Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

LEOS 2MM DRILL

Facility

$2,237.00

Hospital Charge Code	27663810
Hospital Revenue Code	270
Min. Negotiated Rate	$581.62
Max. Negotiated Rate	$2,013.30
Rate for Payer: Aetna of AZ Commercial	$2,013.30
Rate for Payer: Bisbee Police All Plans	$581.62
Rate for Payer: Cash Price	$1,789.60
Rate for Payer: Self Pay Self Pay	$1,789.60

LEOS 3.5MM LOCKING SCREW 16MM

Facility

$2,595.00

Hospital Charge Code	27808543
Hospital Revenue Code	270
Min. Negotiated Rate	$415.20
Max. Negotiated Rate	$2,335.50
Rate for Payer: Aetna of AZ Commercial	$2,335.50
Rate for Payer: Aetna of AZ Medicare	$726.60
Rate for Payer: Allwell Medicare	$415.20
Rate for Payer: Amerigroup Medicare	$415.20
Rate for Payer: APIPA Medicare/Medicaid	$969.23
Rate for Payer: AZCH Complete Medicare	$415.20
Rate for Payer: Banner UC Health Medicare	$415.20
Rate for Payer: Bisbee Police All Plans	$674.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,764.60
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Cigna of AZ Commercial	$1,816.50
Rate for Payer: Copperpoint Commercial	$642.26
Rate for Payer: Health Net of AZ Commercial	$1,557.00
Rate for Payer: Health Net of AZ Medicare	$726.60
Rate for Payer: Humana of AZ Medicare	$415.20
Rate for Payer: Self Pay Self Pay	$2,076.00
Rate for Payer: TriWest Medicare	$415.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,512.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$467.10

LEOS 3.5MM LOCKING SCREW 16MM

Facility

$2,595.00

Hospital Charge Code	27808543
Hospital Revenue Code	270
Min. Negotiated Rate	$674.70
Max. Negotiated Rate	$2,335.50
Rate for Payer: Aetna of AZ Commercial	$2,335.50
Rate for Payer: Bisbee Police All Plans	$674.70
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Self Pay Self Pay	$2,076.00

LEOS 3.5MM LOCKING SCREW 18MM

Facility

$2,595.00

Hospital Charge Code	27808544
Hospital Revenue Code	270
Min. Negotiated Rate	$674.70
Max. Negotiated Rate	$2,335.50
Rate for Payer: Aetna of AZ Commercial	$2,335.50
Rate for Payer: Bisbee Police All Plans	$674.70
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Self Pay Self Pay	$2,076.00

LEOS 3.5MM LOCKING SCREW 18MM

Facility

$2,595.00

Hospital Charge Code	27808544
Hospital Revenue Code	270
Min. Negotiated Rate	$415.20
Max. Negotiated Rate	$2,335.50
Rate for Payer: Aetna of AZ Commercial	$2,335.50
Rate for Payer: Aetna of AZ Medicare	$726.60
Rate for Payer: Allwell Medicare	$415.20
Rate for Payer: Amerigroup Medicare	$415.20
Rate for Payer: APIPA Medicare/Medicaid	$969.23
Rate for Payer: AZCH Complete Medicare	$415.20
Rate for Payer: Banner UC Health Medicare	$415.20
Rate for Payer: Bisbee Police All Plans	$674.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,764.60
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Cigna of AZ Commercial	$1,816.50
Rate for Payer: Copperpoint Commercial	$642.26
Rate for Payer: Health Net of AZ Commercial	$1,557.00
Rate for Payer: Health Net of AZ Medicare	$726.60
Rate for Payer: Humana of AZ Medicare	$415.20
Rate for Payer: Self Pay Self Pay	$2,076.00
Rate for Payer: TriWest Medicare	$415.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,512.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$467.10

LEOS 3.5MM LOCKING SCREW 8MM

Facility

$2,595.00

Hospital Charge Code	27808545
Hospital Revenue Code	270
Min. Negotiated Rate	$415.20
Max. Negotiated Rate	$2,335.50
Rate for Payer: Aetna of AZ Commercial	$2,335.50
Rate for Payer: Aetna of AZ Medicare	$726.60
Rate for Payer: Allwell Medicare	$415.20
Rate for Payer: Amerigroup Medicare	$415.20
Rate for Payer: APIPA Medicare/Medicaid	$969.23
Rate for Payer: AZCH Complete Medicare	$415.20
Rate for Payer: Banner UC Health Medicare	$415.20
Rate for Payer: Bisbee Police All Plans	$674.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,764.60
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Cigna of AZ Commercial	$1,816.50
Rate for Payer: Copperpoint Commercial	$642.26
Rate for Payer: Health Net of AZ Commercial	$1,557.00
Rate for Payer: Health Net of AZ Medicare	$726.60
Rate for Payer: Humana of AZ Medicare	$415.20
Rate for Payer: Self Pay Self Pay	$2,076.00
Rate for Payer: TriWest Medicare	$415.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,512.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$467.10

LEOS 3.5MM LOCKING SCREW 8MM

Facility

$2,595.00

Hospital Charge Code	27808545
Hospital Revenue Code	270
Min. Negotiated Rate	$674.70
Max. Negotiated Rate	$2,335.50
Rate for Payer: Aetna of AZ Commercial	$2,335.50
Rate for Payer: Bisbee Police All Plans	$674.70
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Self Pay Self Pay	$2,076.00

LEOS MTP PLATE SM 5 DEGREE LT

Facility

$18,675.00

Hospital Charge Code	27810503
Hospital Revenue Code	270
Min. Negotiated Rate	$4,855.50
Max. Negotiated Rate	$16,807.50
Rate for Payer: Aetna of AZ Commercial	$16,807.50
Rate for Payer: Bisbee Police All Plans	$4,855.50
Rate for Payer: Cash Price	$14,940.00
Rate for Payer: Self Pay Self Pay	$14,940.00

LEOS MTP PLATE SM 5 DEGREE LT

Facility

$18,675.00

Hospital Charge Code	27810503
Hospital Revenue Code	270
Min. Negotiated Rate	$2,988.00
Max. Negotiated Rate	$16,807.50
Rate for Payer: Aetna of AZ Commercial	$16,807.50
Rate for Payer: Aetna of AZ Medicare	$5,229.00
Rate for Payer: Allwell Medicare	$2,988.00
Rate for Payer: Amerigroup Medicare	$2,988.00
Rate for Payer: APIPA Medicare/Medicaid	$6,975.11
Rate for Payer: AZCH Complete Medicare	$2,988.00
Rate for Payer: Banner UC Health Medicare	$2,988.00
Rate for Payer: Bisbee Police All Plans	$4,855.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12,699.00
Rate for Payer: Cash Price	$14,940.00
Rate for Payer: Cigna of AZ Commercial	$13,072.50
Rate for Payer: Copperpoint Commercial	$4,622.06
Rate for Payer: Health Net of AZ Commercial	$11,205.00
Rate for Payer: Health Net of AZ Medicare	$5,229.00
Rate for Payer: Humana of AZ Medicare	$2,988.00
Rate for Payer: Self Pay Self Pay	$14,940.00
Rate for Payer: TriWest Medicare	$2,988.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$10,887.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$3,361.50

LEOS PLATE TACK 10MM

Facility

$1,260.00

Hospital Charge Code	27595626
Hospital Revenue Code	270
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$1,134.00
Rate for Payer: Aetna of AZ Commercial	$1,134.00
Rate for Payer: Bisbee Police All Plans	$327.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Self Pay Self Pay	$1,008.00

LEOS PLATE TACK 10MM

Facility

$1,260.00

Hospital Charge Code	27595626
Hospital Revenue Code	270
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$1,134.00
Rate for Payer: Aetna of AZ Commercial	$1,134.00
Rate for Payer: Aetna of AZ Medicare	$352.80
Rate for Payer: Allwell Medicare	$201.60
Rate for Payer: Amerigroup Medicare	$201.60
Rate for Payer: APIPA Medicare/Medicaid	$470.61
Rate for Payer: AZCH Complete Medicare	$201.60
Rate for Payer: Banner UC Health Medicare	$201.60
Rate for Payer: Bisbee Police All Plans	$327.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$856.80
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Cigna of AZ Commercial	$882.00
Rate for Payer: Copperpoint Commercial	$311.85
Rate for Payer: Health Net of AZ Commercial	$756.00
Rate for Payer: Health Net of AZ Medicare	$352.80
Rate for Payer: Humana of AZ Medicare	$201.60
Rate for Payer: Self Pay Self Pay	$1,008.00
Rate for Payer: TriWest Medicare	$201.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$734.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$226.80

LEOS PLATE TACK 20MM

Facility

$1,245.00

Hospital Charge Code	27702569
Hospital Revenue Code	270
Min. Negotiated Rate	$199.20
Max. Negotiated Rate	$1,120.50
Rate for Payer: Aetna of AZ Commercial	$1,120.50
Rate for Payer: Aetna of AZ Medicare	$348.60
Rate for Payer: Allwell Medicare	$199.20
Rate for Payer: Amerigroup Medicare	$199.20
Rate for Payer: APIPA Medicare/Medicaid	$465.01
Rate for Payer: AZCH Complete Medicare	$199.20
Rate for Payer: Banner UC Health Medicare	$199.20
Rate for Payer: Bisbee Police All Plans	$323.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$846.60
Rate for Payer: Cash Price	$996.00
Rate for Payer: Cigna of AZ Commercial	$871.50
Rate for Payer: Copperpoint Commercial	$308.14
Rate for Payer: Health Net of AZ Commercial	$747.00
Rate for Payer: Health Net of AZ Medicare	$348.60
Rate for Payer: Humana of AZ Medicare	$199.20
Rate for Payer: Self Pay Self Pay	$996.00
Rate for Payer: TriWest Medicare	$199.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$725.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$224.10

LEOS PLATE TACK 20MM

Facility

$1,245.00

Hospital Charge Code	27702569
Hospital Revenue Code	270
Min. Negotiated Rate	$323.70
Max. Negotiated Rate	$1,120.50
Rate for Payer: Aetna of AZ Commercial	$1,120.50
Rate for Payer: Bisbee Police All Plans	$323.70
Rate for Payer: Cash Price	$996.00
Rate for Payer: Self Pay Self Pay	$996.00

LETs Topical Gel[CQCH]

Facility

$3.93

Service Code	NDC 51552153601
Hospital Charge Code	138784370
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna of AZ Commercial	$3.54
Rate for Payer: Aetna of AZ Medicare	$1.10
Rate for Payer: Allwell Medicare	$0.63
Rate for Payer: Amerigroup Medicare	$0.63
Rate for Payer: APIPA Medicare/Medicaid	$1.47
Rate for Payer: AZCH Complete Medicare	$0.63
Rate for Payer: Banner UC Health Medicare	$0.63
Rate for Payer: Bisbee Police All Plans	$1.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.67
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cigna of AZ Commercial	$2.55
Rate for Payer: Copperpoint Commercial	$0.97
Rate for Payer: Health Net of AZ Commercial	$2.36
Rate for Payer: Health Net of AZ Medicare	$1.10
Rate for Payer: Humana of AZ Medicare	$0.63
Rate for Payer: Self Pay Self Pay	$3.14
Rate for Payer: TriWest Medicare	$0.63
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.71

LETs Topical Gel[CQCH]

Facility

$3.93

Service Code	NDC 51552153601
Hospital Charge Code	138784370
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna of AZ Commercial	$3.54
Rate for Payer: Bisbee Police All Plans	$1.02
Rate for Payer: Cash Price	$3.14
Rate for Payer: Self Pay Self Pay	$3.14

levalbuterol 1.25 mg/0.5 mL Inh Sol UD [CQCH]

Facility

$1.51

Service Code	HCPCS J7614
Hospital Charge Code	105927907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Aetna of AZ Medicare	$0.42
Rate for Payer: Allwell Medicare	$0.24
Rate for Payer: Amerigroup Medicare	$0.24
Rate for Payer: APIPA Medicare/Medicaid	$0.56
Rate for Payer: AZCH Complete Medicare	$0.24
Rate for Payer: Banner UC Health Medicare	$0.24
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.03
Rate for Payer: Cash Price	$1.21
Rate for Payer: Cigna of AZ Commercial	$0.98
Rate for Payer: Copperpoint Commercial	$0.37
Rate for Payer: Health Net of AZ Commercial	$0.91
Rate for Payer: Health Net of AZ Medicare	$0.42
Rate for Payer: Humana of AZ Medicare	$0.24
Rate for Payer: Self Pay Self Pay	$1.21
Rate for Payer: TriWest Medicare	$0.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.27

levalbuterol 1.25 mg/0.5 mL Inh Sol UD [CQCH]

Facility

$1.51

Service Code	HCPCS J7614
Hospital Charge Code	105927907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Cash Price	$1.21
Rate for Payer: Self Pay Self Pay	$1.21

levETIRAcetam 500 mg/ 5 mL Oral Sol UD [CQCH]

Facility

$0.25

Service Code	NDC 603138458
Hospital Charge Code	105927980
Hospital Revenue Code	251
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

levETIRAcetam 500 mg/ 5 mL Oral Sol UD [CQCH]

Facility

$0.25

Service Code	NDC 603138458
Hospital Charge Code	105927980
Hospital Revenue Code	251
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

levETIRAcetam 500 mg Inj 5 mL [CQCH]

Facility

$0.29

Service Code	HCPCS J1953
Hospital Charge Code	108073828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.23
Rate for Payer: Self Pay Self Pay	$0.23

levETIRAcetam 500 mg Inj 5 mL [CQCH]

Facility

$0.29

Service Code	HCPCS J1953
Hospital Charge Code	108073828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Aetna of AZ Medicare	$0.08
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.11
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.20
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of AZ Commercial	$0.19
Rate for Payer: Copperpoint Commercial	$0.07
Rate for Payer: Health Net of AZ Commercial	$0.17
Rate for Payer: Health Net of AZ Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.23
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

levETIRAcetam 500 mg Tab [CQCH]

Facility

$0.31

Service Code	NDC 68180011316
Hospital Charge Code	105928045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of AZ Commercial	$0.28
Rate for Payer: Aetna of AZ Medicare	$0.09
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.12
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.21
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of AZ Commercial	$0.20
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.19
Rate for Payer: Health Net of AZ Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.25
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

levETIRAcetam 500 mg Tab [CQCH]

Facility

$0.31

Service Code	NDC 68180011316
Hospital Charge Code	105928045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of AZ Commercial	$0.28
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.24
Rate for Payer: Self Pay Self Pay	$0.25

Levetiracetam (Keppra), S LC

Facility

$281.00

Service Code	CPT 80299
Hospital Charge Code	1906919
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

Levetiracetam (Keppra), S LC

Facility

$281.00

Service Code	CPT 80299
Hospital Charge Code	1906919
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

Know your out-of-pocket cost for care.

All Charges