Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Shoulder 2 Views Left

Facility

$445.00

Service Code	CPT 73020 LT
Hospital Charge Code	1284694
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 Shoulder 2 Views Right

Facility

$445.00

Service Code	CPT 73020 RT
Hospital Charge Code	1284697
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 Shoulder 2 Views Right

Facility

$445.00

Service Code	CPT 73020 RT
Hospital Charge Code	1284697
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 Shoulder Complete Left

Facility

$555.00

Service Code	CPT 73030 LT
Hospital Charge Code	823627
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 Shoulder Complete Left

Facility

$555.00

Service Code	CPT 73030 LT
Hospital Charge Code	823627
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 Shoulder Complete Right

Facility

$555.00

Service Code	CPT 73030 RT
Hospital Charge Code	823629
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 Shoulder Complete Right

Facility

$555.00

Service Code	CPT 73030 RT
Hospital Charge Code	823629
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 Sinuses Paranasal < 3 Views

Facility

$465.00

Service Code	CPT 70210
Hospital Charge Code	1008070
Hospital Revenue Code	320
Min. Negotiated Rate	$120.90
Max. Negotiated Rate	$418.50
Rate for Payer: Aetna of AZ Commercial	$418.50
Rate for Payer: Bisbee Police All Plans	$120.90
Rate for Payer: Cash Price	$372.00
Rate for Payer: Self Pay Self Pay	$372.00

XR Sinuses Paranasal < 3 Views

Facility

$465.00

Service Code	CPT 70210
Hospital Charge Code	1008070
Hospital Revenue Code	320
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$418.50
Rate for Payer: Aetna of AZ Commercial	$418.50
Rate for Payer: Aetna of AZ Medicare	$130.20
Rate for Payer: Allwell Medicare	$74.40
Rate for Payer: Amerigroup Medicare	$74.40
Rate for Payer: APIPA Medicare/Medicaid	$173.68
Rate for Payer: AZCH Complete Medicare	$74.40
Rate for Payer: Banner UC Health Medicare	$74.40
Rate for Payer: Bisbee Police All Plans	$120.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$316.20
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cigna of AZ Commercial	$302.25
Rate for Payer: Copperpoint Commercial	$115.09
Rate for Payer: Health Net of AZ Commercial	$279.00
Rate for Payer: Health Net of AZ Medicare	$130.20
Rate for Payer: Humana of AZ Medicare	$74.40
Rate for Payer: Self Pay Self Pay	$372.00
Rate for Payer: TriWest Medicare	$74.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$271.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$83.70

XR Sinuses Paranasal Complete

Facility

$923.00

Service Code	CPT 70220
Hospital Charge Code	823631
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 Sinuses Paranasal Complete

Facility

$923.00

Service Code	CPT 70220
Hospital Charge Code	823631
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 Skull < 4 Views

Facility

$464.00

Service Code	CPT 70250
Hospital Charge Code	823633
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 Skull < 4 Views

Facility

$464.00

Service Code	CPT 70250
Hospital Charge Code	823633
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 Skull Complete

Facility

$1,108.00

Service Code	CPT 70260
Hospital Charge Code	1008072
Hospital Revenue Code	320
Min. Negotiated Rate	$288.08
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Bisbee Police All Plans	$288.08
Rate for Payer: Cash Price	$886.40
Rate for Payer: Self Pay Self Pay	$886.40

XR Skull Complete

Facility

$1,108.00

Service Code	CPT 70260
Hospital Charge Code	1008072
Hospital Revenue Code	320
Min. Negotiated Rate	$177.28
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Aetna of AZ Medicare	$310.24
Rate for Payer: Allwell Medicare	$177.28
Rate for Payer: Amerigroup Medicare	$177.28
Rate for Payer: APIPA Medicare/Medicaid	$413.84
Rate for Payer: AZCH Complete Medicare	$177.28
Rate for Payer: Banner UC Health Medicare	$177.28
Rate for Payer: Bisbee Police All Plans	$288.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$753.44
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cigna of AZ Commercial	$720.20
Rate for Payer: Copperpoint Commercial	$274.23
Rate for Payer: Health Net of AZ Commercial	$664.80
Rate for Payer: Health Net of AZ Medicare	$310.24
Rate for Payer: Humana of AZ Medicare	$177.28
Rate for Payer: Self Pay Self Pay	$886.40
Rate for Payer: TriWest Medicare	$177.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$645.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$199.44

XR Spine Cervical 2 or 3 Views

Facility

$551.00

Service Code	CPT 72040
Hospital Charge Code	823635
Hospital Revenue Code	320
Min. Negotiated Rate	$88.16
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Aetna of AZ Medicare	$154.28
Rate for Payer: Allwell Medicare	$88.16
Rate for Payer: Amerigroup Medicare	$88.16
Rate for Payer: APIPA Medicare/Medicaid	$205.80
Rate for Payer: AZCH Complete Medicare	$88.16
Rate for Payer: Banner UC Health Medicare	$88.16
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$374.68
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Copperpoint Commercial	$136.37
Rate for Payer: Health Net of AZ Commercial	$330.60
Rate for Payer: Health Net of AZ Medicare	$154.28
Rate for Payer: Humana of AZ Medicare	$88.16
Rate for Payer: Self Pay Self Pay	$440.80
Rate for Payer: TriWest Medicare	$88.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$321.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.18

XR Spine Cervical 2 or 3 Views

Facility

$551.00

Service Code	CPT 72040
Hospital Charge Code	823635
Hospital Revenue Code	320
Min. Negotiated Rate	$143.26
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Cash Price	$440.80
Rate for Payer: Self Pay Self Pay	$440.80

XR Spine Cervical 4 or 5 Views

Facility

$1,108.00

Service Code	CPT 72050
Hospital Charge Code	4694460
Hospital Revenue Code	320
Min. Negotiated Rate	$177.28
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Aetna of AZ Medicare	$310.24
Rate for Payer: Allwell Medicare	$177.28
Rate for Payer: Amerigroup Medicare	$177.28
Rate for Payer: APIPA Medicare/Medicaid	$413.84
Rate for Payer: AZCH Complete Medicare	$177.28
Rate for Payer: Banner UC Health Medicare	$177.28
Rate for Payer: Bisbee Police All Plans	$288.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$753.44
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cigna of AZ Commercial	$720.20
Rate for Payer: Copperpoint Commercial	$274.23
Rate for Payer: Health Net of AZ Commercial	$664.80
Rate for Payer: Health Net of AZ Medicare	$310.24
Rate for Payer: Humana of AZ Medicare	$177.28
Rate for Payer: Self Pay Self Pay	$886.40
Rate for Payer: TriWest Medicare	$177.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$645.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$199.44

XR Spine Cervical 4 or 5 Views

Facility

$1,108.00

Service Code	CPT 72050
Hospital Charge Code	4694460
Hospital Revenue Code	320
Min. Negotiated Rate	$288.08
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Bisbee Police All Plans	$288.08
Rate for Payer: Cash Price	$886.40
Rate for Payer: Self Pay Self Pay	$886.40

XR Spine Cervical Comp w/ Flex/Ext

Facility

$843.00

Service Code	CPT 72052
Hospital Charge Code	1008084
Hospital Revenue Code	320
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$758.70
Rate for Payer: Aetna of AZ Commercial	$758.70
Rate for Payer: Bisbee Police All Plans	$219.18
Rate for Payer: Cash Price	$674.40
Rate for Payer: Self Pay Self Pay	$674.40

XR Spine Cervical Comp w/ Flex/Ext

Facility

$843.00

Service Code	CPT 72052
Hospital Charge Code	1008084
Hospital Revenue Code	320
Min. Negotiated Rate	$134.88
Max. Negotiated Rate	$758.70
Rate for Payer: Aetna of AZ Commercial	$758.70
Rate for Payer: Aetna of AZ Medicare	$236.04
Rate for Payer: Allwell Medicare	$134.88
Rate for Payer: Amerigroup Medicare	$134.88
Rate for Payer: APIPA Medicare/Medicaid	$314.86
Rate for Payer: AZCH Complete Medicare	$134.88
Rate for Payer: Banner UC Health Medicare	$134.88
Rate for Payer: Bisbee Police All Plans	$219.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$573.24
Rate for Payer: Cash Price	$674.40
Rate for Payer: Cigna of AZ Commercial	$547.95
Rate for Payer: Copperpoint Commercial	$208.64
Rate for Payer: Health Net of AZ Commercial	$505.80
Rate for Payer: Health Net of AZ Medicare	$236.04
Rate for Payer: Humana of AZ Medicare	$134.88
Rate for Payer: Self Pay Self Pay	$674.40
Rate for Payer: TriWest Medicare	$134.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$491.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$151.74

XR Spine Entire 1 View

Facility

$743.00

Service Code	CPT 72081
Hospital Charge Code	22200642
Hospital Revenue Code	320
Min. Negotiated Rate	$118.88
Max. Negotiated Rate	$668.70
Rate for Payer: Aetna of AZ Commercial	$668.70
Rate for Payer: Aetna of AZ Medicare	$208.04
Rate for Payer: Allwell Medicare	$118.88
Rate for Payer: Amerigroup Medicare	$118.88
Rate for Payer: APIPA Medicare/Medicaid	$277.51
Rate for Payer: AZCH Complete Medicare	$118.88
Rate for Payer: Banner UC Health Medicare	$118.88
Rate for Payer: Bisbee Police All Plans	$193.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$505.24
Rate for Payer: Cash Price	$594.40
Rate for Payer: Cigna of AZ Commercial	$482.95
Rate for Payer: Copperpoint Commercial	$183.89
Rate for Payer: Health Net of AZ Commercial	$445.80
Rate for Payer: Health Net of AZ Medicare	$208.04
Rate for Payer: Humana of AZ Medicare	$118.88
Rate for Payer: Self Pay Self Pay	$594.40
Rate for Payer: TriWest Medicare	$118.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$433.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$133.74

XR Spine Entire 1 View

Facility

$743.00

Service Code	CPT 72081
Hospital Charge Code	22200642
Hospital Revenue Code	320
Min. Negotiated Rate	$193.18
Max. Negotiated Rate	$668.70
Rate for Payer: Aetna of AZ Commercial	$668.70
Rate for Payer: Bisbee Police All Plans	$193.18
Rate for Payer: Cash Price	$594.40
Rate for Payer: Self Pay Self Pay	$594.40

XR Spine Lumbosacral 2 or 3 Views

Facility

$918.00

Service Code	CPT 72100
Hospital Charge Code	823641
Hospital Revenue Code	320
Min. Negotiated Rate	$238.68
Max. Negotiated Rate	$826.20
Rate for Payer: Aetna of AZ Commercial	$826.20
Rate for Payer: Bisbee Police All Plans	$238.68
Rate for Payer: Cash Price	$734.40
Rate for Payer: Self Pay Self Pay	$734.40

XR Spine Lumbosacral 2 or 3 Views

Facility

$918.00

Service Code	CPT 72100
Hospital Charge Code	823641
Hospital Revenue Code	320
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$826.20
Rate for Payer: Aetna of AZ Commercial	$826.20
Rate for Payer: Aetna of AZ Medicare	$257.04
Rate for Payer: Allwell Medicare	$146.88
Rate for Payer: Amerigroup Medicare	$146.88
Rate for Payer: APIPA Medicare/Medicaid	$342.87
Rate for Payer: AZCH Complete Medicare	$146.88
Rate for Payer: Banner UC Health Medicare	$146.88
Rate for Payer: Bisbee Police All Plans	$238.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$624.24
Rate for Payer: Cash Price	$734.40
Rate for Payer: Cigna of AZ Commercial	$596.70
Rate for Payer: Copperpoint Commercial	$227.21
Rate for Payer: Health Net of AZ Commercial	$550.80
Rate for Payer: Health Net of AZ Medicare	$257.04
Rate for Payer: Humana of AZ Medicare	$146.88
Rate for Payer: Self Pay Self Pay	$734.40
Rate for Payer: TriWest Medicare	$146.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$535.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$165.24

Know your out-of-pocket cost for care.

All Charges