Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MRI UE Joint w/ Contrast Right

Facility

$2,233.00

Service Code	CPT 73222 RT
Hospital Charge Code	1007517
Hospital Revenue Code	610
Min. Negotiated Rate	$334.95
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	$334.95
Rate for Payer: Amerigroup Medicare	$334.95
Rate for Payer: APIPA Medicare/Medicaid	$834.03
Rate for Payer: AZCH Complete Medicare	$334.95
Rate for Payer: Banner UC Health Medicare	$334.95
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	$334.95
Rate for Payer: Self Pay Self Pay	$1,786.40
Rate for Payer: TriWest Medicare	$334.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,301.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$401.94

MRI UE Joint w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73221 50
Hospital Charge Code	821453
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 UE Joint w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73221 50
Hospital Charge Code	821453
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Joint w/o Contrast Left

Facility

$3,247.00

Service Code	CPT 73221 LT
Hospital Charge Code	821455
Hospital Revenue Code	610
Min. Negotiated Rate	$844.22
Max. Negotiated Rate	$2,922.30
Rate for Payer: Aetna of AZ Commercial	$2,922.30
Rate for Payer: Bisbee Police All Plans	$844.22
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Self Pay Self Pay	$2,597.60

MRI UE Joint w/o Contrast Left

Facility

$3,247.00

Service Code	CPT 73221 LT
Hospital Charge Code	821455
Hospital Revenue Code	610
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$2,922.30
Rate for Payer: Aetna of AZ Commercial	$2,922.30
Rate for Payer: Aetna of AZ Medicare	$909.16
Rate for Payer: Allwell Medicare	$487.05
Rate for Payer: Amerigroup Medicare	$487.05
Rate for Payer: APIPA Medicare/Medicaid	$1,212.75
Rate for Payer: AZCH Complete Medicare	$487.05
Rate for Payer: Banner UC Health Medicare	$487.05
Rate for Payer: Bisbee Police All Plans	$844.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,207.96
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Cigna of AZ Commercial	$2,272.90
Rate for Payer: Copperpoint Commercial	$803.63
Rate for Payer: Health Net of AZ Commercial	$1,948.20
Rate for Payer: Health Net of AZ Medicare	$909.16
Rate for Payer: Humana of AZ Medicare	$487.05
Rate for Payer: Self Pay Self Pay	$2,597.60
Rate for Payer: TriWest Medicare	$487.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,893.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$584.46

MRI UE Joint w/o Contrast Right

Facility

$3,247.00

Service Code	CPT 73221 RT
Hospital Charge Code	821457
Hospital Revenue Code	610
Min. Negotiated Rate	$844.22
Max. Negotiated Rate	$2,922.30
Rate for Payer: Aetna of AZ Commercial	$2,922.30
Rate for Payer: Bisbee Police All Plans	$844.22
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Self Pay Self Pay	$2,597.60

MRI UE Joint w/o Contrast Right

Facility

$3,247.00

Service Code	CPT 73221 RT
Hospital Charge Code	821457
Hospital Revenue Code	610
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$2,922.30
Rate for Payer: Aetna of AZ Commercial	$2,922.30
Rate for Payer: Aetna of AZ Medicare	$909.16
Rate for Payer: Allwell Medicare	$487.05
Rate for Payer: Amerigroup Medicare	$487.05
Rate for Payer: APIPA Medicare/Medicaid	$1,212.75
Rate for Payer: AZCH Complete Medicare	$487.05
Rate for Payer: Banner UC Health Medicare	$487.05
Rate for Payer: Bisbee Police All Plans	$844.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,207.96
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Cigna of AZ Commercial	$2,272.90
Rate for Payer: Copperpoint Commercial	$803.63
Rate for Payer: Health Net of AZ Commercial	$1,948.20
Rate for Payer: Health Net of AZ Medicare	$909.16
Rate for Payer: Humana of AZ Medicare	$487.05
Rate for Payer: Self Pay Self Pay	$2,597.60
Rate for Payer: TriWest Medicare	$487.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,893.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$584.46

MRI UE Joint w/ + w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73221 50
Hospital Charge Code	821451
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 UE Joint w/ + w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73221 50
Hospital Charge Code	821451
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Joint w/ + w/o Contrast Left

Facility

$2,481.00

Service Code	CPT 73223 LT
Hospital Charge Code	1005509
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 UE Joint w/ + w/o Contrast Left

Facility

$2,481.00

Service Code	CPT 73223 LT
Hospital Charge Code	1005509
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Joint w/ + w/o Contrast Right

Facility

$2,481.00

Service Code	CPT 73223 RT
Hospital Charge Code	1005511
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 UE Joint w/ + w/o Contrast Right

Facility

$2,481.00

Service Code	CPT 73223 RT
Hospital Charge Code	1005511
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Non Joint w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73218 50
Hospital Charge Code	1007535
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 UE Non Joint w/o Contrast Bilateral

Facility

$2,481.00

Service Code	CPT 73218 50
Hospital Charge Code	1007535
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Non Joint w/o Contrast Left

Facility

$1,985.00

Service Code	CPT 73218 LT
Hospital Charge Code	1007537
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

MRI UE Non Joint w/o Contrast Left

Facility

$1,985.00

Service Code	CPT 73218 LT
Hospital Charge Code	1007537
Hospital Revenue Code	610
Min. Negotiated Rate	$297.75
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	$297.75
Rate for Payer: Amerigroup Medicare	$297.75
Rate for Payer: APIPA Medicare/Medicaid	$741.40
Rate for Payer: AZCH Complete Medicare	$297.75
Rate for Payer: Banner UC Health Medicare	$297.75
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	$297.75
Rate for Payer: Self Pay Self Pay	$1,588.00
Rate for Payer: TriWest Medicare	$297.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,157.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$357.30

MRI UE Non Joint w/o Contrast Right

Facility

$3,957.00

Service Code	CPT 73218 RT
Hospital Charge Code	1007539
Hospital Revenue Code	610
Min. Negotiated Rate	$1,028.82
Max. Negotiated Rate	$3,561.30
Rate for Payer: Aetna of AZ Commercial	$3,561.30
Rate for Payer: Bisbee Police All Plans	$1,028.82
Rate for Payer: Cash Price	$3,165.60
Rate for Payer: Self Pay Self Pay	$3,165.60

MRI UE Non Joint w/o Contrast Right

Facility

$3,957.00

Service Code	CPT 73218 RT
Hospital Charge Code	1007539
Hospital Revenue Code	610
Min. Negotiated Rate	$593.55
Max. Negotiated Rate	$3,561.30
Rate for Payer: Aetna of AZ Commercial	$3,561.30
Rate for Payer: Aetna of AZ Medicare	$1,107.96
Rate for Payer: Allwell Medicare	$593.55
Rate for Payer: Amerigroup Medicare	$593.55
Rate for Payer: APIPA Medicare/Medicaid	$1,477.94
Rate for Payer: AZCH Complete Medicare	$593.55
Rate for Payer: Banner UC Health Medicare	$593.55
Rate for Payer: Bisbee Police All Plans	$1,028.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,690.76
Rate for Payer: Cash Price	$3,165.60
Rate for Payer: Cigna of AZ Commercial	$2,769.90
Rate for Payer: Copperpoint Commercial	$979.36
Rate for Payer: Health Net of AZ Commercial	$2,374.20
Rate for Payer: Health Net of AZ Medicare	$1,107.96
Rate for Payer: Humana of AZ Medicare	$593.55
Rate for Payer: Self Pay Self Pay	$3,165.60
Rate for Payer: TriWest Medicare	$593.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,306.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$712.26

MRI UE Non Joint w/ + w/o Contrast Bilat

Facility

$2,481.00

Service Code	CPT 73220 50
Hospital Charge Code	1007522
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Non Joint w/ + w/o Contrast Bilat

Facility

$2,481.00

Service Code	CPT 73220 50
Hospital Charge Code	1007522
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 UE Non Joint w/ + w/o Contrast Left

Facility

$2,481.00

Service Code	CPT 73220 LT
Hospital Charge Code	1007524
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 UE Non Joint w/ + w/o Contrast Left

Facility

$2,481.00

Service Code	CPT 73220 LT
Hospital Charge Code	1007524
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Non Joint w/ + w/o Contrast Right

Facility

$2,481.00

Service Code	CPT 73220 RT
Hospital Charge Code	1007526
Hospital Revenue Code	610
Min. Negotiated Rate	$372.15
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	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicare	$372.15
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	$372.15
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRI UE Non Joint w/ + w/o Contrast Right

Facility

$2,481.00

Service Code	CPT 73220 RT
Hospital Charge Code	1007526
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