Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Ankle Complete Left

Facility

$462.00

Service Code	CPT 73610 LT
Hospital Charge Code	823492
Hospital Revenue Code	320
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$415.80
Rate for Payer: Aetna of AZ Commercial	$415.80
Rate for Payer: Bisbee Police All Plans	$120.12
Rate for Payer: Cash Price	$369.60
Rate for Payer: Self Pay Self Pay	$369.60

XR Ankle Complete Right

Facility

$460.00

Service Code	CPT 73610 RT
Hospital Charge Code	823494
Hospital Revenue Code	320
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna of AZ Commercial	$414.00
Rate for Payer: Aetna of AZ Medicare	$128.80
Rate for Payer: Allwell Medicare	$73.60
Rate for Payer: Amerigroup Medicare	$73.60
Rate for Payer: APIPA Medicare/Medicaid	$171.81
Rate for Payer: AZCH Complete Medicare	$73.60
Rate for Payer: Banner UC Health Medicare	$73.60
Rate for Payer: Bisbee Police All Plans	$119.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$312.80
Rate for Payer: Cash Price	$368.00
Rate for Payer: Cigna of AZ Commercial	$299.00
Rate for Payer: Copperpoint Commercial	$113.85
Rate for Payer: Health Net of AZ Commercial	$276.00
Rate for Payer: Health Net of AZ Medicare	$128.80
Rate for Payer: Humana of AZ Medicare	$73.60
Rate for Payer: Self Pay Self Pay	$368.00
Rate for Payer: TriWest Medicare	$73.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$268.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$82.80

XR Ankle Complete Right

Facility

$460.00

Service Code	CPT 73610 RT
Hospital Charge Code	823494
Hospital Revenue Code	320
Min. Negotiated Rate	$119.60
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna of AZ Commercial	$414.00
Rate for Payer: Bisbee Police All Plans	$119.60
Rate for Payer: Cash Price	$368.00
Rate for Payer: Self Pay Self Pay	$368.00

XR Bone Age Studies

Facility

$555.00

Service Code	CPT 77072
Hospital Charge Code	1007877
Hospital Revenue Code	320
Min. Negotiated Rate	$144.30
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Bisbee Police All Plans	$144.30
Rate for Payer: Cash Price	$444.00
Rate for Payer: Self Pay Self Pay	$444.00

XR Bone Age Studies

Facility

$555.00

Service Code	CPT 77072
Hospital Charge Code	1007877
Hospital Revenue Code	320
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Aetna of AZ Medicare	$155.40
Rate for Payer: Allwell Medicare	$88.80
Rate for Payer: Amerigroup Medicare	$88.80
Rate for Payer: APIPA Medicare/Medicaid	$207.29
Rate for Payer: AZCH Complete Medicare	$88.80
Rate for Payer: Banner UC Health Medicare	$88.80
Rate for Payer: Bisbee Police All Plans	$144.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$377.40
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cigna of AZ Commercial	$360.75
Rate for Payer: Copperpoint Commercial	$137.36
Rate for Payer: Health Net of AZ Commercial	$333.00
Rate for Payer: Health Net of AZ Medicare	$155.40
Rate for Payer: Humana of AZ Medicare	$88.80
Rate for Payer: Self Pay Self Pay	$444.00
Rate for Payer: TriWest Medicare	$88.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$323.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.90

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 Length Studies/Ort

Facility

$680.00

Service Code	CPT 77073
Hospital Charge Code	1007881
Hospital Revenue Code	320
Min. Negotiated Rate	$108.80
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	$108.80
Rate for Payer: Amerigroup Medicare	$108.80
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicare	$108.80
Rate for Payer: Banner UC Health Medicare	$108.80
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	$108.80
Rate for Payer: Self Pay Self Pay	$544.00
Rate for Payer: TriWest Medicare	$108.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$396.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.40

XR Bone Survey Complete

Facility

$1,474.00

Service Code	CPT 77075
Hospital Charge Code	1319957
Hospital Revenue Code	320
Min. Negotiated Rate	$235.84
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Aetna of AZ Medicare	$412.72
Rate for Payer: Allwell Medicare	$235.84
Rate for Payer: Amerigroup Medicare	$235.84
Rate for Payer: APIPA Medicare/Medicaid	$550.54
Rate for Payer: AZCH Complete Medicare	$235.84
Rate for Payer: Banner UC Health Medicare	$235.84
Rate for Payer: Bisbee Police All Plans	$383.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,002.32
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cigna of AZ Commercial	$958.10
Rate for Payer: Copperpoint Commercial	$364.81
Rate for Payer: Health Net of AZ Commercial	$884.40
Rate for Payer: Health Net of AZ Medicare	$412.72
Rate for Payer: Humana of AZ Medicare	$235.84
Rate for Payer: Self Pay Self Pay	$1,179.20
Rate for Payer: TriWest Medicare	$235.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$859.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$265.32

XR Bone Survey Complete

Facility

$1,474.00

Service Code	CPT 77075
Hospital Charge Code	1319957
Hospital Revenue Code	320
Min. Negotiated Rate	$383.24
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Bisbee Police All Plans	$383.24
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Self Pay Self Pay	$1,179.20

XR Bone Survey Limited

Facility

$876.00

Service Code	CPT 77074
Hospital Charge Code	1319960
Hospital Revenue Code	320
Min. Negotiated Rate	$140.16
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: Allwell Medicare	$140.16
Rate for Payer: Amerigroup Medicare	$140.16
Rate for Payer: APIPA Medicare/Medicaid	$327.19
Rate for Payer: AZCH Complete Medicare	$140.16
Rate for Payer: Banner UC Health Medicare	$140.16
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: 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	$140.16
Rate for Payer: Self Pay Self Pay	$700.80
Rate for Payer: TriWest Medicare	$140.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$510.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$157.68

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 Calcaneous Left

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823496
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 Calcaneous Left

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823496
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 Calcaneous Right

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823498
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 Calcaneous Right

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823498
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 Calcaneus Left

Facility

$488.00

Service Code	CPT 73650 LT
Hospital Charge Code	22147265
Hospital Revenue Code	320
Min. Negotiated Rate	$78.08
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	$78.08
Rate for Payer: Amerigroup Medicare	$78.08
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$78.08
Rate for Payer: Banner UC Health Medicare	$78.08
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	$78.08
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$78.08
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

XR Calcaneus Right

Facility

$488.00

Service Code	CPT 73650 RT
Hospital Charge Code	22147268
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 Calcaneus Right

Facility

$488.00

Service Code	CPT 73650 RT
Hospital Charge Code	22147268
Hospital Revenue Code	320
Min. Negotiated Rate	$78.08
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	$78.08
Rate for Payer: Amerigroup Medicare	$78.08
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$78.08
Rate for Payer: Banner UC Health Medicare	$78.08
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	$78.08
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$78.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Chest 1 View

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	823510
Hospital Revenue Code	324
Min. Negotiated Rate	$53.44
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Aetna of AZ Medicare	$93.52
Rate for Payer: Allwell Medicare	$53.44
Rate for Payer: Amerigroup Medicare	$53.44
Rate for Payer: APIPA Medicare/Medicaid	$124.75
Rate for Payer: AZCH Complete Medicare	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$227.12
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Copperpoint Commercial	$82.67
Rate for Payer: Health Net of AZ Commercial	$200.40
Rate for Payer: Health Net of AZ Medicare	$93.52
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Self Pay Self Pay	$267.20
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$194.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.12

XR Chest 1 View

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	823510
Hospital Revenue Code	324
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Cash Price	$267.20
Rate for Payer: Self Pay Self Pay	$267.20

XR Chest 1 View Special

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	3642285
Hospital Revenue Code	324
Min. Negotiated Rate	$53.44
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Aetna of AZ Medicare	$93.52
Rate for Payer: Allwell Medicare	$53.44
Rate for Payer: Amerigroup Medicare	$53.44
Rate for Payer: APIPA Medicare/Medicaid	$124.75
Rate for Payer: AZCH Complete Medicare	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$227.12
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Copperpoint Commercial	$82.67
Rate for Payer: Health Net of AZ Commercial	$200.40
Rate for Payer: Health Net of AZ Medicare	$93.52
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Self Pay Self Pay	$267.20
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$194.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.12

XR Chest 1 View Special

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	3642285
Hospital Revenue Code	324
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Cash Price	$267.20
Rate for Payer: Self Pay Self Pay	$267.20

XR Chest 2 Views

Facility

$454.00

Service Code	CPT 71046
Hospital Charge Code	823512
Hospital Revenue Code	324
Min. Negotiated Rate	$72.64
Max. Negotiated Rate	$408.60
Rate for Payer: Aetna of AZ Commercial	$408.60
Rate for Payer: Aetna of AZ Medicare	$127.12
Rate for Payer: Allwell Medicare	$72.64
Rate for Payer: Amerigroup Medicare	$72.64
Rate for Payer: APIPA Medicare/Medicaid	$169.57
Rate for Payer: AZCH Complete Medicare	$72.64
Rate for Payer: Banner UC Health Medicare	$72.64
Rate for Payer: Bisbee Police All Plans	$118.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$308.72
Rate for Payer: Cash Price	$363.20
Rate for Payer: Cigna of AZ Commercial	$295.10
Rate for Payer: Copperpoint Commercial	$112.36
Rate for Payer: Health Net of AZ Commercial	$272.40
Rate for Payer: Health Net of AZ Medicare	$127.12
Rate for Payer: Humana of AZ Medicare	$72.64
Rate for Payer: Self Pay Self Pay	$363.20
Rate for Payer: TriWest Medicare	$72.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$264.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$81.72

XR Chest 2 Views

Facility

$454.00

Service Code	CPT 71046
Hospital Charge Code	823512
Hospital Revenue Code	324
Min. Negotiated Rate	$118.04
Max. Negotiated Rate	$408.60
Rate for Payer: Aetna of AZ Commercial	$408.60
Rate for Payer: Bisbee Police All Plans	$118.04
Rate for Payer: Cash Price	$363.20
Rate for Payer: Self Pay Self Pay	$363.20

Know your out-of-pocket cost for care.

All Charges