Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Facial Bones < 3 Views

Facility

$426.00

Service Code	CPT 70140
Hospital Charge Code	823524
Hospital Revenue Code	320
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$383.40
Rate for Payer: Aetna of AZ Commercial	$383.40
Rate for Payer: Aetna of AZ Medicare	$119.28
Rate for Payer: Allwell Medicare	$68.16
Rate for Payer: Amerigroup Medicare	$68.16
Rate for Payer: APIPA Medicare/Medicaid	$159.11
Rate for Payer: AZCH Complete Medicare	$68.16
Rate for Payer: Banner UC Health Medicare	$68.16
Rate for Payer: Bisbee Police All Plans	$110.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$289.68
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cigna of AZ Commercial	$276.90
Rate for Payer: Copperpoint Commercial	$105.44
Rate for Payer: Health Net of AZ Commercial	$255.60
Rate for Payer: Health Net of AZ Medicare	$119.28
Rate for Payer: Humana of AZ Medicare	$68.16
Rate for Payer: Self Pay Self Pay	$340.80
Rate for Payer: TriWest Medicare	$68.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$248.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$76.68

XR Facial Bones Minimum 3 Views

Facility

$850.00

Service Code	CPT 70150
Hospital Charge Code	823526
Hospital Revenue Code	320
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna of AZ Commercial	$765.00
Rate for Payer: Bisbee Police All Plans	$221.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Self Pay Self Pay	$680.00

XR Facial Bones Minimum 3 Views

Facility

$850.00

Service Code	CPT 70150
Hospital Charge Code	823526
Hospital Revenue Code	320
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna of AZ Commercial	$765.00
Rate for Payer: Aetna of AZ Medicare	$238.00
Rate for Payer: Allwell Medicare	$136.00
Rate for Payer: Amerigroup Medicare	$136.00
Rate for Payer: APIPA Medicare/Medicaid	$317.48
Rate for Payer: AZCH Complete Medicare	$136.00
Rate for Payer: Banner UC Health Medicare	$136.00
Rate for Payer: Bisbee Police All Plans	$221.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$578.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cigna of AZ Commercial	$552.50
Rate for Payer: Copperpoint Commercial	$210.38
Rate for Payer: Health Net of AZ Commercial	$510.00
Rate for Payer: Health Net of AZ Medicare	$238.00
Rate for Payer: Humana of AZ Medicare	$136.00
Rate for Payer: Self Pay Self Pay	$680.00
Rate for Payer: TriWest Medicare	$136.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$495.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$153.00

XR Femur 1 View Left

Facility

$30.00

Service Code	CPT 73551 LT
Hospital Charge Code	22862300
Hospital Revenue Code	972
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

XR Femur 1 View Left

Facility

$30.00

Service Code	CPT 73551 LT
Hospital Charge Code	22862300
Hospital Revenue Code	972
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.80
Rate for Payer: Amerigroup Medicare	$4.80
Rate for Payer: APIPA Medicare/Medicaid	$11.21
Rate for Payer: AZCH Complete Medicare	$4.80
Rate for Payer: Banner UC Health Medicare	$4.80
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$21.00
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.80
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

XR Femur 1 View Left

Facility

$445.00

Service Code	CPT 73551 LT
Hospital Charge Code	2160505
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 Femur 1 View Left

Facility

$445.00

Service Code	CPT 73551 LT
Hospital Charge Code	2160505
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 Femur 1 View Right

Facility

$445.00

Service Code	CPT 73551 RT
Hospital Charge Code	2160508
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 Femur 1 View Right

Facility

$445.00

Service Code	CPT 73551 RT
Hospital Charge Code	2160508
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 Femur 2 Views Left

Facility

$421.00

Service Code	CPT 73552
Hospital Charge Code	2214248
Hospital Revenue Code	320
Min. Negotiated Rate	$109.46
Max. Negotiated Rate	$378.90
Rate for Payer: Aetna of AZ Commercial	$378.90
Rate for Payer: Bisbee Police All Plans	$109.46
Rate for Payer: Cash Price	$336.80
Rate for Payer: Self Pay Self Pay	$336.80

XR Femur 2 Views Left

Facility

$421.00

Service Code	CPT 73552
Hospital Charge Code	2214248
Hospital Revenue Code	320
Min. Negotiated Rate	$67.36
Max. Negotiated Rate	$378.90
Rate for Payer: Aetna of AZ Commercial	$378.90
Rate for Payer: Aetna of AZ Medicare	$117.88
Rate for Payer: Allwell Medicare	$67.36
Rate for Payer: Amerigroup Medicare	$67.36
Rate for Payer: APIPA Medicare/Medicaid	$157.24
Rate for Payer: AZCH Complete Medicare	$67.36
Rate for Payer: Banner UC Health Medicare	$67.36
Rate for Payer: Bisbee Police All Plans	$109.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$286.28
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cigna of AZ Commercial	$273.65
Rate for Payer: Copperpoint Commercial	$104.20
Rate for Payer: Health Net of AZ Commercial	$252.60
Rate for Payer: Health Net of AZ Medicare	$117.88
Rate for Payer: Humana of AZ Medicare	$67.36
Rate for Payer: Self Pay Self Pay	$336.80
Rate for Payer: TriWest Medicare	$67.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$245.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.78

XR Femur 2 Views Right

Facility

$421.00

Service Code	CPT 73552
Hospital Charge Code	2214251
Hospital Revenue Code	320
Min. Negotiated Rate	$109.46
Max. Negotiated Rate	$378.90
Rate for Payer: Aetna of AZ Commercial	$378.90
Rate for Payer: Bisbee Police All Plans	$109.46
Rate for Payer: Cash Price	$336.80
Rate for Payer: Self Pay Self Pay	$336.80

XR Femur 2 Views Right

Facility

$421.00

Service Code	CPT 73552
Hospital Charge Code	2214251
Hospital Revenue Code	320
Min. Negotiated Rate	$67.36
Max. Negotiated Rate	$378.90
Rate for Payer: Aetna of AZ Commercial	$378.90
Rate for Payer: Aetna of AZ Medicare	$117.88
Rate for Payer: Allwell Medicare	$67.36
Rate for Payer: Amerigroup Medicare	$67.36
Rate for Payer: APIPA Medicare/Medicaid	$157.24
Rate for Payer: AZCH Complete Medicare	$67.36
Rate for Payer: Banner UC Health Medicare	$67.36
Rate for Payer: Bisbee Police All Plans	$109.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$286.28
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cigna of AZ Commercial	$273.65
Rate for Payer: Copperpoint Commercial	$104.20
Rate for Payer: Health Net of AZ Commercial	$252.60
Rate for Payer: Health Net of AZ Medicare	$117.88
Rate for Payer: Humana of AZ Medicare	$67.36
Rate for Payer: Self Pay Self Pay	$336.80
Rate for Payer: TriWest Medicare	$67.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$245.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.78

XR Finger 2nd Digit Left

Facility

$494.00

Service Code	CPT 73140 F1
Hospital Charge Code	823532
Hospital Revenue Code	320
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Aetna of AZ Medicare	$138.32
Rate for Payer: Allwell Medicare	$79.04
Rate for Payer: Amerigroup Medicare	$79.04
Rate for Payer: APIPA Medicare/Medicaid	$184.51
Rate for Payer: AZCH Complete Medicare	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$335.92
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Copperpoint Commercial	$122.27
Rate for Payer: Health Net of AZ Commercial	$296.40
Rate for Payer: Health Net of AZ Medicare	$138.32
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Self Pay Self Pay	$395.20
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$288.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.92

XR Finger 2nd Digit Left

Facility

$494.00

Service Code	CPT 73140 F1
Hospital Charge Code	823532
Hospital Revenue Code	320
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Cash Price	$395.20
Rate for Payer: Self Pay Self Pay	$395.20

XR Finger 2nd Digit Right

Facility

$494.00

Service Code	CPT 73140 F6
Hospital Charge Code	823534
Hospital Revenue Code	320
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Cash Price	$395.20
Rate for Payer: Self Pay Self Pay	$395.20

XR Finger 2nd Digit Right

Facility

$494.00

Service Code	CPT 73140 F6
Hospital Charge Code	823534
Hospital Revenue Code	320
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Aetna of AZ Medicare	$138.32
Rate for Payer: Allwell Medicare	$79.04
Rate for Payer: Amerigroup Medicare	$79.04
Rate for Payer: APIPA Medicare/Medicaid	$184.51
Rate for Payer: AZCH Complete Medicare	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$335.92
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Copperpoint Commercial	$122.27
Rate for Payer: Health Net of AZ Commercial	$296.40
Rate for Payer: Health Net of AZ Medicare	$138.32
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Self Pay Self Pay	$395.20
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$288.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.92

XR Finger 3rd Digit Left

Facility

$494.00

Service Code	CPT 73140 F2
Hospital Charge Code	823536
Hospital Revenue Code	320
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Cash Price	$395.20
Rate for Payer: Self Pay Self Pay	$395.20

XR Finger 3rd Digit Left

Facility

$494.00

Service Code	CPT 73140 F2
Hospital Charge Code	823536
Hospital Revenue Code	320
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Aetna of AZ Medicare	$138.32
Rate for Payer: Allwell Medicare	$79.04
Rate for Payer: Amerigroup Medicare	$79.04
Rate for Payer: APIPA Medicare/Medicaid	$184.51
Rate for Payer: AZCH Complete Medicare	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$335.92
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Copperpoint Commercial	$122.27
Rate for Payer: Health Net of AZ Commercial	$296.40
Rate for Payer: Health Net of AZ Medicare	$138.32
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Self Pay Self Pay	$395.20
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$288.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.92

XR Finger 3rd Digit Right

Facility

$494.00

Service Code	CPT 73140 F7
Hospital Charge Code	823538
Hospital Revenue Code	320
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Cash Price	$395.20
Rate for Payer: Self Pay Self Pay	$395.20

XR Finger 3rd Digit Right

Facility

$494.00

Service Code	CPT 73140 F7
Hospital Charge Code	823538
Hospital Revenue Code	320
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Aetna of AZ Medicare	$138.32
Rate for Payer: Allwell Medicare	$79.04
Rate for Payer: Amerigroup Medicare	$79.04
Rate for Payer: APIPA Medicare/Medicaid	$184.51
Rate for Payer: AZCH Complete Medicare	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$335.92
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Copperpoint Commercial	$122.27
Rate for Payer: Health Net of AZ Commercial	$296.40
Rate for Payer: Health Net of AZ Medicare	$138.32
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Self Pay Self Pay	$395.20
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$288.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.92

XR Finger 4th Digit Left

Facility

$494.00

Service Code	CPT 73140 F3
Hospital Charge Code	823540
Hospital Revenue Code	320
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Aetna of AZ Medicare	$138.32
Rate for Payer: Allwell Medicare	$79.04
Rate for Payer: Amerigroup Medicare	$79.04
Rate for Payer: APIPA Medicare/Medicaid	$184.51
Rate for Payer: AZCH Complete Medicare	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$335.92
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Copperpoint Commercial	$122.27
Rate for Payer: Health Net of AZ Commercial	$296.40
Rate for Payer: Health Net of AZ Medicare	$138.32
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Self Pay Self Pay	$395.20
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$288.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.92

XR Finger 4th Digit Left

Facility

$494.00

Service Code	CPT 73140 F3
Hospital Charge Code	823540
Hospital Revenue Code	320
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Cash Price	$395.20
Rate for Payer: Self Pay Self Pay	$395.20

XR Finger 4th Digit Right

Facility

$494.00

Service Code	CPT 73140 F8
Hospital Charge Code	823542
Hospital Revenue Code	320
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Aetna of AZ Medicare	$138.32
Rate for Payer: Allwell Medicare	$79.04
Rate for Payer: Amerigroup Medicare	$79.04
Rate for Payer: APIPA Medicare/Medicaid	$184.51
Rate for Payer: AZCH Complete Medicare	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$335.92
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Copperpoint Commercial	$122.27
Rate for Payer: Health Net of AZ Commercial	$296.40
Rate for Payer: Health Net of AZ Medicare	$138.32
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Self Pay Self Pay	$395.20
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$288.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.92

XR Finger 4th Digit Right

Facility

$494.00

Service Code	CPT 73140 F8
Hospital Charge Code	823542
Hospital Revenue Code	320
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Bisbee Police All Plans	$128.44
Rate for Payer: Cash Price	$395.20
Rate for Payer: Self Pay Self Pay	$395.20

Know your out-of-pocket cost for care.

All Charges