Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Hip 2-3 Views Rt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 RT
Hospital Charge Code	22200624
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 Rt w/ Pelvis

Facility

$577.00

Service Code	CPT 73502 RT
Hospital Charge Code	22200624
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

XR Hips Bil w/ Pelvis 2 Views

Facility

$478.00

Service Code	CPT 73521
Hospital Charge Code	22200633
Hospital Revenue Code	320
Min. Negotiated Rate	$430.20
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Cash Price	$382.40

XR Hips Bil w/ Pelvis 2 Views

Facility

$478.00

Service Code	CPT 73521
Hospital Charge Code	22200633
Hospital Revenue Code	320
Min. Negotiated Rate	$38.94
Max. Negotiated Rate	$430.20
Rate for Payer: Aetna of AZ Commercial	$430.20
Rate for Payer: Arizona Complete Health Allwell	$76.48
Rate for Payer: Banner UC Health Medicare	$76.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$325.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$76.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.94
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cigna of AZ Commercial	$310.70
Rate for Payer: Devoted Health Medicare	$86.04
Rate for Payer: Humana of AZ Medicare	$76.48
Rate for Payer: Seven Corners Travel Insurance	$161.76
Rate for Payer: Southwest Service Administrators UFCW	$325.04
Rate for Payer: TriWest Medicare	$76.48
Rate for Payer: United Healthcare Commercial	$273.42
Rate for Payer: United Healthcare Medicare	$76.48
Rate for Payer: Veterans Affairs TRICARE	$75.72

XR Humerus 1 View Left

Facility

$488.00

Service Code	CPT 73060 LT
Hospital Charge Code	22170716
Hospital Revenue Code	320
Min. Negotiated Rate	$30.26
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	$30.26
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 Humerus 1 View Left

Facility

$488.00

Service Code	CPT 73060 LT
Hospital Charge Code	22170716
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 Humerus 1 View Right

Facility

$488.00

Service Code	CPT 73060 RT
Hospital Charge Code	22170719
Hospital Revenue Code	320
Min. Negotiated Rate	$30.26
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	$30.26
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 Humerus 1 View Right

Facility

$488.00

Service Code	CPT 73060 RT
Hospital Charge Code	22170719
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 Humerus Left

Facility

$464.00

Service Code	CPT 73060
Hospital Charge Code	823588
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 Humerus Left

Facility

$464.00

Service Code	CPT 73060
Hospital Charge Code	823588
Hospital Revenue Code	320
Min. Negotiated Rate	$30.26
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	$30.26
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 Humerus Right

Facility

$488.00

Service Code	CPT 73060
Hospital Charge Code	823590
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 Humerus Right

Facility

$488.00

Service Code	CPT 73060
Hospital Charge Code	823590
Hospital Revenue Code	320
Min. Negotiated Rate	$30.26
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	$30.26
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: Seven Corners Travel Insurance	$134.65
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 Internal Audio Meati Complete Left

Facility

$680.00

Service Code	CPT 70134 LT
Hospital Charge Code	22271685
Hospital Revenue Code	320
Min. Negotiated Rate	$56.73
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	$56.73
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: 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 Internal Audio Meati Complete Left

Facility

$680.00

Service Code	CPT 70134 LT
Hospital Charge Code	22271685
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 Internal Audio Meati Complete Right

Facility

$680.00

Service Code	CPT 70134 RT
Hospital Charge Code	22271687
Hospital Revenue Code	320
Min. Negotiated Rate	$56.73
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	$56.73
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: 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 Internal Audio Meati Complete Right

Facility

$680.00

Service Code	CPT 70134 RT
Hospital Charge Code	22271687
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 Knee Complete Left

Facility

$48.00

Service Code	CPT 73564 LT
Hospital Charge Code	22862304
Hospital Revenue Code	972
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Cash Price	$38.40

XR Knee Complete Left

Facility

$48.00

Service Code	CPT 73564 LT
Hospital Charge Code	22862304
Hospital Revenue Code	972
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Arizona Complete Health Allwell	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.68
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$33.60
Rate for Payer: Devoted Health Medicare	$8.64
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Southwest Service Administrators UFCW	$32.64
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: United Healthcare Commercial	$27.46
Rate for Payer: United Healthcare Medicare	$7.68
Rate for Payer: United Healthcare New Mexico Commercial	$9.12
Rate for Payer: Veterans Affairs TRICARE	$7.60

XR Knee Complete Left

Facility

$610.05

Service Code	CPT 73564 LT
Hospital Charge Code	1007996
Hospital Revenue Code	320
Min. Negotiated Rate	$44.74
Max. Negotiated Rate	$549.04
Rate for Payer: Aetna of AZ Commercial	$549.04
Rate for Payer: Arizona Complete Health Allwell	$97.61
Rate for Payer: Banner UC Health Medicare	$97.61
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$414.83
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$97.61
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.74
Rate for Payer: Cash Price	$488.04
Rate for Payer: Cash Price	$488.04
Rate for Payer: Cigna of AZ Commercial	$396.53
Rate for Payer: Devoted Health Medicare	$109.81
Rate for Payer: Humana of AZ Medicare	$97.61
Rate for Payer: Southwest Service Administrators UFCW	$414.83
Rate for Payer: TriWest Medicare	$97.61
Rate for Payer: United Healthcare Commercial	$348.95
Rate for Payer: United Healthcare Medicare	$97.61
Rate for Payer: Veterans Affairs TRICARE	$96.63

XR Knee Complete Left

Facility

$610.05

Service Code	CPT 73564 LT
Hospital Charge Code	1007996
Hospital Revenue Code	320
Min. Negotiated Rate	$549.04
Max. Negotiated Rate	$549.04
Rate for Payer: Aetna of AZ Commercial	$549.04
Rate for Payer: Cash Price	$488.04

XR Knee Complete Right

Facility

$611.03

Service Code	CPT 73564 RT
Hospital Charge Code	1007998
Hospital Revenue Code	320
Min. Negotiated Rate	$549.93
Max. Negotiated Rate	$549.93
Rate for Payer: Aetna of AZ Commercial	$549.93
Rate for Payer: Cash Price	$488.82

XR Knee Complete Right

Facility

$611.03

Service Code	CPT 73564 RT
Hospital Charge Code	1007998
Hospital Revenue Code	320
Min. Negotiated Rate	$44.74
Max. Negotiated Rate	$549.93
Rate for Payer: Aetna of AZ Commercial	$549.93
Rate for Payer: Arizona Complete Health Allwell	$97.76
Rate for Payer: Banner UC Health Medicare	$97.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$415.50
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$97.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$44.74
Rate for Payer: Cash Price	$488.82
Rate for Payer: Cash Price	$488.82
Rate for Payer: Cigna of AZ Commercial	$397.17
Rate for Payer: Devoted Health Medicare	$109.99
Rate for Payer: Humana of AZ Medicare	$97.76
Rate for Payer: Southwest Service Administrators UFCW	$415.50
Rate for Payer: TriWest Medicare	$97.76
Rate for Payer: United Healthcare Commercial	$349.51
Rate for Payer: United Healthcare Medicare	$97.76
Rate for Payer: Veterans Affairs TRICARE	$96.79

XR Knee One or Two Views Left

Facility

$537.00

Service Code	CPT 73560 LT
Hospital Charge Code	823596
Hospital Revenue Code	320
Min. Negotiated Rate	$483.30
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Cash Price	$429.60

XR Knee One or Two Views Left

Facility

$537.00

Service Code	CPT 73560 LT
Hospital Charge Code	823596
Hospital Revenue Code	320
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Arizona Complete Health Allwell	$85.92
Rate for Payer: Banner UC Health Medicare	$85.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$365.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$85.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.51
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cigna of AZ Commercial	$349.05
Rate for Payer: Devoted Health Medicare	$96.66
Rate for Payer: Humana of AZ Medicare	$85.92
Rate for Payer: Southwest Service Administrators UFCW	$365.16
Rate for Payer: TriWest Medicare	$85.92
Rate for Payer: United Healthcare Commercial	$307.16
Rate for Payer: United Healthcare Medicare	$85.92
Rate for Payer: Veterans Affairs TRICARE	$85.06

XR Knee One or Two Views Right

Facility

$537.00

Service Code	CPT 73560 RT
Hospital Charge Code	823598
Hospital Revenue Code	320
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Arizona Complete Health Allwell	$85.92
Rate for Payer: Banner UC Health Medicare	$85.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$365.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$85.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.51
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cigna of AZ Commercial	$349.05
Rate for Payer: Devoted Health Medicare	$96.66
Rate for Payer: Humana of AZ Medicare	$85.92
Rate for Payer: Southwest Service Administrators UFCW	$365.16
Rate for Payer: TriWest Medicare	$85.92
Rate for Payer: United Healthcare Commercial	$307.16
Rate for Payer: United Healthcare Medicare	$85.92
Rate for Payer: Veterans Affairs TRICARE	$85.06

Know your out-of-pocket cost for care.

All Charges