Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Abdomen 1 View w/Decub

Facility

$445.00

Service Code	CPT 74018
Hospital Charge Code	11849879
Hospital Revenue Code	320
Min. Negotiated Rate	$400.50
Max. Negotiated Rate	$400.50
Rate for Payer: Aetna of AZ Commercial	$400.50
Rate for Payer: Cash Price	$356.00

XR Abdomen 2 Views

Facility

$405.00

Service Code	CPT 74019
Hospital Charge Code	823486
Hospital Revenue Code	320
Min. Negotiated Rate	$364.50
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of AZ Commercial	$364.50
Rate for Payer: Cash Price	$324.00

XR Abdomen 2 Views

Facility

$405.00

Service Code	CPT 74019
Hospital Charge Code	823486
Hospital Revenue Code	320
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna of AZ Commercial	$364.50
Rate for Payer: Arizona Complete Health Allwell	$64.80
Rate for Payer: Banner UC Health Medicare	$64.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$275.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$64.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.76
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cigna of AZ Commercial	$263.25
Rate for Payer: Devoted Health Medicare	$72.90
Rate for Payer: Humana of AZ Medicare	$64.80
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$275.40
Rate for Payer: TriWest Medicare	$64.80
Rate for Payer: United Healthcare Commercial	$231.66
Rate for Payer: United Healthcare Medicare	$64.80
Rate for Payer: Veterans Affairs TRICARE	$64.15

XR Abdomen Acute 3 Views/Chest 1 View

Facility

$923.00

Service Code	CPT 74022
Hospital Charge Code	2214245
Hospital Revenue Code	320
Min. Negotiated Rate	$47.31
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna of AZ Commercial	$830.70
Rate for Payer: Arizona Complete Health Allwell	$147.68
Rate for Payer: Banner UC Health Medicare	$147.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$627.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$147.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.31
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cigna of AZ Commercial	$599.95
Rate for Payer: Devoted Health Medicare	$166.14
Rate for Payer: Humana of AZ Medicare	$147.68
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$627.64
Rate for Payer: TriWest Medicare	$147.68
Rate for Payer: United Healthcare Commercial	$527.96
Rate for Payer: United Healthcare Medicare	$147.68
Rate for Payer: Veterans Affairs TRICARE	$146.20

XR Abdomen Acute 3 Views/Chest 1 View

Facility

$923.00

Service Code	CPT 74022
Hospital Charge Code	2214245
Hospital Revenue Code	320
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna of AZ Commercial	$830.70
Rate for Payer: Cash Price	$738.40

XR AC Joints Bilateral

Facility

$464.00

Service Code	CPT 73050 50
Hospital Charge Code	1163782
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR AC Joints Bilateral

Facility

$464.00

Service Code	CPT 73050 50
Hospital Charge Code	1163782
Hospital Revenue Code	320
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.36
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Ankle 2 Views Left

Facility

$464.00

Service Code	CPT 73600 LT
Hospital Charge Code	1007853
Hospital Revenue Code	320
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.57
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Ankle 2 Views Left

Facility

$464.00

Service Code	CPT 73600 LT
Hospital Charge Code	1007853
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Ankle 2 Views Right

Facility

$464.00

Service Code	CPT 73600 RT
Hospital Charge Code	1007855
Hospital Revenue Code	320
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.57
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

XR Ankle 2 Views Right

Facility

$464.00

Service Code	CPT 73600 RT
Hospital Charge Code	1007855
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Ankle Complete Left

Facility

$462.00

Service Code	CPT 73610 LT
Hospital Charge Code	823492
Hospital Revenue Code	320
Min. Negotiated Rate	$415.80
Max. Negotiated Rate	$415.80
Rate for Payer: Aetna of AZ Commercial	$415.80
Rate for Payer: Cash Price	$369.60

XR Ankle Complete Left

Facility

$462.00

Service Code	CPT 73610 LT
Hospital Charge Code	823492
Hospital Revenue Code	320
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$415.80
Rate for Payer: Aetna of AZ Commercial	$415.80
Rate for Payer: Arizona Complete Health Allwell	$73.92
Rate for Payer: Banner UC Health Medicare	$73.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$314.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$73.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.44
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cigna of AZ Commercial	$300.30
Rate for Payer: Devoted Health Medicare	$83.16
Rate for Payer: Humana of AZ Medicare	$73.92
Rate for Payer: Southwest Service Administrators UFCW	$314.16
Rate for Payer: TriWest Medicare	$73.92
Rate for Payer: United Healthcare Commercial	$264.26
Rate for Payer: United Healthcare Medicare	$73.92
Rate for Payer: Veterans Affairs TRICARE	$73.18

XR Ankle Complete Right

Facility

$460.00

Service Code	CPT 73610 RT
Hospital Charge Code	823494
Hospital Revenue Code	320
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna of AZ Commercial	$414.00
Rate for Payer: Arizona Complete Health Allwell	$73.60
Rate for Payer: Banner UC Health Medicare	$73.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$312.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$73.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.44
Rate for Payer: Cash Price	$368.00
Rate for Payer: Cash Price	$368.00
Rate for Payer: Cigna of AZ Commercial	$299.00
Rate for Payer: Devoted Health Medicare	$82.80
Rate for Payer: Humana of AZ Medicare	$73.60
Rate for Payer: Southwest Service Administrators UFCW	$312.80
Rate for Payer: TriWest Medicare	$73.60
Rate for Payer: United Healthcare Commercial	$263.12
Rate for Payer: United Healthcare Medicare	$73.60
Rate for Payer: Veterans Affairs TRICARE	$72.86

XR Ankle Complete Right

Facility

$460.00

Service Code	CPT 73610 RT
Hospital Charge Code	823494
Hospital Revenue Code	320
Min. Negotiated Rate	$414.00
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna of AZ Commercial	$414.00
Rate for Payer: Cash Price	$368.00

XR Bone Age Studies

Facility

$555.00

Service Code	CPT 77072
Hospital Charge Code	1007877
Hospital Revenue Code	320
Min. Negotiated Rate	$499.50
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Cash Price	$444.00

XR Bone Age Studies

Facility

$555.00

Service Code	CPT 77072
Hospital Charge Code	1007877
Hospital Revenue Code	320
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$499.50
Rate for Payer: Aetna of AZ Commercial	$499.50
Rate for Payer: Arizona Complete Health Allwell	$88.80
Rate for Payer: Banner UC Health Medicare	$88.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$377.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$88.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.58
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cigna of AZ Commercial	$360.75
Rate for Payer: Devoted Health Medicare	$99.90
Rate for Payer: Humana of AZ Medicare	$88.80
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$377.40
Rate for Payer: TriWest Medicare	$88.80
Rate for Payer: United Healthcare Commercial	$317.46
Rate for Payer: United Healthcare Medicare	$88.80
Rate for Payer: Veterans Affairs TRICARE	$87.91

XR Bone Length Studies/Ort

Facility

$680.00

Service Code	CPT 77073
Hospital Charge Code	1007881
Hospital Revenue Code	320
Min. Negotiated Rate	$43.02
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Arizona Complete Health Allwell	$108.80
Rate for Payer: Banner UC Health Medicare	$108.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$462.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$43.02
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$442.00
Rate for Payer: Devoted Health Medicare	$122.40
Rate for Payer: Humana of AZ Medicare	$108.80
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$462.40
Rate for Payer: TriWest Medicare	$108.80
Rate for Payer: United Healthcare Commercial	$388.96
Rate for Payer: United Healthcare Medicare	$108.80
Rate for Payer: Veterans Affairs TRICARE	$107.71

XR Bone Length Studies/Ort

Facility

$680.00

Service Code	CPT 77073
Hospital Charge Code	1007881
Hospital Revenue Code	320
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Cash Price	$544.00

XR Bone Survey Complete

Facility

$1,474.00

Service Code	CPT 77075
Hospital Charge Code	1319957
Hospital Revenue Code	320
Min. Negotiated Rate	$90.82
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Arizona Complete Health Allwell	$235.84
Rate for Payer: Banner UC Health Medicare	$235.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,002.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$235.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$90.82
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cash Price	$1,179.20
Rate for Payer: Cigna of AZ Commercial	$958.10
Rate for Payer: Devoted Health Medicare	$265.32
Rate for Payer: Humana of AZ Medicare	$235.84
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$1,002.32
Rate for Payer: TriWest Medicare	$235.84
Rate for Payer: United Healthcare Commercial	$843.13
Rate for Payer: United Healthcare Medicare	$235.84
Rate for Payer: Veterans Affairs TRICARE	$233.48

XR Bone Survey Complete

Facility

$1,474.00

Service Code	CPT 77075
Hospital Charge Code	1319957
Hospital Revenue Code	320
Min. Negotiated Rate	$1,326.60
Max. Negotiated Rate	$1,326.60
Rate for Payer: Aetna of AZ Commercial	$1,326.60
Rate for Payer: Cash Price	$1,179.20

XR Bone Survey Limited

Facility

$876.00

Service Code	CPT 77074
Hospital Charge Code	1319960
Hospital Revenue Code	320
Min. Negotiated Rate	$788.40
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Cash Price	$700.80

XR Bone Survey Limited

Facility

$876.00

Service Code	CPT 77074
Hospital Charge Code	1319960
Hospital Revenue Code	320
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Arizona Complete Health Allwell	$140.16
Rate for Payer: Banner UC Health Medicare	$140.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$595.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$140.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.23
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cigna of AZ Commercial	$569.40
Rate for Payer: Devoted Health Medicare	$157.68
Rate for Payer: Humana of AZ Medicare	$140.16
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$595.68
Rate for Payer: TriWest Medicare	$140.16
Rate for Payer: United Healthcare Commercial	$501.07
Rate for Payer: United Healthcare Medicare	$140.16
Rate for Payer: Veterans Affairs TRICARE	$138.76

XR Calcaneous Left

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823496
Hospital Revenue Code	320
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Cash Price	$371.20

XR Calcaneous Left

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823496
Hospital Revenue Code	320
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$417.60
Rate for Payer: Aetna of AZ Commercial	$417.60
Rate for Payer: Arizona Complete Health Allwell	$74.24
Rate for Payer: Banner UC Health Medicare	$74.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$315.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$74.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.04
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cigna of AZ Commercial	$301.60
Rate for Payer: Devoted Health Medicare	$83.52
Rate for Payer: Humana of AZ Medicare	$74.24
Rate for Payer: Seven Corners Travel Insurance	$134.65
Rate for Payer: Southwest Service Administrators UFCW	$315.52
Rate for Payer: TriWest Medicare	$74.24
Rate for Payer: United Healthcare Commercial	$265.41
Rate for Payer: United Healthcare Medicare	$74.24
Rate for Payer: Veterans Affairs TRICARE	$73.50

Know your out-of-pocket cost for care.

All Charges