Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Lactoferrin, Fecal, Quant. LC

Facility

$245.00

Service Code	CPT 83631
Hospital Charge Code	22311197
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna of AZ Commercial	$220.50
Rate for Payer: Aetna of AZ Medicare	$68.60
Rate for Payer: AHCCCS Medicaid	$19.63
Rate for Payer: Allwell Medicaid	$19.63
Rate for Payer: Allwell Medicare	$36.75
Rate for Payer: Amerigroup Medicare	$36.75
Rate for Payer: APIPA Medicare/Medicaid	$91.51
Rate for Payer: AZCH Complete Medicaid	$19.63
Rate for Payer: AZCH Complete Medicare	$36.75
Rate for Payer: Banner UC Health Medicaid	$19.63
Rate for Payer: Banner UC Health Medicare	$36.75
Rate for Payer: Bisbee Police All Plans	$63.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$166.60
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cigna of AZ Commercial	$159.25
Rate for Payer: Copperpoint Commercial	$60.64
Rate for Payer: Health Net of AZ Commercial	$147.00
Rate for Payer: Health Net of AZ Medicare	$68.60
Rate for Payer: Humana of AZ Medicare	$36.75
Rate for Payer: Mercy Care Medicaid	$19.63
Rate for Payer: Self Pay Self Pay	$196.00
Rate for Payer: TriWest Medicare	$36.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$142.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.10

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

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

LAMBDA FREE LT CHAIN QNT

Facility

$288.00

Service Code	CPT 83883
Hospital Charge Code	22481488
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$259.20
Rate for Payer: Aetna of AZ Commercial	$259.20
Rate for Payer: Aetna of AZ Medicare	$80.64
Rate for Payer: AHCCCS Medicaid	$13.60
Rate for Payer: Allwell Medicaid	$13.60
Rate for Payer: Allwell Medicare	$43.20
Rate for Payer: Amerigroup Medicare	$43.20
Rate for Payer: APIPA Medicare/Medicaid	$107.57
Rate for Payer: AZCH Complete Medicaid	$13.60
Rate for Payer: AZCH Complete Medicare	$43.20
Rate for Payer: Banner UC Health Medicaid	$13.60
Rate for Payer: Banner UC Health Medicare	$43.20
Rate for Payer: Bisbee Police All Plans	$74.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$195.84
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cigna of AZ Commercial	$187.20
Rate for Payer: Copperpoint Commercial	$71.28
Rate for Payer: Health Net of AZ Commercial	$172.80
Rate for Payer: Health Net of AZ Medicare	$80.64
Rate for Payer: Humana of AZ Medicare	$43.20
Rate for Payer: Mercy Care Medicaid	$13.60
Rate for Payer: Self Pay Self Pay	$230.40
Rate for Payer: TriWest Medicare	$43.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$167.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.84

LAMBDA FREE LT CHAIN QNT

Facility

$288.00

Service Code	CPT 83883
Hospital Charge Code	22481488
Hospital Revenue Code	301
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$259.20
Rate for Payer: Aetna of AZ Commercial	$259.20
Rate for Payer: Bisbee Police All Plans	$74.88
Rate for Payer: Cash Price	$230.40
Rate for Payer: Self Pay Self Pay	$230.40

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

Lamotrigine (Lamictal), Serum LC

Facility

$338.00

Service Code	CPT 80299
Hospital Charge Code	1905811
Hospital Revenue Code	301
Min. Negotiated Rate	$87.88
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Cash Price	$270.40
Rate for Payer: Self Pay Self Pay	$270.40

Lamotrigine (Lamictal), Serum LC

Facility

$338.00

Service Code	CPT 80299
Hospital Charge Code	1905811
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Aetna of AZ Medicare	$94.64
Rate for Payer: AHCCCS Medicaid	$18.64
Rate for Payer: Allwell Medicaid	$18.64
Rate for Payer: Allwell Medicare	$50.70
Rate for Payer: Amerigroup Medicare	$50.70
Rate for Payer: APIPA Medicare/Medicaid	$126.24
Rate for Payer: AZCH Complete Medicaid	$18.64
Rate for Payer: AZCH Complete Medicare	$50.70
Rate for Payer: Banner UC Health Medicaid	$18.64
Rate for Payer: Banner UC Health Medicare	$50.70
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$229.84
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cigna of AZ Commercial	$219.70
Rate for Payer: Copperpoint Commercial	$83.66
Rate for Payer: Health Net of AZ Commercial	$202.80
Rate for Payer: Health Net of AZ Medicare	$94.64
Rate for Payer: Humana of AZ Medicare	$50.70
Rate for Payer: Mercy Care Medicaid	$18.64
Rate for Payer: Self Pay Self Pay	$270.40
Rate for Payer: TriWest Medicare	$50.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$197.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.84

Laparoscopic burch

Facility

$4,037.00

Service Code	CPT 51990
Hospital Charge Code	27267839
Hospital Revenue Code	360
Min. Negotiated Rate	$605.55
Max. Negotiated Rate	$7,337.64
Rate for Payer: Aetna of AZ Commercial	$3,633.30
Rate for Payer: Aetna of AZ Medicare	$1,130.36
Rate for Payer: AHCCCS Medicaid	$7,337.64
Rate for Payer: Allwell Medicaid	$7,337.64
Rate for Payer: Allwell Medicare	$605.55
Rate for Payer: Amerigroup Medicare	$605.55
Rate for Payer: APIPA Medicare/Medicaid	$1,507.82
Rate for Payer: AZCH Complete Medicaid	$7,337.64
Rate for Payer: AZCH Complete Medicare	$605.55
Rate for Payer: Banner UC Health Medicaid	$7,337.64
Rate for Payer: Banner UC Health Medicare	$605.55
Rate for Payer: Bisbee Police All Plans	$1,049.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,745.16
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cigna of AZ Commercial	$2,018.50
Rate for Payer: Copperpoint Commercial	$999.16
Rate for Payer: Health Net of AZ Commercial	$2,422.20
Rate for Payer: Health Net of AZ Medicare	$1,130.36
Rate for Payer: Humana of AZ Medicare	$605.55
Rate for Payer: Mercy Care Medicaid	$7,337.64
Rate for Payer: Self Pay Self Pay	$3,229.60
Rate for Payer: TriWest Medicare	$605.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$726.66

Laparoscopic burch

Facility

$4,037.00

Service Code	CPT 51990
Hospital Charge Code	27267839
Hospital Revenue Code	360
Min. Negotiated Rate	$1,049.62
Max. Negotiated Rate	$3,633.30
Rate for Payer: Aetna of AZ Commercial	$3,633.30
Rate for Payer: Bisbee Police All Plans	$1,049.62
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Self Pay Self Pay	$3,229.60

Laparoscopic myomectomy

Facility

$5,082.00

Service Code	CPT 58140
Hospital Charge Code	27281908
Hospital Revenue Code	360
Min. Negotiated Rate	$1,321.32
Max. Negotiated Rate	$4,573.80
Rate for Payer: Aetna of AZ Commercial	$4,573.80
Rate for Payer: Bisbee Police All Plans	$1,321.32
Rate for Payer: Cash Price	$4,065.60
Rate for Payer: Self Pay Self Pay	$4,065.60

Laparoscopic myomectomy

Facility

$5,082.00

Service Code	CPT 58140
Hospital Charge Code	27281908
Hospital Revenue Code	360
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$4,573.80
Rate for Payer: Aetna of AZ Commercial	$4,573.80
Rate for Payer: Aetna of AZ Medicare	$1,422.96
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$762.30
Rate for Payer: Amerigroup Medicare	$762.30
Rate for Payer: APIPA Medicare/Medicaid	$1,898.13
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$762.30
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$762.30
Rate for Payer: Bisbee Police All Plans	$1,321.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,455.76
Rate for Payer: Cash Price	$4,065.60
Rate for Payer: Cash Price	$4,065.60
Rate for Payer: Cigna of AZ Commercial	$2,541.00
Rate for Payer: Copperpoint Commercial	$1,257.80
Rate for Payer: Health Net of AZ Commercial	$3,049.20
Rate for Payer: Health Net of AZ Medicare	$1,422.96
Rate for Payer: Humana of AZ Medicare	$762.30
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$4,065.60
Rate for Payer: TriWest Medicare	$762.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$914.76

Laparoscopy lysis of adhesiions

Facility

$3,525.00

Service Code	CPT 58660
Hospital Charge Code	27281902
Hospital Revenue Code	360
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$3,172.50
Rate for Payer: Aetna of AZ Commercial	$3,172.50
Rate for Payer: Bisbee Police All Plans	$916.50
Rate for Payer: Cash Price	$2,820.00
Rate for Payer: Self Pay Self Pay	$2,820.00

Laparoscopy lysis of adhesiions

Facility

$3,525.00

Service Code	CPT 58660
Hospital Charge Code	27281902
Hospital Revenue Code	360
Min. Negotiated Rate	$528.75
Max. Negotiated Rate	$7,337.64
Rate for Payer: Aetna of AZ Commercial	$3,172.50
Rate for Payer: Aetna of AZ Medicare	$987.00
Rate for Payer: AHCCCS Medicaid	$7,337.64
Rate for Payer: Allwell Medicaid	$7,337.64
Rate for Payer: Allwell Medicare	$528.75
Rate for Payer: Amerigroup Medicare	$528.75
Rate for Payer: APIPA Medicare/Medicaid	$1,316.59
Rate for Payer: AZCH Complete Medicaid	$7,337.64
Rate for Payer: AZCH Complete Medicare	$528.75
Rate for Payer: Banner UC Health Medicaid	$7,337.64
Rate for Payer: Banner UC Health Medicare	$528.75
Rate for Payer: Bisbee Police All Plans	$916.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,397.00
Rate for Payer: Cash Price	$2,820.00
Rate for Payer: Cash Price	$2,820.00
Rate for Payer: Cigna of AZ Commercial	$1,762.50
Rate for Payer: Copperpoint Commercial	$872.44
Rate for Payer: Health Net of AZ Commercial	$2,115.00
Rate for Payer: Health Net of AZ Medicare	$987.00
Rate for Payer: Humana of AZ Medicare	$528.75
Rate for Payer: Mercy Care Medicaid	$7,337.64
Rate for Payer: Self Pay Self Pay	$2,820.00
Rate for Payer: TriWest Medicare	$528.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$634.50

LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINEN

Facility

$19,694.00

Service Code	CPT 51992
Hospital Charge Code	23093915
Hospital Revenue Code	360
Min. Negotiated Rate	$2,954.10
Max. Negotiated Rate	$17,724.60
Rate for Payer: Aetna of AZ Commercial	$17,724.60
Rate for Payer: Aetna of AZ Medicare	$5,514.32
Rate for Payer: AHCCCS Medicaid	$7,337.64
Rate for Payer: Allwell Medicaid	$7,337.64
Rate for Payer: Allwell Medicare	$2,954.10
Rate for Payer: Amerigroup Medicare	$2,954.10
Rate for Payer: APIPA Medicare/Medicaid	$7,355.71
Rate for Payer: AZCH Complete Medicaid	$7,337.64
Rate for Payer: AZCH Complete Medicare	$2,954.10
Rate for Payer: Banner UC Health Medicaid	$7,337.64
Rate for Payer: Banner UC Health Medicare	$2,954.10
Rate for Payer: Bisbee Police All Plans	$5,120.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13,391.92
Rate for Payer: Cash Price	$15,755.20
Rate for Payer: Cash Price	$15,755.20
Rate for Payer: Cigna of AZ Commercial	$9,847.00
Rate for Payer: Copperpoint Commercial	$4,874.26
Rate for Payer: Health Net of AZ Commercial	$11,816.40
Rate for Payer: Health Net of AZ Medicare	$5,514.32
Rate for Payer: Humana of AZ Medicare	$2,954.10
Rate for Payer: Mercy Care Medicaid	$7,337.64
Rate for Payer: Self Pay Self Pay	$15,755.20
Rate for Payer: TriWest Medicare	$2,954.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$3,544.92

LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINEN

Facility

$19,694.00

Service Code	CPT 51992
Hospital Charge Code	23093915
Hospital Revenue Code	360
Min. Negotiated Rate	$5,120.44
Max. Negotiated Rate	$17,724.60
Rate for Payer: Aetna of AZ Commercial	$17,724.60
Rate for Payer: Bisbee Police All Plans	$5,120.44
Rate for Payer: Cash Price	$15,755.20
Rate for Payer: Self Pay Self Pay	$15,755.20

LAPIPLASTY SPEEDPLATE QUAD 28X13X11

Facility

$31,427.00

Hospital Charge Code	27733676
Hospital Revenue Code	270
Min. Negotiated Rate	$4,714.05
Max. Negotiated Rate	$28,284.30
Rate for Payer: Aetna of AZ Commercial	$28,284.30
Rate for Payer: Aetna of AZ Medicare	$8,799.56
Rate for Payer: Allwell Medicare	$4,714.05
Rate for Payer: Amerigroup Medicare	$4,714.05
Rate for Payer: APIPA Medicare/Medicaid	$11,737.98
Rate for Payer: AZCH Complete Medicare	$4,714.05
Rate for Payer: Banner UC Health Medicare	$4,714.05
Rate for Payer: Bisbee Police All Plans	$8,171.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21,370.36
Rate for Payer: Cash Price	$25,141.60
Rate for Payer: Cigna of AZ Commercial	$21,998.90
Rate for Payer: Copperpoint Commercial	$7,778.18
Rate for Payer: Health Net of AZ Commercial	$18,856.20
Rate for Payer: Health Net of AZ Medicare	$8,799.56
Rate for Payer: Humana of AZ Medicare	$4,714.05
Rate for Payer: Self Pay Self Pay	$25,141.60
Rate for Payer: TriWest Medicare	$4,714.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$18,321.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$5,656.86

LAPIPLASTY SPEEDPLATE QUAD 28X13X11

Facility

$31,427.00

Hospital Charge Code	27733676
Hospital Revenue Code	270
Min. Negotiated Rate	$8,171.02
Max. Negotiated Rate	$28,284.30
Rate for Payer: Aetna of AZ Commercial	$28,284.30
Rate for Payer: Bisbee Police All Plans	$8,171.02
Rate for Payer: Cash Price	$25,141.60
Rate for Payer: Self Pay Self Pay	$25,141.60

LAPIPLASTY SYSTEM 4

Facility

$33,448.00

Hospital Charge Code	27431788
Hospital Revenue Code	270
Min. Negotiated Rate	$8,696.48
Max. Negotiated Rate	$30,103.20
Rate for Payer: Aetna of AZ Commercial	$30,103.20
Rate for Payer: Bisbee Police All Plans	$8,696.48
Rate for Payer: Cash Price	$26,758.40
Rate for Payer: Self Pay Self Pay	$26,758.40

LAPIPLASTY SYSTEM 4

Facility

$33,448.00

Hospital Charge Code	27431788
Hospital Revenue Code	270
Min. Negotiated Rate	$5,017.20
Max. Negotiated Rate	$30,103.20
Rate for Payer: Aetna of AZ Commercial	$30,103.20
Rate for Payer: Aetna of AZ Medicare	$9,365.44
Rate for Payer: Allwell Medicare	$5,017.20
Rate for Payer: Amerigroup Medicare	$5,017.20
Rate for Payer: APIPA Medicare/Medicaid	$12,492.83
Rate for Payer: AZCH Complete Medicare	$5,017.20
Rate for Payer: Banner UC Health Medicare	$5,017.20
Rate for Payer: Bisbee Police All Plans	$8,696.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22,744.64
Rate for Payer: Cash Price	$26,758.40
Rate for Payer: Cigna of AZ Commercial	$23,413.60
Rate for Payer: Copperpoint Commercial	$8,278.38
Rate for Payer: Health Net of AZ Commercial	$20,068.80
Rate for Payer: Health Net of AZ Medicare	$9,365.44
Rate for Payer: Humana of AZ Medicare	$5,017.20
Rate for Payer: Self Pay Self Pay	$26,758.40
Rate for Payer: TriWest Medicare	$5,017.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$19,500.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$6,020.64

LAP-KIT INSTRUMENT HOLDER ETHOX

Facility

$26.00

Hospital Charge Code	22561837
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

LAP-KIT INSTRUMENT HOLDER ETHOX

Facility

$26.00

Hospital Charge Code	22561837
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

LAP KIT LAPAROSCOPIC INSTRUMENT HOLDER

Facility

$33.00

Hospital Charge Code	27372824
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

LAP KIT LAPAROSCOPIC INSTRUMENT HOLDER

Facility

$33.00

Hospital Charge Code	27372824
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$4.95
Rate for Payer: Amerigroup Medicare	$4.95
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$4.95
Rate for Payer: Banner UC Health Medicare	$4.95
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$4.95
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$4.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

Know your out-of-pocket cost for care.

All Charges