Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Foot 2 Views Left

Facility

$464.00

Service Code	CPT 73620 LT
Hospital Charge Code	823554
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 Foot 2 Views Right

Facility

$464.00

Service Code	CPT 73620 RT
Hospital Charge Code	823556
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

XR Foot 2 Views Right

Facility

$464.00

Service Code	CPT 73620 RT
Hospital Charge Code	823556
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 Foot Complete Left

Facility

$464.00

Service Code	CPT 73630 LT
Hospital Charge Code	823558
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 Foot Complete Left

Facility

$464.00

Service Code	CPT 73630 LT
Hospital Charge Code	823558
Hospital Revenue Code	320
Min. Negotiated Rate	$32.51
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	$32.51
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 Foot Complete Right

Facility

$462.00

Service Code	CPT 73630 RT
Hospital Charge Code	823560
Hospital Revenue Code	320
Min. Negotiated Rate	$32.51
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	$32.51
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 Foot Complete Right

Facility

$462.00

Service Code	CPT 73630 RT
Hospital Charge Code	823560
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 Forearm 2 Views Left

Facility

$464.00

Service Code	CPT 73090 LT
Hospital Charge Code	823562
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 Forearm 2 Views Left

Facility

$464.00

Service Code	CPT 73090 LT
Hospital Charge Code	823562
Hospital Revenue Code	320
Min. Negotiated Rate	$27.68
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	$27.68
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 Forearm 2 Views Right

Facility

$464.00

Service Code	CPT 73090 RT
Hospital Charge Code	823564
Hospital Revenue Code	320
Min. Negotiated Rate	$27.68
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	$27.68
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 Forearm 2 Views Right

Facility

$464.00

Service Code	CPT 73090 RT
Hospital Charge Code	823564
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 Hand 2 Views Left

Facility

$464.00

Service Code	CPT 73120 LT
Hospital Charge Code	823568
Hospital Revenue Code	320
Min. Negotiated Rate	$29.93
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	$29.93
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 Hand 2 Views Left

Facility

$464.00

Service Code	CPT 73120 LT
Hospital Charge Code	823568
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 Hand 2 Views Right

Facility

$464.00

Service Code	CPT 73120 RT
Hospital Charge Code	823570
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 Hand 2 Views Right

Facility

$464.00

Service Code	CPT 73120 RT
Hospital Charge Code	823570
Hospital Revenue Code	320
Min. Negotiated Rate	$29.93
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	$29.93
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 Hand Complete Left

Facility

$464.00

Service Code	CPT 73130 LT
Hospital Charge Code	823572
Hospital Revenue Code	320
Min. Negotiated Rate	$35.08
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	$35.08
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 Hand Complete Left

Facility

$464.00

Service Code	CPT 73130 LT
Hospital Charge Code	823572
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 Hand Complete Right

Facility

$462.00

Service Code	CPT 73130 RT
Hospital Charge Code	823574
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 Hand Complete Right

Facility

$462.00

Service Code	CPT 73130 RT
Hospital Charge Code	823574
Hospital Revenue Code	320
Min. Negotiated Rate	$35.08
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	$35.08
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 Hip 1 View Lt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 LT
Hospital Charge Code	22200615
Hospital Revenue Code	320
Min. Negotiated Rate	$31.22
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Arizona Complete Health Allwell	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$257.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.22
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$246.35
Rate for Payer: Devoted Health Medicare	$68.22
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Southwest Service Administrators UFCW	$257.72
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: United Healthcare Commercial	$216.79
Rate for Payer: United Healthcare Medicare	$60.64
Rate for Payer: Veterans Affairs TRICARE	$60.03

XR Hip 1 View Lt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 LT
Hospital Charge Code	22200615
Hospital Revenue Code	320
Min. Negotiated Rate	$341.10
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Cash Price	$303.20

XR Hip 1 View Rt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 RT
Hospital Charge Code	22200618
Hospital Revenue Code	320
Min. Negotiated Rate	$341.10
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Cash Price	$303.20

XR Hip 1 View Rt w/ Pelvis

Facility

$379.00

Service Code	CPT 73501 RT
Hospital Charge Code	22200618
Hospital Revenue Code	320
Min. Negotiated Rate	$31.22
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Arizona Complete Health Allwell	$60.64
Rate for Payer: Banner UC Health Medicare	$60.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$257.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.22
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$246.35
Rate for Payer: Devoted Health Medicare	$68.22
Rate for Payer: Humana of AZ Medicare	$60.64
Rate for Payer: Southwest Service Administrators UFCW	$257.72
Rate for Payer: TriWest Medicare	$60.64
Rate for Payer: United Healthcare Commercial	$216.79
Rate for Payer: United Healthcare Medicare	$60.64
Rate for Payer: Veterans Affairs TRICARE	$60.03

XR Hip 2-3 Views Lt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 LT
Hospital Charge Code	22200621
Hospital Revenue Code	320
Min. Negotiated Rate	$519.30
Max. Negotiated Rate	$519.30
Rate for Payer: Aetna of AZ Commercial	$519.30
Rate for Payer: Cash Price	$461.60

XR Hip 2-3 Views Lt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 LT
Hospital Charge Code	22200621
Hospital Revenue Code	320
Min. Negotiated Rate	$45.06
Max. Negotiated Rate	$519.30
Rate for Payer: Aetna of AZ Commercial	$519.30
Rate for Payer: Arizona Complete Health Allwell	$92.32
Rate for Payer: Banner UC Health Medicare	$92.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$392.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$92.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.06
Rate for Payer: Cash Price	$461.60
Rate for Payer: Cash Price	$461.60
Rate for Payer: Cigna of AZ Commercial	$375.05
Rate for Payer: Devoted Health Medicare	$103.86
Rate for Payer: Humana of AZ Medicare	$92.32
Rate for Payer: Southwest Service Administrators UFCW	$392.36
Rate for Payer: TriWest Medicare	$92.32
Rate for Payer: United Healthcare Commercial	$330.04
Rate for Payer: United Healthcare Medicare	$92.32
Rate for Payer: Veterans Affairs TRICARE	$91.40

Know your out-of-pocket cost for care.

All Charges