Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Calcaneous Right

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823498
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

XR Calcaneous Right

Facility

$464.00

Service Code	CPT 73650
Hospital Charge Code	823498
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 Calcaneus Left

Facility

$488.00

Service Code	CPT 73650 LT
Hospital Charge Code	22147265
Hospital Revenue Code	320
Min. Negotiated Rate	$439.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Cash Price	$390.40

XR Calcaneus Left

Facility

$488.00

Service Code	CPT 73650 LT
Hospital Charge Code	22147265
Hospital Revenue Code	320
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Arizona Complete Health Allwell	$78.08
Rate for Payer: Banner UC Health Medicare	$78.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$331.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$78.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.04
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Devoted Health Medicare	$87.84
Rate for Payer: Humana of AZ Medicare	$78.08
Rate for Payer: Southwest Service Administrators UFCW	$331.84
Rate for Payer: TriWest Medicare	$78.08
Rate for Payer: United Healthcare Commercial	$279.14
Rate for Payer: United Healthcare Medicare	$78.08
Rate for Payer: Veterans Affairs TRICARE	$77.30

XR Calcaneus Right

Facility

$488.00

Service Code	CPT 73650 RT
Hospital Charge Code	22147268
Hospital Revenue Code	320
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Arizona Complete Health Allwell	$78.08
Rate for Payer: Banner UC Health Medicare	$78.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$331.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$78.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.04
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Devoted Health Medicare	$87.84
Rate for Payer: Humana of AZ Medicare	$78.08
Rate for Payer: Southwest Service Administrators UFCW	$331.84
Rate for Payer: TriWest Medicare	$78.08
Rate for Payer: United Healthcare Commercial	$279.14
Rate for Payer: United Healthcare Medicare	$78.08
Rate for Payer: Veterans Affairs TRICARE	$77.30

XR Calcaneus Right

Facility

$488.00

Service Code	CPT 73650 RT
Hospital Charge Code	22147268
Hospital Revenue Code	320
Min. Negotiated Rate	$439.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Cash Price	$390.40

XR Chest 1 View

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	823510
Hospital Revenue Code	324
Min. Negotiated Rate	$300.60
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Cash Price	$267.20

XR Chest 1 View

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	823510
Hospital Revenue Code	324
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Arizona Complete Health Allwell	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$227.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.14
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Devoted Health Medicare	$60.12
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Seven Corners Travel Insurance	$134.65
Rate for Payer: Southwest Service Administrators UFCW	$227.12
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: United Healthcare Commercial	$191.05
Rate for Payer: United Healthcare Medicare	$53.44
Rate for Payer: Veterans Affairs TRICARE	$52.91

XR Chest 1 View Special

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	3642285
Hospital Revenue Code	324
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Arizona Complete Health Allwell	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$227.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.14
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Devoted Health Medicare	$60.12
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Seven Corners Travel Insurance	$134.65
Rate for Payer: Southwest Service Administrators UFCW	$227.12
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: United Healthcare Commercial	$191.05
Rate for Payer: United Healthcare Medicare	$53.44
Rate for Payer: Veterans Affairs TRICARE	$52.91

XR Chest 1 View Special

Facility

$334.00

Service Code	CPT 71045
Hospital Charge Code	3642285
Hospital Revenue Code	324
Min. Negotiated Rate	$300.60
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Cash Price	$267.20

XR Chest 2 Views

Facility

$454.00

Service Code	CPT 71046
Hospital Charge Code	823512
Hospital Revenue Code	324
Min. Negotiated Rate	$408.60
Max. Negotiated Rate	$408.60
Rate for Payer: Aetna of AZ Commercial	$408.60
Rate for Payer: Cash Price	$363.20

XR Chest 2 Views

Facility

$454.00

Service Code	CPT 71046
Hospital Charge Code	823512
Hospital Revenue Code	324
Min. Negotiated Rate	$31.86
Max. Negotiated Rate	$408.60
Rate for Payer: Aetna of AZ Commercial	$408.60
Rate for Payer: Arizona Complete Health Allwell	$72.64
Rate for Payer: Banner UC Health Medicare	$72.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$308.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$72.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.86
Rate for Payer: Cash Price	$363.20
Rate for Payer: Cash Price	$363.20
Rate for Payer: Cigna of AZ Commercial	$295.10
Rate for Payer: Devoted Health Medicare	$81.72
Rate for Payer: Humana of AZ Medicare	$72.64
Rate for Payer: Seven Corners Travel Insurance	$134.65
Rate for Payer: Southwest Service Administrators UFCW	$308.72
Rate for Payer: TriWest Medicare	$72.64
Rate for Payer: United Healthcare Commercial	$259.69
Rate for Payer: United Healthcare Medicare	$72.64
Rate for Payer: Veterans Affairs TRICARE	$71.91

XR Chest 4 Views w/ Obliques

Facility

$1,108.00

Service Code	CPT 71048
Hospital Charge Code	1780010
Hospital Revenue Code	324
Min. Negotiated Rate	$43.13
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Arizona Complete Health Allwell	$177.28
Rate for Payer: Banner UC Health Medicare	$177.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$753.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$177.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$43.13
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cigna of AZ Commercial	$720.20
Rate for Payer: Devoted Health Medicare	$199.44
Rate for Payer: Humana of AZ Medicare	$177.28
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$753.44
Rate for Payer: TriWest Medicare	$177.28
Rate for Payer: United Healthcare Commercial	$633.78
Rate for Payer: United Healthcare Medicare	$177.28
Rate for Payer: Veterans Affairs TRICARE	$175.51

XR Chest 4 Views w/ Obliques

Facility

$1,108.00

Service Code	CPT 71048
Hospital Charge Code	1780010
Hospital Revenue Code	324
Min. Negotiated Rate	$997.20
Max. Negotiated Rate	$997.20
Rate for Payer: Aetna of AZ Commercial	$997.20
Rate for Payer: Cash Price	$886.40

XR Child Nose-Rectum For FB

Facility

$352.00

Service Code	CPT 76010
Hospital Charge Code	1007907
Hospital Revenue Code	320
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Cash Price	$281.60

XR Child Nose-Rectum For FB

Facility

$352.00

Service Code	CPT 76010
Hospital Charge Code	1007907
Hospital Revenue Code	320
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Arizona Complete Health Allwell	$56.32
Rate for Payer: Banner UC Health Medicare	$56.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$239.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$56.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.77
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cigna of AZ Commercial	$228.80
Rate for Payer: Devoted Health Medicare	$63.36
Rate for Payer: Humana of AZ Medicare	$56.32
Rate for Payer: Seven Corners Travel Insurance	$134.65
Rate for Payer: Southwest Service Administrators UFCW	$239.36
Rate for Payer: TriWest Medicare	$56.32
Rate for Payer: United Healthcare Commercial	$201.34
Rate for Payer: United Healthcare Medicare	$56.32
Rate for Payer: Veterans Affairs TRICARE	$55.76

XR Cholangiogram in OR

Facility

$1,262.00

Service Code	CPT 74300
Hospital Charge Code	1021642
Hospital Revenue Code	320
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$1,135.80
Rate for Payer: Aetna of AZ Commercial	$1,135.80
Rate for Payer: Arizona Complete Health Allwell	$201.92
Rate for Payer: Banner UC Health Medicare	$201.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$858.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$201.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.50
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Cigna of AZ Commercial	$820.30
Rate for Payer: Devoted Health Medicare	$227.16
Rate for Payer: Humana of AZ Medicare	$201.92
Rate for Payer: Southwest Service Administrators UFCW	$858.16
Rate for Payer: TriWest Medicare	$201.92
Rate for Payer: United Healthcare Commercial	$721.86
Rate for Payer: United Healthcare Medicare	$201.92
Rate for Payer: Veterans Affairs TRICARE	$199.90

XR Cholangiogram in OR

Facility

$1,262.00

Service Code	CPT 74300
Hospital Charge Code	1021642
Hospital Revenue Code	320
Min. Negotiated Rate	$1,135.80
Max. Negotiated Rate	$1,135.80
Rate for Payer: Aetna of AZ Commercial	$1,135.80
Rate for Payer: Cash Price	$1,009.60

XR Cholangiogram OR w/ Existing Catheter

Facility

$700.00

Service Code	CPT 74305
Hospital Charge Code	1735705
Hospital Revenue Code	320
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Arizona Complete Health Allwell	$112.00
Rate for Payer: Banner UC Health Medicare	$112.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$476.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$112.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$112.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cigna of AZ Commercial	$455.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Humana of AZ Medicare	$112.00
Rate for Payer: Southwest Service Administrators UFCW	$476.00
Rate for Payer: TriWest Medicare	$112.00
Rate for Payer: United Healthcare Commercial	$400.40
Rate for Payer: United Healthcare Medicare	$112.00
Rate for Payer: Veterans Affairs TRICARE	$110.88

XR Cholangiogram OR w/ Existing Catheter

Facility

$700.00

Service Code	CPT 74305
Hospital Charge Code	1735705
Hospital Revenue Code	320
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Cash Price	$560.00

XR Clavicle Left

Facility

$482.00

Service Code	CPT 73000 LT
Hospital Charge Code	823516
Hospital Revenue Code	320
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Arizona Complete Health Allwell	$77.12
Rate for Payer: Banner UC Health Medicare	$77.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$327.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.90
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$313.30
Rate for Payer: Devoted Health Medicare	$86.76
Rate for Payer: Humana of AZ Medicare	$77.12
Rate for Payer: Southwest Service Administrators UFCW	$327.76
Rate for Payer: TriWest Medicare	$77.12
Rate for Payer: United Healthcare Commercial	$275.70
Rate for Payer: United Healthcare Medicare	$77.12
Rate for Payer: Veterans Affairs TRICARE	$76.35

XR Clavicle Left

Facility

$482.00

Service Code	CPT 73000 LT
Hospital Charge Code	823516
Hospital Revenue Code	320
Min. Negotiated Rate	$433.80
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Cash Price	$385.60

XR Clavicle Right

Facility

$482.00

Service Code	CPT 73000 RT
Hospital Charge Code	823518
Hospital Revenue Code	320
Min. Negotiated Rate	$433.80
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Cash Price	$385.60

XR Clavicle Right

Facility

$482.00

Service Code	CPT 73000 RT
Hospital Charge Code	823518
Hospital Revenue Code	320
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Arizona Complete Health Allwell	$77.12
Rate for Payer: Banner UC Health Medicare	$77.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$327.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.90
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$313.30
Rate for Payer: Devoted Health Medicare	$86.76
Rate for Payer: Humana of AZ Medicare	$77.12
Rate for Payer: Southwest Service Administrators UFCW	$327.76
Rate for Payer: TriWest Medicare	$77.12
Rate for Payer: United Healthcare Commercial	$275.70
Rate for Payer: United Healthcare Medicare	$77.12
Rate for Payer: Veterans Affairs TRICARE	$76.35

XR Cystogram Non Voiding

Facility

$285.00

Service Code	CPT 74430
Hospital Charge Code	1319963
Hospital Revenue Code	320
Min. Negotiated Rate	$38.88
Max. Negotiated Rate	$539.81
Rate for Payer: Aetna of AZ Commercial	$256.50
Rate for Payer: Arizona Complete Health Allwell	$45.60
Rate for Payer: Banner UC Health Medicare	$45.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$193.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.88
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cigna of AZ Commercial	$185.25
Rate for Payer: Devoted Health Medicare	$51.30
Rate for Payer: Humana of AZ Medicare	$45.60
Rate for Payer: Seven Corners Travel Insurance	$539.81
Rate for Payer: Southwest Service Administrators UFCW	$193.80
Rate for Payer: TriWest Medicare	$45.60
Rate for Payer: United Healthcare Commercial	$163.02
Rate for Payer: United Healthcare Medicare	$45.60
Rate for Payer: Veterans Affairs TRICARE	$45.14

Know your out-of-pocket cost for care.

All Charges