Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Chest 4 Views w/ Obliques

Facility

$1,108.00

Service Code	CPT 71048
Hospital Charge Code	1780010
Hospital Revenue Code	324
Min. Negotiated Rate	$177.28
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Aetna of AZ Medicare	$310.24
Rate for Payer: Allwell Medicare	$177.28
Rate for Payer: Amerigroup Medicare	$177.28
Rate for Payer: APIPA Medicare/Medicaid	$413.84
Rate for Payer: AZCH Complete Medicare	$177.28
Rate for Payer: Banner UC Health Medicare	$177.28
Rate for Payer: Bisbee Police All Plans	$288.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$753.44
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cigna of AZ Commercial	$720.20
Rate for Payer: Copperpoint Commercial	$274.23
Rate for Payer: Health Net of AZ Commercial	$664.80
Rate for Payer: Health Net of AZ Medicare	$310.24
Rate for Payer: Humana of AZ Medicare	$177.28
Rate for Payer: Self Pay Self Pay	$886.40
Rate for Payer: TriWest Medicare	$177.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$645.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$199.44

XR Chest 4 Views w/ Obliques

Facility

$1,108.00

Service Code	CPT 71048
Hospital Charge Code	1780010
Hospital Revenue Code	324
Min. Negotiated Rate	$288.08
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Bisbee Police All Plans	$288.08
Rate for Payer: Cash Price	$886.40
Rate for Payer: Self Pay Self Pay	$886.40

XR Child Nose-Rectum For FB

Facility

$352.00

Service Code	CPT 76010
Hospital Charge Code	1007907
Hospital Revenue Code	320
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Bisbee Police All Plans	$91.52
Rate for Payer: Cash Price	$281.60
Rate for Payer: Self Pay Self Pay	$281.60

XR Child Nose-Rectum For FB

Facility

$352.00

Service Code	CPT 76010
Hospital Charge Code	1007907
Hospital Revenue Code	320
Min. Negotiated Rate	$56.32
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Aetna of AZ Medicare	$98.56
Rate for Payer: Allwell Medicare	$56.32
Rate for Payer: Amerigroup Medicare	$56.32
Rate for Payer: APIPA Medicare/Medicaid	$131.47
Rate for Payer: AZCH Complete Medicare	$56.32
Rate for Payer: Banner UC Health Medicare	$56.32
Rate for Payer: Bisbee Police All Plans	$91.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$239.36
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cigna of AZ Commercial	$228.80
Rate for Payer: Copperpoint Commercial	$87.12
Rate for Payer: Health Net of AZ Commercial	$211.20
Rate for Payer: Health Net of AZ Medicare	$98.56
Rate for Payer: Humana of AZ Medicare	$56.32
Rate for Payer: Self Pay Self Pay	$281.60
Rate for Payer: TriWest Medicare	$56.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$205.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$63.36

XR Cholangiogram in OR

Facility

$1,262.00

Service Code	CPT 74300
Hospital Charge Code	1021642
Hospital Revenue Code	320
Min. Negotiated Rate	$201.92
Max. Negotiated Rate	$1,135.80
Rate for Payer: Aetna of AZ Commercial	$1,135.80
Rate for Payer: Aetna of AZ Medicare	$353.36
Rate for Payer: Allwell Medicare	$201.92
Rate for Payer: Amerigroup Medicare	$201.92
Rate for Payer: APIPA Medicare/Medicaid	$471.36
Rate for Payer: AZCH Complete Medicare	$201.92
Rate for Payer: Banner UC Health Medicare	$201.92
Rate for Payer: Bisbee Police All Plans	$328.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$858.16
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Cigna of AZ Commercial	$820.30
Rate for Payer: Copperpoint Commercial	$312.35
Rate for Payer: Health Net of AZ Commercial	$757.20
Rate for Payer: Health Net of AZ Medicare	$353.36
Rate for Payer: Humana of AZ Medicare	$201.92
Rate for Payer: Self Pay Self Pay	$1,009.60
Rate for Payer: TriWest Medicare	$201.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$735.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$227.16

XR Cholangiogram in OR

Facility

$1,262.00

Service Code	CPT 74300
Hospital Charge Code	1021642
Hospital Revenue Code	320
Min. Negotiated Rate	$328.12
Max. Negotiated Rate	$1,135.80
Rate for Payer: Aetna of AZ Commercial	$1,135.80
Rate for Payer: Bisbee Police All Plans	$328.12
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Self Pay Self Pay	$1,009.60

XR Cholangiogram OR w/ Existing Catheter

Facility

$700.00

Service Code	CPT 74305
Hospital Charge Code	1735705
Hospital Revenue Code	320
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Bisbee Police All Plans	$182.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Self Pay Self Pay	$560.00

XR Cholangiogram OR w/ Existing Catheter

Facility

$700.00

Service Code	CPT 74305
Hospital Charge Code	1735705
Hospital Revenue Code	320
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Aetna of AZ Medicare	$196.00
Rate for Payer: Allwell Medicare	$112.00
Rate for Payer: Amerigroup Medicare	$112.00
Rate for Payer: APIPA Medicare/Medicaid	$261.45
Rate for Payer: AZCH Complete Medicare	$112.00
Rate for Payer: Banner UC Health Medicare	$112.00
Rate for Payer: Bisbee Police All Plans	$182.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$476.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cigna of AZ Commercial	$455.00
Rate for Payer: Copperpoint Commercial	$173.25
Rate for Payer: Health Net of AZ Commercial	$420.00
Rate for Payer: Health Net of AZ Medicare	$196.00
Rate for Payer: Humana of AZ Medicare	$112.00
Rate for Payer: Self Pay Self Pay	$560.00
Rate for Payer: TriWest Medicare	$112.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$408.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$126.00

XR Clavicle Left

Facility

$482.00

Service Code	CPT 73000 LT
Hospital Charge Code	823516
Hospital Revenue Code	320
Min. Negotiated Rate	$77.12
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	$77.12
Rate for Payer: Amerigroup Medicare	$77.12
Rate for Payer: APIPA Medicare/Medicaid	$180.03
Rate for Payer: AZCH Complete Medicare	$77.12
Rate for Payer: Banner UC Health Medicare	$77.12
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	$77.12
Rate for Payer: Self Pay Self Pay	$385.60
Rate for Payer: TriWest Medicare	$77.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.76

XR Clavicle Left

Facility

$482.00

Service Code	CPT 73000 LT
Hospital Charge Code	823516
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 Clavicle Right

Facility

$482.00

Service Code	CPT 73000 RT
Hospital Charge Code	823518
Hospital Revenue Code	320
Min. Negotiated Rate	$77.12
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	$77.12
Rate for Payer: Amerigroup Medicare	$77.12
Rate for Payer: APIPA Medicare/Medicaid	$180.03
Rate for Payer: AZCH Complete Medicare	$77.12
Rate for Payer: Banner UC Health Medicare	$77.12
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	$77.12
Rate for Payer: Self Pay Self Pay	$385.60
Rate for Payer: TriWest Medicare	$77.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.76

XR Clavicle Right

Facility

$482.00

Service Code	CPT 73000 RT
Hospital Charge Code	823518
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 Cystogram Non Voiding

Facility

$285.00

Service Code	CPT 74430
Hospital Charge Code	1319963
Hospital Revenue Code	320
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna of AZ Commercial	$256.50
Rate for Payer: Aetna of AZ Medicare	$79.80
Rate for Payer: Allwell Medicare	$45.60
Rate for Payer: Amerigroup Medicare	$45.60
Rate for Payer: APIPA Medicare/Medicaid	$106.45
Rate for Payer: AZCH Complete Medicare	$45.60
Rate for Payer: Banner UC Health Medicare	$45.60
Rate for Payer: Bisbee Police All Plans	$74.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$193.80
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cigna of AZ Commercial	$185.25
Rate for Payer: Copperpoint Commercial	$70.54
Rate for Payer: Health Net of AZ Commercial	$171.00
Rate for Payer: Health Net of AZ Medicare	$79.80
Rate for Payer: Humana of AZ Medicare	$45.60
Rate for Payer: Self Pay Self Pay	$228.00
Rate for Payer: TriWest Medicare	$45.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$166.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.30

XR Cystogram Non Voiding

Facility

$285.00

Service Code	CPT 74430
Hospital Charge Code	1319963
Hospital Revenue Code	320
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna of AZ Commercial	$256.50
Rate for Payer: Bisbee Police All Plans	$74.10
Rate for Payer: Cash Price	$228.00
Rate for Payer: Self Pay Self Pay	$228.00

XR Cystogram Voiding

Facility

$308.00

Service Code	CPT 51600
Hospital Charge Code	1319966
Hospital Revenue Code	320
Min. Negotiated Rate	$80.08
Max. Negotiated Rate	$277.20
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Bisbee Police All Plans	$80.08
Rate for Payer: Cash Price	$246.40
Rate for Payer: Self Pay Self Pay	$246.40

XR Cystogram Voiding

Facility

$308.00

Service Code	CPT 51600
Hospital Charge Code	1319966
Hospital Revenue Code	320
Min. Negotiated Rate	$49.28
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$277.20
Rate for Payer: Aetna of AZ Medicare	$86.24
Rate for Payer: Allwell Medicare	$49.28
Rate for Payer: Amerigroup Medicare	$49.28
Rate for Payer: APIPA Medicare/Medicaid	$115.04
Rate for Payer: AZCH Complete Medicare	$49.28
Rate for Payer: Banner UC Health Medicare	$49.28
Rate for Payer: Bisbee Police All Plans	$80.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$209.44
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cigna of AZ Commercial	$200.20
Rate for Payer: Copperpoint Commercial	$76.23
Rate for Payer: Health Net of AZ Commercial	$184.80
Rate for Payer: Health Net of AZ Medicare	$86.24
Rate for Payer: Humana of AZ Medicare	$49.28
Rate for Payer: Self Pay Self Pay	$246.40
Rate for Payer: TriWest Medicare	$49.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.44

XR Elbow 2 Views Left

Facility

$363.00

Service Code	CPT 73070 LT
Hospital Charge Code	823520
Hospital Revenue Code	320
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of AZ Commercial	$326.70
Rate for Payer: Aetna of AZ Medicare	$101.64
Rate for Payer: Allwell Medicare	$58.08
Rate for Payer: Amerigroup Medicare	$58.08
Rate for Payer: APIPA Medicare/Medicaid	$135.58
Rate for Payer: AZCH Complete Medicare	$58.08
Rate for Payer: Banner UC Health Medicare	$58.08
Rate for Payer: Bisbee Police All Plans	$94.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.84
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cigna of AZ Commercial	$235.95
Rate for Payer: Copperpoint Commercial	$89.84
Rate for Payer: Health Net of AZ Commercial	$217.80
Rate for Payer: Health Net of AZ Medicare	$101.64
Rate for Payer: Humana of AZ Medicare	$58.08
Rate for Payer: Self Pay Self Pay	$290.40
Rate for Payer: TriWest Medicare	$58.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.34

XR Elbow 2 Views Left

Facility

$363.00

Service Code	CPT 73070 LT
Hospital Charge Code	823520
Hospital Revenue Code	320
Min. Negotiated Rate	$94.38
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of AZ Commercial	$326.70
Rate for Payer: Bisbee Police All Plans	$94.38
Rate for Payer: Cash Price	$290.40
Rate for Payer: Self Pay Self Pay	$290.40

XR Elbow 2 Views Right

Facility

$363.00

Service Code	CPT 73070 RT
Hospital Charge Code	823522
Hospital Revenue Code	320
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of AZ Commercial	$326.70
Rate for Payer: Aetna of AZ Medicare	$101.64
Rate for Payer: Allwell Medicare	$58.08
Rate for Payer: Amerigroup Medicare	$58.08
Rate for Payer: APIPA Medicare/Medicaid	$135.58
Rate for Payer: AZCH Complete Medicare	$58.08
Rate for Payer: Banner UC Health Medicare	$58.08
Rate for Payer: Bisbee Police All Plans	$94.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.84
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cigna of AZ Commercial	$235.95
Rate for Payer: Copperpoint Commercial	$89.84
Rate for Payer: Health Net of AZ Commercial	$217.80
Rate for Payer: Health Net of AZ Medicare	$101.64
Rate for Payer: Humana of AZ Medicare	$58.08
Rate for Payer: Self Pay Self Pay	$290.40
Rate for Payer: TriWest Medicare	$58.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.34

XR Elbow 2 Views Right

Facility

$363.00

Service Code	CPT 73070 RT
Hospital Charge Code	823522
Hospital Revenue Code	320
Min. Negotiated Rate	$94.38
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of AZ Commercial	$326.70
Rate for Payer: Bisbee Police All Plans	$94.38
Rate for Payer: Cash Price	$290.40
Rate for Payer: Self Pay Self Pay	$290.40

XR Elbow Complete Left

Facility

$555.00

Service Code	CPT 73080 LT
Hospital Charge Code	1007932
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 Elbow Complete Left

Facility

$555.00

Service Code	CPT 73080 LT
Hospital Charge Code	1007932
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 Elbow Complete Right

Facility

$555.00

Service Code	CPT 73080 RT
Hospital Charge Code	1007934
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 Elbow Complete Right

Facility

$555.00

Service Code	CPT 73080 RT
Hospital Charge Code	1007934
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 Facial Bones < 3 Views

Facility

$426.00

Service Code	CPT 70140
Hospital Charge Code	823524
Hospital Revenue Code	320
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Bisbee Police All Plans	$110.76
Rate for Payer: Cash Price	$340.80
Rate for Payer: Self Pay Self Pay	$340.80

Know your out-of-pocket cost for care.

All Charges