Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	$765.28
Max. Negotiated Rate	$4,304.70
Rate for Payer: Aetna of AZ Commercial	$4,304.70
Rate for Payer: Aetna of AZ Medicare	$1,339.24
Rate for Payer: Allwell Medicare	$765.28
Rate for Payer: Amerigroup Medicare	$765.28
Rate for Payer: APIPA Medicare/Medicaid	$1,786.45
Rate for Payer: AZCH Complete Medicare	$765.28
Rate for Payer: Banner UC Health Medicare	$765.28
Rate for Payer: Bisbee Police All Plans	$1,243.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,252.44
Rate for Payer: Cash Price	$3,826.40
Rate for Payer: Cigna of AZ Commercial	$3,348.10
Rate for Payer: Copperpoint Commercial	$1,183.79
Rate for Payer: Health Net of AZ Commercial	$2,869.80
Rate for Payer: Health Net of AZ Medicare	$1,339.24
Rate for Payer: Humana of AZ Medicare	$765.28
Rate for Payer: Self Pay Self Pay	$3,826.40
Rate for Payer: TriWest Medicare	$765.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,788.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$860.94

MRI Chest w/o Contrast

Facility

$2,553.00

Service Code	CPT 71550
Hospital Charge Code	1005415
Hospital Revenue Code	610
Min. Negotiated Rate	$663.78
Max. Negotiated Rate	$2,297.70
Rate for Payer: Aetna of AZ Commercial	$2,297.70
Rate for Payer: Bisbee Police All Plans	$663.78
Rate for Payer: Cash Price	$2,042.40
Rate for Payer: Self Pay Self Pay	$2,042.40

MRI Chest w/o Contrast

Facility

$2,553.00

Service Code	CPT 71550
Hospital Charge Code	1005415
Hospital Revenue Code	610
Min. Negotiated Rate	$408.48
Max. Negotiated Rate	$2,297.70
Rate for Payer: Aetna of AZ Commercial	$2,297.70
Rate for Payer: Aetna of AZ Medicare	$714.84
Rate for Payer: Allwell Medicare	$408.48
Rate for Payer: Amerigroup Medicare	$408.48
Rate for Payer: APIPA Medicare/Medicaid	$953.55
Rate for Payer: AZCH Complete Medicare	$408.48
Rate for Payer: Banner UC Health Medicare	$408.48
Rate for Payer: Bisbee Police All Plans	$663.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,736.04
Rate for Payer: Cash Price	$2,042.40
Rate for Payer: Cigna of AZ Commercial	$1,787.10
Rate for Payer: Copperpoint Commercial	$631.87
Rate for Payer: Health Net of AZ Commercial	$1,531.80
Rate for Payer: Health Net of AZ Medicare	$714.84
Rate for Payer: Humana of AZ Medicare	$408.48
Rate for Payer: Self Pay Self Pay	$2,042.40
Rate for Payer: TriWest Medicare	$408.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,488.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$459.54

MRI Chest w/ + w/o Contrast

Facility

$2,363.00

Service Code	CPT 71552
Hospital Charge Code	821404
Hospital Revenue Code	610
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

MRI Chest w/ + w/o Contrast

Facility

$2,363.00

Service Code	CPT 71552
Hospital Charge Code	821404
Hospital Revenue Code	610
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

MRI Face Neck Orbit w/ Contrast

Facility

$2,233.00

Service Code	CPT 70542
Hospital Charge Code	821408
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 Face Neck Orbit w/ Contrast

Facility

$2,233.00

Service Code	CPT 70542
Hospital Charge Code	821408
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 Face Neck Orbit w/o Contrast

Facility

$3,533.00

Service Code	CPT 70540
Hospital Charge Code	1005420
Hospital Revenue Code	610
Min. Negotiated Rate	$918.58
Max. Negotiated Rate	$3,179.70
Rate for Payer: Aetna of AZ Commercial	$3,179.70
Rate for Payer: Bisbee Police All Plans	$918.58
Rate for Payer: Cash Price	$2,826.40
Rate for Payer: Self Pay Self Pay	$2,826.40

MRI Face Neck Orbit w/o Contrast

Facility

$3,533.00

Service Code	CPT 70540
Hospital Charge Code	1005420
Hospital Revenue Code	610
Min. Negotiated Rate	$565.28
Max. Negotiated Rate	$3,179.70
Rate for Payer: Aetna of AZ Commercial	$3,179.70
Rate for Payer: Aetna of AZ Medicare	$989.24
Rate for Payer: Allwell Medicare	$565.28
Rate for Payer: Amerigroup Medicare	$565.28
Rate for Payer: APIPA Medicare/Medicaid	$1,319.58
Rate for Payer: AZCH Complete Medicare	$565.28
Rate for Payer: Banner UC Health Medicare	$565.28
Rate for Payer: Bisbee Police All Plans	$918.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,402.44
Rate for Payer: Cash Price	$2,826.40
Rate for Payer: Cigna of AZ Commercial	$2,473.10
Rate for Payer: Copperpoint Commercial	$874.42
Rate for Payer: Health Net of AZ Commercial	$2,119.80
Rate for Payer: Health Net of AZ Medicare	$989.24
Rate for Payer: Humana of AZ Medicare	$565.28
Rate for Payer: Self Pay Self Pay	$2,826.40
Rate for Payer: TriWest Medicare	$565.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,059.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$635.94

MRI Face Neck Orbit w/ + w/o Contrast

Facility

$5,157.00

Service Code	CPT 70543
Hospital Charge Code	821406
Hospital Revenue Code	610
Min. Negotiated Rate	$825.12
Max. Negotiated Rate	$4,641.30
Rate for Payer: Aetna of AZ Commercial	$4,641.30
Rate for Payer: Aetna of AZ Medicare	$1,443.96
Rate for Payer: Allwell Medicare	$825.12
Rate for Payer: Amerigroup Medicare	$825.12
Rate for Payer: APIPA Medicare/Medicaid	$1,926.14
Rate for Payer: AZCH Complete Medicare	$825.12
Rate for Payer: Banner UC Health Medicare	$825.12
Rate for Payer: Bisbee Police All Plans	$1,340.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,506.76
Rate for Payer: Cash Price	$4,125.60
Rate for Payer: Cigna of AZ Commercial	$3,609.90
Rate for Payer: Copperpoint Commercial	$1,276.36
Rate for Payer: Health Net of AZ Commercial	$3,094.20
Rate for Payer: Health Net of AZ Medicare	$1,443.96
Rate for Payer: Humana of AZ Medicare	$825.12
Rate for Payer: Self Pay Self Pay	$4,125.60
Rate for Payer: TriWest Medicare	$825.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,006.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$928.26

MRI Face Neck Orbit w/ + w/o Contrast

Facility

$5,157.00

Service Code	CPT 70543
Hospital Charge Code	821406
Hospital Revenue Code	610
Min. Negotiated Rate	$1,340.82
Max. Negotiated Rate	$4,641.30
Rate for Payer: Aetna of AZ Commercial	$4,641.30
Rate for Payer: Bisbee Police All Plans	$1,340.82
Rate for Payer: Cash Price	$4,125.60
Rate for Payer: Self Pay Self Pay	$4,125.60

MRI LE Joint w/ Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73722 50
Hospital Charge Code	1287203
Hospital Revenue Code	610
Min. Negotiated Rate	$645.06
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Self Pay Self Pay	$1,984.80

MRI LE Joint w/ Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73722 50
Hospital Charge Code	1287203
Hospital Revenue Code	610
Min. Negotiated Rate	$396.96
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Aetna of AZ Medicare	$694.68
Rate for Payer: Allwell Medicare	$396.96
Rate for Payer: Amerigroup Medicare	$396.96
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$396.96
Rate for Payer: Banner UC Health Medicare	$396.96
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,687.08
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Copperpoint Commercial	$614.05
Rate for Payer: Health Net of AZ Commercial	$1,488.60
Rate for Payer: Health Net of AZ Medicare	$694.68
Rate for Payer: Humana of AZ Medicare	$396.96
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$396.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI LE Joint w/ Contrast Left

Facility

$2,233.00

Service Code	CPT 73722 LT
Hospital Charge Code	1005460
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 LE Joint w/ Contrast Left

Facility

$2,233.00

Service Code	CPT 73722 LT
Hospital Charge Code	1005460
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 LE Joint w/ Contrast Right

Facility

$2,233.00

Service Code	CPT 73722 RT
Hospital Charge Code	1005462
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 LE Joint w/ Contrast Right

Facility

$2,233.00

Service Code	CPT 73722 RT
Hospital Charge Code	1005462
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 LE Joint w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73721 50
Hospital Charge Code	821418
Hospital Revenue Code	610
Min. Negotiated Rate	$396.96
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Aetna of AZ Medicare	$694.68
Rate for Payer: Allwell Medicare	$396.96
Rate for Payer: Amerigroup Medicare	$396.96
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$396.96
Rate for Payer: Banner UC Health Medicare	$396.96
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,687.08
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Copperpoint Commercial	$614.05
Rate for Payer: Health Net of AZ Commercial	$1,488.60
Rate for Payer: Health Net of AZ Medicare	$694.68
Rate for Payer: Humana of AZ Medicare	$396.96
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$396.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI LE Joint w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73721 50
Hospital Charge Code	821418
Hospital Revenue Code	610
Min. Negotiated Rate	$645.06
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Self Pay Self Pay	$1,984.80

MRI LE Joint w/o Contrast Left

Facility

$3,081.00

Service Code	CPT 73721 LT
Hospital Charge Code	821420
Hospital Revenue Code	610
Min. Negotiated Rate	$801.06
Max. Negotiated Rate	$2,772.90
Rate for Payer: Aetna of AZ Commercial	$2,772.90
Rate for Payer: Bisbee Police All Plans	$801.06
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Self Pay Self Pay	$2,464.80

MRI LE Joint w/o Contrast Left

Facility

$3,081.00

Service Code	CPT 73721 LT
Hospital Charge Code	821420
Hospital Revenue Code	610
Min. Negotiated Rate	$492.96
Max. Negotiated Rate	$2,772.90
Rate for Payer: Aetna of AZ Commercial	$2,772.90
Rate for Payer: Aetna of AZ Medicare	$862.68
Rate for Payer: Allwell Medicare	$492.96
Rate for Payer: Amerigroup Medicare	$492.96
Rate for Payer: APIPA Medicare/Medicaid	$1,150.75
Rate for Payer: AZCH Complete Medicare	$492.96
Rate for Payer: Banner UC Health Medicare	$492.96
Rate for Payer: Bisbee Police All Plans	$801.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,095.08
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Cigna of AZ Commercial	$2,156.70
Rate for Payer: Copperpoint Commercial	$762.55
Rate for Payer: Health Net of AZ Commercial	$1,848.60
Rate for Payer: Health Net of AZ Medicare	$862.68
Rate for Payer: Humana of AZ Medicare	$492.96
Rate for Payer: Self Pay Self Pay	$2,464.80
Rate for Payer: TriWest Medicare	$492.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,796.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$554.58

MRI LE Joint w/o Contrast Right

Facility

$3,081.00

Service Code	CPT 73721 RT
Hospital Charge Code	821422
Hospital Revenue Code	610
Min. Negotiated Rate	$492.96
Max. Negotiated Rate	$2,772.90
Rate for Payer: Aetna of AZ Commercial	$2,772.90
Rate for Payer: Aetna of AZ Medicare	$862.68
Rate for Payer: Allwell Medicare	$492.96
Rate for Payer: Amerigroup Medicare	$492.96
Rate for Payer: APIPA Medicare/Medicaid	$1,150.75
Rate for Payer: AZCH Complete Medicare	$492.96
Rate for Payer: Banner UC Health Medicare	$492.96
Rate for Payer: Bisbee Police All Plans	$801.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,095.08
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Cigna of AZ Commercial	$2,156.70
Rate for Payer: Copperpoint Commercial	$762.55
Rate for Payer: Health Net of AZ Commercial	$1,848.60
Rate for Payer: Health Net of AZ Medicare	$862.68
Rate for Payer: Humana of AZ Medicare	$492.96
Rate for Payer: Self Pay Self Pay	$2,464.80
Rate for Payer: TriWest Medicare	$492.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,796.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$554.58

MRI LE Joint w/o Contrast Right

Facility

$3,081.00

Service Code	CPT 73721 RT
Hospital Charge Code	821422
Hospital Revenue Code	610
Min. Negotiated Rate	$801.06
Max. Negotiated Rate	$2,772.90
Rate for Payer: Aetna of AZ Commercial	$2,772.90
Rate for Payer: Bisbee Police All Plans	$801.06
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Self Pay Self Pay	$2,464.80

MRI LE Joint w/ + w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73723 50
Hospital Charge Code	1005458
Hospital Revenue Code	610
Min. Negotiated Rate	$396.96
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Aetna of AZ Medicare	$694.68
Rate for Payer: Allwell Medicare	$396.96
Rate for Payer: Amerigroup Medicare	$396.96
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$396.96
Rate for Payer: Banner UC Health Medicare	$396.96
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,687.08
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Copperpoint Commercial	$614.05
Rate for Payer: Health Net of AZ Commercial	$1,488.60
Rate for Payer: Health Net of AZ Medicare	$694.68
Rate for Payer: Humana of AZ Medicare	$396.96
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$396.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI LE Joint w/ + w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73723 50
Hospital Charge Code	1005458
Hospital Revenue Code	610
Min. Negotiated Rate	$645.06
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Self Pay Self Pay	$1,984.80

Know your out-of-pocket cost for care.

All Charges