Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MRI UE Non Joint w/o Contrast Right

Facility

$5,143.00

Service Code	CPT 73218 RT
Hospital Charge Code	1007539
Hospital Revenue Code	610
Min. Negotiated Rate	$1,337.18
Max. Negotiated Rate	$4,628.70
Rate for Payer: Aetna of AZ Commercial	$4,628.70
Rate for Payer: Bisbee Police All Plans	$1,337.18
Rate for Payer: Cash Price	$4,114.40
Rate for Payer: Self Pay Self Pay	$4,114.40

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	$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 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	$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 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 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

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	$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

MRSA Screen Culture

Facility

$127.00

Service Code	CPT 87081
Hospital Charge Code	1164500
Hospital Revenue Code	306
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of AZ Commercial	$114.30
Rate for Payer: Aetna of AZ Medicare	$35.56
Rate for Payer: Allwell Medicare	$20.32
Rate for Payer: Amerigroup Medicare	$20.32
Rate for Payer: APIPA Medicare/Medicaid	$47.43
Rate for Payer: AZCH Complete Medicare	$20.32
Rate for Payer: Banner UC Health Medicare	$20.32
Rate for Payer: Bisbee Police All Plans	$33.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$86.36
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cigna of AZ Commercial	$82.55
Rate for Payer: Copperpoint Commercial	$31.43
Rate for Payer: Health Net of AZ Commercial	$76.20
Rate for Payer: Health Net of AZ Medicare	$35.56
Rate for Payer: Humana of AZ Medicare	$20.32
Rate for Payer: Self Pay Self Pay	$101.60
Rate for Payer: TriWest Medicare	$20.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$74.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.86

MRSA Screen Culture

Facility

$127.00

Service Code	CPT 87081
Hospital Charge Code	1164500
Hospital Revenue Code	306
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$114.30
Rate for Payer: Aetna of AZ Commercial	$114.30
Rate for Payer: Bisbee Police All Plans	$33.02
Rate for Payer: Cash Price	$101.60
Rate for Payer: Self Pay Self Pay	$101.60

MRV Head w/o Contrast

Facility

$3,085.00

Service Code	CPT 70544
Hospital Charge Code	1003592
Hospital Revenue Code	610
Min. Negotiated Rate	$802.10
Max. Negotiated Rate	$2,776.50
Rate for Payer: Aetna of AZ Commercial	$2,776.50
Rate for Payer: Bisbee Police All Plans	$802.10
Rate for Payer: Cash Price	$2,468.00
Rate for Payer: Self Pay Self Pay	$2,468.00

MRV Head w/o Contrast

Facility

$3,247.00

Service Code	CPT 70544
Hospital Charge Code	1005367
Hospital Revenue Code	610
Min. Negotiated Rate	$519.52
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	$519.52
Rate for Payer: Amerigroup Medicare	$519.52
Rate for Payer: APIPA Medicare/Medicaid	$1,212.75
Rate for Payer: AZCH Complete Medicare	$519.52
Rate for Payer: Banner UC Health Medicare	$519.52
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	$519.52
Rate for Payer: Self Pay Self Pay	$2,597.60
Rate for Payer: TriWest Medicare	$519.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,893.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$584.46

MRV Head w/o Contrast

Facility

$1,985.00

Service Code	CPT 70544
Hospital Charge Code	1007574
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

MRV Head w/o Contrast

Facility

$1,985.00

Service Code	CPT 70544
Hospital Charge Code	1007574
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

MRV Head w/o Contrast

Facility

$3,247.00

Service Code	CPT 70544
Hospital Charge Code	1005367
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

MRV Head w/o Contrast

Facility

$3,085.00

Service Code	CPT 70544
Hospital Charge Code	1003592
Hospital Revenue Code	610
Min. Negotiated Rate	$493.60
Max. Negotiated Rate	$2,776.50
Rate for Payer: Aetna of AZ Commercial	$2,776.50
Rate for Payer: Aetna of AZ Medicare	$863.80
Rate for Payer: Allwell Medicare	$493.60
Rate for Payer: Amerigroup Medicare	$493.60
Rate for Payer: APIPA Medicare/Medicaid	$1,152.25
Rate for Payer: AZCH Complete Medicare	$493.60
Rate for Payer: Banner UC Health Medicare	$493.60
Rate for Payer: Bisbee Police All Plans	$802.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,097.80
Rate for Payer: Cash Price	$2,468.00
Rate for Payer: Cigna of AZ Commercial	$2,159.50
Rate for Payer: Copperpoint Commercial	$763.54
Rate for Payer: Health Net of AZ Commercial	$1,851.00
Rate for Payer: Health Net of AZ Medicare	$863.80
Rate for Payer: Humana of AZ Medicare	$493.60
Rate for Payer: Self Pay Self Pay	$2,468.00
Rate for Payer: TriWest Medicare	$493.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,798.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$555.30

MTP 0 DEGREE PLATE RIGHT

Facility

$19,609.00

Hospital Charge Code	27663808
Hospital Revenue Code	270
Min. Negotiated Rate	$3,137.44
Max. Negotiated Rate	$17,648.10
Rate for Payer: Aetna of AZ Commercial	$17,648.10
Rate for Payer: Aetna of AZ Medicare	$5,490.52
Rate for Payer: Allwell Medicare	$3,137.44
Rate for Payer: Amerigroup Medicare	$3,137.44
Rate for Payer: APIPA Medicare/Medicaid	$7,323.96
Rate for Payer: AZCH Complete Medicare	$3,137.44
Rate for Payer: Banner UC Health Medicare	$3,137.44
Rate for Payer: Bisbee Police All Plans	$5,098.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$13,334.12
Rate for Payer: Cash Price	$15,687.20
Rate for Payer: Cigna of AZ Commercial	$13,726.30
Rate for Payer: Copperpoint Commercial	$4,853.23
Rate for Payer: Health Net of AZ Commercial	$11,765.40
Rate for Payer: Health Net of AZ Medicare	$5,490.52
Rate for Payer: Humana of AZ Medicare	$3,137.44
Rate for Payer: Self Pay Self Pay	$15,687.20
Rate for Payer: TriWest Medicare	$3,137.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$11,432.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$3,529.62

MTP 0 DEGREE PLATE RIGHT

Facility

$19,609.00

Hospital Charge Code	27663808
Hospital Revenue Code	270
Min. Negotiated Rate	$5,098.34
Max. Negotiated Rate	$17,648.10
Rate for Payer: Aetna of AZ Commercial	$17,648.10
Rate for Payer: Bisbee Police All Plans	$5,098.34
Rate for Payer: Cash Price	$15,687.20
Rate for Payer: Self Pay Self Pay	$15,687.20

MUCOUS TRAP ADULT

Facility

$9.00

Hospital Charge Code	22355581
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

MUCOUS TRAP ADULT

Facility

$9.00

Hospital Charge Code	22355581
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

MULTI-LUMEN CVC KIT 7FRX20CM

Facility

$203.00

Hospital Charge Code	23641815
Hospital Revenue Code	270
Min. Negotiated Rate	$32.48
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: Allwell Medicare	$32.48
Rate for Payer: Amerigroup Medicare	$32.48
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicare	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

MULTI-LUMEN CVC KIT 7FRX20CM

Facility

$203.00

Hospital Charge Code	23641815
Hospital Revenue Code	270
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies

Facility

$7,869.71

Service Code	APR-DRG 0432
Hospital Charge Code	APRDRG0432
Min. Negotiated Rate	$7,869.71
Max. Negotiated Rate	$7,869.71
Rate for Payer: AHCCCS Medicaid	$7,869.71
Rate for Payer: Allwell Medicaid	$7,869.71
Rate for Payer: AZCH Complete Medicaid	$7,869.71
Rate for Payer: Banner UC Health Medicaid	$7,869.71
Rate for Payer: Mercy Care Medicaid	$7,869.71

Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies

Facility

$12,183.32

Service Code	APR-DRG 0433
Hospital Charge Code	APRDRG0432
Min. Negotiated Rate	$12,183.32
Max. Negotiated Rate	$12,183.32
Rate for Payer: AHCCCS Medicaid	$12,183.32
Rate for Payer: Allwell Medicaid	$12,183.32
Rate for Payer: AZCH Complete Medicaid	$12,183.32
Rate for Payer: Banner UC Health Medicaid	$12,183.32
Rate for Payer: Mercy Care Medicaid	$12,183.32

Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies

Facility

$23,520.05

Service Code	APR-DRG 0434
Hospital Charge Code	APRDRG0431
Min. Negotiated Rate	$23,520.05
Max. Negotiated Rate	$23,520.05
Rate for Payer: AHCCCS Medicaid	$23,520.05
Rate for Payer: Allwell Medicaid	$23,520.05
Rate for Payer: AZCH Complete Medicaid	$23,520.05
Rate for Payer: Banner UC Health Medicaid	$23,520.05
Rate for Payer: Mercy Care Medicaid	$23,520.05

Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies

Facility

$7,869.71

Service Code	APR-DRG 0432
Hospital Charge Code	APRDRG0431
Min. Negotiated Rate	$7,869.71
Max. Negotiated Rate	$7,869.71
Rate for Payer: AHCCCS Medicaid	$7,869.71
Rate for Payer: Allwell Medicaid	$7,869.71
Rate for Payer: AZCH Complete Medicaid	$7,869.71
Rate for Payer: Banner UC Health Medicaid	$7,869.71
Rate for Payer: Mercy Care Medicaid	$7,869.71

Know your out-of-pocket cost for care.

All Charges