Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Ribs 3 Views Left

Facility

$464.00

Service Code	CPT 71100 LT
Hospital Charge Code	7003381
Hospital Revenue Code	324
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 Ribs 3 Views Left

Facility

$464.00

Service Code	CPT 71100 LT
Hospital Charge Code	7003381
Hospital Revenue Code	324
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 Ribs 3 Views Right

Facility

$488.00

Service Code	CPT 71100 RT
Hospital Charge Code	7003384
Hospital Revenue Code	324
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 Ribs 3 Views Right

Facility

$488.00

Service Code	CPT 71100 RT
Hospital Charge Code	7003384
Hospital Revenue Code	324
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 Ribs Min 4 Views Bilateral

Facility

$618.00

Service Code	CPT 71110 50
Hospital Charge Code	2214281
Hospital Revenue Code	324
Min. Negotiated Rate	$98.88
Max. Negotiated Rate	$556.20
Rate for Payer: Aetna of AZ Commercial	$556.20
Rate for Payer: Aetna of AZ Medicare	$173.04
Rate for Payer: Allwell Medicare	$98.88
Rate for Payer: Amerigroup Medicare	$98.88
Rate for Payer: APIPA Medicare/Medicaid	$230.82
Rate for Payer: AZCH Complete Medicare	$98.88
Rate for Payer: Banner UC Health Medicare	$98.88
Rate for Payer: Bisbee Police All Plans	$160.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$420.24
Rate for Payer: Cash Price	$494.40
Rate for Payer: Cigna of AZ Commercial	$401.70
Rate for Payer: Copperpoint Commercial	$152.96
Rate for Payer: Health Net of AZ Commercial	$370.80
Rate for Payer: Health Net of AZ Medicare	$173.04
Rate for Payer: Humana of AZ Medicare	$98.88
Rate for Payer: Self Pay Self Pay	$494.40
Rate for Payer: TriWest Medicare	$98.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$360.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$111.24

XR Ribs Min 4 Views Bilateral

Facility

$618.00

Service Code	CPT 71110 50
Hospital Charge Code	2214281
Hospital Revenue Code	324
Min. Negotiated Rate	$160.68
Max. Negotiated Rate	$556.20
Rate for Payer: Aetna of AZ Commercial	$556.20
Rate for Payer: Bisbee Police All Plans	$160.68
Rate for Payer: Cash Price	$494.40
Rate for Payer: Self Pay Self Pay	$494.40

XR Ribs w/ PA Chest Bilateral

Facility

$591.00

Service Code	CPT 71111 50
Hospital Charge Code	1008048
Hospital Revenue Code	320
Min. Negotiated Rate	$94.56
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Aetna of AZ Medicare	$165.48
Rate for Payer: Allwell Medicare	$94.56
Rate for Payer: Amerigroup Medicare	$94.56
Rate for Payer: APIPA Medicare/Medicaid	$220.74
Rate for Payer: AZCH Complete Medicare	$94.56
Rate for Payer: Banner UC Health Medicare	$94.56
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$401.88
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cigna of AZ Commercial	$384.15
Rate for Payer: Copperpoint Commercial	$146.27
Rate for Payer: Health Net of AZ Commercial	$354.60
Rate for Payer: Health Net of AZ Medicare	$165.48
Rate for Payer: Humana of AZ Medicare	$94.56
Rate for Payer: Self Pay Self Pay	$472.80
Rate for Payer: TriWest Medicare	$94.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$344.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$106.38

XR Ribs w/ PA Chest Bilateral

Facility

$591.00

Service Code	CPT 71111 50
Hospital Charge Code	1008048
Hospital Revenue Code	320
Min. Negotiated Rate	$153.66
Max. Negotiated Rate	$531.90
Rate for Payer: Aetna of AZ Commercial	$531.90
Rate for Payer: Bisbee Police All Plans	$153.66
Rate for Payer: Cash Price	$472.80
Rate for Payer: Self Pay Self Pay	$472.80

XR Ribs w/ PA Chest Left

Facility

$464.00

Service Code	CPT 71101 LT
Hospital Charge Code	1008050
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 Ribs w/ PA Chest Left

Facility

$464.00

Service Code	CPT 71101 LT
Hospital Charge Code	1008050
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 Ribs w/ PA Chest Right

Facility

$488.00

Service Code	CPT 71101 RT
Hospital Charge Code	1008052
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 Ribs w/ PA Chest Right

Facility

$488.00

Service Code	CPT 71101 RT
Hospital Charge Code	1008052
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 Sacroiliac Joints 1 or 2 Views

Facility

$395.00

Service Code	CPT 72200
Hospital Charge Code	1008054
Hospital Revenue Code	320
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Aetna of AZ Medicare	$110.60
Rate for Payer: Allwell Medicare	$63.20
Rate for Payer: Amerigroup Medicare	$63.20
Rate for Payer: APIPA Medicare/Medicaid	$147.53
Rate for Payer: AZCH Complete Medicare	$63.20
Rate for Payer: Banner UC Health Medicare	$63.20
Rate for Payer: Bisbee Police All Plans	$102.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$268.60
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cigna of AZ Commercial	$256.75
Rate for Payer: Copperpoint Commercial	$97.76
Rate for Payer: Health Net of AZ Commercial	$237.00
Rate for Payer: Health Net of AZ Medicare	$110.60
Rate for Payer: Humana of AZ Medicare	$63.20
Rate for Payer: Self Pay Self Pay	$316.00
Rate for Payer: TriWest Medicare	$63.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$230.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.10

XR Sacroiliac Joints 1 or 2 Views

Facility

$395.00

Service Code	CPT 72200
Hospital Charge Code	1008054
Hospital Revenue Code	320
Min. Negotiated Rate	$102.70
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna of AZ Commercial	$355.50
Rate for Payer: Bisbee Police All Plans	$102.70
Rate for Payer: Cash Price	$316.00
Rate for Payer: Self Pay Self Pay	$316.00

XR Sacroiliac Joints Minimum 3 Views

Facility

$464.00

Service Code	CPT 72202
Hospital Charge Code	1021658
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 Sacroiliac Joints Minimum 3 Views

Facility

$464.00

Service Code	CPT 72202
Hospital Charge Code	1021658
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 Sacrum and Coccyx

Facility

$464.00

Service Code	CPT 72220
Hospital Charge Code	1163877
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 Sacrum and Coccyx

Facility

$464.00

Service Code	CPT 72220
Hospital Charge Code	1163877
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 Scapula Left

Facility

$464.00

Service Code	CPT 73010 LT
Hospital Charge Code	823619
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 Scapula Left

Facility

$464.00

Service Code	CPT 73010 LT
Hospital Charge Code	823619
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 Scapula Right

Facility

$464.00

Service Code	CPT 73010 RT
Hospital Charge Code	823621
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 Scapula Right

Facility

$464.00

Service Code	CPT 73010 RT
Hospital Charge Code	823621
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 Sella Turcica

Facility

$352.00

Service Code	CPT 70240
Hospital Charge Code	1008063
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 Sella Turcica

Facility

$352.00

Service Code	CPT 70240
Hospital Charge Code	1008063
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 Shoulder 2 Views Left

Facility

$445.00

Service Code	CPT 73020 LT
Hospital Charge Code	1284694
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

Know your out-of-pocket cost for care.

All Charges