Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Sternoclavicular Joint(s)

Facility

$478.00

Service Code	CPT 71130
Hospital Charge Code	823651
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 Sternum Minimum 2 Views

Facility

$646.00

Service Code	CPT 71120
Hospital Charge Code	823653
Hospital Revenue Code	320
Min. Negotiated Rate	$30.59
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	$30.59
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	$134.65
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 Sternum Minimum 2 Views

Facility

$646.00

Service Code	CPT 71120
Hospital Charge Code	823653
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 Temporomandibular Joints

Facility

$739.00

Service Code	CPT 70330
Hospital Charge Code	1008107
Hospital Revenue Code	320
Min. Negotiated Rate	$49.72
Max. Negotiated Rate	$665.10
Rate for Payer: Aetna of AZ Commercial	$665.10
Rate for Payer: Arizona Complete Health Allwell	$118.24
Rate for Payer: Banner UC Health Medicare	$118.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$502.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$118.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$49.72
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cigna of AZ Commercial	$480.35
Rate for Payer: Devoted Health Medicare	$133.02
Rate for Payer: Humana of AZ Medicare	$118.24
Rate for Payer: Seven Corners Travel Insurance	$134.65
Rate for Payer: Southwest Service Administrators UFCW	$502.52
Rate for Payer: TriWest Medicare	$118.24
Rate for Payer: United Healthcare Commercial	$422.71
Rate for Payer: United Healthcare Medicare	$118.24
Rate for Payer: Veterans Affairs TRICARE	$117.06

XR Temporomandibular Joints

Facility

$739.00

Service Code	CPT 70330
Hospital Charge Code	1008107
Hospital Revenue Code	320
Min. Negotiated Rate	$665.10
Max. Negotiated Rate	$665.10
Rate for Payer: Aetna of AZ Commercial	$665.10
Rate for Payer: Cash Price	$591.20

XR Tibia/Fibula 2 Views Left

Facility

$537.00

Service Code	CPT 73590 LT
Hospital Charge Code	2214290
Hospital Revenue Code	320
Min. Negotiated Rate	$29.93
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	$29.93
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 Tibia/Fibula 2 Views Left

Facility

$537.00

Service Code	CPT 73590 LT
Hospital Charge Code	2214290
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 Tibia/Fibula 2 Views Right

Facility

$537.00

Service Code	CPT 73590 RT
Hospital Charge Code	2214293
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 Tibia/Fibula 2 Views Right

Facility

$537.00

Service Code	CPT 73590 RT
Hospital Charge Code	2214293
Hospital Revenue Code	320
Min. Negotiated Rate	$29.93
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	$29.93
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 Toes 2nd Digit Left

Facility

$464.00

Service Code	CPT 73660 T1
Hospital Charge Code	823659
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 Toes 2nd Digit Left

Facility

$464.00

Service Code	CPT 73660 T1
Hospital Charge Code	823659
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 Toes 2nd Digit Right

Facility

$464.00

Service Code	CPT 73660 T6
Hospital Charge Code	823661
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 Toes 2nd Digit Right

Facility

$464.00

Service Code	CPT 73660 T6
Hospital Charge Code	823661
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 Toes 3rd Digit Left

Facility

$464.00

Service Code	CPT 73660 T2
Hospital Charge Code	823663
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 Toes 3rd Digit Left

Facility

$464.00

Service Code	CPT 73660 T2
Hospital Charge Code	823663
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 Toes 3rd Digit Right

Facility

$464.00

Service Code	CPT 73660 T7
Hospital Charge Code	823665
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 Toes 3rd Digit Right

Facility

$464.00

Service Code	CPT 73660 T7
Hospital Charge Code	823665
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 Toes 4th Digit Left

Facility

$464.00

Service Code	CPT 73660 T3
Hospital Charge Code	823667
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 Toes 4th Digit Left

Facility

$464.00

Service Code	CPT 73660 T3
Hospital Charge Code	823667
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 Toes 4th Digit Right

Facility

$464.00

Service Code	CPT 73660 T8
Hospital Charge Code	823669
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 Toes 4th Digit Right

Facility

$464.00

Service Code	CPT 73660 T8
Hospital Charge Code	823669
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 Toes 5th Digit Left

Facility

$464.00

Service Code	CPT 73660 T4
Hospital Charge Code	823671
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 Toes 5th Digit Left

Facility

$464.00

Service Code	CPT 73660 T4
Hospital Charge Code	823671
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 Toes 5th Digit Right

Facility

$464.00

Service Code	CPT 73660 T9
Hospital Charge Code	823673
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 Toes 5th Digit Right

Facility

$464.00

Service Code	CPT 73660 T9
Hospital Charge Code	823673
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

Know your out-of-pocket cost for care.

All Charges