Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

XR Hand 2 Views Right

Facility

$464.00

Service Code	CPT 73120 RT
Hospital Charge Code	823570
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 Right

Facility

$464.00

Service Code	CPT 73120 RT
Hospital Charge Code	823570
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 Hand Complete Left

Facility

$464.00

Service Code	CPT 73130 LT
Hospital Charge Code	823572
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 Complete Left

Facility

$464.00

Service Code	CPT 73130 LT
Hospital Charge Code	823572
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 Hand Complete Right

Facility

$462.00

Service Code	CPT 73130 RT
Hospital Charge Code	823574
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 Hand Complete Right

Facility

$462.00

Service Code	CPT 73130 RT
Hospital Charge Code	823574
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 Hip 1 View Lt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 LT
Hospital Charge Code	22200615
Hospital Revenue Code	320
Min. Negotiated Rate	$60.64
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Aetna of AZ Medicare	$106.12
Rate for Payer: Allwell Medicare	$60.64
Rate for Payer: Amerigroup Medicare	$60.64
Rate for Payer: APIPA Medicare/Medicaid	$141.56
Rate for Payer: AZCH Complete Medicare	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$257.72
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$246.35
Rate for Payer: Copperpoint Commercial	$93.80
Rate for Payer: Health Net of AZ Commercial	$227.40
Rate for Payer: Health Net of AZ Medicare	$106.12
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Self Pay Self Pay	$303.20
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$220.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.22

XR Hip 1 View Lt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 LT
Hospital Charge Code	22200615
Hospital Revenue Code	320
Min. Negotiated Rate	$98.54
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Cash Price	$303.20
Rate for Payer: Self Pay Self Pay	$303.20

XR Hip 1 View Rt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 RT
Hospital Charge Code	22200618
Hospital Revenue Code	320
Min. Negotiated Rate	$60.64
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Aetna of AZ Medicare	$106.12
Rate for Payer: Allwell Medicare	$60.64
Rate for Payer: Amerigroup Medicare	$60.64
Rate for Payer: APIPA Medicare/Medicaid	$141.56
Rate for Payer: AZCH Complete Medicare	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$257.72
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$246.35
Rate for Payer: Copperpoint Commercial	$93.80
Rate for Payer: Health Net of AZ Commercial	$227.40
Rate for Payer: Health Net of AZ Medicare	$106.12
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Self Pay Self Pay	$303.20
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$220.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.22

XR Hip 1 View Rt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 RT
Hospital Charge Code	22200618
Hospital Revenue Code	320
Min. Negotiated Rate	$98.54
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Cash Price	$303.20
Rate for Payer: Self Pay Self Pay	$303.20

XR Hip 2-3 Views Lt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 LT
Hospital Charge Code	22200621
Hospital Revenue Code	320
Min. Negotiated Rate	$150.02
Max. Negotiated Rate	$519.30
Rate for Payer: Aetna of AZ Commercial	$519.30
Rate for Payer: Bisbee Police All Plans	$150.02
Rate for Payer: Cash Price	$461.60
Rate for Payer: Self Pay Self Pay	$461.60

XR Hip 2-3 Views Lt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 LT
Hospital Charge Code	22200621
Hospital Revenue Code	320
Min. Negotiated Rate	$92.32
Max. Negotiated Rate	$519.30
Rate for Payer: Aetna of AZ Commercial	$519.30
Rate for Payer: Aetna of AZ Medicare	$161.56
Rate for Payer: Allwell Medicare	$92.32
Rate for Payer: Amerigroup Medicare	$92.32
Rate for Payer: APIPA Medicare/Medicaid	$215.51
Rate for Payer: AZCH Complete Medicare	$92.32
Rate for Payer: Banner UC Health Medicare	$92.32
Rate for Payer: Bisbee Police All Plans	$150.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$392.36
Rate for Payer: Cash Price	$461.60
Rate for Payer: Cigna of AZ Commercial	$375.05
Rate for Payer: Copperpoint Commercial	$142.81
Rate for Payer: Health Net of AZ Commercial	$346.20
Rate for Payer: Health Net of AZ Medicare	$161.56
Rate for Payer: Humana of AZ Medicare	$92.32
Rate for Payer: Self Pay Self Pay	$461.60
Rate for Payer: TriWest Medicare	$92.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$336.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$103.86

XR Hip 2-3 Views Rt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 RT
Hospital Charge Code	22200624
Hospital Revenue Code	320
Min. Negotiated Rate	$92.32
Max. Negotiated Rate	$519.30
Rate for Payer: Aetna of AZ Commercial	$519.30
Rate for Payer: Aetna of AZ Medicare	$161.56
Rate for Payer: Allwell Medicare	$92.32
Rate for Payer: Amerigroup Medicare	$92.32
Rate for Payer: APIPA Medicare/Medicaid	$215.51
Rate for Payer: AZCH Complete Medicare	$92.32
Rate for Payer: Banner UC Health Medicare	$92.32
Rate for Payer: Bisbee Police All Plans	$150.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$392.36
Rate for Payer: Cash Price	$461.60
Rate for Payer: Cigna of AZ Commercial	$375.05
Rate for Payer: Copperpoint Commercial	$142.81
Rate for Payer: Health Net of AZ Commercial	$346.20
Rate for Payer: Health Net of AZ Medicare	$161.56
Rate for Payer: Humana of AZ Medicare	$92.32
Rate for Payer: Self Pay Self Pay	$461.60
Rate for Payer: TriWest Medicare	$92.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$336.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$103.86

XR Hip 2-3 Views Rt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 RT
Hospital Charge Code	22200624
Hospital Revenue Code	320
Min. Negotiated Rate	$150.02
Max. Negotiated Rate	$519.30
Rate for Payer: Aetna of AZ Commercial	$519.30
Rate for Payer: Bisbee Police All Plans	$150.02
Rate for Payer: Cash Price	$461.60
Rate for Payer: Self Pay Self Pay	$461.60

XR Hips Bil w/ Pelvis 2 Views

Facility

$478.00

Service Code	CPT 73521
Hospital Charge Code	22200633
Hospital Revenue Code	320
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Bisbee Police All Plans	$124.28
Rate for Payer: Cash Price	$382.40
Rate for Payer: Self Pay Self Pay	$382.40

XR Hips Bil w/ Pelvis 2 Views

Facility

$478.00

Service Code	CPT 73521
Hospital Charge Code	22200633
Hospital Revenue Code	320
Min. Negotiated Rate	$76.48
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Aetna of AZ Medicare	$133.84
Rate for Payer: Allwell Medicare	$76.48
Rate for Payer: Amerigroup Medicare	$76.48
Rate for Payer: APIPA Medicare/Medicaid	$178.53
Rate for Payer: AZCH Complete Medicare	$76.48
Rate for Payer: Banner UC Health Medicare	$76.48
Rate for Payer: Bisbee Police All Plans	$124.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$325.04
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cigna of AZ Commercial	$310.70
Rate for Payer: Copperpoint Commercial	$118.31
Rate for Payer: Health Net of AZ Commercial	$286.80
Rate for Payer: Health Net of AZ Medicare	$133.84
Rate for Payer: Humana of AZ Medicare	$76.48
Rate for Payer: Self Pay Self Pay	$382.40
Rate for Payer: TriWest Medicare	$76.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$278.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.04

XR Humerus 1 View Left

Facility

$488.00

Service Code	CPT 73060 LT
Hospital Charge Code	22170716
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 Humerus 1 View Left

Facility

$488.00

Service Code	CPT 73060 LT
Hospital Charge Code	22170716
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 Humerus 1 View Right

Facility

$488.00

Service Code	CPT 73060 RT
Hospital Charge Code	22170719
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 Humerus 1 View Right

Facility

$488.00

Service Code	CPT 73060 RT
Hospital Charge Code	22170719
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 Humerus Left

Facility

$464.00

Service Code	CPT 73060
Hospital Charge Code	823588
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 Humerus Left

Facility

$464.00

Service Code	CPT 73060
Hospital Charge Code	823588
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 Humerus Right

Facility

$488.00

Service Code	CPT 73060
Hospital Charge Code	823590
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 Humerus Right

Facility

$488.00

Service Code	CPT 73060
Hospital Charge Code	823590
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

Know your out-of-pocket cost for care.

All Charges