Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

OT COGNITIVE TRAIN @ 15 MIN

Facility

$181.00

Service Code	CPT 97532 GO
Hospital Charge Code	691289
Hospital Revenue Code	430
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

OT COGNITIVE TRAIN @ 15 MIN

Facility

$181.00

Service Code	CPT 97532 GO
Hospital Charge Code	11473411
Hospital Revenue Code	430
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

OT COGNITIVE TRAIN @ 15 MIN

Facility

$181.00

Service Code	CPT 97532 GO
Hospital Charge Code	11473411
Hospital Revenue Code	430
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

OT COGNITIVE TRAIN @ 15 MIN

Facility

$181.00

Service Code	CPT 97532 GO
Hospital Charge Code	691289
Hospital Revenue Code	430
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

OT COMMUNITY/WORK TRAIN @ 15 MIN

Facility

$184.00

Service Code	CPT 97537 GO
Hospital Charge Code	11473418
Hospital Revenue Code	430
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Bisbee Police All Plans	$47.84
Rate for Payer: Cash Price	$147.20
Rate for Payer: Self Pay Self Pay	$147.20

OT COMMUNITY/WORK TRAIN @ 15 MIN

Facility

$172.00

Service Code	CPT 97537 GO
Hospital Charge Code	691287
Hospital Revenue Code	430
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

OT COMMUNITY/WORK TRAIN @ 15 MIN

Facility

$172.00

Service Code	CPT 97537 GO
Hospital Charge Code	691287
Hospital Revenue Code	430
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: Allwell Medicare	$27.52
Rate for Payer: Amerigroup Medicare	$27.52
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

OT COMMUNITY/WORK TRAIN @ 15 MIN

Facility

$184.00

Service Code	CPT 97537 GO
Hospital Charge Code	11473418
Hospital Revenue Code	430
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna of AZ Commercial	$165.60
Rate for Payer: Aetna of AZ Medicare	$51.52
Rate for Payer: Allwell Medicare	$29.44
Rate for Payer: Amerigroup Medicare	$29.44
Rate for Payer: APIPA Medicare/Medicaid	$68.72
Rate for Payer: AZCH Complete Medicare	$29.44
Rate for Payer: Banner UC Health Medicare	$29.44
Rate for Payer: Bisbee Police All Plans	$47.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.12
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cigna of AZ Commercial	$128.80
Rate for Payer: Copperpoint Commercial	$45.54
Rate for Payer: Health Net of AZ Commercial	$110.40
Rate for Payer: Health Net of AZ Medicare	$51.52
Rate for Payer: Humana of AZ Medicare	$29.44
Rate for Payer: Self Pay Self Pay	$147.20
Rate for Payer: TriWest Medicare	$29.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.12

OT CONTRAST BATH EA 15 MIN

Facility

$181.00

Service Code	CPT 97034 GO
Hospital Charge Code	22056771
Hospital Revenue Code	430
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

OT CONTRAST BATH EA 15 MIN

Facility

$181.00

Service Code	CPT 97034 GO
Hospital Charge Code	22056771
Hospital Revenue Code	430
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

OT ELECT STIM MANUAL @ 15 MIN

Facility

$181.00

Service Code	CPT 97032 GO
Hospital Charge Code	691324
Hospital Revenue Code	430
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

OT ELECT STIM MANUAL @ 15 MIN

Facility

$181.00

Service Code	CPT 97032 GO
Hospital Charge Code	691324
Hospital Revenue Code	430
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

OT E-STIM W US - EACH 15

Facility

$181.00

Service Code	CPT 97035 GO
Hospital Charge Code	8865394
Hospital Revenue Code	430
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$28.96
Rate for Payer: Amerigroup Medicare	$28.96
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

OT E-STIM W US - EACH 15

Facility

$181.00

Service Code	CPT 97035 GO
Hospital Charge Code	8865394
Hospital Revenue Code	430
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

OT EVAL 30 MIN

Facility

$358.00

Service Code	CPT 97165 GO
Hospital Charge Code	22528841
Hospital Revenue Code	430
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of AZ Commercial	$322.20
Rate for Payer: Bisbee Police All Plans	$93.08
Rate for Payer: Cash Price	$286.40
Rate for Payer: Self Pay Self Pay	$286.40

OT EVAL 30 MIN

Facility

$358.00

Service Code	CPT 97165 GO
Hospital Charge Code	22528841
Hospital Revenue Code	430
Min. Negotiated Rate	$57.28
Max. Negotiated Rate	$322.20
Rate for Payer: Aetna of AZ Commercial	$322.20
Rate for Payer: Aetna of AZ Medicare	$100.24
Rate for Payer: Allwell Medicare	$57.28
Rate for Payer: Amerigroup Medicare	$57.28
Rate for Payer: APIPA Medicare/Medicaid	$133.71
Rate for Payer: AZCH Complete Medicare	$57.28
Rate for Payer: Banner UC Health Medicare	$57.28
Rate for Payer: Bisbee Police All Plans	$93.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$243.44
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cigna of AZ Commercial	$250.60
Rate for Payer: Copperpoint Commercial	$88.61
Rate for Payer: Health Net of AZ Commercial	$214.80
Rate for Payer: Health Net of AZ Medicare	$100.24
Rate for Payer: Humana of AZ Medicare	$57.28
Rate for Payer: Self Pay Self Pay	$286.40
Rate for Payer: TriWest Medicare	$57.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$208.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.44

OT EVAL 45MIN

Facility

$537.00

Hospital Charge Code	22528845
Hospital Revenue Code	430
Min. Negotiated Rate	$85.92
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Aetna of AZ Medicare	$150.36
Rate for Payer: Allwell Medicare	$85.92
Rate for Payer: Amerigroup Medicare	$85.92
Rate for Payer: APIPA Medicare/Medicaid	$200.57
Rate for Payer: AZCH Complete Medicare	$85.92
Rate for Payer: Banner UC Health Medicare	$85.92
Rate for Payer: Bisbee Police All Plans	$139.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$365.16
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cigna of AZ Commercial	$375.90
Rate for Payer: Copperpoint Commercial	$132.91
Rate for Payer: Health Net of AZ Commercial	$322.20
Rate for Payer: Health Net of AZ Medicare	$150.36
Rate for Payer: Humana of AZ Medicare	$85.92
Rate for Payer: Self Pay Self Pay	$429.60
Rate for Payer: TriWest Medicare	$85.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$313.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$96.66

OT EVAL 45MIN

Facility

$662.00

Service Code	CPT 97166 GO
Hospital Charge Code	22528987
Hospital Revenue Code	434
Min. Negotiated Rate	$172.12
Max. Negotiated Rate	$595.80
Rate for Payer: Aetna of AZ Commercial	$595.80
Rate for Payer: Bisbee Police All Plans	$172.12
Rate for Payer: Cash Price	$529.60
Rate for Payer: Self Pay Self Pay	$529.60

OT EVAL 45MIN

Facility

$537.00

Hospital Charge Code	22528845
Hospital Revenue Code	430
Min. Negotiated Rate	$139.62
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Bisbee Police All Plans	$139.62
Rate for Payer: Cash Price	$429.60
Rate for Payer: Self Pay Self Pay	$429.60

OT EVAL 45MIN

Facility

$662.00

Service Code	CPT 97166 GO
Hospital Charge Code	22528987
Hospital Revenue Code	434
Min. Negotiated Rate	$105.92
Max. Negotiated Rate	$595.80
Rate for Payer: Aetna of AZ Commercial	$595.80
Rate for Payer: Aetna of AZ Medicare	$185.36
Rate for Payer: Allwell Medicare	$105.92
Rate for Payer: Amerigroup Medicare	$105.92
Rate for Payer: APIPA Medicare/Medicaid	$247.26
Rate for Payer: AZCH Complete Medicare	$105.92
Rate for Payer: Banner UC Health Medicare	$105.92
Rate for Payer: Bisbee Police All Plans	$172.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$450.16
Rate for Payer: Cash Price	$529.60
Rate for Payer: Cigna of AZ Commercial	$463.40
Rate for Payer: Copperpoint Commercial	$163.84
Rate for Payer: Health Net of AZ Commercial	$397.20
Rate for Payer: Health Net of AZ Medicare	$185.36
Rate for Payer: Humana of AZ Medicare	$105.92
Rate for Payer: Self Pay Self Pay	$529.60
Rate for Payer: TriWest Medicare	$105.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$385.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$119.16

OT EVAL 60 MIN

Facility

$662.00

Service Code	CPT 97167 GO
Hospital Charge Code	22528868
Hospital Revenue Code	430
Min. Negotiated Rate	$105.92
Max. Negotiated Rate	$595.80
Rate for Payer: Aetna of AZ Commercial	$595.80
Rate for Payer: Aetna of AZ Medicare	$185.36
Rate for Payer: Allwell Medicare	$105.92
Rate for Payer: Amerigroup Medicare	$105.92
Rate for Payer: APIPA Medicare/Medicaid	$247.26
Rate for Payer: AZCH Complete Medicare	$105.92
Rate for Payer: Banner UC Health Medicare	$105.92
Rate for Payer: Bisbee Police All Plans	$172.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$450.16
Rate for Payer: Cash Price	$529.60
Rate for Payer: Cigna of AZ Commercial	$463.40
Rate for Payer: Copperpoint Commercial	$163.84
Rate for Payer: Health Net of AZ Commercial	$397.20
Rate for Payer: Health Net of AZ Medicare	$185.36
Rate for Payer: Humana of AZ Medicare	$105.92
Rate for Payer: Self Pay Self Pay	$529.60
Rate for Payer: TriWest Medicare	$105.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$385.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$119.16

OT EVAL 60 MIN

Facility

$662.00

Service Code	CPT 97167 GO
Hospital Charge Code	22528868
Hospital Revenue Code	430
Min. Negotiated Rate	$172.12
Max. Negotiated Rate	$595.80
Rate for Payer: Aetna of AZ Commercial	$595.80
Rate for Payer: Bisbee Police All Plans	$172.12
Rate for Payer: Cash Price	$529.60
Rate for Payer: Self Pay Self Pay	$529.60

OT GROUP THERAPY @ 15 MIN

Facility

$92.00

Service Code	CPT 97150 GO
Hospital Charge Code	22329309
Hospital Revenue Code	430
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Aetna of AZ Medicare	$25.76
Rate for Payer: Allwell Medicare	$14.72
Rate for Payer: Amerigroup Medicare	$14.72
Rate for Payer: APIPA Medicare/Medicaid	$34.36
Rate for Payer: AZCH Complete Medicare	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.56
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$64.40
Rate for Payer: Copperpoint Commercial	$22.77
Rate for Payer: Health Net of AZ Commercial	$55.20
Rate for Payer: Health Net of AZ Medicare	$25.76
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Self Pay Self Pay	$73.60
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.56

OT GROUP THERAPY @ 15 MIN

Facility

$92.00

Service Code	CPT 97150 GO
Hospital Charge Code	22329309
Hospital Revenue Code	430
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Cash Price	$73.60
Rate for Payer: Self Pay Self Pay	$73.60

Other Aftercare And Convalescence

Facility

$9,211.49

Service Code	APR-DRG 8624
Hospital Charge Code	APRDRG8624
Min. Negotiated Rate	$9,211.49
Max. Negotiated Rate	$9,211.49
Rate for Payer: AHCCCS Medicaid	$9,211.49
Rate for Payer: Allwell Medicaid	$9,211.49
Rate for Payer: AZCH Complete Medicaid	$9,211.49
Rate for Payer: Banner UC Health Medicaid	$9,211.49
Rate for Payer: Mercy Care Medicaid	$9,211.49

Know your out-of-pocket cost for care.

All Charges