Copper Queen Community Hospital

All Charges

Charge

Type

Price

XR Hips Bil w/ Pelvis 2 Views

Facility IP

$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

XR Humerus 1 View Left

Facility OP

$488.00

Service Code	CPT 73060 LT
Hospital Charge Code	22170716
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 Humerus 1 View Left

Facility IP

$488.00

Service Code	CPT 73060 LT
Hospital Charge Code	22170716
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 Humerus 1 View Right

Facility OP

$488.00

Service Code	CPT 73060 RT
Hospital Charge Code	22170719
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 Humerus 1 View Right

Facility IP

$488.00

Service Code	CPT 73060 RT
Hospital Charge Code	22170719
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 Humerus Left

Facility OP

$488.00

Service Code	CPT 73060
Hospital Charge Code	823588
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 Humerus Left

Facility IP

$488.00

Service Code	CPT 73060
Hospital Charge Code	823588
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 Humerus Right

Facility IP

$488.00

Service Code	CPT 73060
Hospital Charge Code	823590
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 Humerus Right

Facility OP

$488.00

Service Code	CPT 73060
Hospital Charge Code	823590
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 Internal Audio Meati Complete Left

Facility OP

$680.00

Service Code	CPT 70134 LT
Hospital Charge Code	22271685
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: Allwell Medicare	$102.00
Rate for Payer: Amerigroup Medicare	$102.00
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicare	$102.00
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: 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: 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 Internal Audio Meati Complete Left

Facility IP

$680.00

Service Code	CPT 70134 LT
Hospital Charge Code	22271685
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 Internal Audio Meati Complete Right

Facility IP

$680.00

Service Code	CPT 70134 RT
Hospital Charge Code	22271687
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 Internal Audio Meati Complete Right

Facility OP

$680.00

Service Code	CPT 70134 RT
Hospital Charge Code	22271687
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: Allwell Medicare	$102.00
Rate for Payer: Amerigroup Medicare	$102.00
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicare	$102.00
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: 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: 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 Knee Complete Left

Facility OP

$488.00

Service Code	CPT 73564 LT
Hospital Charge Code	1007996
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 Knee Complete Left

Facility IP

$488.00

Service Code	CPT 73564 LT
Hospital Charge Code	1007996
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 Knee Complete Right

Facility IP

$488.00

Service Code	CPT 73564 RT
Hospital Charge Code	1007998
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 Knee Complete Right

Facility OP

$488.00

Service Code	CPT 73564 RT
Hospital Charge Code	1007998
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 Knee One or Two Views Left

Facility OP

$565.00

Service Code	CPT 73560 LT
Hospital Charge Code	823596
Hospital Revenue Code	320
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna of AZ Commercial	$508.50
Rate for Payer: Aetna of AZ Medicare	$158.20
Rate for Payer: Allwell Medicare	$84.75
Rate for Payer: Amerigroup Medicare	$84.75
Rate for Payer: APIPA Medicare/Medicaid	$211.03
Rate for Payer: AZCH Complete Medicare	$84.75
Rate for Payer: Banner UC Health Medicare	$84.75
Rate for Payer: Bisbee Police All Plans	$146.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$384.20
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cigna of AZ Commercial	$367.25
Rate for Payer: Copperpoint Commercial	$139.84
Rate for Payer: Health Net of AZ Commercial	$339.00
Rate for Payer: Health Net of AZ Medicare	$158.20
Rate for Payer: Humana of AZ Medicare	$84.75
Rate for Payer: Self Pay Self Pay	$452.00
Rate for Payer: TriWest Medicare	$84.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$329.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$101.70

XR Knee One or Two Views Left

Facility IP

$565.00

Service Code	CPT 73560 LT
Hospital Charge Code	823596
Hospital Revenue Code	320
Min. Negotiated Rate	$146.90
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna of AZ Commercial	$508.50
Rate for Payer: Bisbee Police All Plans	$146.90
Rate for Payer: Cash Price	$452.00
Rate for Payer: Self Pay Self Pay	$452.00

XR Knee One or Two Views Right

Facility OP

$565.00

Service Code	CPT 73560 RT
Hospital Charge Code	823598
Hospital Revenue Code	320
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna of AZ Commercial	$508.50
Rate for Payer: Aetna of AZ Medicare	$158.20
Rate for Payer: Allwell Medicare	$84.75
Rate for Payer: Amerigroup Medicare	$84.75
Rate for Payer: APIPA Medicare/Medicaid	$211.03
Rate for Payer: AZCH Complete Medicare	$84.75
Rate for Payer: Banner UC Health Medicare	$84.75
Rate for Payer: Bisbee Police All Plans	$146.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$384.20
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cigna of AZ Commercial	$367.25
Rate for Payer: Copperpoint Commercial	$139.84
Rate for Payer: Health Net of AZ Commercial	$339.00
Rate for Payer: Health Net of AZ Medicare	$158.20
Rate for Payer: Humana of AZ Medicare	$84.75
Rate for Payer: Self Pay Self Pay	$452.00
Rate for Payer: TriWest Medicare	$84.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$329.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$101.70

XR Knee One or Two Views Right

Facility IP

$565.00

Service Code	CPT 73560 RT
Hospital Charge Code	823598
Hospital Revenue Code	320
Min. Negotiated Rate	$146.90
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna of AZ Commercial	$508.50
Rate for Payer: Bisbee Police All Plans	$146.90
Rate for Payer: Cash Price	$452.00
Rate for Payer: Self Pay Self Pay	$452.00

XR Knee Standing AP Bilateral

Facility IP

$439.00

Service Code	CPT 73565 50
Hospital Charge Code	1008002
Hospital Revenue Code	320
Min. Negotiated Rate	$114.14
Max. Negotiated Rate	$395.10
Rate for Payer: Aetna of AZ Commercial	$395.10
Rate for Payer: Bisbee Police All Plans	$114.14
Rate for Payer: Cash Price	$351.20
Rate for Payer: Self Pay Self Pay	$351.20

XR Knee Standing AP Bilateral

Facility OP

$439.00

Service Code	CPT 73565 50
Hospital Charge Code	1008002
Hospital Revenue Code	320
Min. Negotiated Rate	$65.85
Max. Negotiated Rate	$395.10
Rate for Payer: Aetna of AZ Commercial	$395.10
Rate for Payer: Aetna of AZ Medicare	$122.92
Rate for Payer: Allwell Medicare	$65.85
Rate for Payer: Amerigroup Medicare	$65.85
Rate for Payer: APIPA Medicare/Medicaid	$163.97
Rate for Payer: AZCH Complete Medicare	$65.85
Rate for Payer: Banner UC Health Medicare	$65.85
Rate for Payer: Bisbee Police All Plans	$114.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$298.52
Rate for Payer: Cash Price	$351.20
Rate for Payer: Cigna of AZ Commercial	$285.35
Rate for Payer: Copperpoint Commercial	$108.65
Rate for Payer: Health Net of AZ Commercial	$263.40
Rate for Payer: Health Net of AZ Medicare	$122.92
Rate for Payer: Humana of AZ Medicare	$65.85
Rate for Payer: Self Pay Self Pay	$351.20
Rate for Payer: TriWest Medicare	$65.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$255.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$79.02

XR Mandible Complete Minimum 4 Views

Facility OP

$972.00

Service Code	CPT 70110
Hospital Charge Code	823600
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 Mandible Complete Minimum 4 Views

Facility IP

$972.00

Service Code	CPT 70110
Hospital Charge Code	823600
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

Know your out-of-pocket cost for care.

All Charges