Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

lidoderm patch (5% lidocaine) [CQCH]

Facility

$2.23

Service Code	NDC 42858011830
Hospital Charge Code	105929145
Hospital Revenue Code	251
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$2.01
Rate for Payer: Aetna of AZ Commercial	$2.01
Rate for Payer: Aetna of AZ Medicare	$0.62
Rate for Payer: Allwell Medicare	$0.36
Rate for Payer: Amerigroup Medicare	$0.36
Rate for Payer: APIPA Medicare/Medicaid	$0.83
Rate for Payer: AZCH Complete Medicare	$0.36
Rate for Payer: Banner UC Health Medicare	$0.36
Rate for Payer: Bisbee Police All Plans	$0.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.52
Rate for Payer: Cash Price	$1.79
Rate for Payer: Cigna of AZ Commercial	$1.45
Rate for Payer: Copperpoint Commercial	$0.55
Rate for Payer: Health Net of AZ Commercial	$1.34
Rate for Payer: Health Net of AZ Medicare	$0.62
Rate for Payer: Humana of AZ Medicare	$0.36
Rate for Payer: Self Pay Self Pay	$1.78
Rate for Payer: TriWest Medicare	$0.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.40

lidoderm patch (5% lidocaine) [CQCH]

Facility

$2.23

Service Code	NDC 42858011830
Hospital Charge Code	105929145
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$2.01
Rate for Payer: Aetna of AZ Commercial	$2.01
Rate for Payer: Bisbee Police All Plans	$0.58
Rate for Payer: Cash Price	$1.79
Rate for Payer: Self Pay Self Pay	$1.78

LIGACLIP ROTATING CLIP APPLIER

Facility

$1,998.00

Hospital Charge Code	24055041
Hospital Revenue Code	270
Min. Negotiated Rate	$519.48
Max. Negotiated Rate	$1,798.20
Rate for Payer: Aetna of AZ Commercial	$1,798.20
Rate for Payer: Bisbee Police All Plans	$519.48
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Self Pay Self Pay	$1,598.40

LIGACLIP ROTATING CLIP APPLIER

Facility

$1,998.00

Hospital Charge Code	24055041
Hospital Revenue Code	270
Min. Negotiated Rate	$319.68
Max. Negotiated Rate	$1,798.20
Rate for Payer: Aetna of AZ Commercial	$1,798.20
Rate for Payer: Aetna of AZ Medicare	$559.44
Rate for Payer: Allwell Medicare	$319.68
Rate for Payer: Amerigroup Medicare	$319.68
Rate for Payer: APIPA Medicare/Medicaid	$746.25
Rate for Payer: AZCH Complete Medicare	$319.68
Rate for Payer: Banner UC Health Medicare	$319.68
Rate for Payer: Bisbee Police All Plans	$519.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,358.64
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Cigna of AZ Commercial	$1,398.60
Rate for Payer: Copperpoint Commercial	$494.50
Rate for Payer: Health Net of AZ Commercial	$1,198.80
Rate for Payer: Health Net of AZ Medicare	$559.44
Rate for Payer: Humana of AZ Medicare	$319.68
Rate for Payer: Self Pay Self Pay	$1,598.40
Rate for Payer: TriWest Medicare	$319.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,164.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$359.64

LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREM

Facility

$1,772.00

Service Code	CPT 37618
Hospital Charge Code	2084137
Hospital Revenue Code	450
Min. Negotiated Rate	$460.72
Max. Negotiated Rate	$1,594.80
Rate for Payer: Aetna of AZ Commercial	$1,594.80
Rate for Payer: Bisbee Police All Plans	$460.72
Rate for Payer: Cash Price	$1,417.60
Rate for Payer: Self Pay Self Pay	$1,417.60

LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREM

Facility

$1,772.00

Service Code	CPT 37618
Hospital Charge Code	2084137
Hospital Revenue Code	450
Min. Negotiated Rate	$283.52
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,594.80
Rate for Payer: Aetna of AZ Medicare	$496.16
Rate for Payer: Allwell Medicare	$283.52
Rate for Payer: Amerigroup Medicare	$283.52
Rate for Payer: APIPA Medicare/Medicaid	$661.84
Rate for Payer: AZCH Complete Medicare	$283.52
Rate for Payer: Banner UC Health Medicare	$283.52
Rate for Payer: Bisbee Police All Plans	$460.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,204.96
Rate for Payer: Cash Price	$1,417.60
Rate for Payer: Cash Price	$1,417.60
Rate for Payer: Cigna of AZ Commercial	$1,240.40
Rate for Payer: Copperpoint Commercial	$438.57
Rate for Payer: Health Net of AZ Commercial	$1,063.20
Rate for Payer: Health Net of AZ Medicare	$496.16
Rate for Payer: Humana of AZ Medicare	$283.52
Rate for Payer: Self Pay Self Pay	$1,417.60
Rate for Payer: TriWest Medicare	$283.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$318.96

LIGHT WAND FLEXIBLE

Facility

$197.00

Hospital Charge Code	22578012
Hospital Revenue Code	271
Min. Negotiated Rate	$51.22
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Bisbee Police All Plans	$51.22
Rate for Payer: Cash Price	$157.60
Rate for Payer: Self Pay Self Pay	$157.60

LIGHT WAND FLEXIBLE

Facility

$197.00

Hospital Charge Code	22578012
Hospital Revenue Code	271
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Aetna of AZ Medicare	$55.16
Rate for Payer: Allwell Medicare	$31.52
Rate for Payer: Amerigroup Medicare	$31.52
Rate for Payer: APIPA Medicare/Medicaid	$73.58
Rate for Payer: AZCH Complete Medicare	$31.52
Rate for Payer: Banner UC Health Medicare	$31.52
Rate for Payer: Bisbee Police All Plans	$51.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$133.96
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cigna of AZ Commercial	$137.90
Rate for Payer: Copperpoint Commercial	$48.76
Rate for Payer: Health Net of AZ Commercial	$118.20
Rate for Payer: Health Net of AZ Medicare	$55.16
Rate for Payer: Humana of AZ Medicare	$31.52
Rate for Payer: Self Pay Self Pay	$157.60
Rate for Payer: TriWest Medicare	$31.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$114.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.46

LINEAR CUTTER ENDOSCOPIC 45MM

Facility

$945.00

Hospital Charge Code	22951123
Hospital Revenue Code	270
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of AZ Commercial	$850.50
Rate for Payer: Aetna of AZ Medicare	$264.60
Rate for Payer: Allwell Medicare	$151.20
Rate for Payer: Amerigroup Medicare	$151.20
Rate for Payer: APIPA Medicare/Medicaid	$352.96
Rate for Payer: AZCH Complete Medicare	$151.20
Rate for Payer: Banner UC Health Medicare	$151.20
Rate for Payer: Bisbee Police All Plans	$245.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$642.60
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cigna of AZ Commercial	$661.50
Rate for Payer: Copperpoint Commercial	$233.89
Rate for Payer: Health Net of AZ Commercial	$567.00
Rate for Payer: Health Net of AZ Medicare	$264.60
Rate for Payer: Humana of AZ Medicare	$151.20
Rate for Payer: Self Pay Self Pay	$756.00
Rate for Payer: TriWest Medicare	$151.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$550.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$170.10

LINEAR CUTTER ENDOSCOPIC 45MM

Facility

$945.00

Hospital Charge Code	22951123
Hospital Revenue Code	270
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of AZ Commercial	$850.50
Rate for Payer: Bisbee Police All Plans	$245.70
Rate for Payer: Cash Price	$756.00
Rate for Payer: Self Pay Self Pay	$756.00

Lipase Level

Facility

$175.00

Service Code	CPT 83690
Hospital Charge Code	633776
Hospital Revenue Code	301
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Bisbee Police All Plans	$45.50
Rate for Payer: Cash Price	$140.00
Rate for Payer: Self Pay Self Pay	$140.00

Lipase Level

Facility

$175.00

Service Code	CPT 83690
Hospital Charge Code	633776
Hospital Revenue Code	301
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Aetna of AZ Medicare	$49.00
Rate for Payer: Allwell Medicare	$28.00
Rate for Payer: Amerigroup Medicare	$28.00
Rate for Payer: APIPA Medicare/Medicaid	$65.36
Rate for Payer: AZCH Complete Medicare	$28.00
Rate for Payer: Banner UC Health Medicare	$28.00
Rate for Payer: Bisbee Police All Plans	$45.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$119.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cigna of AZ Commercial	$113.75
Rate for Payer: Copperpoint Commercial	$43.31
Rate for Payer: Health Net of AZ Commercial	$105.00
Rate for Payer: Health Net of AZ Medicare	$49.00
Rate for Payer: Humana of AZ Medicare	$28.00
Rate for Payer: Self Pay Self Pay	$140.00
Rate for Payer: TriWest Medicare	$28.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$102.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.50

Lipid Panel Standard

Facility

$197.00

Service Code	CPT 80061
Hospital Charge Code	22141051
Hospital Revenue Code	301
Min. Negotiated Rate	$51.22
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Bisbee Police All Plans	$51.22
Rate for Payer: Cash Price	$157.60
Rate for Payer: Self Pay Self Pay	$157.60

Lipid Panel Standard

Facility

$197.00

Service Code	CPT 80061
Hospital Charge Code	22141051
Hospital Revenue Code	301
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Aetna of AZ Medicare	$55.16
Rate for Payer: Allwell Medicare	$31.52
Rate for Payer: Amerigroup Medicare	$31.52
Rate for Payer: APIPA Medicare/Medicaid	$73.58
Rate for Payer: AZCH Complete Medicare	$31.52
Rate for Payer: Banner UC Health Medicare	$31.52
Rate for Payer: Bisbee Police All Plans	$51.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$133.96
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cigna of AZ Commercial	$128.05
Rate for Payer: Copperpoint Commercial	$48.76
Rate for Payer: Health Net of AZ Commercial	$118.20
Rate for Payer: Health Net of AZ Medicare	$55.16
Rate for Payer: Humana of AZ Medicare	$31.52
Rate for Payer: Self Pay Self Pay	$157.60
Rate for Payer: TriWest Medicare	$31.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$114.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.46

.LIPO FRAC

Facility

$458.00

Service Code	CPT 83701
Hospital Charge Code	22481447
Hospital Revenue Code	301
Min. Negotiated Rate	$73.28
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna of AZ Commercial	$412.20
Rate for Payer: Aetna of AZ Medicare	$128.24
Rate for Payer: Allwell Medicare	$73.28
Rate for Payer: Amerigroup Medicare	$73.28
Rate for Payer: APIPA Medicare/Medicaid	$171.06
Rate for Payer: AZCH Complete Medicare	$73.28
Rate for Payer: Banner UC Health Medicare	$73.28
Rate for Payer: Bisbee Police All Plans	$119.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$311.44
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cigna of AZ Commercial	$297.70
Rate for Payer: Copperpoint Commercial	$113.36
Rate for Payer: Health Net of AZ Commercial	$274.80
Rate for Payer: Health Net of AZ Medicare	$128.24
Rate for Payer: Humana of AZ Medicare	$73.28
Rate for Payer: Self Pay Self Pay	$366.40
Rate for Payer: TriWest Medicare	$73.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$267.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$82.44

.LIPO FRAC

Facility

$458.00

Service Code	CPT 83701
Hospital Charge Code	22481447
Hospital Revenue Code	301
Min. Negotiated Rate	$119.08
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna of AZ Commercial	$412.20
Rate for Payer: Bisbee Police All Plans	$119.08
Rate for Payer: Cash Price	$366.40
Rate for Payer: Self Pay Self Pay	$366.40

Lipoprotein (A) LC

Facility

$280.00

Service Code	CPT 83695
Hospital Charge Code	4711245
Hospital Revenue Code	301
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Aetna of AZ Medicare	$78.40
Rate for Payer: Allwell Medicare	$44.80
Rate for Payer: Amerigroup Medicare	$44.80
Rate for Payer: APIPA Medicare/Medicaid	$104.58
Rate for Payer: AZCH Complete Medicare	$44.80
Rate for Payer: Banner UC Health Medicare	$44.80
Rate for Payer: Bisbee Police All Plans	$72.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$190.40
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cigna of AZ Commercial	$182.00
Rate for Payer: Copperpoint Commercial	$69.30
Rate for Payer: Health Net of AZ Commercial	$168.00
Rate for Payer: Health Net of AZ Medicare	$78.40
Rate for Payer: Humana of AZ Medicare	$44.80
Rate for Payer: Self Pay Self Pay	$224.00
Rate for Payer: TriWest Medicare	$44.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.40

Lipoprotein (A) LC

Facility

$280.00

Service Code	CPT 83695
Hospital Charge Code	4711245
Hospital Revenue Code	301
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Bisbee Police All Plans	$72.80
Rate for Payer: Cash Price	$224.00
Rate for Payer: Self Pay Self Pay	$224.00

lisinopril 10 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 904679861
Hospital Charge Code	105929476
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.03
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

lisinopril 10 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 904679861
Hospital Charge Code	105929476
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

lisinopril 20 mg Tab [CQCH]

Facility

$0.07

Service Code	NDC 904679961
Hospital Charge Code	105929344
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

lisinopril 20 mg Tab [CQCH]

Facility

$0.07

Service Code	NDC 904679961
Hospital Charge Code	105929344
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.06

lisinopril 2.5 mg Tab [CQCH]

Facility

$0.44

Service Code	NDC 68084076525
Hospital Charge Code	105929411
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of AZ Commercial	$0.40
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.35
Rate for Payer: Self Pay Self Pay	$0.35

lisinopril 2.5 mg Tab [CQCH]

Facility

$0.44

Service Code	NDC 68084076525
Hospital Charge Code	105929411
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of AZ Commercial	$0.40
Rate for Payer: Aetna of AZ Medicare	$0.12
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.16
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.30
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of AZ Commercial	$0.29
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.26
Rate for Payer: Health Net of AZ Medicare	$0.12
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.35
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

lisinopril 5 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 904679761
Hospital Charge Code	105929279
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

Know your out-of-pocket cost for care.

All Charges