Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XCEL 11MM TROCAR ENDOPATH

Facility

$256.00

Hospital Charge Code	23152395
Hospital Revenue Code	270
Min. Negotiated Rate	$40.96
Max. Negotiated Rate	$230.40
Rate for Payer: Aetna of AZ Commercial	$230.40
Rate for Payer: Aetna of AZ Medicare	$71.68
Rate for Payer: Allwell Medicare	$40.96
Rate for Payer: Amerigroup Medicare	$40.96
Rate for Payer: APIPA Medicare/Medicaid	$95.62
Rate for Payer: AZCH Complete Medicare	$40.96
Rate for Payer: Banner UC Health Medicare	$40.96
Rate for Payer: Bisbee Police All Plans	$66.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$174.08
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cigna of AZ Commercial	$179.20
Rate for Payer: Copperpoint Commercial	$63.36
Rate for Payer: Health Net of AZ Commercial	$153.60
Rate for Payer: Health Net of AZ Medicare	$71.68
Rate for Payer: Humana of AZ Medicare	$40.96
Rate for Payer: Self Pay Self Pay	$204.80
Rate for Payer: TriWest Medicare	$40.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$149.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.08

XCEL 11MM TROCAR ENDOPATH

Facility

$256.00

Hospital Charge Code	23152395
Hospital Revenue Code	270
Min. Negotiated Rate	$66.56
Max. Negotiated Rate	$230.40
Rate for Payer: Aetna of AZ Commercial	$230.40
Rate for Payer: Bisbee Police All Plans	$66.56
Rate for Payer: Cash Price	$204.80
Rate for Payer: Self Pay Self Pay	$204.80

XCEL 5MM TROCAR ENDOPATH

Facility

$200.00

Hospital Charge Code	23152394
Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Bisbee Police All Plans	$52.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Self Pay Self Pay	$160.00

XCEL 5MM TROCAR ENDOPATH

Facility

$200.00

Hospital Charge Code	23152394
Hospital Revenue Code	272
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Aetna of AZ Medicare	$56.00
Rate for Payer: Allwell Medicare	$32.00
Rate for Payer: Amerigroup Medicare	$32.00
Rate for Payer: APIPA Medicare/Medicaid	$74.70
Rate for Payer: AZCH Complete Medicare	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Bisbee Police All Plans	$52.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$136.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$140.00
Rate for Payer: Copperpoint Commercial	$49.50
Rate for Payer: Health Net of AZ Commercial	$120.00
Rate for Payer: Health Net of AZ Medicare	$56.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Self Pay Self Pay	$160.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$116.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.00

XFORCE U30 BALLOON CATHETER 6FRX10CM

Facility

$1,893.00

Hospital Charge Code	27770320
Hospital Revenue Code	270
Min. Negotiated Rate	$302.88
Max. Negotiated Rate	$1,703.70
Rate for Payer: Aetna of AZ Commercial	$1,703.70
Rate for Payer: Aetna of AZ Medicare	$530.04
Rate for Payer: Allwell Medicare	$302.88
Rate for Payer: Amerigroup Medicare	$302.88
Rate for Payer: APIPA Medicare/Medicaid	$707.04
Rate for Payer: AZCH Complete Medicare	$302.88
Rate for Payer: Banner UC Health Medicare	$302.88
Rate for Payer: Bisbee Police All Plans	$492.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,287.24
Rate for Payer: Cash Price	$1,514.40
Rate for Payer: Cigna of AZ Commercial	$1,325.10
Rate for Payer: Copperpoint Commercial	$468.52
Rate for Payer: Health Net of AZ Commercial	$1,135.80
Rate for Payer: Health Net of AZ Medicare	$530.04
Rate for Payer: Humana of AZ Medicare	$302.88
Rate for Payer: Self Pay Self Pay	$1,514.40
Rate for Payer: TriWest Medicare	$302.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,103.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$340.74

XFORCE U30 BALLOON CATHETER 6FRX10CM

Facility

$1,893.00

Hospital Charge Code	27770320
Hospital Revenue Code	270
Min. Negotiated Rate	$492.18
Max. Negotiated Rate	$1,703.70
Rate for Payer: Aetna of AZ Commercial	$1,703.70
Rate for Payer: Bisbee Police All Plans	$492.18
Rate for Payer: Cash Price	$1,514.40
Rate for Payer: Self Pay Self Pay	$1,514.40

XFORCE U30 BALLOON CATHETER 6FRX4CM

Facility

$1,893.00

Hospital Charge Code	27778599
Hospital Revenue Code	270
Min. Negotiated Rate	$492.18
Max. Negotiated Rate	$1,703.70
Rate for Payer: Aetna of AZ Commercial	$1,703.70
Rate for Payer: Bisbee Police All Plans	$492.18
Rate for Payer: Cash Price	$1,514.40
Rate for Payer: Self Pay Self Pay	$1,514.40

XFORCE U30 BALLOON CATHETER 6FRX4CM

Facility

$1,893.00

Hospital Charge Code	27778599
Hospital Revenue Code	270
Min. Negotiated Rate	$302.88
Max. Negotiated Rate	$1,703.70
Rate for Payer: Aetna of AZ Commercial	$1,703.70
Rate for Payer: Aetna of AZ Medicare	$530.04
Rate for Payer: Allwell Medicare	$302.88
Rate for Payer: Amerigroup Medicare	$302.88
Rate for Payer: APIPA Medicare/Medicaid	$707.04
Rate for Payer: AZCH Complete Medicare	$302.88
Rate for Payer: Banner UC Health Medicare	$302.88
Rate for Payer: Bisbee Police All Plans	$492.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,287.24
Rate for Payer: Cash Price	$1,514.40
Rate for Payer: Cigna of AZ Commercial	$1,325.10
Rate for Payer: Copperpoint Commercial	$468.52
Rate for Payer: Health Net of AZ Commercial	$1,135.80
Rate for Payer: Health Net of AZ Medicare	$530.04
Rate for Payer: Humana of AZ Medicare	$302.88
Rate for Payer: Self Pay Self Pay	$1,514.40
Rate for Payer: TriWest Medicare	$302.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,103.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$340.74

XPEEDA DSL DUAL WAVELENGHT FIBER

Facility

$8,242.95

Hospital Charge Code	27844712
Hospital Revenue Code	270
Min. Negotiated Rate	$1,318.87
Max. Negotiated Rate	$7,418.65
Rate for Payer: Aetna of AZ Commercial	$7,418.65
Rate for Payer: Aetna of AZ Medicare	$2,308.03
Rate for Payer: Allwell Medicare	$1,318.87
Rate for Payer: Amerigroup Medicare	$1,318.87
Rate for Payer: APIPA Medicare/Medicaid	$3,078.74
Rate for Payer: AZCH Complete Medicare	$1,318.87
Rate for Payer: Banner UC Health Medicare	$1,318.87
Rate for Payer: Bisbee Police All Plans	$2,143.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5,605.21
Rate for Payer: Cash Price	$6,594.36
Rate for Payer: Cigna of AZ Commercial	$5,770.06
Rate for Payer: Copperpoint Commercial	$2,040.13
Rate for Payer: Health Net of AZ Commercial	$4,945.77
Rate for Payer: Health Net of AZ Medicare	$2,308.03
Rate for Payer: Humana of AZ Medicare	$1,318.87
Rate for Payer: Self Pay Self Pay	$6,594.36
Rate for Payer: TriWest Medicare	$1,318.87
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,805.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,483.73

XPEEDA DSL DUAL WAVELENGHT FIBER

Facility

$8,242.95

Hospital Charge Code	27844712
Hospital Revenue Code	270
Min. Negotiated Rate	$2,143.17
Max. Negotiated Rate	$7,418.65
Rate for Payer: Aetna of AZ Commercial	$7,418.65
Rate for Payer: Bisbee Police All Plans	$2,143.17
Rate for Payer: Cash Price	$6,594.36
Rate for Payer: Self Pay Self Pay	$6,594.36

XR Abdomen 1 View

Facility

$353.00

Service Code	CPT 74018
Hospital Charge Code	823483
Hospital Revenue Code	320
Min. Negotiated Rate	$91.78
Max. Negotiated Rate	$317.70
Rate for Payer: Aetna of AZ Commercial	$317.70
Rate for Payer: Bisbee Police All Plans	$91.78
Rate for Payer: Cash Price	$282.40
Rate for Payer: Self Pay Self Pay	$282.40

XR Abdomen 1 View

Facility

$353.00

Service Code	CPT 74018
Hospital Charge Code	823483
Hospital Revenue Code	320
Min. Negotiated Rate	$56.48
Max. Negotiated Rate	$317.70
Rate for Payer: Aetna of AZ Commercial	$317.70
Rate for Payer: Aetna of AZ Medicare	$98.84
Rate for Payer: Allwell Medicare	$56.48
Rate for Payer: Amerigroup Medicare	$56.48
Rate for Payer: APIPA Medicare/Medicaid	$131.85
Rate for Payer: AZCH Complete Medicare	$56.48
Rate for Payer: Banner UC Health Medicare	$56.48
Rate for Payer: Bisbee Police All Plans	$91.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$240.04
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cigna of AZ Commercial	$229.45
Rate for Payer: Copperpoint Commercial	$87.37
Rate for Payer: Health Net of AZ Commercial	$211.80
Rate for Payer: Health Net of AZ Medicare	$98.84
Rate for Payer: Humana of AZ Medicare	$56.48
Rate for Payer: Self Pay Self Pay	$282.40
Rate for Payer: TriWest Medicare	$56.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$205.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$63.54

XR Abdomen 1 View w/Decub

Facility

$445.00

Service Code	CPT 74018
Hospital Charge Code	11849879
Hospital Revenue Code	320
Min. Negotiated Rate	$115.70
Max. Negotiated Rate	$400.50
Rate for Payer: Aetna of AZ Commercial	$400.50
Rate for Payer: Bisbee Police All Plans	$115.70
Rate for Payer: Cash Price	$356.00
Rate for Payer: Self Pay Self Pay	$356.00

XR Abdomen 1 View w/Decub

Facility

$445.00

Service Code	CPT 74018
Hospital Charge Code	11849879
Hospital Revenue Code	320
Min. Negotiated Rate	$71.20
Max. Negotiated Rate	$400.50
Rate for Payer: Aetna of AZ Commercial	$400.50
Rate for Payer: Aetna of AZ Medicare	$124.60
Rate for Payer: Allwell Medicare	$71.20
Rate for Payer: Amerigroup Medicare	$71.20
Rate for Payer: APIPA Medicare/Medicaid	$166.21
Rate for Payer: AZCH Complete Medicare	$71.20
Rate for Payer: Banner UC Health Medicare	$71.20
Rate for Payer: Bisbee Police All Plans	$115.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$302.60
Rate for Payer: Cash Price	$356.00
Rate for Payer: Cigna of AZ Commercial	$289.25
Rate for Payer: Copperpoint Commercial	$110.14
Rate for Payer: Health Net of AZ Commercial	$267.00
Rate for Payer: Health Net of AZ Medicare	$124.60
Rate for Payer: Humana of AZ Medicare	$71.20
Rate for Payer: Self Pay Self Pay	$356.00
Rate for Payer: TriWest Medicare	$71.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$259.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$80.10

XR Abdomen 2 Views

Facility

$405.00

Service Code	CPT 74019
Hospital Charge Code	823486
Hospital Revenue Code	320
Min. Negotiated Rate	$64.80
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: Allwell Medicare	$64.80
Rate for Payer: Amerigroup Medicare	$64.80
Rate for Payer: APIPA Medicare/Medicaid	$151.27
Rate for Payer: AZCH Complete Medicare	$64.80
Rate for Payer: Banner UC Health Medicare	$64.80
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: 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	$64.80
Rate for Payer: Self Pay Self Pay	$324.00
Rate for Payer: TriWest Medicare	$64.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$236.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.90

XR Abdomen 2 Views

Facility

$405.00

Service Code	CPT 74019
Hospital Charge Code	823486
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 Abdomen Acute 3 Views/Chest 1 View

Facility

$923.00

Service Code	CPT 74022
Hospital Charge Code	2214245
Hospital Revenue Code	320
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna of AZ Commercial	$830.70
Rate for Payer: Bisbee Police All Plans	$239.98
Rate for Payer: Cash Price	$738.40
Rate for Payer: Self Pay Self Pay	$738.40

XR Abdomen Acute 3 Views/Chest 1 View

Facility

$923.00

Service Code	CPT 74022
Hospital Charge Code	2214245
Hospital Revenue Code	320
Min. Negotiated Rate	$147.68
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna of AZ Commercial	$830.70
Rate for Payer: Aetna of AZ Medicare	$258.44
Rate for Payer: Allwell Medicare	$147.68
Rate for Payer: Amerigroup Medicare	$147.68
Rate for Payer: APIPA Medicare/Medicaid	$344.74
Rate for Payer: AZCH Complete Medicare	$147.68
Rate for Payer: Banner UC Health Medicare	$147.68
Rate for Payer: Bisbee Police All Plans	$239.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$627.64
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cigna of AZ Commercial	$599.95
Rate for Payer: Copperpoint Commercial	$228.44
Rate for Payer: Health Net of AZ Commercial	$553.80
Rate for Payer: Health Net of AZ Medicare	$258.44
Rate for Payer: Humana of AZ Medicare	$147.68
Rate for Payer: Self Pay Self Pay	$738.40
Rate for Payer: TriWest Medicare	$147.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$538.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$166.14

XR AC Joints Bilateral

Facility

$464.00

Service Code	CPT 73050 50
Hospital Charge Code	1163782
Hospital Revenue Code	320
Min. Negotiated Rate	$74.24
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Aetna of AZ Medicare	$129.92
Rate for Payer: Allwell Medicare	$74.24
Rate for Payer: Amerigroup Medicare	$74.24
Rate for Payer: APIPA Medicare/Medicaid	$173.30
Rate for Payer: AZCH Complete Medicare	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Bisbee Police All Plans	$120.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$315.52
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Copperpoint Commercial	$114.84
Rate for Payer: Health Net of AZ Commercial	$278.40
Rate for Payer: Health Net of AZ Medicare	$129.92
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Self Pay Self Pay	$371.20
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$270.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$83.52

XR AC Joints Bilateral

Facility

$464.00

Service Code	CPT 73050 50
Hospital Charge Code	1163782
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Bisbee Police All Plans	$120.64
Rate for Payer: Cash Price	$371.20
Rate for Payer: Self Pay Self Pay	$371.20

XR Ankle 2 Views Left

Facility

$464.00

Service Code	CPT 73600 LT
Hospital Charge Code	1007853
Hospital Revenue Code	320
Min. Negotiated Rate	$74.24
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Aetna of AZ Medicare	$129.92
Rate for Payer: Allwell Medicare	$74.24
Rate for Payer: Amerigroup Medicare	$74.24
Rate for Payer: APIPA Medicare/Medicaid	$173.30
Rate for Payer: AZCH Complete Medicare	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Bisbee Police All Plans	$120.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$315.52
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Copperpoint Commercial	$114.84
Rate for Payer: Health Net of AZ Commercial	$278.40
Rate for Payer: Health Net of AZ Medicare	$129.92
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Self Pay Self Pay	$371.20
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$270.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$83.52

XR Ankle 2 Views Left

Facility

$464.00

Service Code	CPT 73600 LT
Hospital Charge Code	1007853
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Bisbee Police All Plans	$120.64
Rate for Payer: Cash Price	$371.20
Rate for Payer: Self Pay Self Pay	$371.20

XR Ankle 2 Views Right

Facility

$464.00

Service Code	CPT 73600 RT
Hospital Charge Code	1007855
Hospital Revenue Code	320
Min. Negotiated Rate	$74.24
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Aetna of AZ Medicare	$129.92
Rate for Payer: Allwell Medicare	$74.24
Rate for Payer: Amerigroup Medicare	$74.24
Rate for Payer: APIPA Medicare/Medicaid	$173.30
Rate for Payer: AZCH Complete Medicare	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Bisbee Police All Plans	$120.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$315.52
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Copperpoint Commercial	$114.84
Rate for Payer: Health Net of AZ Commercial	$278.40
Rate for Payer: Health Net of AZ Medicare	$129.92
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Self Pay Self Pay	$371.20
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$270.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$83.52

XR Ankle 2 Views Right

Facility

$464.00

Service Code	CPT 73600 RT
Hospital Charge Code	1007855
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Bisbee Police All Plans	$120.64
Rate for Payer: Cash Price	$371.20
Rate for Payer: Self Pay Self Pay	$371.20

XR Ankle Complete Left

Facility

$462.00

Service Code	CPT 73610 LT
Hospital Charge Code	823492
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$415.80
Rate for Payer: Aetna of AZ Commercial	$415.80
Rate for Payer: Aetna of AZ Medicare	$129.36
Rate for Payer: Allwell Medicare	$73.92
Rate for Payer: Amerigroup Medicare	$73.92
Rate for Payer: APIPA Medicare/Medicaid	$172.56
Rate for Payer: AZCH Complete Medicare	$73.92
Rate for Payer: Banner UC Health Medicare	$73.92
Rate for Payer: Bisbee Police All Plans	$120.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$314.16
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cigna of AZ Commercial	$300.30
Rate for Payer: Copperpoint Commercial	$114.34
Rate for Payer: Health Net of AZ Commercial	$277.20
Rate for Payer: Health Net of AZ Medicare	$129.36
Rate for Payer: Humana of AZ Medicare	$73.92
Rate for Payer: Self Pay Self Pay	$369.60
Rate for Payer: TriWest Medicare	$73.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$269.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$83.16

Know your out-of-pocket cost for care.

All Charges