Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

LIGACLIP ROTATING CLIP APPLIER

Facility

$1,998.00

Hospital Charge Code	24055041
Hospital Revenue Code	270
Min. Negotiated Rate	$1,798.20
Max. Negotiated Rate	$1,798.20
Rate for Payer: Aetna of AZ Commercial	$1,798.20
Rate for Payer: Cash Price	$1,598.40

LIGACLIP ROTATING CLIP APPLIER

Facility

$1,998.00

Hospital Charge Code	24055041
Hospital Revenue Code	270
Min. Negotiated Rate	$316.48
Max. Negotiated Rate	$1,798.20
Rate for Payer: Aetna of AZ Commercial	$1,798.20
Rate for Payer: Arizona Complete Health Allwell	$319.68
Rate for Payer: Banner UC Health Medicare	$319.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,358.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$319.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$319.68
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Cigna of AZ Commercial	$1,398.60
Rate for Payer: Devoted Health Medicare	$359.64
Rate for Payer: Humana of AZ Medicare	$319.68
Rate for Payer: Southwest Service Administrators UFCW	$1,358.64
Rate for Payer: TriWest Medicare	$319.68
Rate for Payer: United Healthcare Commercial	$1,142.86
Rate for Payer: United Healthcare Medicare	$319.68
Rate for Payer: Veterans Affairs TRICARE	$316.48

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	$280.68
Max. Negotiated Rate	$1,594.80
Rate for Payer: Aetna of AZ Commercial	$1,594.80
Rate for Payer: Arizona Complete Health Allwell	$283.52
Rate for Payer: Banner UC Health Medicare	$283.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,204.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$283.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$283.52
Rate for Payer: Cash Price	$1,417.60
Rate for Payer: Cigna of AZ Commercial	$1,240.40
Rate for Payer: Devoted Health Medicare	$318.96
Rate for Payer: Humana of AZ Medicare	$283.52
Rate for Payer: Southwest Service Administrators UFCW	$1,204.96
Rate for Payer: TriWest Medicare	$283.52
Rate for Payer: United Healthcare Commercial	$1,013.58
Rate for Payer: United Healthcare Medicare	$283.52
Rate for Payer: United Healthcare New Mexico Commercial	$336.68
Rate for Payer: Veterans Affairs TRICARE	$280.68

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	$1,594.80
Max. Negotiated Rate	$1,594.80
Rate for Payer: Aetna of AZ Commercial	$1,594.80
Rate for Payer: Cash Price	$1,417.60

LIGHT WAND FLEXIBLE

Facility

$197.00

Hospital Charge Code	22578012
Hospital Revenue Code	271
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Cash Price	$157.60

LIGHT WAND FLEXIBLE

Facility

$197.00

Hospital Charge Code	22578012
Hospital Revenue Code	271
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Arizona Complete Health Allwell	$31.52
Rate for Payer: Banner UC Health Medicare	$31.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$133.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.52
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cigna of AZ Commercial	$137.90
Rate for Payer: Devoted Health Medicare	$35.46
Rate for Payer: Humana of AZ Medicare	$31.52
Rate for Payer: Southwest Service Administrators UFCW	$133.96
Rate for Payer: TriWest Medicare	$31.52
Rate for Payer: United Healthcare Commercial	$112.68
Rate for Payer: United Healthcare Medicare	$31.52
Rate for Payer: Veterans Affairs TRICARE	$31.20

LILETTA IUD CQCH_AZ

Facility

$250.00

Service Code	HCPCS J7297
Hospital Charge Code	28223762
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Cash Price	$200.00

LILETTA IUD CQCH_AZ

Facility

$250.00

Service Code	HCPCS J7297
Hospital Charge Code	28223762
Hospital Revenue Code	272
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Arizona Complete Health Allwell	$40.00
Rate for Payer: Banner UC Health Medicare	$40.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$170.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cigna of AZ Commercial	$175.00
Rate for Payer: Devoted Health Medicare	$45.00
Rate for Payer: Humana of AZ Medicare	$40.00
Rate for Payer: Southwest Service Administrators UFCW	$170.00
Rate for Payer: TriWest Medicare	$40.00
Rate for Payer: United Healthcare Commercial	$143.00
Rate for Payer: United Healthcare Medicare	$40.00
Rate for Payer: Veterans Affairs TRICARE	$39.60

LIMB HOLDER WRIST QUICK RELEASE

Facility

$91.00

Hospital Charge Code	23839265
Hospital Revenue Code	270
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Arizona Complete Health Allwell	$14.56
Rate for Payer: Banner UC Health Medicare	$14.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.56
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$63.70
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Humana of AZ Medicare	$14.56
Rate for Payer: Southwest Service Administrators UFCW	$61.88
Rate for Payer: TriWest Medicare	$14.56
Rate for Payer: United Healthcare Commercial	$52.05
Rate for Payer: United Healthcare Medicare	$14.56
Rate for Payer: Veterans Affairs TRICARE	$14.41

LIMB HOLDER WRIST QUICK RELEASE

Facility

$91.00

Hospital Charge Code	23839265
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Cash Price	$72.80

LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$48,633.55

Service Code	MSDRG 956
Min. Negotiated Rate	$48,633.55
Max. Negotiated Rate	$48,633.55
Rate for Payer: Seven Corners Travel Insurance	$48,633.55

LINEAR CUTTER ENDOSCOPIC 45MM

Facility

$945.00

Hospital Charge Code	22951123
Hospital Revenue Code	270
Min. Negotiated Rate	$850.50
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of AZ Commercial	$850.50
Rate for Payer: Cash Price	$756.00

LINEAR CUTTER ENDOSCOPIC 45MM

Facility

$945.00

Hospital Charge Code	22951123
Hospital Revenue Code	270
Min. Negotiated Rate	$149.69
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna of AZ Commercial	$850.50
Rate for Payer: Arizona Complete Health Allwell	$151.20
Rate for Payer: Banner UC Health Medicare	$151.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$642.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$151.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$151.20
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cigna of AZ Commercial	$661.50
Rate for Payer: Devoted Health Medicare	$170.10
Rate for Payer: Humana of AZ Medicare	$151.20
Rate for Payer: Southwest Service Administrators UFCW	$642.60
Rate for Payer: TriWest Medicare	$151.20
Rate for Payer: United Healthcare Commercial	$540.54
Rate for Payer: United Healthcare Medicare	$151.20
Rate for Payer: Veterans Affairs TRICARE	$149.69

Lipase Level

Facility

$242.00

Service Code	CPT 83690
Hospital Charge Code	633776
Hospital Revenue Code	301
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Arizona Complete Health Allwell	$28.00
Rate for Payer: Arizona Complete Health Allwell	$38.72
Rate for Payer: Banner UC Health Medicare	$28.00
Rate for Payer: Banner UC Health Medicare	$38.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$164.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$119.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.72
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cigna of AZ Commercial	$157.30
Rate for Payer: Cigna of AZ Commercial	$113.75
Rate for Payer: Devoted Health Medicare	$43.56
Rate for Payer: Devoted Health Medicare	$31.50
Rate for Payer: Humana of AZ Medicare	$28.00
Rate for Payer: Humana of AZ Medicare	$38.72
Rate for Payer: Seven Corners Travel Insurance	$9.99
Rate for Payer: Seven Corners Travel Insurance	$9.99
Rate for Payer: Southwest Service Administrators UFCW	$119.00
Rate for Payer: Southwest Service Administrators UFCW	$164.56
Rate for Payer: TriWest Medicare	$28.00
Rate for Payer: TriWest Medicare	$38.72
Rate for Payer: United Healthcare Commercial	$138.42
Rate for Payer: United Healthcare Commercial	$100.10
Rate for Payer: United Healthcare Medicare	$28.00
Rate for Payer: United Healthcare Medicare	$38.72
Rate for Payer: Veterans Affairs TRICARE	$38.33
Rate for Payer: Veterans Affairs TRICARE	$27.72

Lipase Level

Facility

$175.00

Service Code	CPT 83690
Hospital Charge Code	633776
Hospital Revenue Code	301
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$193.60

Lipid Panel Standard

Facility

$197.00

Service Code	CPT 80061
Hospital Charge Code	22141051
Hospital Revenue Code	301
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$177.30
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Aetna of AZ Commercial	$237.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$211.20

Lipid Panel Standard

Facility

$264.00

Service Code	CPT 80061
Hospital Charge Code	22141051
Hospital Revenue Code	301
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$237.60
Rate for Payer: Aetna of AZ Commercial	$237.60
Rate for Payer: Aetna of AZ Commercial	$177.30
Rate for Payer: Arizona Complete Health Allwell	$31.52
Rate for Payer: Arizona Complete Health Allwell	$42.24
Rate for Payer: Banner UC Health Medicare	$31.52
Rate for Payer: Banner UC Health Medicare	$42.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$179.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$133.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.24
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$211.20
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cigna of AZ Commercial	$171.60
Rate for Payer: Cigna of AZ Commercial	$128.05
Rate for Payer: Devoted Health Medicare	$47.52
Rate for Payer: Devoted Health Medicare	$35.46
Rate for Payer: Humana of AZ Medicare	$31.52
Rate for Payer: Humana of AZ Medicare	$42.24
Rate for Payer: Seven Corners Travel Insurance	$19.42
Rate for Payer: Seven Corners Travel Insurance	$19.42
Rate for Payer: Southwest Service Administrators UFCW	$133.96
Rate for Payer: Southwest Service Administrators UFCW	$179.52
Rate for Payer: TriWest Medicare	$31.52
Rate for Payer: TriWest Medicare	$42.24
Rate for Payer: United Healthcare Commercial	$151.01
Rate for Payer: United Healthcare Commercial	$112.68
Rate for Payer: United Healthcare Medicare	$31.52
Rate for Payer: United Healthcare Medicare	$42.24
Rate for Payer: Veterans Affairs TRICARE	$41.82
Rate for Payer: Veterans Affairs TRICARE	$31.20

.LIPO FRAC

Facility

$458.00

Service Code	CPT 83701
Hospital Charge Code	22481447
Hospital Revenue Code	301
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna of AZ Commercial	$412.20
Rate for Payer: Arizona Complete Health Allwell	$73.28
Rate for Payer: Banner UC Health Medicare	$73.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$311.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$73.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$73.28
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cigna of AZ Commercial	$297.70
Rate for Payer: Devoted Health Medicare	$82.44
Rate for Payer: Humana of AZ Medicare	$73.28
Rate for Payer: Seven Corners Travel Insurance	$49.10
Rate for Payer: Southwest Service Administrators UFCW	$311.44
Rate for Payer: TriWest Medicare	$73.28
Rate for Payer: United Healthcare Commercial	$261.98
Rate for Payer: United Healthcare Medicare	$73.28
Rate for Payer: Veterans Affairs TRICARE	$72.55

.LIPO FRAC

Facility

$458.00

Service Code	CPT 83701
Hospital Charge Code	22481447
Hospital Revenue Code	301
Min. Negotiated Rate	$412.20
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna of AZ Commercial	$412.20
Rate for Payer: Cash Price	$366.40

Lipoprotein (A) LC

Facility

$280.00

Service Code	CPT 83695
Hospital Charge Code	4711245
Hospital Revenue Code	301
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Cash Price	$224.00

Lipoprotein (A) LC

Facility

$280.00

Service Code	CPT 83695
Hospital Charge Code	4711245
Hospital Revenue Code	301
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Arizona Complete Health Allwell	$44.80
Rate for Payer: Banner UC Health Medicare	$44.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$190.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$44.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.80
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cigna of AZ Commercial	$182.00
Rate for Payer: Devoted Health Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$44.80
Rate for Payer: Seven Corners Travel Insurance	$20.76
Rate for Payer: Southwest Service Administrators UFCW	$190.40
Rate for Payer: TriWest Medicare	$44.80
Rate for Payer: United Healthcare Commercial	$160.16
Rate for Payer: United Healthcare Medicare	$44.80
Rate for Payer: Veterans Affairs TRICARE	$44.35

lisinopril 10 mg Tab [CQCH]

Facility

$0.05

Service Code	NDC 904679861
Hospital Charge Code	105929476
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Cash Price	$0.04

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: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.03
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$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	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.04
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$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	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Cash Price	$0.05

Know your out-of-pocket cost for care.

All Charges