Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CT Angiography Head w/ Contrast

Facility

$4,133.00

Service Code	CPT 70496
Hospital Charge Code	1477517
Hospital Revenue Code	351
Min. Negotiated Rate	$661.28
Max. Negotiated Rate	$3,719.70
Rate for Payer: Aetna of AZ Commercial	$3,719.70
Rate for Payer: Aetna of AZ Medicare	$1,157.24
Rate for Payer: Allwell Medicare	$661.28
Rate for Payer: Amerigroup Medicare	$661.28
Rate for Payer: APIPA Medicare/Medicaid	$1,543.68
Rate for Payer: AZCH Complete Medicare	$661.28
Rate for Payer: Banner UC Health Medicare	$661.28
Rate for Payer: Bisbee Police All Plans	$1,074.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,810.44
Rate for Payer: Cash Price	$3,306.40
Rate for Payer: Cigna of AZ Commercial	$2,686.45
Rate for Payer: Copperpoint Commercial	$1,022.92
Rate for Payer: Health Net of AZ Commercial	$2,479.80
Rate for Payer: Health Net of AZ Medicare	$1,157.24
Rate for Payer: Humana of AZ Medicare	$661.28
Rate for Payer: Self Pay Self Pay	$3,306.40
Rate for Payer: TriWest Medicare	$661.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,409.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$743.94

CT Angiography Head w/ Contrast

Facility

$4,326.00

Service Code	CPT 70496
Hospital Charge Code	22035134
Hospital Revenue Code	350
Min. Negotiated Rate	$1,124.76
Max. Negotiated Rate	$3,893.40
Rate for Payer: Aetna of AZ Commercial	$3,893.40
Rate for Payer: Bisbee Police All Plans	$1,124.76
Rate for Payer: Cash Price	$3,460.80
Rate for Payer: Self Pay Self Pay	$3,460.80

CT Angiography Head w/ Contrast

Facility

$4,133.00

Service Code	CPT 70496
Hospital Charge Code	1477517
Hospital Revenue Code	351
Min. Negotiated Rate	$1,074.58
Max. Negotiated Rate	$3,719.70
Rate for Payer: Aetna of AZ Commercial	$3,719.70
Rate for Payer: Bisbee Police All Plans	$1,074.58
Rate for Payer: Cash Price	$3,306.40
Rate for Payer: Self Pay Self Pay	$3,306.40

CT Angiography Neck w/ Contrast

Facility

$4,126.00

Service Code	CPT 70498
Hospital Charge Code	1021517
Hospital Revenue Code	351
Min. Negotiated Rate	$660.16
Max. Negotiated Rate	$3,713.40
Rate for Payer: Aetna of AZ Commercial	$3,713.40
Rate for Payer: Aetna of AZ Medicare	$1,155.28
Rate for Payer: Allwell Medicare	$660.16
Rate for Payer: Amerigroup Medicare	$660.16
Rate for Payer: APIPA Medicare/Medicaid	$1,541.06
Rate for Payer: AZCH Complete Medicare	$660.16
Rate for Payer: Banner UC Health Medicare	$660.16
Rate for Payer: Bisbee Police All Plans	$1,072.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,805.68
Rate for Payer: Cash Price	$3,300.80
Rate for Payer: Cigna of AZ Commercial	$2,681.90
Rate for Payer: Copperpoint Commercial	$1,021.18
Rate for Payer: Health Net of AZ Commercial	$2,475.60
Rate for Payer: Health Net of AZ Medicare	$1,155.28
Rate for Payer: Humana of AZ Medicare	$660.16
Rate for Payer: Self Pay Self Pay	$3,300.80
Rate for Payer: TriWest Medicare	$660.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,405.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$742.68

CT Angiography Neck w/ Contrast

Facility

$4,126.00

Service Code	CPT 70498
Hospital Charge Code	1021517
Hospital Revenue Code	351
Min. Negotiated Rate	$1,072.76
Max. Negotiated Rate	$3,713.40
Rate for Payer: Aetna of AZ Commercial	$3,713.40
Rate for Payer: Bisbee Police All Plans	$1,072.76
Rate for Payer: Cash Price	$3,300.80
Rate for Payer: Self Pay Self Pay	$3,300.80

CT Chest W/Contrast

Facility

$2,385.00

Service Code	CPT 71260
Hospital Charge Code	1005140
Hospital Revenue Code	352
Min. Negotiated Rate	$381.60
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Aetna of AZ Medicare	$667.80
Rate for Payer: Allwell Medicare	$381.60
Rate for Payer: Amerigroup Medicare	$381.60
Rate for Payer: APIPA Medicare/Medicaid	$890.80
Rate for Payer: AZCH Complete Medicare	$381.60
Rate for Payer: Banner UC Health Medicare	$381.60
Rate for Payer: Bisbee Police All Plans	$620.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,621.80
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Cigna of AZ Commercial	$1,550.25
Rate for Payer: Copperpoint Commercial	$590.29
Rate for Payer: Health Net of AZ Commercial	$1,431.00
Rate for Payer: Health Net of AZ Medicare	$667.80
Rate for Payer: Humana of AZ Medicare	$381.60
Rate for Payer: Self Pay Self Pay	$1,908.00
Rate for Payer: TriWest Medicare	$381.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,390.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$429.30

CT Chest W/Contrast

Facility

$2,385.00

Service Code	CPT 71260
Hospital Charge Code	1005140
Hospital Revenue Code	352
Min. Negotiated Rate	$620.10
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Bisbee Police All Plans	$620.10
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Self Pay Self Pay	$1,908.00

CT Chest W/O Contrast

Facility

$1,950.00

Service Code	CPT 71250
Hospital Charge Code	1005143
Hospital Revenue Code	352
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna of AZ Commercial	$1,755.00
Rate for Payer: Aetna of AZ Medicare	$546.00
Rate for Payer: Allwell Medicare	$312.00
Rate for Payer: Amerigroup Medicare	$312.00
Rate for Payer: APIPA Medicare/Medicaid	$728.33
Rate for Payer: AZCH Complete Medicare	$312.00
Rate for Payer: Banner UC Health Medicare	$312.00
Rate for Payer: Bisbee Police All Plans	$507.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,326.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Cigna of AZ Commercial	$1,267.50
Rate for Payer: Copperpoint Commercial	$482.62
Rate for Payer: Health Net of AZ Commercial	$1,170.00
Rate for Payer: Health Net of AZ Medicare	$546.00
Rate for Payer: Humana of AZ Medicare	$312.00
Rate for Payer: Self Pay Self Pay	$1,560.00
Rate for Payer: TriWest Medicare	$312.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,136.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$351.00

CT Chest W/O Contrast

Facility

$1,950.00

Service Code	CPT 71250
Hospital Charge Code	1005143
Hospital Revenue Code	352
Min. Negotiated Rate	$507.00
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna of AZ Commercial	$1,755.00
Rate for Payer: Bisbee Police All Plans	$507.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Self Pay Self Pay	$1,560.00

CT Chest W/WO Contrast

Facility

$2,920.00

Service Code	CPT 71270
Hospital Charge Code	1005146
Hospital Revenue Code	352
Min. Negotiated Rate	$467.20
Max. Negotiated Rate	$2,628.00
Rate for Payer: Aetna of AZ Commercial	$2,628.00
Rate for Payer: Aetna of AZ Medicare	$817.60
Rate for Payer: Allwell Medicare	$467.20
Rate for Payer: Amerigroup Medicare	$467.20
Rate for Payer: APIPA Medicare/Medicaid	$1,090.62
Rate for Payer: AZCH Complete Medicare	$467.20
Rate for Payer: Banner UC Health Medicare	$467.20
Rate for Payer: Bisbee Police All Plans	$759.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,985.60
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Cigna of AZ Commercial	$1,898.00
Rate for Payer: Copperpoint Commercial	$722.70
Rate for Payer: Health Net of AZ Commercial	$1,752.00
Rate for Payer: Health Net of AZ Medicare	$817.60
Rate for Payer: Humana of AZ Medicare	$467.20
Rate for Payer: Self Pay Self Pay	$2,336.00
Rate for Payer: TriWest Medicare	$467.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,702.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$525.60

CT Chest W/WO Contrast

Facility

$2,920.00

Service Code	CPT 71270
Hospital Charge Code	1005146
Hospital Revenue Code	352
Min. Negotiated Rate	$759.20
Max. Negotiated Rate	$2,628.00
Rate for Payer: Aetna of AZ Commercial	$2,628.00
Rate for Payer: Bisbee Police All Plans	$759.20
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Self Pay Self Pay	$2,336.00

CT Head or Brain w/ Contrast

Facility

$2,097.00

Service Code	CPT 70460
Hospital Charge Code	821334
Hospital Revenue Code	351
Min. Negotiated Rate	$335.52
Max. Negotiated Rate	$1,887.30
Rate for Payer: Aetna of AZ Commercial	$1,887.30
Rate for Payer: Aetna of AZ Medicare	$587.16
Rate for Payer: Allwell Medicare	$335.52
Rate for Payer: Amerigroup Medicare	$335.52
Rate for Payer: APIPA Medicare/Medicaid	$783.23
Rate for Payer: AZCH Complete Medicare	$335.52
Rate for Payer: Banner UC Health Medicare	$335.52
Rate for Payer: Bisbee Police All Plans	$545.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,425.96
Rate for Payer: Cash Price	$1,677.60
Rate for Payer: Cigna of AZ Commercial	$1,363.05
Rate for Payer: Copperpoint Commercial	$519.01
Rate for Payer: Health Net of AZ Commercial	$1,258.20
Rate for Payer: Health Net of AZ Medicare	$587.16
Rate for Payer: Humana of AZ Medicare	$335.52
Rate for Payer: Self Pay Self Pay	$1,677.60
Rate for Payer: TriWest Medicare	$335.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,222.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$377.46

CT Head or Brain w/ Contrast

Facility

$383.00

Service Code	CPT 70460
Hospital Charge Code	22862164
Hospital Revenue Code	972
Min. Negotiated Rate	$61.28
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Aetna of AZ Medicare	$107.24
Rate for Payer: Allwell Medicare	$61.28
Rate for Payer: Amerigroup Medicare	$61.28
Rate for Payer: APIPA Medicare/Medicaid	$143.05
Rate for Payer: AZCH Complete Medicare	$61.28
Rate for Payer: Banner UC Health Medicare	$61.28
Rate for Payer: Bisbee Police All Plans	$99.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$260.44
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cigna of AZ Commercial	$268.10
Rate for Payer: Copperpoint Commercial	$94.79
Rate for Payer: Health Net of AZ Commercial	$229.80
Rate for Payer: Health Net of AZ Medicare	$107.24
Rate for Payer: Humana of AZ Medicare	$61.28
Rate for Payer: Self Pay Self Pay	$306.40
Rate for Payer: TriWest Medicare	$61.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$223.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.94

CT Head or Brain w/ Contrast

Facility

$383.00

Service Code	CPT 70460
Hospital Charge Code	22862164
Hospital Revenue Code	972
Min. Negotiated Rate	$99.58
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Bisbee Police All Plans	$99.58
Rate for Payer: Cash Price	$306.40
Rate for Payer: Self Pay Self Pay	$306.40

CT Head or Brain w/ Contrast

Facility

$2,097.00

Service Code	CPT 70460
Hospital Charge Code	821334
Hospital Revenue Code	351
Min. Negotiated Rate	$545.22
Max. Negotiated Rate	$1,887.30
Rate for Payer: Aetna of AZ Commercial	$1,887.30
Rate for Payer: Bisbee Police All Plans	$545.22
Rate for Payer: Cash Price	$1,677.60
Rate for Payer: Self Pay Self Pay	$1,677.60

CT Head or Brain w/o Contrast

Facility

$1,657.00

Service Code	CPT 70450
Hospital Charge Code	821336
Hospital Revenue Code	351
Min. Negotiated Rate	$265.12
Max. Negotiated Rate	$1,491.30
Rate for Payer: Aetna of AZ Commercial	$1,491.30
Rate for Payer: Aetna of AZ Medicare	$463.96
Rate for Payer: Allwell Medicare	$265.12
Rate for Payer: Amerigroup Medicare	$265.12
Rate for Payer: APIPA Medicare/Medicaid	$618.89
Rate for Payer: AZCH Complete Medicare	$265.12
Rate for Payer: Banner UC Health Medicare	$265.12
Rate for Payer: Bisbee Police All Plans	$430.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,126.76
Rate for Payer: Cash Price	$1,325.60
Rate for Payer: Cigna of AZ Commercial	$1,077.05
Rate for Payer: Copperpoint Commercial	$410.11
Rate for Payer: Health Net of AZ Commercial	$994.20
Rate for Payer: Health Net of AZ Medicare	$463.96
Rate for Payer: Humana of AZ Medicare	$265.12
Rate for Payer: Self Pay Self Pay	$1,325.60
Rate for Payer: TriWest Medicare	$265.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$966.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$298.26

CT Head or Brain w/o Contrast

Facility

$1,657.00

Service Code	CPT 70450
Hospital Charge Code	821336
Hospital Revenue Code	351
Min. Negotiated Rate	$430.82
Max. Negotiated Rate	$1,491.30
Rate for Payer: Aetna of AZ Commercial	$1,491.30
Rate for Payer: Bisbee Police All Plans	$430.82
Rate for Payer: Cash Price	$1,325.60
Rate for Payer: Self Pay Self Pay	$1,325.60

CT Head or Brain w/ + w/o Contrast

Facility

$2,574.00

Service Code	CPT 70470
Hospital Charge Code	821332
Hospital Revenue Code	351
Min. Negotiated Rate	$411.84
Max. Negotiated Rate	$2,316.60
Rate for Payer: Aetna of AZ Commercial	$2,316.60
Rate for Payer: Aetna of AZ Medicare	$720.72
Rate for Payer: Allwell Medicare	$411.84
Rate for Payer: Amerigroup Medicare	$411.84
Rate for Payer: APIPA Medicare/Medicaid	$961.39
Rate for Payer: AZCH Complete Medicare	$411.84
Rate for Payer: Banner UC Health Medicare	$411.84
Rate for Payer: Bisbee Police All Plans	$669.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,750.32
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Cigna of AZ Commercial	$1,673.10
Rate for Payer: Copperpoint Commercial	$637.07
Rate for Payer: Health Net of AZ Commercial	$1,544.40
Rate for Payer: Health Net of AZ Medicare	$720.72
Rate for Payer: Humana of AZ Medicare	$411.84
Rate for Payer: Self Pay Self Pay	$2,059.20
Rate for Payer: TriWest Medicare	$411.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,500.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$463.32

CT Head or Brain w/ + w/o Contrast

Facility

$2,574.00

Service Code	CPT 70470
Hospital Charge Code	821332
Hospital Revenue Code	351
Min. Negotiated Rate	$669.24
Max. Negotiated Rate	$2,316.60
Rate for Payer: Aetna of AZ Commercial	$2,316.60
Rate for Payer: Bisbee Police All Plans	$669.24
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Self Pay Self Pay	$2,059.20

CT Lower Extremity w/ Contrast Left

Facility

$2,385.00

Service Code	CPT 73701 LT
Hospital Charge Code	821338
Hospital Revenue Code	352
Min. Negotiated Rate	$381.60
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Aetna of AZ Medicare	$667.80
Rate for Payer: Allwell Medicare	$381.60
Rate for Payer: Amerigroup Medicare	$381.60
Rate for Payer: APIPA Medicare/Medicaid	$890.80
Rate for Payer: AZCH Complete Medicare	$381.60
Rate for Payer: Banner UC Health Medicare	$381.60
Rate for Payer: Bisbee Police All Plans	$620.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,621.80
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Cigna of AZ Commercial	$1,550.25
Rate for Payer: Copperpoint Commercial	$590.29
Rate for Payer: Health Net of AZ Commercial	$1,431.00
Rate for Payer: Health Net of AZ Medicare	$667.80
Rate for Payer: Humana of AZ Medicare	$381.60
Rate for Payer: Self Pay Self Pay	$1,908.00
Rate for Payer: TriWest Medicare	$381.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,390.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$429.30

CT Lower Extremity w/ Contrast Left

Facility

$2,385.00

Service Code	CPT 73701 LT
Hospital Charge Code	821338
Hospital Revenue Code	352
Min. Negotiated Rate	$620.10
Max. Negotiated Rate	$2,146.50
Rate for Payer: Aetna of AZ Commercial	$2,146.50
Rate for Payer: Bisbee Police All Plans	$620.10
Rate for Payer: Cash Price	$1,908.00
Rate for Payer: Self Pay Self Pay	$1,908.00

CT Lower Extremity w/ Contrast Right

Facility

$2,389.00

Service Code	CPT 73701 RT
Hospital Charge Code	821340
Hospital Revenue Code	352
Min. Negotiated Rate	$621.14
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Bisbee Police All Plans	$621.14
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Self Pay Self Pay	$1,911.20

CT Lower Extremity w/ Contrast Right

Facility

$2,389.00

Service Code	CPT 73701 RT
Hospital Charge Code	821340
Hospital Revenue Code	352
Min. Negotiated Rate	$382.24
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Aetna of AZ Medicare	$668.92
Rate for Payer: Allwell Medicare	$382.24
Rate for Payer: Amerigroup Medicare	$382.24
Rate for Payer: APIPA Medicare/Medicaid	$892.29
Rate for Payer: AZCH Complete Medicare	$382.24
Rate for Payer: Banner UC Health Medicare	$382.24
Rate for Payer: Bisbee Police All Plans	$621.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,624.52
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Cigna of AZ Commercial	$1,552.85
Rate for Payer: Copperpoint Commercial	$591.28
Rate for Payer: Health Net of AZ Commercial	$1,433.40
Rate for Payer: Health Net of AZ Medicare	$668.92
Rate for Payer: Humana of AZ Medicare	$382.24
Rate for Payer: Self Pay Self Pay	$1,911.20
Rate for Payer: TriWest Medicare	$382.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,392.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$430.02

CT Lower Extremity w/o Contrast Left

Facility

$1,918.00

Service Code	CPT 73700 LT
Hospital Charge Code	821342
Hospital Revenue Code	352
Min. Negotiated Rate	$498.68
Max. Negotiated Rate	$1,726.20
Rate for Payer: Aetna of AZ Commercial	$1,726.20
Rate for Payer: Bisbee Police All Plans	$498.68
Rate for Payer: Cash Price	$1,534.40
Rate for Payer: Self Pay Self Pay	$1,534.40

CT Lower Extremity w/o Contrast Left

Facility

$1,918.00

Service Code	CPT 73700 LT
Hospital Charge Code	821342
Hospital Revenue Code	352
Min. Negotiated Rate	$306.88
Max. Negotiated Rate	$1,726.20
Rate for Payer: Aetna of AZ Commercial	$1,726.20
Rate for Payer: Aetna of AZ Medicare	$537.04
Rate for Payer: Allwell Medicare	$306.88
Rate for Payer: Amerigroup Medicare	$306.88
Rate for Payer: APIPA Medicare/Medicaid	$716.37
Rate for Payer: AZCH Complete Medicare	$306.88
Rate for Payer: Banner UC Health Medicare	$306.88
Rate for Payer: Bisbee Police All Plans	$498.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,304.24
Rate for Payer: Cash Price	$1,534.40
Rate for Payer: Cigna of AZ Commercial	$1,246.70
Rate for Payer: Copperpoint Commercial	$474.70
Rate for Payer: Health Net of AZ Commercial	$1,150.80
Rate for Payer: Health Net of AZ Medicare	$537.04
Rate for Payer: Humana of AZ Medicare	$306.88
Rate for Payer: Self Pay Self Pay	$1,534.40
Rate for Payer: TriWest Medicare	$306.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,118.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$345.24

Know your out-of-pocket cost for care.

All Charges