Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Foot Complete Left

Facility

$488.00

Service Code	CPT 73630 LT
Hospital Charge Code	823558
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 Foot Complete Left

Facility

$488.00

Service Code	CPT 73630 LT
Hospital Charge Code	823558
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 Foot Complete Right

Facility

$488.00

Service Code	CPT 73630 RT
Hospital Charge Code	823560
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 Foot Complete Right

Facility

$488.00

Service Code	CPT 73630 RT
Hospital Charge Code	823560
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 Forearm 2 Views Left

Facility

$488.00

Service Code	CPT 73090 LT
Hospital Charge Code	823562
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 Forearm 2 Views Left

Facility

$488.00

Service Code	CPT 73090 LT
Hospital Charge Code	823562
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 Forearm 2 Views Right

Facility

$488.00

Service Code	CPT 73090 RT
Hospital Charge Code	823564
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 Forearm 2 Views Right

Facility

$488.00

Service Code	CPT 73090 RT
Hospital Charge Code	823564
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 Hand 2 Views Left

Facility

$488.00

Service Code	CPT 73120 LT
Hospital Charge Code	823568
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 Hand 2 Views Left

Facility

$488.00

Service Code	CPT 73120 LT
Hospital Charge Code	823568
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 Hand 2 Views Right

Facility

$488.00

Service Code	CPT 73120 RT
Hospital Charge Code	823570
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 Hand 2 Views Right

Facility

$488.00

Service Code	CPT 73120 RT
Hospital Charge Code	823570
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 Hand Complete Left

Facility

$488.00

Service Code	CPT 73130 LT
Hospital Charge Code	823572
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 Hand Complete Left

Facility

$488.00

Service Code	CPT 73130 LT
Hospital Charge Code	823572
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 Hand Complete Right

Facility

$488.00

Service Code	CPT 73130 RT
Hospital Charge Code	823574
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 Hand Complete Right

Facility

$488.00

Service Code	CPT 73130 RT
Hospital Charge Code	823574
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 Hip 1 View Lt w/ Pelvis

Facility

$387.00

Service Code	CPT 73501 LT
Hospital Charge Code	22200615
Hospital Revenue Code	320
Min. Negotiated Rate	$100.62
Max. Negotiated Rate	$348.30
Rate for Payer: Aetna of AZ Commercial	$348.30
Rate for Payer: Bisbee Police All Plans	$100.62
Rate for Payer: Cash Price	$309.60
Rate for Payer: Self Pay Self Pay	$309.60

XR Hip 1 View Lt w/ Pelvis

Facility

$387.00

Service Code	CPT 73501 LT
Hospital Charge Code	22200615
Hospital Revenue Code	320
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$348.30
Rate for Payer: Aetna of AZ Commercial	$348.30
Rate for Payer: Aetna of AZ Medicare	$108.36
Rate for Payer: Allwell Medicare	$58.05
Rate for Payer: Amerigroup Medicare	$58.05
Rate for Payer: APIPA Medicare/Medicaid	$144.54
Rate for Payer: AZCH Complete Medicare	$58.05
Rate for Payer: Banner UC Health Medicare	$58.05
Rate for Payer: Bisbee Police All Plans	$100.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$263.16
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cigna of AZ Commercial	$251.55
Rate for Payer: Copperpoint Commercial	$95.78
Rate for Payer: Health Net of AZ Commercial	$232.20
Rate for Payer: Health Net of AZ Medicare	$108.36
Rate for Payer: Humana of AZ Medicare	$58.05
Rate for Payer: Self Pay Self Pay	$309.60
Rate for Payer: TriWest Medicare	$58.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$225.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$69.66

XR Hip 1 View Rt w/ Pelvis

Facility

$387.00

Service Code	CPT 73501 RT
Hospital Charge Code	22200618
Hospital Revenue Code	320
Min. Negotiated Rate	$100.62
Max. Negotiated Rate	$348.30
Rate for Payer: Aetna of AZ Commercial	$348.30
Rate for Payer: Bisbee Police All Plans	$100.62
Rate for Payer: Cash Price	$309.60
Rate for Payer: Self Pay Self Pay	$309.60

XR Hip 1 View Rt w/ Pelvis

Facility

$387.00

Service Code	CPT 73501 RT
Hospital Charge Code	22200618
Hospital Revenue Code	320
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$348.30
Rate for Payer: Aetna of AZ Commercial	$348.30
Rate for Payer: Aetna of AZ Medicare	$108.36
Rate for Payer: Allwell Medicare	$58.05
Rate for Payer: Amerigroup Medicare	$58.05
Rate for Payer: APIPA Medicare/Medicaid	$144.54
Rate for Payer: AZCH Complete Medicare	$58.05
Rate for Payer: Banner UC Health Medicare	$58.05
Rate for Payer: Bisbee Police All Plans	$100.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$263.16
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cigna of AZ Commercial	$251.55
Rate for Payer: Copperpoint Commercial	$95.78
Rate for Payer: Health Net of AZ Commercial	$232.20
Rate for Payer: Health Net of AZ Medicare	$108.36
Rate for Payer: Humana of AZ Medicare	$58.05
Rate for Payer: Self Pay Self Pay	$309.60
Rate for Payer: TriWest Medicare	$58.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$225.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$69.66

XR Hip 2-3 Views Lt w/ Pelvis

Facility

$482.00

Service Code	CPT 73502 LT
Hospital Charge Code	22200621
Hospital Revenue Code	320
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Cash Price	$385.60
Rate for Payer: Self Pay Self Pay	$385.60

XR Hip 2-3 Views Lt w/ Pelvis

Facility

$482.00

Service Code	CPT 73502 LT
Hospital Charge Code	22200621
Hospital Revenue Code	320
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Aetna of AZ Medicare	$134.96
Rate for Payer: Allwell Medicare	$72.30
Rate for Payer: Amerigroup Medicare	$72.30
Rate for Payer: APIPA Medicare/Medicaid	$180.03
Rate for Payer: AZCH Complete Medicare	$72.30
Rate for Payer: Banner UC Health Medicare	$72.30
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$327.76
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$313.30
Rate for Payer: Copperpoint Commercial	$119.30
Rate for Payer: Health Net of AZ Commercial	$289.20
Rate for Payer: Health Net of AZ Medicare	$134.96
Rate for Payer: Humana of AZ Medicare	$72.30
Rate for Payer: Self Pay Self Pay	$385.60
Rate for Payer: TriWest Medicare	$72.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.76

XR Hip 2-3 Views Rt w/ Pelvis

Facility

$482.00

Service Code	CPT 73502 RT
Hospital Charge Code	22200624
Hospital Revenue Code	320
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Aetna of AZ Medicare	$134.96
Rate for Payer: Allwell Medicare	$72.30
Rate for Payer: Amerigroup Medicare	$72.30
Rate for Payer: APIPA Medicare/Medicaid	$180.03
Rate for Payer: AZCH Complete Medicare	$72.30
Rate for Payer: Banner UC Health Medicare	$72.30
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$327.76
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$313.30
Rate for Payer: Copperpoint Commercial	$119.30
Rate for Payer: Health Net of AZ Commercial	$289.20
Rate for Payer: Health Net of AZ Medicare	$134.96
Rate for Payer: Humana of AZ Medicare	$72.30
Rate for Payer: Self Pay Self Pay	$385.60
Rate for Payer: TriWest Medicare	$72.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.76

XR Hip 2-3 Views Rt w/ Pelvis

Facility

$482.00

Service Code	CPT 73502 RT
Hospital Charge Code	22200624
Hospital Revenue Code	320
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Cash Price	$385.60
Rate for Payer: Self Pay Self Pay	$385.60

XR Hips Bil w/ Pelvis 2 Views

Facility

$488.00

Service Code	CPT 73521
Hospital Charge Code	22200633
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