Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Abdomen Acute 3 Views/Chest 1 View

Facility

$972.00

Service Code	CPT 74022
Hospital Charge Code	2214245
Hospital Revenue Code	320
Min. Negotiated Rate	$145.80
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Aetna of AZ Medicare	$272.16
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$145.80
Rate for Payer: Amerigroup Medicare	$145.80
Rate for Payer: APIPA Medicare/Medicaid	$363.04
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$145.80
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$145.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$660.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cigna of AZ Commercial	$631.80
Rate for Payer: Copperpoint Commercial	$240.57
Rate for Payer: Health Net of AZ Commercial	$583.20
Rate for Payer: Health Net of AZ Medicare	$272.16
Rate for Payer: Humana of AZ Medicare	$145.80
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$777.60
Rate for Payer: TriWest Medicare	$145.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$566.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$174.96

XR Abdomen Acute 3 Views/Chest 1 View

Facility

$972.00

Service Code	CPT 74022
Hospital Charge Code	2214245
Hospital Revenue Code	320
Min. Negotiated Rate	$252.72
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Cash Price	$777.60
Rate for Payer: Self Pay Self Pay	$777.60

XR AC Joints Bilateral

Facility

$488.00

Service Code	CPT 73050 50
Hospital Charge Code	1163782
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR AC Joints Bilateral

Facility

$488.00

Service Code	CPT 73050 50
Hospital Charge Code	1163782
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Ankle 2 Views Left

Facility

$488.00

Service Code	CPT 73600 LT
Hospital Charge Code	1007853
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Ankle 2 Views Left

Facility

$488.00

Service Code	CPT 73600 LT
Hospital Charge Code	1007853
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Ankle 2 Views Right

Facility

$488.00

Service Code	CPT 73600 RT
Hospital Charge Code	1007855
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Ankle 2 Views Right

Facility

$488.00

Service Code	CPT 73600 RT
Hospital Charge Code	1007855
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Ankle Complete Left

Facility

$488.00

Service Code	CPT 73610 LT
Hospital Charge Code	823492
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Ankle Complete Left

Facility

$488.00

Service Code	CPT 73610 LT
Hospital Charge Code	823492
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Ankle Complete Right

Facility

$488.00

Service Code	CPT 73610 RT
Hospital Charge Code	823494
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Ankle Complete Right

Facility

$488.00

Service Code	CPT 73610 RT
Hospital Charge Code	823494
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Bone Age Studies

Facility

$584.00

Service Code	CPT 77072
Hospital Charge Code	1007877
Hospital Revenue Code	320
Min. Negotiated Rate	$87.60
Max. Negotiated Rate	$525.60
Rate for Payer: Aetna of AZ Commercial	$525.60
Rate for Payer: Aetna of AZ Medicare	$163.52
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$87.60
Rate for Payer: Amerigroup Medicare	$87.60
Rate for Payer: APIPA Medicare/Medicaid	$218.12
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$87.60
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$87.60
Rate for Payer: Bisbee Police All Plans	$151.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$397.12
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cigna of AZ Commercial	$379.60
Rate for Payer: Copperpoint Commercial	$144.54
Rate for Payer: Health Net of AZ Commercial	$350.40
Rate for Payer: Health Net of AZ Medicare	$163.52
Rate for Payer: Humana of AZ Medicare	$87.60
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$467.20
Rate for Payer: TriWest Medicare	$87.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$340.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$105.12

XR Bone Age Studies

Facility

$584.00

Service Code	CPT 77072
Hospital Charge Code	1007877
Hospital Revenue Code	320
Min. Negotiated Rate	$151.84
Max. Negotiated Rate	$525.60
Rate for Payer: Aetna of AZ Commercial	$525.60
Rate for Payer: Bisbee Police All Plans	$151.84
Rate for Payer: Cash Price	$467.20
Rate for Payer: Self Pay Self Pay	$467.20

XR Bone Length Studies/Ort

Facility

$680.00

Service Code	CPT 77073
Hospital Charge Code	1007881
Hospital Revenue Code	320
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Aetna of AZ Medicare	$190.40
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$102.00
Rate for Payer: Amerigroup Medicare	$102.00
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$102.00
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$102.00
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$462.40
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$442.00
Rate for Payer: Copperpoint Commercial	$168.30
Rate for Payer: Health Net of AZ Commercial	$408.00
Rate for Payer: Health Net of AZ Medicare	$190.40
Rate for Payer: Humana of AZ Medicare	$102.00
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$544.00
Rate for Payer: TriWest Medicare	$102.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$396.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.40

XR Bone Length Studies/Ort

Facility

$680.00

Service Code	CPT 77073
Hospital Charge Code	1007881
Hospital Revenue Code	320
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Cash Price	$544.00
Rate for Payer: Self Pay Self Pay	$544.00

XR Bone Survey Complete

Facility

$1,552.00

Service Code	CPT 77075
Hospital Charge Code	1319957
Hospital Revenue Code	320
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$1,396.80
Rate for Payer: Aetna of AZ Commercial	$1,396.80
Rate for Payer: Aetna of AZ Medicare	$434.56
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$232.80
Rate for Payer: Amerigroup Medicare	$232.80
Rate for Payer: APIPA Medicare/Medicaid	$579.67
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$232.80
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$232.80
Rate for Payer: Bisbee Police All Plans	$403.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,055.36
Rate for Payer: Cash Price	$1,241.60
Rate for Payer: Cash Price	$1,241.60
Rate for Payer: Cigna of AZ Commercial	$1,008.80
Rate for Payer: Copperpoint Commercial	$384.12
Rate for Payer: Health Net of AZ Commercial	$931.20
Rate for Payer: Health Net of AZ Medicare	$434.56
Rate for Payer: Humana of AZ Medicare	$232.80
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$1,241.60
Rate for Payer: TriWest Medicare	$232.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$904.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$279.36

XR Bone Survey Complete

Facility

$1,552.00

Service Code	CPT 77075
Hospital Charge Code	1319957
Hospital Revenue Code	320
Min. Negotiated Rate	$403.52
Max. Negotiated Rate	$1,396.80
Rate for Payer: Aetna of AZ Commercial	$1,396.80
Rate for Payer: Bisbee Police All Plans	$403.52
Rate for Payer: Cash Price	$1,241.60
Rate for Payer: Self Pay Self Pay	$1,241.60

XR Bone Survey Limited

Facility

$876.00

Service Code	CPT 77074
Hospital Charge Code	1319960
Hospital Revenue Code	320
Min. Negotiated Rate	$227.76
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Bisbee Police All Plans	$227.76
Rate for Payer: Cash Price	$700.80
Rate for Payer: Self Pay Self Pay	$700.80

XR Bone Survey Limited

Facility

$876.00

Service Code	CPT 77074
Hospital Charge Code	1319960
Hospital Revenue Code	320
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Aetna of AZ Medicare	$245.28
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$131.40
Rate for Payer: Amerigroup Medicare	$131.40
Rate for Payer: APIPA Medicare/Medicaid	$327.19
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$131.40
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$131.40
Rate for Payer: Bisbee Police All Plans	$227.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$595.68
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cigna of AZ Commercial	$569.40
Rate for Payer: Copperpoint Commercial	$216.81
Rate for Payer: Health Net of AZ Commercial	$525.60
Rate for Payer: Health Net of AZ Medicare	$245.28
Rate for Payer: Humana of AZ Medicare	$131.40
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$700.80
Rate for Payer: TriWest Medicare	$131.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$510.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$157.68

XR Calcaneous Left

Facility

$488.00

Service Code	CPT 73650
Hospital Charge Code	823496
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Calcaneous Left

Facility

$488.00

Service Code	CPT 73650
Hospital Charge Code	823496
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Calcaneous Right

Facility

$488.00

Service Code	CPT 73650
Hospital Charge Code	823498
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Calcaneous Right

Facility

$488.00

Service Code	CPT 73650
Hospital Charge Code	823498
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Calcaneus Left

Facility

$488.00

Service Code	CPT 73650 LT
Hospital Charge Code	22147265
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

Know your out-of-pocket cost for care.

All Charges