of AZ Commercial	$157.95
Rate for Payer: Copperpoint Commercial	$60.14
Rate for Payer: Health Net of AZ Commercial	$145.80
Rate for Payer: Health Net of AZ Medicare	$68.04
Rate for Payer: Humana of AZ Medicare	$38.88
Rate for Payer: Self Pay Self Pay	$194.40
Rate for Payer: TriWest Medicare	$38.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.74

Lactate

Facility

$243.00

Service Code	CPT 83605
Hospital Charge Code	9578903
Hospital Revenue Code	301
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$218.70
Rate for Payer: Aetna of AZ Commercial	$218.70
Rate for Payer: Bisbee Police All Plans	$63.18
Rate for Payer: Cash Price	$194.40
Rate for Payer: Self Pay Self Pay	$194.40

Lactate Dehydrogenase

Facility

$69.00

Service Code	CPT 83615
Hospital Charge Code	633770
Hospital Revenue Code	301
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$11.04
Rate for Payer: Amerigroup Medicare	$11.04
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$44.85
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$11.04
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

Lactate Dehydrogenase

Facility

$69.00

Service Code	CPT 83615
Hospital Charge Code	633770
Hospital Revenue Code	301
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

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	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
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 Medicare	$0.00
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: 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

$236.00

Service Code	CPT 83630
Hospital Charge Code	1853551
Hospital Revenue Code	301
Min. Negotiated Rate	$37.76
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Aetna of AZ Medicare	$66.08
Rate for Payer: Allwell Medicare	$37.76
Rate for Payer: Amerigroup Medicare	$37.76
Rate for Payer: APIPA Medicare/Medicaid	$88.15
Rate for Payer: AZCH Complete Medicare	$37.76
Rate for Payer: Banner UC Health Medicare	$37.76
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$160.48
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cigna of AZ Commercial	$153.40
Rate for Payer: Copperpoint Commercial	$58.41
Rate for Payer: Health Net of AZ Commercial	$141.60
Rate for Payer: Health Net of AZ Medicare	$66.08
Rate for Payer: Humana of AZ Medicare	$37.76
Rate for Payer: Self Pay Self Pay	$188.80
Rate for Payer: TriWest Medicare	$37.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$137.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.48

Lactoferrin

Facility

$236.00

Service Code	CPT 83630
Hospital Charge Code	1853551
Hospital Revenue Code	301
Min. Negotiated Rate	$61.36
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna of AZ Commercial	$212.40
Rate for Payer: Bisbee Police All Plans	$61.36
Rate for Payer: Cash Price	$188.80
Rate for Payer: Self Pay Self Pay	$188.80

Lactoferrin, Fecal, Quant. LC

Facility

$233.00

Service Code	CPT 83631
Hospital Charge Code	22311197
Hospital Revenue Code	301
Min. Negotiated Rate	$60.58
Max. Negotiated Rate	$209.70
Rate for Payer: Aetna of AZ Commercial	$209.70
Rate for Payer: Bisbee Police All Plans	$60.58
Rate for Payer: Cash Price	$186.40
Rate for Payer: Self Pay Self Pay	$186.40

Lactoferrin, Fecal, Quant. LC

Facility

$233.00

Service Code	CPT 83631
Hospital Charge Code	22311197
Hospital Revenue Code	301
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$209.70
Rate for Payer: Aetna of AZ Commercial	$209.70
Rate for Payer: Aetna of AZ Medicare	$65.24
Rate for Payer: Allwell Medicare	$37.28
Rate for Payer: Amerigroup Medicare	$37.28
Rate for Payer: APIPA Medicare/Medicaid	$87.03
Rate for Payer: AZCH Complete Medicare	$37.28
Rate for Payer: Banner UC Health Medicare	$37.28
Rate for Payer: Bisbee Police All Plans	$60.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$158.44
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cigna of AZ Commercial	$151.45
Rate for Payer: Copperpoint Commercial	$57.67
Rate for Payer: Health Net of AZ Commercial	$139.80
Rate for Payer: Health Net of AZ Medicare	$65.24
Rate for Payer: Humana of AZ Medicare	$37.28
Rate for Payer: Self Pay Self Pay	$186.40
Rate for Payer: TriWest Medicare	$37.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$135.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.94

lactulose 20 gm/30 mL Oral Syrup UD [CQCH]

Facility

$0.01

Service Code	NDC 121457730
Hospital Charge Code	105927775
Hospital Revenue Code	251
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: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

lactulose 20 gm/30 mL Oral Syrup UD [CQCH]

Facility

$0.01

Service Code	NDC 121457730
Hospital Charge Code	105927775
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
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 Medicare	$0.00
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: Cash Price	$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: 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

LAMBDA FREE LT CHAIN QNT

Facility

$274.00

Service Code	CPT 83883
Hospital Charge Code	22481488
Hospital Revenue Code	301
Min. Negotiated Rate	$71.24
Max. Negotiated Rate	$246.60
Rate for Payer: Aetna of AZ Commercial	$246.60
Rate for Payer: Bisbee Police All Plans	$71.24
Rate for Payer: Cash Price	$219.20
Rate for Payer: Self Pay Self Pay	$219.20

LAMBDA FREE LT CHAIN QNT

Facility

$274.00

Service Code	CPT 83883
Hospital Charge Code	22481488
Hospital Revenue Code	301
Min. Negotiated Rate	$43.84
Max. Negotiated Rate	$246.60
Rate for Payer: Aetna of AZ Commercial	$246.60
Rate for Payer: Aetna of AZ Medicare	$76.72
Rate for Payer: Allwell Medicare	$43.84
Rate for Payer: Amerigroup Medicare	$43.84
Rate for Payer: APIPA Medicare/Medicaid	$102.34
Rate for Payer: AZCH Complete Medicare	$43.84
Rate for Payer: Banner UC Health Medicare	$43.84
Rate for Payer: Bisbee Police All Plans	$71.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$186.32
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cigna of AZ Commercial	$178.10
Rate for Payer: Copperpoint Commercial	$67.81
Rate for Payer: Health Net of AZ Commercial	$164.40
Rate for Payer: Health Net of AZ Medicare	$76.72
Rate for Payer: Humana of AZ Medicare	$43.84
Rate for Payer: Self Pay Self Pay	$219.20
Rate for Payer: TriWest Medicare	$43.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$159.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$49.32

lamoTRIgine 100 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 904700861
Hospital Charge Code	105950212
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
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	$0.09
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

lamoTRIgine 100 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 904700861
Hospital Charge Code	105950212
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.10
Rate for Payer: Self Pay Self Pay	$0.10

Know your out-of-pocket cost for care.

All Charges