Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Mastoids < 3 Views Right

Facility

$488.00

Service Code	CPT 70120 RT
Hospital Charge Code	3381505
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 Mastoids Complete Bilateral

Facility

$972.00

Service Code	CPT 70130 50
Hospital Charge Code	1008017
Hospital Revenue Code	320
Min. Negotiated Rate	$252.72
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Cash Price	$777.60
Rate for Payer: Self Pay Self Pay	$777.60

XR Mastoids Complete Bilateral

Facility

$972.00

Service Code	CPT 70130 50
Hospital Charge Code	1008017
Hospital Revenue Code	320
Min. Negotiated Rate	$155.52
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Aetna of AZ Medicare	$272.16
Rate for Payer: Allwell Medicare	$155.52
Rate for Payer: Amerigroup Medicare	$155.52
Rate for Payer: APIPA Medicare/Medicaid	$363.04
Rate for Payer: AZCH Complete Medicare	$155.52
Rate for Payer: Banner UC Health Medicare	$155.52
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$660.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cigna of AZ Commercial	$631.80
Rate for Payer: Copperpoint Commercial	$240.57
Rate for Payer: Health Net of AZ Commercial	$583.20
Rate for Payer: Health Net of AZ Medicare	$272.16
Rate for Payer: Humana of AZ Medicare	$155.52
Rate for Payer: Self Pay Self Pay	$777.60
Rate for Payer: TriWest Medicare	$155.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$566.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$174.96

XR Mastoids Complete Left

Facility

$972.00

Service Code	CPT 70130 LT
Hospital Charge Code	1021647
Hospital Revenue Code	320
Min. Negotiated Rate	$155.52
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Aetna of AZ Medicare	$272.16
Rate for Payer: Allwell Medicare	$155.52
Rate for Payer: Amerigroup Medicare	$155.52
Rate for Payer: APIPA Medicare/Medicaid	$363.04
Rate for Payer: AZCH Complete Medicare	$155.52
Rate for Payer: Banner UC Health Medicare	$155.52
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$660.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cigna of AZ Commercial	$631.80
Rate for Payer: Copperpoint Commercial	$240.57
Rate for Payer: Health Net of AZ Commercial	$583.20
Rate for Payer: Health Net of AZ Medicare	$272.16
Rate for Payer: Humana of AZ Medicare	$155.52
Rate for Payer: Self Pay Self Pay	$777.60
Rate for Payer: TriWest Medicare	$155.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$566.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$174.96

XR Mastoids Complete Left

Facility

$972.00

Service Code	CPT 70130 LT
Hospital Charge Code	1021647
Hospital Revenue Code	320
Min. Negotiated Rate	$252.72
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Cash Price	$777.60
Rate for Payer: Self Pay Self Pay	$777.60

XR Mastoids Complete Right

Facility

$972.00

Service Code	CPT 70130 RT
Hospital Charge Code	1021649
Hospital Revenue Code	320
Min. Negotiated Rate	$252.72
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Cash Price	$777.60
Rate for Payer: Self Pay Self Pay	$777.60

XR Mastoids Complete Right

Facility

$972.00

Service Code	CPT 70130 RT
Hospital Charge Code	1021649
Hospital Revenue Code	320
Min. Negotiated Rate	$155.52
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Aetna of AZ Medicare	$272.16
Rate for Payer: Allwell Medicare	$155.52
Rate for Payer: Amerigroup Medicare	$155.52
Rate for Payer: APIPA Medicare/Medicaid	$363.04
Rate for Payer: AZCH Complete Medicare	$155.52
Rate for Payer: Banner UC Health Medicare	$155.52
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$660.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cigna of AZ Commercial	$631.80
Rate for Payer: Copperpoint Commercial	$240.57
Rate for Payer: Health Net of AZ Commercial	$583.20
Rate for Payer: Health Net of AZ Medicare	$272.16
Rate for Payer: Humana of AZ Medicare	$155.52
Rate for Payer: Self Pay Self Pay	$777.60
Rate for Payer: TriWest Medicare	$155.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$566.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$174.96

XR Nasal Bones Minimum 3 Views

Facility

$555.00

Service Code	CPT 70160
Hospital Charge Code	823602
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 Nasal Bones Minimum 3 Views

Facility

$555.00

Service Code	CPT 70160
Hospital Charge Code	823602
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 Neck Soft Tissue

Facility

$170.00

Service Code	CPT 70360
Hospital Charge Code	823604
Hospital Revenue Code	320
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Cash Price	$136.00
Rate for Payer: Self Pay Self Pay	$136.00

XR Neck Soft Tissue

Facility

$170.00

Service Code	CPT 70360
Hospital Charge Code	823604
Hospital Revenue Code	320
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Aetna of AZ Medicare	$47.60
Rate for Payer: Allwell Medicare	$27.20
Rate for Payer: Amerigroup Medicare	$27.20
Rate for Payer: APIPA Medicare/Medicaid	$63.49
Rate for Payer: AZCH Complete Medicare	$27.20
Rate for Payer: Banner UC Health Medicare	$27.20
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$115.60
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cigna of AZ Commercial	$110.50
Rate for Payer: Copperpoint Commercial	$42.08
Rate for Payer: Health Net of AZ Commercial	$102.00
Rate for Payer: Health Net of AZ Medicare	$47.60
Rate for Payer: Humana of AZ Medicare	$27.20
Rate for Payer: Self Pay Self Pay	$136.00
Rate for Payer: TriWest Medicare	$27.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$99.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.60

XR Optic Foramina

Facility

$305.00

Service Code	CPT 70190
Hospital Charge Code	1008029
Hospital Revenue Code	320
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Aetna of AZ Medicare	$85.40
Rate for Payer: Allwell Medicare	$48.80
Rate for Payer: Amerigroup Medicare	$48.80
Rate for Payer: APIPA Medicare/Medicaid	$113.92
Rate for Payer: AZCH Complete Medicare	$48.80
Rate for Payer: Banner UC Health Medicare	$48.80
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$207.40
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cigna of AZ Commercial	$198.25
Rate for Payer: Copperpoint Commercial	$75.49
Rate for Payer: Health Net of AZ Commercial	$183.00
Rate for Payer: Health Net of AZ Medicare	$85.40
Rate for Payer: Humana of AZ Medicare	$48.80
Rate for Payer: Self Pay Self Pay	$244.00
Rate for Payer: TriWest Medicare	$48.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$177.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.90

XR Optic Foramina

Facility

$305.00

Service Code	CPT 70190
Hospital Charge Code	1008029
Hospital Revenue Code	320
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Cash Price	$244.00
Rate for Payer: Self Pay Self Pay	$244.00

XR Orbits Complete Bilateral

Facility

$923.00

Service Code	CPT 70200 50
Hospital Charge Code	823606
Hospital Revenue Code	320
Min. Negotiated Rate	$147.68
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna of AZ Commercial	$830.70
Rate for Payer: Aetna of AZ Medicare	$258.44
Rate for Payer: Allwell Medicare	$147.68
Rate for Payer: Amerigroup Medicare	$147.68
Rate for Payer: APIPA Medicare/Medicaid	$344.74
Rate for Payer: AZCH Complete Medicare	$147.68
Rate for Payer: Banner UC Health Medicare	$147.68
Rate for Payer: Bisbee Police All Plans	$239.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$627.64
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cigna of AZ Commercial	$599.95
Rate for Payer: Copperpoint Commercial	$228.44
Rate for Payer: Health Net of AZ Commercial	$553.80
Rate for Payer: Health Net of AZ Medicare	$258.44
Rate for Payer: Humana of AZ Medicare	$147.68
Rate for Payer: Self Pay Self Pay	$738.40
Rate for Payer: TriWest Medicare	$147.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$538.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$166.14

XR Orbits Complete Bilateral

Facility

$923.00

Service Code	CPT 70200 50
Hospital Charge Code	823606
Hospital Revenue Code	320
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna of AZ Commercial	$830.70
Rate for Payer: Bisbee Police All Plans	$239.98
Rate for Payer: Cash Price	$738.40
Rate for Payer: Self Pay Self Pay	$738.40

XR Orbits Complete Left

Facility

$972.00

Service Code	CPT 70200 LT
Hospital Charge Code	1163868
Hospital Revenue Code	320
Min. Negotiated Rate	$252.72
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Cash Price	$777.60
Rate for Payer: Self Pay Self Pay	$777.60

XR Orbits Complete Left

Facility

$972.00

Service Code	CPT 70200 LT
Hospital Charge Code	1163868
Hospital Revenue Code	320
Min. Negotiated Rate	$155.52
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Aetna of AZ Medicare	$272.16
Rate for Payer: Allwell Medicare	$155.52
Rate for Payer: Amerigroup Medicare	$155.52
Rate for Payer: APIPA Medicare/Medicaid	$363.04
Rate for Payer: AZCH Complete Medicare	$155.52
Rate for Payer: Banner UC Health Medicare	$155.52
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$660.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cigna of AZ Commercial	$631.80
Rate for Payer: Copperpoint Commercial	$240.57
Rate for Payer: Health Net of AZ Commercial	$583.20
Rate for Payer: Health Net of AZ Medicare	$272.16
Rate for Payer: Humana of AZ Medicare	$155.52
Rate for Payer: Self Pay Self Pay	$777.60
Rate for Payer: TriWest Medicare	$155.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$566.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$174.96

XR Orbits Complete Right

Facility

$972.00

Service Code	CPT 70200 RT
Hospital Charge Code	1163870
Hospital Revenue Code	320
Min. Negotiated Rate	$252.72
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Cash Price	$777.60
Rate for Payer: Self Pay Self Pay	$777.60

XR Orbits Complete Right

Facility

$972.00

Service Code	CPT 70200 RT
Hospital Charge Code	1163870
Hospital Revenue Code	320
Min. Negotiated Rate	$155.52
Max. Negotiated Rate	$874.80
Rate for Payer: Aetna of AZ Commercial	$874.80
Rate for Payer: Aetna of AZ Medicare	$272.16
Rate for Payer: Allwell Medicare	$155.52
Rate for Payer: Amerigroup Medicare	$155.52
Rate for Payer: APIPA Medicare/Medicaid	$363.04
Rate for Payer: AZCH Complete Medicare	$155.52
Rate for Payer: Banner UC Health Medicare	$155.52
Rate for Payer: Bisbee Police All Plans	$252.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$660.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cigna of AZ Commercial	$631.80
Rate for Payer: Copperpoint Commercial	$240.57
Rate for Payer: Health Net of AZ Commercial	$583.20
Rate for Payer: Health Net of AZ Medicare	$272.16
Rate for Payer: Humana of AZ Medicare	$155.52
Rate for Payer: Self Pay Self Pay	$777.60
Rate for Payer: TriWest Medicare	$155.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$566.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$174.96

XR Pelvis 1 View

Facility

$339.00

Service Code	CPT 72170
Hospital Charge Code	1319989
Hospital Revenue Code	320
Min. Negotiated Rate	$88.14
Max. Negotiated Rate	$305.10
Rate for Payer: Aetna of AZ Commercial	$305.10
Rate for Payer: Bisbee Police All Plans	$88.14
Rate for Payer: Cash Price	$271.20
Rate for Payer: Self Pay Self Pay	$271.20

XR Pelvis 1 View

Facility

$339.00

Service Code	CPT 72170
Hospital Charge Code	1319989
Hospital Revenue Code	320
Min. Negotiated Rate	$54.24
Max. Negotiated Rate	$305.10
Rate for Payer: Aetna of AZ Commercial	$305.10
Rate for Payer: Aetna of AZ Medicare	$94.92
Rate for Payer: Allwell Medicare	$54.24
Rate for Payer: Amerigroup Medicare	$54.24
Rate for Payer: APIPA Medicare/Medicaid	$126.62
Rate for Payer: AZCH Complete Medicare	$54.24
Rate for Payer: Banner UC Health Medicare	$54.24
Rate for Payer: Bisbee Police All Plans	$88.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$230.52
Rate for Payer: Cash Price	$271.20
Rate for Payer: Cigna of AZ Commercial	$220.35
Rate for Payer: Copperpoint Commercial	$83.90
Rate for Payer: Health Net of AZ Commercial	$203.40
Rate for Payer: Health Net of AZ Medicare	$94.92
Rate for Payer: Humana of AZ Medicare	$54.24
Rate for Payer: Self Pay Self Pay	$271.20
Rate for Payer: TriWest Medicare	$54.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$197.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.02

XR Pelvis Complete Minimum 3 Views

Facility

$555.00

Service Code	CPT 72190
Hospital Charge Code	1021656
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 Pelvis Complete Minimum 3 Views

Facility

$555.00

Service Code	CPT 72190
Hospital Charge Code	1021656
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 Radiological Specimen

Facility

$226.00

Service Code	CPT 76098
Hospital Charge Code	2214272
Hospital Revenue Code	320
Min. Negotiated Rate	$58.76
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Bisbee Police All Plans	$58.76
Rate for Payer: Cash Price	$180.80
Rate for Payer: Self Pay Self Pay	$180.80

XR Radiological Specimen

Facility

$226.00

Service Code	CPT 76098
Hospital Charge Code	2214272
Hospital Revenue Code	320
Min. Negotiated Rate	$36.16
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Aetna of AZ Medicare	$63.28
Rate for Payer: Allwell Medicare	$36.16
Rate for Payer: Amerigroup Medicare	$36.16
Rate for Payer: APIPA Medicare/Medicaid	$84.41
Rate for Payer: AZCH Complete Medicare	$36.16
Rate for Payer: Banner UC Health Medicare	$36.16
Rate for Payer: Bisbee Police All Plans	$58.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$153.68
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cigna of AZ Commercial	$146.90
Rate for Payer: Copperpoint Commercial	$55.94
Rate for Payer: Health Net of AZ Commercial	$135.60
Rate for Payer: Health Net of AZ Medicare	$63.28
Rate for Payer: Humana of AZ Medicare	$36.16
Rate for Payer: Self Pay Self Pay	$180.80
Rate for Payer: TriWest Medicare	$36.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$131.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.68

Know your out-of-pocket cost for care.

All Charges