Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	$530.48
Max. Negotiated Rate	$3,014.10
Rate for Payer: Aetna of AZ Commercial	$3,014.10
Rate for Payer: Arizona Complete Health Allwell	$535.84
Rate for Payer: Banner UC Health Medicare	$535.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,277.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$535.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$535.84
Rate for Payer: Cash Price	$2,679.20
Rate for Payer: Cigna of AZ Commercial	$2,344.30
Rate for Payer: Devoted Health Medicare	$602.82
Rate for Payer: Humana of AZ Medicare	$535.84
Rate for Payer: Southwest Service Administrators UFCW	$2,277.32
Rate for Payer: TriWest Medicare	$535.84
Rate for Payer: United Healthcare Commercial	$1,915.63
Rate for Payer: United Healthcare Medicare	$535.84
Rate for Payer: United Healthcare New Mexico Commercial	$636.31
Rate for Payer: Veterans Affairs TRICARE	$530.48

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	$3,014.10
Max. Negotiated Rate	$3,014.10
Rate for Payer: Aetna of AZ Commercial	$3,014.10
Rate for Payer: Cash Price	$2,679.20

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	$374.30
Max. Negotiated Rate	$2,126.70
Rate for Payer: Aetna of AZ Commercial	$2,126.70
Rate for Payer: Arizona Complete Health Allwell	$378.08
Rate for Payer: Banner UC Health Medicare	$378.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,606.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$378.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$378.08
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cigna of AZ Commercial	$1,654.10
Rate for Payer: Devoted Health Medicare	$425.34
Rate for Payer: Humana of AZ Medicare	$378.08
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$1,606.84
Rate for Payer: TriWest Medicare	$378.08
Rate for Payer: United Healthcare Commercial	$1,351.64
Rate for Payer: United Healthcare Medicare	$378.08
Rate for Payer: United Healthcare New Mexico Commercial	$448.97
Rate for Payer: Veterans Affairs TRICARE	$374.30

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	$2,126.70
Max. Negotiated Rate	$2,126.70
Rate for Payer: Aetna of AZ Commercial	$2,126.70
Rate for Payer: Cash Price	$1,890.40

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	$1,701.90
Max. Negotiated Rate	$1,701.90
Rate for Payer: Aetna of AZ Commercial	$1,701.90
Rate for Payer: Cash Price	$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	$299.53
Max. Negotiated Rate	$1,701.90
Rate for Payer: Aetna of AZ Commercial	$1,701.90
Rate for Payer: Arizona Complete Health Allwell	$302.56
Rate for Payer: Banner UC Health Medicare	$302.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,285.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$302.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$302.56
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Cigna of AZ Commercial	$1,323.70
Rate for Payer: Devoted Health Medicare	$340.38
Rate for Payer: Humana of AZ Medicare	$302.56
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,285.88
Rate for Payer: TriWest Medicare	$302.56
Rate for Payer: United Healthcare Commercial	$1,081.65
Rate for Payer: United Healthcare Medicare	$302.56
Rate for Payer: United Healthcare New Mexico Commercial	$359.29
Rate for Payer: Veterans Affairs TRICARE	$299.53

MRA Neck w/ Contrast

Facility

$4,777.00

Service Code	CPT 70549
Hospital Charge Code	1005378
Hospital Revenue Code	615
Min. Negotiated Rate	$4,299.30
Max. Negotiated Rate	$4,299.30
Rate for Payer: Aetna of AZ Commercial	$4,299.30
Rate for Payer: Cash Price	$3,821.60

MRA Neck w/ Contrast

Facility

$4,777.00

Service Code	CPT 70549
Hospital Charge Code	1005378
Hospital Revenue Code	615
Min. Negotiated Rate	$539.81
Max. Negotiated Rate	$4,299.30
Rate for Payer: Aetna of AZ Commercial	$4,299.30
Rate for Payer: Arizona Complete Health Allwell	$764.32
Rate for Payer: Banner UC Health Medicare	$764.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,248.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$764.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$764.32
Rate for Payer: Cash Price	$3,821.60
Rate for Payer: Cash Price	$3,821.60
Rate for Payer: Cigna of AZ Commercial	$3,343.90
Rate for Payer: Devoted Health Medicare	$859.86
Rate for Payer: Humana of AZ Medicare	$764.32
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$3,248.36
Rate for Payer: TriWest Medicare	$764.32
Rate for Payer: United Healthcare Commercial	$2,732.44
Rate for Payer: United Healthcare Medicare	$764.32
Rate for Payer: United Healthcare New Mexico Commercial	$907.63
Rate for Payer: Veterans Affairs TRICARE	$756.68

MRA Neck w/ Contrast 70548

Facility

$2,126.00

Service Code	CPT 70548
Hospital Charge Code	22986619
Hospital Revenue Code	615
Min. Negotiated Rate	$1,913.40
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of AZ Commercial	$1,913.40
Rate for Payer: Cash Price	$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	$336.76
Max. Negotiated Rate	$1,913.40
Rate for Payer: Aetna of AZ Commercial	$1,913.40
Rate for Payer: Arizona Complete Health Allwell	$340.16
Rate for Payer: Banner UC Health Medicare	$340.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,445.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$340.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$340.16
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Cigna of AZ Commercial	$1,488.20
Rate for Payer: Devoted Health Medicare	$382.68
Rate for Payer: Humana of AZ Medicare	$340.16
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$1,445.68
Rate for Payer: TriWest Medicare	$340.16
Rate for Payer: United Healthcare Commercial	$1,216.07
Rate for Payer: United Healthcare Medicare	$340.16
Rate for Payer: United Healthcare New Mexico Commercial	$403.94
Rate for Payer: Veterans Affairs TRICARE	$336.76

MRA Neck w/o Contrast

Facility

$3,253.00

Service Code	CPT 70547
Hospital Charge Code	821396
Hospital Revenue Code	615
Min. Negotiated Rate	$369.18
Max. Negotiated Rate	$2,927.70
Rate for Payer: Aetna of AZ Commercial	$2,927.70
Rate for Payer: Arizona Complete Health Allwell	$520.48
Rate for Payer: Banner UC Health Medicare	$520.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,212.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$520.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$520.48
Rate for Payer: Cash Price	$2,602.40
Rate for Payer: Cash Price	$2,602.40
Rate for Payer: Cigna of AZ Commercial	$2,277.10
Rate for Payer: Devoted Health Medicare	$585.54
Rate for Payer: Humana of AZ Medicare	$520.48
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$2,212.04
Rate for Payer: TriWest Medicare	$520.48
Rate for Payer: United Healthcare Commercial	$1,860.72
Rate for Payer: United Healthcare Medicare	$520.48
Rate for Payer: United Healthcare New Mexico Commercial	$618.07
Rate for Payer: Veterans Affairs TRICARE	$515.28

MRA Neck w/o Contrast

Facility

$3,253.00

Service Code	CPT 70547
Hospital Charge Code	821396
Hospital Revenue Code	615
Min. Negotiated Rate	$2,927.70
Max. Negotiated Rate	$2,927.70
Rate for Payer: Aetna of AZ Commercial	$2,927.70
Rate for Payer: Cash Price	$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	$2,009.70
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Cash Price	$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	$353.71
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Arizona Complete Health Allwell	$357.28
Rate for Payer: Banner UC Health Medicare	$357.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,518.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$357.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$357.28
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cigna of AZ Commercial	$1,563.10
Rate for Payer: Devoted Health Medicare	$401.94
Rate for Payer: Humana of AZ Medicare	$357.28
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$1,518.44
Rate for Payer: TriWest Medicare	$357.28
Rate for Payer: United Healthcare Commercial	$1,277.28
Rate for Payer: United Healthcare Medicare	$357.28
Rate for Payer: United Healthcare New Mexico Commercial	$424.27
Rate for Payer: Veterans Affairs TRICARE	$353.71

MRI Abdomen w/o Contrast

Facility

$2,916.00

Service Code	CPT 74181
Hospital Charge Code	1005395
Hospital Revenue Code	610
Min. Negotiated Rate	$369.18
Max. Negotiated Rate	$2,624.40
Rate for Payer: Aetna of AZ Commercial	$2,624.40
Rate for Payer: Arizona Complete Health Allwell	$466.56
Rate for Payer: Banner UC Health Medicare	$466.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,982.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$466.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$466.56
Rate for Payer: Cash Price	$2,332.80
Rate for Payer: Cash Price	$2,332.80
Rate for Payer: Cigna of AZ Commercial	$2,041.20
Rate for Payer: Devoted Health Medicare	$524.88
Rate for Payer: Humana of AZ Medicare	$466.56
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,982.88
Rate for Payer: TriWest Medicare	$466.56
Rate for Payer: United Healthcare Commercial	$1,667.95
Rate for Payer: United Healthcare Medicare	$466.56
Rate for Payer: United Healthcare New Mexico Commercial	$554.04
Rate for Payer: Veterans Affairs TRICARE	$461.89

MRI Abdomen w/o Contrast

Facility

$2,916.00

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

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	$539.81
Max. Negotiated Rate	$4,577.40
Rate for Payer: Aetna of AZ Commercial	$4,577.40
Rate for Payer: Arizona Complete Health Allwell	$813.76
Rate for Payer: Banner UC Health Medicare	$813.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,458.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$813.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$813.76
Rate for Payer: Cash Price	$4,068.80
Rate for Payer: Cash Price	$4,068.80
Rate for Payer: Cigna of AZ Commercial	$3,560.20
Rate for Payer: Devoted Health Medicare	$915.48
Rate for Payer: Humana of AZ Medicare	$813.76
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$3,458.48
Rate for Payer: TriWest Medicare	$813.76
Rate for Payer: United Healthcare Commercial	$2,909.19
Rate for Payer: United Healthcare Medicare	$813.76
Rate for Payer: United Healthcare New Mexico Commercial	$966.34
Rate for Payer: Veterans Affairs TRICARE	$805.62

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	$4,577.40
Max. Negotiated Rate	$4,577.40
Rate for Payer: Aetna of AZ Commercial	$4,577.40
Rate for Payer: Cash Price	$4,068.80

MRI Brain w/ Contrast

Facility

$2,233.00

Service Code	CPT 70552
Hospital Charge Code	821400
Hospital Revenue Code	611
Min. Negotiated Rate	$2,009.70
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Cash Price	$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	$353.71
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Arizona Complete Health Allwell	$357.28
Rate for Payer: Banner UC Health Medicare	$357.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,518.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$357.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$357.28
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cigna of AZ Commercial	$1,563.10
Rate for Payer: Devoted Health Medicare	$401.94
Rate for Payer: Humana of AZ Medicare	$357.28
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$1,518.44
Rate for Payer: TriWest Medicare	$357.28
Rate for Payer: United Healthcare Commercial	$1,277.28
Rate for Payer: United Healthcare Medicare	$357.28
Rate for Payer: United Healthcare New Mexico Commercial	$424.27
Rate for Payer: Veterans Affairs TRICARE	$353.71

MRI Brain w/o Contrast

Facility

$3,261.98

Service Code	CPT 70551
Hospital Charge Code	821402
Hospital Revenue Code	611
Min. Negotiated Rate	$2,935.78
Max. Negotiated Rate	$2,935.78
Rate for Payer: Aetna of AZ Commercial	$2,935.78
Rate for Payer: Cash Price	$2,609.58

MRI Brain w/o Contrast

Facility

$3,261.98

Service Code	CPT 70551
Hospital Charge Code	821402
Hospital Revenue Code	611
Min. Negotiated Rate	$369.18
Max. Negotiated Rate	$2,935.78
Rate for Payer: Aetna of AZ Commercial	$2,935.78
Rate for Payer: Arizona Complete Health Allwell	$521.92
Rate for Payer: Banner UC Health Medicare	$521.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,218.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$521.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$521.92
Rate for Payer: Cash Price	$2,609.58
Rate for Payer: Cash Price	$2,609.58
Rate for Payer: Cigna of AZ Commercial	$2,283.39
Rate for Payer: Devoted Health Medicare	$587.16
Rate for Payer: Humana of AZ Medicare	$521.92
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$2,218.15
Rate for Payer: TriWest Medicare	$521.92
Rate for Payer: United Healthcare Commercial	$1,865.85
Rate for Payer: United Healthcare Medicare	$521.92
Rate for Payer: United Healthcare New Mexico Commercial	$619.78
Rate for Payer: Veterans Affairs TRICARE	$516.70

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	$4,304.70
Max. Negotiated Rate	$4,304.70
Rate for Payer: Aetna of AZ Commercial	$4,304.70
Rate for Payer: Cash Price	$3,826.40

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	$539.81
Max. Negotiated Rate	$4,304.70
Rate for Payer: Aetna of AZ Commercial	$4,304.70
Rate for Payer: Arizona Complete Health Allwell	$765.28
Rate for Payer: Banner UC Health Medicare	$765.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3,252.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$765.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$765.28
Rate for Payer: Cash Price	$3,826.40
Rate for Payer: Cash Price	$3,826.40
Rate for Payer: Cigna of AZ Commercial	$3,348.10
Rate for Payer: Devoted Health Medicare	$860.94
Rate for Payer: Humana of AZ Medicare	$765.28
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$3,252.44
Rate for Payer: TriWest Medicare	$765.28
Rate for Payer: United Healthcare Commercial	$2,735.88
Rate for Payer: United Healthcare Medicare	$765.28
Rate for Payer: United Healthcare New Mexico Commercial	$908.77
Rate for Payer: Veterans Affairs TRICARE	$757.63

MRI Chest w/o Contrast

Facility

$2,553.00

Service Code	CPT 71550
Hospital Charge Code	1005415
Hospital Revenue Code	610
Min. Negotiated Rate	$369.18
Max. Negotiated Rate	$2,297.70
Rate for Payer: Aetna of AZ Commercial	$2,297.70
Rate for Payer: Arizona Complete Health Allwell	$408.48
Rate for Payer: Banner UC Health Medicare	$408.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,736.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$408.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$408.48
Rate for Payer: Cash Price	$2,042.40
Rate for Payer: Cash Price	$2,042.40
Rate for Payer: Cigna of AZ Commercial	$1,787.10
Rate for Payer: Devoted Health Medicare	$459.54
Rate for Payer: Humana of AZ Medicare	$408.48
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$1,736.04
Rate for Payer: TriWest Medicare	$408.48
Rate for Payer: United Healthcare Commercial	$1,460.32
Rate for Payer: United Healthcare Medicare	$408.48
Rate for Payer: United Healthcare New Mexico Commercial	$485.07
Rate for Payer: Veterans Affairs TRICARE	$404.40

Know your out-of-pocket cost for care.

All Charges