Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MRA Abdomen w/o Contrast

Facility

$1,985.00

Service Code	CPT 74185
Hospital Charge Code	2214014
Hospital Revenue Code	610
Min. Negotiated Rate	$516.10
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Bisbee Police All Plans	$516.10
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Self Pay Self Pay	$1,588.00

MRA Abdomen w/o Contrast

Facility

$1,985.00

Service Code	CPT 74185
Hospital Charge Code	2214014
Hospital Revenue Code	610
Min. Negotiated Rate	$317.60
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Aetna of AZ Medicare	$555.80
Rate for Payer: Allwell Medicare	$317.60
Rate for Payer: Amerigroup Medicare	$317.60
Rate for Payer: APIPA Medicare/Medicaid	$741.40
Rate for Payer: AZCH Complete Medicare	$317.60
Rate for Payer: Banner UC Health Medicare	$317.60
Rate for Payer: Bisbee Police All Plans	$516.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,349.80
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cigna of AZ Commercial	$1,389.50
Rate for Payer: Copperpoint Commercial	$491.29
Rate for Payer: Health Net of AZ Commercial	$1,191.00
Rate for Payer: Health Net of AZ Medicare	$555.80
Rate for Payer: Humana of AZ Medicare	$317.60
Rate for Payer: Self Pay Self Pay	$1,588.00
Rate for Payer: TriWest Medicare	$317.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,157.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$357.30

MRA Abdomen w/ + w/o Contrast

Facility

$3,349.00

Service Code	CPT 74185
Hospital Charge Code	1284639
Hospital Revenue Code	610
Min. Negotiated Rate	$870.74
Max. Negotiated Rate	$3,014.10
Rate for Payer: Aetna of AZ Commercial	$3,014.10
Rate for Payer: Bisbee Police All Plans	$870.74
Rate for Payer: Cash Price	$2,679.20
Rate for Payer: Self Pay Self Pay	$2,679.20

MRA Abdomen w/ + w/o Contrast

Facility

$3,349.00

Service Code	CPT 74185
Hospital Charge Code	1284639
Hospital Revenue Code	610
Min. Negotiated Rate	$535.84
Max. Negotiated Rate	$3,014.10
Rate for Payer: Aetna of AZ Commercial	$3,014.10
Rate for Payer: Aetna of AZ Medicare	$937.72
Rate for Payer: Allwell Medicare	$535.84
Rate for Payer: Amerigroup Medicare	$535.84
Rate for Payer: APIPA Medicare/Medicaid	$1,250.85
Rate for Payer: AZCH Complete Medicare	$535.84
Rate for Payer: Banner UC Health Medicare	$535.84
Rate for Payer: Bisbee Police All Plans	$870.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,277.32
Rate for Payer: Cash Price	$2,679.20
Rate for Payer: Cigna of AZ Commercial	$2,344.30
Rate for Payer: Copperpoint Commercial	$828.88
Rate for Payer: Health Net of AZ Commercial	$2,009.40
Rate for Payer: Health Net of AZ Medicare	$937.72
Rate for Payer: Humana of AZ Medicare	$535.84
Rate for Payer: Self Pay Self Pay	$2,679.20
Rate for Payer: TriWest Medicare	$535.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,952.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$602.82

MRA Brain w/o + w/ Contrast 70553

Facility

$2,363.00

Service Code	CPT 70553
Hospital Charge Code	22990106
Hospital Revenue Code	611
Min. Negotiated Rate	$614.38
Max. Negotiated Rate	$2,126.70
Rate for Payer: Aetna of AZ Commercial	$2,126.70
Rate for Payer: Bisbee Police All Plans	$614.38
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Self Pay Self Pay	$1,890.40

MRA Brain w/o + w/ Contrast 70553

Facility

$2,363.00

Service Code	CPT 70553
Hospital Charge Code	22990106
Hospital Revenue Code	611
Min. Negotiated Rate	$378.08
Max. Negotiated Rate	$2,126.70
Rate for Payer: Aetna of AZ Commercial	$2,126.70
Rate for Payer: Aetna of AZ Medicare	$661.64
Rate for Payer: Allwell Medicare	$378.08
Rate for Payer: Amerigroup Medicare	$378.08
Rate for Payer: APIPA Medicare/Medicaid	$882.58
Rate for Payer: AZCH Complete Medicare	$378.08
Rate for Payer: Banner UC Health Medicare	$378.08
Rate for Payer: Bisbee Police All Plans	$614.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,606.84
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cigna of AZ Commercial	$1,654.10
Rate for Payer: Copperpoint Commercial	$584.84
Rate for Payer: Health Net of AZ Commercial	$1,417.80
Rate for Payer: Health Net of AZ Medicare	$661.64
Rate for Payer: Humana of AZ Medicare	$378.08
Rate for Payer: Self Pay Self Pay	$1,890.40
Rate for Payer: TriWest Medicare	$378.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,377.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$425.34

MRA Head w/o Contrast 70544

Facility

$1,891.00

Service Code	CPT 70544
Hospital Charge Code	22986618
Hospital Revenue Code	615
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$1,701.90
Rate for Payer: Aetna of AZ Commercial	$1,701.90
Rate for Payer: Bisbee Police All Plans	$491.66
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Self Pay Self Pay	$1,512.80

MRA Head w/o Contrast 70544

Facility

$1,891.00

Service Code	CPT 70544
Hospital Charge Code	22986618
Hospital Revenue Code	615
Min. Negotiated Rate	$302.56
Max. Negotiated Rate	$1,701.90
Rate for Payer: Aetna of AZ Commercial	$1,701.90
Rate for Payer: Aetna of AZ Medicare	$529.48
Rate for Payer: Allwell Medicare	$302.56
Rate for Payer: Amerigroup Medicare	$302.56
Rate for Payer: APIPA Medicare/Medicaid	$706.29
Rate for Payer: AZCH Complete Medicare	$302.56
Rate for Payer: Banner UC Health Medicare	$302.56
Rate for Payer: Bisbee Police All Plans	$491.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,285.88
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Cigna of AZ Commercial	$1,323.70
Rate for Payer: Copperpoint Commercial	$468.02
Rate for Payer: Health Net of AZ Commercial	$1,134.60
Rate for Payer: Health Net of AZ Medicare	$529.48
Rate for Payer: Humana of AZ Medicare	$302.56
Rate for Payer: Self Pay Self Pay	$1,512.80
Rate for Payer: TriWest Medicare	$302.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,102.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$340.38

MRA Neck w/ Contrast

Facility

$4,777.00

Service Code	CPT 70549
Hospital Charge Code	1005378
Hospital Revenue Code	615
Min. Negotiated Rate	$764.32
Max. Negotiated Rate	$4,299.30
Rate for Payer: Aetna of AZ Commercial	$4,299.30
Rate for Payer: Aetna of AZ Medicare	$1,337.56
Rate for Payer: Allwell Medicare	$764.32
Rate for Payer: Amerigroup Medicare	$764.32
Rate for Payer: APIPA Medicare/Medicaid	$1,784.21
Rate for Payer: AZCH Complete Medicare	$764.32
Rate for Payer: Banner UC Health Medicare	$764.32
Rate for Payer: Bisbee Police All Plans	$1,242.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,248.36
Rate for Payer: Cash Price	$3,821.60
Rate for Payer: Cigna of AZ Commercial	$3,343.90
Rate for Payer: Copperpoint Commercial	$1,182.31
Rate for Payer: Health Net of AZ Commercial	$2,866.20
Rate for Payer: Health Net of AZ Medicare	$1,337.56
Rate for Payer: Humana of AZ Medicare	$764.32
Rate for Payer: Self Pay Self Pay	$3,821.60
Rate for Payer: TriWest Medicare	$764.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,784.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$859.86

MRA Neck w/ Contrast

Facility

$4,777.00

Service Code	CPT 70549
Hospital Charge Code	1005378
Hospital Revenue Code	615
Min. Negotiated Rate	$1,242.02
Max. Negotiated Rate	$4,299.30
Rate for Payer: Aetna of AZ Commercial	$4,299.30
Rate for Payer: Bisbee Police All Plans	$1,242.02
Rate for Payer: Cash Price	$3,821.60
Rate for Payer: Self Pay Self Pay	$3,821.60

MRA Neck w/ Contrast 70548

Facility

$2,126.00

Service Code	CPT 70548
Hospital Charge Code	22986619
Hospital Revenue Code	615
Min. Negotiated Rate	$552.76
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of AZ Commercial	$1,913.40
Rate for Payer: Bisbee Police All Plans	$552.76
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Self Pay Self Pay	$1,700.80

MRA Neck w/ Contrast 70548

Facility

$2,126.00

Service Code	CPT 70548
Hospital Charge Code	22986619
Hospital Revenue Code	615
Min. Negotiated Rate	$340.16
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of AZ Commercial	$1,913.40
Rate for Payer: Aetna of AZ Medicare	$595.28
Rate for Payer: Allwell Medicare	$340.16
Rate for Payer: Amerigroup Medicare	$340.16
Rate for Payer: APIPA Medicare/Medicaid	$794.06
Rate for Payer: AZCH Complete Medicare	$340.16
Rate for Payer: Banner UC Health Medicare	$340.16
Rate for Payer: Bisbee Police All Plans	$552.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,445.68
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Cigna of AZ Commercial	$1,488.20
Rate for Payer: Copperpoint Commercial	$526.18
Rate for Payer: Health Net of AZ Commercial	$1,275.60
Rate for Payer: Health Net of AZ Medicare	$595.28
Rate for Payer: Humana of AZ Medicare	$340.16
Rate for Payer: Self Pay Self Pay	$1,700.80
Rate for Payer: TriWest Medicare	$340.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,239.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$382.68

MRA Neck w/o Contrast

Facility

$3,253.00

Service Code	CPT 70547
Hospital Charge Code	821396
Hospital Revenue Code	615
Min. Negotiated Rate	$520.48
Max. Negotiated Rate	$2,927.70
Rate for Payer: Aetna of AZ Commercial	$2,927.70
Rate for Payer: Aetna of AZ Medicare	$910.84
Rate for Payer: Allwell Medicare	$520.48
Rate for Payer: Amerigroup Medicare	$520.48
Rate for Payer: APIPA Medicare/Medicaid	$1,215.00
Rate for Payer: AZCH Complete Medicare	$520.48
Rate for Payer: Banner UC Health Medicare	$520.48
Rate for Payer: Bisbee Police All Plans	$845.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,212.04
Rate for Payer: Cash Price	$2,602.40
Rate for Payer: Cigna of AZ Commercial	$2,277.10
Rate for Payer: Copperpoint Commercial	$805.12
Rate for Payer: Health Net of AZ Commercial	$1,951.80
Rate for Payer: Health Net of AZ Medicare	$910.84
Rate for Payer: Humana of AZ Medicare	$520.48
Rate for Payer: Self Pay Self Pay	$2,602.40
Rate for Payer: TriWest Medicare	$520.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,896.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$585.54

MRA Neck w/o Contrast

Facility

$3,253.00

Service Code	CPT 70547
Hospital Charge Code	821396
Hospital Revenue Code	615
Min. Negotiated Rate	$845.78
Max. Negotiated Rate	$2,927.70
Rate for Payer: Aetna of AZ Commercial	$2,927.70
Rate for Payer: Bisbee Police All Plans	$845.78
Rate for Payer: Cash Price	$2,602.40
Rate for Payer: Self Pay Self Pay	$2,602.40

MRI Abdomen w/ Contrast

Facility

$2,233.00

Service Code	CPT 74182
Hospital Charge Code	1005393
Hospital Revenue Code	610
Min. Negotiated Rate	$580.58
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Self Pay Self Pay	$1,786.40

MRI Abdomen w/ Contrast

Facility

$2,233.00

Service Code	CPT 74182
Hospital Charge Code	1005393
Hospital Revenue Code	610
Min. Negotiated Rate	$357.28
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Aetna of AZ Medicare	$625.24
Rate for Payer: Allwell Medicare	$357.28
Rate for Payer: Amerigroup Medicare	$357.28
Rate for Payer: APIPA Medicare/Medicaid	$834.03
Rate for Payer: AZCH Complete Medicare	$357.28
Rate for Payer: Banner UC Health Medicare	$357.28
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,518.44
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cigna of AZ Commercial	$1,563.10
Rate for Payer: Copperpoint Commercial	$552.67
Rate for Payer: Health Net of AZ Commercial	$1,339.80
Rate for Payer: Health Net of AZ Medicare	$625.24
Rate for Payer: Humana of AZ Medicare	$357.28
Rate for Payer: Self Pay Self Pay	$1,786.40
Rate for Payer: TriWest Medicare	$357.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,301.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$401.94

MRI Abdomen w/o Contrast

Facility

$2,916.00

Service Code	CPT 74181
Hospital Charge Code	1005395
Hospital Revenue Code	610
Min. Negotiated Rate	$758.16
Max. Negotiated Rate	$2,624.40
Rate for Payer: Aetna of AZ Commercial	$2,624.40
Rate for Payer: Bisbee Police All Plans	$758.16
Rate for Payer: Cash Price	$2,332.80
Rate for Payer: Self Pay Self Pay	$2,332.80

MRI Abdomen w/o Contrast

Facility

$2,916.00

Service Code	CPT 74181
Hospital Charge Code	1005395
Hospital Revenue Code	610
Min. Negotiated Rate	$466.56
Max. Negotiated Rate	$2,624.40
Rate for Payer: Aetna of AZ Commercial	$2,624.40
Rate for Payer: Aetna of AZ Medicare	$816.48
Rate for Payer: Allwell Medicare	$466.56
Rate for Payer: Amerigroup Medicare	$466.56
Rate for Payer: APIPA Medicare/Medicaid	$1,089.13
Rate for Payer: AZCH Complete Medicare	$466.56
Rate for Payer: Banner UC Health Medicare	$466.56
Rate for Payer: Bisbee Police All Plans	$758.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,982.88
Rate for Payer: Cash Price	$2,332.80
Rate for Payer: Cigna of AZ Commercial	$2,041.20
Rate for Payer: Copperpoint Commercial	$721.71
Rate for Payer: Health Net of AZ Commercial	$1,749.60
Rate for Payer: Health Net of AZ Medicare	$816.48
Rate for Payer: Humana of AZ Medicare	$466.56
Rate for Payer: Self Pay Self Pay	$2,332.80
Rate for Payer: TriWest Medicare	$466.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,700.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$524.88

MRI Abdomen w/ + w/o Contrast

Facility

$5,086.00

Service Code	CPT 74183
Hospital Charge Code	1005391
Hospital Revenue Code	610
Min. Negotiated Rate	$1,322.36
Max. Negotiated Rate	$4,577.40
Rate for Payer: Aetna of AZ Commercial	$4,577.40
Rate for Payer: Bisbee Police All Plans	$1,322.36
Rate for Payer: Cash Price	$4,068.80
Rate for Payer: Self Pay Self Pay	$4,068.80

MRI Abdomen w/ + w/o Contrast

Facility

$5,086.00

Service Code	CPT 74183
Hospital Charge Code	1005391
Hospital Revenue Code	610
Min. Negotiated Rate	$813.76
Max. Negotiated Rate	$4,577.40
Rate for Payer: Aetna of AZ Commercial	$4,577.40
Rate for Payer: Aetna of AZ Medicare	$1,424.08
Rate for Payer: Allwell Medicare	$813.76
Rate for Payer: Amerigroup Medicare	$813.76
Rate for Payer: APIPA Medicare/Medicaid	$1,899.62
Rate for Payer: AZCH Complete Medicare	$813.76
Rate for Payer: Banner UC Health Medicare	$813.76
Rate for Payer: Bisbee Police All Plans	$1,322.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,458.48
Rate for Payer: Cash Price	$4,068.80
Rate for Payer: Cigna of AZ Commercial	$3,560.20
Rate for Payer: Copperpoint Commercial	$1,258.79
Rate for Payer: Health Net of AZ Commercial	$3,051.60
Rate for Payer: Health Net of AZ Medicare	$1,424.08
Rate for Payer: Humana of AZ Medicare	$813.76
Rate for Payer: Self Pay Self Pay	$4,068.80
Rate for Payer: TriWest Medicare	$813.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,965.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$915.48

MRI Brain w/ Contrast

Facility

$2,233.00

Service Code	CPT 70552
Hospital Charge Code	821400
Hospital Revenue Code	611
Min. Negotiated Rate	$580.58
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Self Pay Self Pay	$1,786.40

MRI Brain w/ Contrast

Facility

$2,233.00

Service Code	CPT 70552
Hospital Charge Code	821400
Hospital Revenue Code	611
Min. Negotiated Rate	$357.28
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Aetna of AZ Medicare	$625.24
Rate for Payer: Allwell Medicare	$357.28
Rate for Payer: Amerigroup Medicare	$357.28
Rate for Payer: APIPA Medicare/Medicaid	$834.03
Rate for Payer: AZCH Complete Medicare	$357.28
Rate for Payer: Banner UC Health Medicare	$357.28
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,518.44
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cigna of AZ Commercial	$1,563.10
Rate for Payer: Copperpoint Commercial	$552.67
Rate for Payer: Health Net of AZ Commercial	$1,339.80
Rate for Payer: Health Net of AZ Medicare	$625.24
Rate for Payer: Humana of AZ Medicare	$357.28
Rate for Payer: Self Pay Self Pay	$1,786.40
Rate for Payer: TriWest Medicare	$357.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,301.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$401.94

MRI Brain w/o Contrast

Facility

$3,027.00

Service Code	CPT 70551
Hospital Charge Code	821402
Hospital Revenue Code	611
Min. Negotiated Rate	$484.32
Max. Negotiated Rate	$2,724.30
Rate for Payer: Aetna of AZ Commercial	$2,724.30
Rate for Payer: Aetna of AZ Medicare	$847.56
Rate for Payer: Allwell Medicare	$484.32
Rate for Payer: Amerigroup Medicare	$484.32
Rate for Payer: APIPA Medicare/Medicaid	$1,130.58
Rate for Payer: AZCH Complete Medicare	$484.32
Rate for Payer: Banner UC Health Medicare	$484.32
Rate for Payer: Bisbee Police All Plans	$787.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,058.36
Rate for Payer: Cash Price	$2,421.60
Rate for Payer: Cigna of AZ Commercial	$2,118.90
Rate for Payer: Copperpoint Commercial	$749.18
Rate for Payer: Health Net of AZ Commercial	$1,816.20
Rate for Payer: Health Net of AZ Medicare	$847.56
Rate for Payer: Humana of AZ Medicare	$484.32
Rate for Payer: Self Pay Self Pay	$2,421.60
Rate for Payer: TriWest Medicare	$484.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,764.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$544.86

MRI Brain w/o Contrast

Facility

$3,027.00

Service Code	CPT 70551
Hospital Charge Code	821402
Hospital Revenue Code	611
Min. Negotiated Rate	$787.02
Max. Negotiated Rate	$2,724.30
Rate for Payer: Aetna of AZ Commercial	$2,724.30
Rate for Payer: Bisbee Police All Plans	$787.02
Rate for Payer: Cash Price	$2,421.60
Rate for Payer: Self Pay Self Pay	$2,421.60

MRI Brain w/ + w/o Contrast

Facility

$4,783.00

Service Code	CPT 70553
Hospital Charge Code	821398
Hospital Revenue Code	611
Min. Negotiated Rate	$1,243.58
Max. Negotiated Rate	$4,304.70
Rate for Payer: Aetna of AZ Commercial	$4,304.70
Rate for Payer: Bisbee Police All Plans	$1,243.58
Rate for Payer: Cash Price	$3,826.40
Rate for Payer: Self Pay Self Pay	$3,826.40

Know your out-of-pocket cost for care.

All Charges