Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Elbow 2 Views Left

Facility

$382.00

Service Code	CPT 73070 LT
Hospital Charge Code	823520
Hospital Revenue Code	320
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Aetna of AZ Medicare	$106.96
Rate for Payer: Allwell Medicare	$57.30
Rate for Payer: Amerigroup Medicare	$57.30
Rate for Payer: APIPA Medicare/Medicaid	$142.68
Rate for Payer: AZCH Complete Medicare	$57.30
Rate for Payer: Banner UC Health Medicare	$57.30
Rate for Payer: Bisbee Police All Plans	$99.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$259.76
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cigna of AZ Commercial	$248.30
Rate for Payer: Copperpoint Commercial	$94.54
Rate for Payer: Health Net of AZ Commercial	$229.20
Rate for Payer: Health Net of AZ Medicare	$106.96
Rate for Payer: Humana of AZ Medicare	$57.30
Rate for Payer: Self Pay Self Pay	$305.60
Rate for Payer: TriWest Medicare	$57.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$222.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.76

XR Elbow 2 Views Left

Facility

$382.00

Service Code	CPT 73070 LT
Hospital Charge Code	823520
Hospital Revenue Code	320
Min. Negotiated Rate	$99.32
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Bisbee Police All Plans	$99.32
Rate for Payer: Cash Price	$305.60
Rate for Payer: Self Pay Self Pay	$305.60

XR Elbow 2 Views Right

Facility

$382.00

Service Code	CPT 73070 RT
Hospital Charge Code	823522
Hospital Revenue Code	320
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Aetna of AZ Medicare	$106.96
Rate for Payer: Allwell Medicare	$57.30
Rate for Payer: Amerigroup Medicare	$57.30
Rate for Payer: APIPA Medicare/Medicaid	$142.68
Rate for Payer: AZCH Complete Medicare	$57.30
Rate for Payer: Banner UC Health Medicare	$57.30
Rate for Payer: Bisbee Police All Plans	$99.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$259.76
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cigna of AZ Commercial	$248.30
Rate for Payer: Copperpoint Commercial	$94.54
Rate for Payer: Health Net of AZ Commercial	$229.20
Rate for Payer: Health Net of AZ Medicare	$106.96
Rate for Payer: Humana of AZ Medicare	$57.30
Rate for Payer: Self Pay Self Pay	$305.60
Rate for Payer: TriWest Medicare	$57.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$222.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.76

XR Elbow 2 Views Right

Facility

$382.00

Service Code	CPT 73070 RT
Hospital Charge Code	823522
Hospital Revenue Code	320
Min. Negotiated Rate	$99.32
Max. Negotiated Rate	$343.80
Rate for Payer: Aetna of AZ Commercial	$343.80
Rate for Payer: Bisbee Police All Plans	$99.32
Rate for Payer: Cash Price	$305.60
Rate for Payer: Self Pay Self Pay	$305.60

XR Elbow Complete Left

Facility

$584.00

Service Code	CPT 73080 LT
Hospital Charge Code	1007932
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: Allwell Medicare	$87.60
Rate for Payer: Amerigroup Medicare	$87.60
Rate for Payer: APIPA Medicare/Medicaid	$218.12
Rate for Payer: AZCH Complete Medicare	$87.60
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: 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: 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 Elbow Complete Left

Facility

$584.00

Service Code	CPT 73080 LT
Hospital Charge Code	1007932
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 Elbow Complete Right

Facility

$584.00

Service Code	CPT 73080 RT
Hospital Charge Code	1007934
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 Elbow Complete Right

Facility

$584.00

Service Code	CPT 73080 RT
Hospital Charge Code	1007934
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: Allwell Medicare	$87.60
Rate for Payer: Amerigroup Medicare	$87.60
Rate for Payer: APIPA Medicare/Medicaid	$218.12
Rate for Payer: AZCH Complete Medicare	$87.60
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: 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: 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 Facial Bones < 3 Views

Facility

$448.00

Service Code	CPT 70140
Hospital Charge Code	823524
Hospital Revenue Code	320
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$403.20
Rate for Payer: Aetna of AZ Commercial	$403.20
Rate for Payer: Aetna of AZ Medicare	$125.44
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$67.20
Rate for Payer: Amerigroup Medicare	$67.20
Rate for Payer: APIPA Medicare/Medicaid	$167.33
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$67.20
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$67.20
Rate for Payer: Bisbee Police All Plans	$116.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$304.64
Rate for Payer: Cash Price	$358.40
Rate for Payer: Cash Price	$358.40
Rate for Payer: Cigna of AZ Commercial	$291.20
Rate for Payer: Copperpoint Commercial	$110.88
Rate for Payer: Health Net of AZ Commercial	$268.80
Rate for Payer: Health Net of AZ Medicare	$125.44
Rate for Payer: Humana of AZ Medicare	$67.20
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$358.40
Rate for Payer: TriWest Medicare	$67.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$261.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$80.64

XR Facial Bones < 3 Views

Facility

$448.00

Service Code	CPT 70140
Hospital Charge Code	823524
Hospital Revenue Code	320
Min. Negotiated Rate	$116.48
Max. Negotiated Rate	$403.20
Rate for Payer: Aetna of AZ Commercial	$403.20
Rate for Payer: Bisbee Police All Plans	$116.48
Rate for Payer: Cash Price	$358.40
Rate for Payer: Self Pay Self Pay	$358.40

XR Facial Bones Minimum 3 Views

Facility

$895.00

Service Code	CPT 70150
Hospital Charge Code	823526
Hospital Revenue Code	320
Min. Negotiated Rate	$232.70
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Bisbee Police All Plans	$232.70
Rate for Payer: Cash Price	$716.00
Rate for Payer: Self Pay Self Pay	$716.00

XR Facial Bones Minimum 3 Views

Facility

$895.00

Service Code	CPT 70150
Hospital Charge Code	823526
Hospital Revenue Code	320
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Aetna of AZ Medicare	$250.60
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$134.25
Rate for Payer: Amerigroup Medicare	$134.25
Rate for Payer: APIPA Medicare/Medicaid	$334.28
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$134.25
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$134.25
Rate for Payer: Bisbee Police All Plans	$232.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$608.60
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cigna of AZ Commercial	$581.75
Rate for Payer: Copperpoint Commercial	$221.51
Rate for Payer: Health Net of AZ Commercial	$537.00
Rate for Payer: Health Net of AZ Medicare	$250.60
Rate for Payer: Humana of AZ Medicare	$134.25
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$716.00
Rate for Payer: TriWest Medicare	$134.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$521.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$161.10

XR Femur 1 View Left

Facility

$30.00

Service Code	CPT 73551 LT
Hospital Charge Code	22862300
Hospital Revenue Code	972
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

XR Femur 1 View Left

Facility

$468.00

Service Code	CPT 73551 LT
Hospital Charge Code	2160505
Hospital Revenue Code	320
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$421.20
Rate for Payer: Aetna of AZ Commercial	$421.20
Rate for Payer: Aetna of AZ Medicare	$131.04
Rate for Payer: Allwell Medicare	$70.20
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: APIPA Medicare/Medicaid	$174.80
Rate for Payer: AZCH Complete Medicare	$70.20
Rate for Payer: Banner UC Health Medicare	$70.20
Rate for Payer: Bisbee Police All Plans	$121.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$318.24
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cigna of AZ Commercial	$304.20
Rate for Payer: Copperpoint Commercial	$115.83
Rate for Payer: Health Net of AZ Commercial	$280.80
Rate for Payer: Health Net of AZ Medicare	$131.04
Rate for Payer: Humana of AZ Medicare	$70.20
Rate for Payer: Self Pay Self Pay	$374.40
Rate for Payer: TriWest Medicare	$70.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$272.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$84.24

XR Femur 1 View Left

Facility

$468.00

Service Code	CPT 73551 LT
Hospital Charge Code	2160505
Hospital Revenue Code	320
Min. Negotiated Rate	$121.68
Max. Negotiated Rate	$421.20
Rate for Payer: Aetna of AZ Commercial	$421.20
Rate for Payer: Bisbee Police All Plans	$121.68
Rate for Payer: Cash Price	$374.40
Rate for Payer: Self Pay Self Pay	$374.40

XR Femur 1 View Left

Facility

$30.00

Service Code	CPT 73551 LT
Hospital Charge Code	22862300
Hospital Revenue Code	972
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

XR Femur 1 View Right

Facility

$468.00

Service Code	CPT 73551 RT
Hospital Charge Code	2160508
Hospital Revenue Code	320
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$421.20
Rate for Payer: Aetna of AZ Commercial	$421.20
Rate for Payer: Aetna of AZ Medicare	$131.04
Rate for Payer: Allwell Medicare	$70.20
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: APIPA Medicare/Medicaid	$174.80
Rate for Payer: AZCH Complete Medicare	$70.20
Rate for Payer: Banner UC Health Medicare	$70.20
Rate for Payer: Bisbee Police All Plans	$121.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$318.24
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cigna of AZ Commercial	$304.20
Rate for Payer: Copperpoint Commercial	$115.83
Rate for Payer: Health Net of AZ Commercial	$280.80
Rate for Payer: Health Net of AZ Medicare	$131.04
Rate for Payer: Humana of AZ Medicare	$70.20
Rate for Payer: Self Pay Self Pay	$374.40
Rate for Payer: TriWest Medicare	$70.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$272.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$84.24

XR Femur 1 View Right

Facility

$468.00

Service Code	CPT 73551 RT
Hospital Charge Code	2160508
Hospital Revenue Code	320
Min. Negotiated Rate	$121.68
Max. Negotiated Rate	$421.20
Rate for Payer: Aetna of AZ Commercial	$421.20
Rate for Payer: Bisbee Police All Plans	$121.68
Rate for Payer: Cash Price	$374.40
Rate for Payer: Self Pay Self Pay	$374.40

XR Femur 2 Views Left

Facility

$405.00

Service Code	CPT 73552
Hospital Charge Code	2214248
Hospital Revenue Code	320
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of AZ Commercial	$364.50
Rate for Payer: Aetna of AZ Medicare	$113.40
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$60.75
Rate for Payer: Amerigroup Medicare	$60.75
Rate for Payer: APIPA Medicare/Medicaid	$151.27
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$60.75
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$60.75
Rate for Payer: Bisbee Police All Plans	$105.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$275.40
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cigna of AZ Commercial	$263.25
Rate for Payer: Copperpoint Commercial	$100.24
Rate for Payer: Health Net of AZ Commercial	$243.00
Rate for Payer: Health Net of AZ Medicare	$113.40
Rate for Payer: Humana of AZ Medicare	$60.75
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$324.00
Rate for Payer: TriWest Medicare	$60.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$236.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.90

XR Femur 2 Views Left

Facility

$405.00

Service Code	CPT 73552
Hospital Charge Code	2214248
Hospital Revenue Code	320
Min. Negotiated Rate	$105.30
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of AZ Commercial	$364.50
Rate for Payer: Bisbee Police All Plans	$105.30
Rate for Payer: Cash Price	$324.00
Rate for Payer: Self Pay Self Pay	$324.00

XR Femur 2 Views Right

Facility

$405.00

Service Code	CPT 73552
Hospital Charge Code	2214251
Hospital Revenue Code	320
Min. Negotiated Rate	$105.30
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of AZ Commercial	$364.50
Rate for Payer: Bisbee Police All Plans	$105.30
Rate for Payer: Cash Price	$324.00
Rate for Payer: Self Pay Self Pay	$324.00

XR Femur 2 Views Right

Facility

$405.00

Service Code	CPT 73552
Hospital Charge Code	2214251
Hospital Revenue Code	320
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of AZ Commercial	$364.50
Rate for Payer: Aetna of AZ Medicare	$113.40
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$60.75
Rate for Payer: Amerigroup Medicare	$60.75
Rate for Payer: APIPA Medicare/Medicaid	$151.27
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$60.75
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$60.75
Rate for Payer: Bisbee Police All Plans	$105.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$275.40
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cigna of AZ Commercial	$263.25
Rate for Payer: Copperpoint Commercial	$100.24
Rate for Payer: Health Net of AZ Commercial	$243.00
Rate for Payer: Health Net of AZ Medicare	$113.40
Rate for Payer: Humana of AZ Medicare	$60.75
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$324.00
Rate for Payer: TriWest Medicare	$60.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$236.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.90

XR Finger 2nd Digit Left

Facility

$488.00

Service Code	CPT 73140 F1
Hospital Charge Code	823532
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 Finger 2nd Digit Left

Facility

$488.00

Service Code	CPT 73140 F1
Hospital Charge Code	823532
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 Finger 2nd Digit Right

Facility

$488.00

Service Code	CPT 73140 F6
Hospital Charge Code	823534
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