Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Finger 2nd Digit Left

Facility

$494.00

Service Code	CPT 73140 F1
Hospital Charge Code	823532
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 2nd Digit Left

Facility

$494.00

Service Code	CPT 73140 F1
Hospital Charge Code	823532
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 2nd Digit Right

Facility

$494.00

Service Code	CPT 73140 F6
Hospital Charge Code	823534
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 2nd Digit Right

Facility

$494.00

Service Code	CPT 73140 F6
Hospital Charge Code	823534
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 3rd Digit Left

Facility

$494.00

Service Code	CPT 73140 F2
Hospital Charge Code	823536
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 3rd Digit Left

Facility

$494.00

Service Code	CPT 73140 F2
Hospital Charge Code	823536
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 3rd Digit Right

Facility

$494.00

Service Code	CPT 73140 F7
Hospital Charge Code	823538
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 3rd Digit Right

Facility

$494.00

Service Code	CPT 73140 F7
Hospital Charge Code	823538
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 4th Digit Left

Facility

$494.00

Service Code	CPT 73140 F3
Hospital Charge Code	823540
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 4th Digit Left

Facility

$494.00

Service Code	CPT 73140 F3
Hospital Charge Code	823540
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 4th Digit Right

Facility

$494.00

Service Code	CPT 73140 F8
Hospital Charge Code	823542
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 4th Digit Right

Facility

$494.00

Service Code	CPT 73140 F8
Hospital Charge Code	823542
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 5th Digit Left

Facility

$494.00

Service Code	CPT 73140 F4
Hospital Charge Code	823544
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger 5th Digit Left

Facility

$494.00

Service Code	CPT 73140 F4
Hospital Charge Code	823544
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 5th Digit Right

Facility

$494.00

Service Code	CPT 73140 F9
Hospital Charge Code	823546
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger 5th Digit Right

Facility

$494.00

Service Code	CPT 73140 F9
Hospital Charge Code	823546
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger Thumb Left

Facility

$494.00

Service Code	CPT 73140 FA
Hospital Charge Code	823548
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger Thumb Left

Facility

$494.00

Service Code	CPT 73140 FA
Hospital Charge Code	823548
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Finger Thumb Right

Facility

$494.00

Service Code	CPT 73140 F5
Hospital Charge Code	823550
Hospital Revenue Code	320
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Arizona Complete Health Allwell	$79.04
Rate for Payer: Banner UC Health Medicare	$79.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$335.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$79.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.05
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cigna of AZ Commercial	$321.10
Rate for Payer: Devoted Health Medicare	$88.92
Rate for Payer: Humana of AZ Medicare	$79.04
Rate for Payer: Southwest Service Administrators UFCW	$335.92
Rate for Payer: TriWest Medicare	$79.04
Rate for Payer: United Healthcare Commercial	$282.57
Rate for Payer: United Healthcare Medicare	$79.04
Rate for Payer: Veterans Affairs TRICARE	$78.25

XR Finger Thumb Right

Facility

$494.00

Service Code	CPT 73140 F5
Hospital Charge Code	823550
Hospital Revenue Code	320
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Aetna of AZ Commercial	$444.60
Rate for Payer: Cash Price	$395.20

XR Fistula or Sinus Tract Abscess Study

Facility

$863.00

Service Code	CPT 76080
Hospital Charge Code	1007948
Hospital Revenue Code	320
Min. Negotiated Rate	$776.70
Max. Negotiated Rate	$776.70
Rate for Payer: Aetna of AZ Commercial	$776.70
Rate for Payer: Cash Price	$690.40

XR Fistula or Sinus Tract Abscess Study

Facility

$863.00

Service Code	CPT 76080
Hospital Charge Code	1007948
Hospital Revenue Code	320
Min. Negotiated Rate	$54.81
Max. Negotiated Rate	$845.45
Rate for Payer: Aetna of AZ Commercial	$776.70
Rate for Payer: Arizona Complete Health Allwell	$138.08
Rate for Payer: Banner UC Health Medicare	$138.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$586.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$138.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$54.81
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cigna of AZ Commercial	$560.95
Rate for Payer: Devoted Health Medicare	$155.34
Rate for Payer: Humana of AZ Medicare	$138.08
Rate for Payer: Seven Corners Travel Insurance	$845.45
Rate for Payer: Southwest Service Administrators UFCW	$586.84
Rate for Payer: TriWest Medicare	$138.08
Rate for Payer: United Healthcare Commercial	$493.64
Rate for Payer: United Healthcare Medicare	$138.08
Rate for Payer: Veterans Affairs TRICARE	$136.70

XR Fluoroscopy Up to 1 Hour

Facility

$646.00

Service Code	CPT 76000
Hospital Charge Code	823552
Hospital Revenue Code	320
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$581.40
Rate for Payer: Aetna of AZ Commercial	$581.40
Rate for Payer: Cash Price	$516.80

XR Fluoroscopy Up to 1 Hour

Facility

$646.00

Service Code	CPT 76000
Hospital Charge Code	823552
Hospital Revenue Code	320
Min. Negotiated Rate	$40.79
Max. Negotiated Rate	$581.40
Rate for Payer: Aetna of AZ Commercial	$581.40
Rate for Payer: Arizona Complete Health Allwell	$103.36
Rate for Payer: Banner UC Health Medicare	$103.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$439.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$103.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.79
Rate for Payer: Cash Price	$516.80
Rate for Payer: Cash Price	$516.80
Rate for Payer: Cigna of AZ Commercial	$419.90
Rate for Payer: Devoted Health Medicare	$116.28
Rate for Payer: Humana of AZ Medicare	$103.36
Rate for Payer: Seven Corners Travel Insurance	$369.18
Rate for Payer: Southwest Service Administrators UFCW	$439.28
Rate for Payer: TriWest Medicare	$103.36
Rate for Payer: United Healthcare Commercial	$369.51
Rate for Payer: United Healthcare Medicare	$103.36
Rate for Payer: Veterans Affairs TRICARE	$102.33

XR Foot 2 Views Left

Facility

$464.00

Service Code	CPT 73620 LT
Hospital Charge Code	823554
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: 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