Copper Queen Community Hospital

All Charges

Charge

Type

Price

XR Tibia/Fibula 2 Views Left

Facility OP

$565.00

Service Code	CPT 73590 LT
Hospital Charge Code	2214290
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 Tibia/Fibula 2 Views Left

Facility IP

$565.00

Service Code	CPT 73590 LT
Hospital Charge Code	2214290
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 Tibia/Fibula 2 Views Right

Facility IP

$565.00

Service Code	CPT 73590 RT
Hospital Charge Code	2214293
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 Tibia/Fibula 2 Views Right

Facility OP

$565.00

Service Code	CPT 73590 RT
Hospital Charge Code	2214293
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 Toes 2nd Digit Left

Facility OP

$488.00

Service Code	CPT 73660 T1
Hospital Charge Code	823659
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 Toes 2nd Digit Left

Facility IP

$488.00

Service Code	CPT 73660 T1
Hospital Charge Code	823659
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 Toes 2nd Digit Right

Facility IP

$488.00

Service Code	CPT 73660 T6
Hospital Charge Code	823661
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 Toes 2nd Digit Right

Facility OP

$488.00

Service Code	CPT 73660 T6
Hospital Charge Code	823661
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 Toes 3rd Digit Left

Facility OP

$488.00

Service Code	CPT 73660 T2
Hospital Charge Code	823663
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 Toes 3rd Digit Left

Facility IP

$488.00

Service Code	CPT 73660 T2
Hospital Charge Code	823663
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 Toes 3rd Digit Right

Facility OP

$488.00

Service Code	CPT 73660 T7
Hospital Charge Code	823665
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 Toes 3rd Digit Right

Facility IP

$488.00

Service Code	CPT 73660 T7
Hospital Charge Code	823665
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 Toes 4th Digit Left

Facility OP

$488.00

Service Code	CPT 73660 T3
Hospital Charge Code	823667
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 Toes 4th Digit Left

Facility IP

$488.00

Service Code	CPT 73660 T3
Hospital Charge Code	823667
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 Toes 4th Digit Right

Facility OP

$488.00

Service Code	CPT 73660 T8
Hospital Charge Code	823669
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 Toes 4th Digit Right

Facility IP

$488.00

Service Code	CPT 73660 T8
Hospital Charge Code	823669
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 Toes 5th Digit Left

Facility OP

$488.00

Service Code	CPT 73660 T4
Hospital Charge Code	823671
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 Toes 5th Digit Left

Facility IP

$488.00

Service Code	CPT 73660 T4
Hospital Charge Code	823671
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 Toes 5th Digit Right

Facility OP

$488.00

Service Code	CPT 73660 T9
Hospital Charge Code	823673
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 Toes 5th Digit Right

Facility IP

$488.00

Service Code	CPT 73660 T9
Hospital Charge Code	823673
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 Toes Great Left

Facility IP

$488.00

Service Code	CPT 73660 TA
Hospital Charge Code	823675
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 Toes Great Left

Facility OP

$488.00

Service Code	CPT 73660 TA
Hospital Charge Code	823675
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 Toes Great Right

Facility OP

$488.00

Service Code	CPT 73660 T5
Hospital Charge Code	823677
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 Toes Great Right

Facility IP

$488.00

Service Code	CPT 73660 T5
Hospital Charge Code	823677
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 Wrist 2 Views Left

Facility OP

$488.00

Service Code	CPT 73100 LT
Hospital Charge Code	823685
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

Know your out-of-pocket cost for care.

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