Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Finger 5th Digit Left

Facility

$494.00

Service Code	CPT 73140 F4
Hospital Charge Code	823544
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 5th Digit Left

Facility

$494.00

Service Code	CPT 73140 F4
Hospital Charge Code	823544
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 5th Digit Right

Facility

$494.00

Service Code	CPT 73140 F9
Hospital Charge Code	823546
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 5th Digit Right

Facility

$494.00

Service Code	CPT 73140 F9
Hospital Charge Code	823546
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 Thumb Left

Facility

$494.00

Service Code	CPT 73140 FA
Hospital Charge Code	823548
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 Thumb Left

Facility

$494.00

Service Code	CPT 73140 FA
Hospital Charge Code	823548
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 Thumb Right

Facility

$494.00

Service Code	CPT 73140 F5
Hospital Charge Code	823550
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 Thumb Right

Facility

$494.00

Service Code	CPT 73140 F5
Hospital Charge Code	823550
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 Fistula or Sinus Tract Abscess Study

Facility

$863.00

Service Code	CPT 76080
Hospital Charge Code	1007948
Hospital Revenue Code	320
Min. Negotiated Rate	$138.08
Max. Negotiated Rate	$776.70
Rate for Payer: Aetna of AZ Commercial	$776.70
Rate for Payer: Aetna of AZ Medicare	$241.64
Rate for Payer: Allwell Medicare	$138.08
Rate for Payer: Amerigroup Medicare	$138.08
Rate for Payer: APIPA Medicare/Medicaid	$322.33
Rate for Payer: AZCH Complete Medicare	$138.08
Rate for Payer: Banner UC Health Medicare	$138.08
Rate for Payer: Bisbee Police All Plans	$224.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$586.84
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cigna of AZ Commercial	$560.95
Rate for Payer: Copperpoint Commercial	$213.59
Rate for Payer: Health Net of AZ Commercial	$517.80
Rate for Payer: Health Net of AZ Medicare	$241.64
Rate for Payer: Humana of AZ Medicare	$138.08
Rate for Payer: Self Pay Self Pay	$690.40
Rate for Payer: TriWest Medicare	$138.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$503.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.34

XR Fistula or Sinus Tract Abscess Study

Facility

$863.00

Service Code	CPT 76080
Hospital Charge Code	1007948
Hospital Revenue Code	320
Min. Negotiated Rate	$224.38
Max. Negotiated Rate	$776.70
Rate for Payer: Aetna of AZ Commercial	$776.70
Rate for Payer: Bisbee Police All Plans	$224.38
Rate for Payer: Cash Price	$690.40
Rate for Payer: Self Pay Self Pay	$690.40

XR Fluoroscopy Up to 1 Hour

Facility

$646.00

Service Code	CPT 76000
Hospital Charge Code	823552
Hospital Revenue Code	320
Min. Negotiated Rate	$167.96
Max. Negotiated Rate	$581.40
Rate for Payer: Aetna of AZ Commercial	$581.40
Rate for Payer: Bisbee Police All Plans	$167.96
Rate for Payer: Cash Price	$516.80
Rate for Payer: Self Pay Self Pay	$516.80

XR Fluoroscopy Up to 1 Hour

Facility

$646.00

Service Code	CPT 76000
Hospital Charge Code	823552
Hospital Revenue Code	320
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$581.40
Rate for Payer: Aetna of AZ Commercial	$581.40
Rate for Payer: Aetna of AZ Medicare	$180.88
Rate for Payer: Allwell Medicare	$103.36
Rate for Payer: Amerigroup Medicare	$103.36
Rate for Payer: APIPA Medicare/Medicaid	$241.28
Rate for Payer: AZCH Complete Medicare	$103.36
Rate for Payer: Banner UC Health Medicare	$103.36
Rate for Payer: Bisbee Police All Plans	$167.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$439.28
Rate for Payer: Cash Price	$516.80
Rate for Payer: Cigna of AZ Commercial	$419.90
Rate for Payer: Copperpoint Commercial	$159.88
Rate for Payer: Health Net of AZ Commercial	$387.60
Rate for Payer: Health Net of AZ Medicare	$180.88
Rate for Payer: Humana of AZ Medicare	$103.36
Rate for Payer: Self Pay Self Pay	$516.80
Rate for Payer: TriWest Medicare	$103.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$376.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$116.28

XR Foot 2 Views Left

Facility

$464.00

Service Code	CPT 73620 LT
Hospital Charge Code	823554
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 Foot 2 Views Left

Facility

$464.00

Service Code	CPT 73620 LT
Hospital Charge Code	823554
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 Foot 2 Views Right

Facility

$464.00

Service Code	CPT 73620 RT
Hospital Charge Code	823556
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 Foot 2 Views Right

Facility

$464.00

Service Code	CPT 73620 RT
Hospital Charge Code	823556
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 Foot Complete Left

Facility

$464.00

Service Code	CPT 73630 LT
Hospital Charge Code	823558
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 Foot Complete Left

Facility

$464.00

Service Code	CPT 73630 LT
Hospital Charge Code	823558
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 Foot Complete Right

Facility

$462.00

Service Code	CPT 73630 RT
Hospital Charge Code	823560
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 Foot Complete Right

Facility

$462.00

Service Code	CPT 73630 RT
Hospital Charge Code	823560
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

XR Forearm 2 Views Left

Facility

$464.00

Service Code	CPT 73090 LT
Hospital Charge Code	823562
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 Forearm 2 Views Left

Facility

$464.00

Service Code	CPT 73090 LT
Hospital Charge Code	823562
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 Forearm 2 Views Right

Facility

$464.00

Service Code	CPT 73090 RT
Hospital Charge Code	823564
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 Forearm 2 Views Right

Facility

$464.00

Service Code	CPT 73090 RT
Hospital Charge Code	823564
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 Hand 2 Views Left

Facility

$464.00

Service Code	CPT 73120 LT
Hospital Charge Code	823568
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

Know your out-of-pocket cost for care.

All Charges