Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PT GAIT TRAINING @ 15 MIN

Facility

$172.00

Service Code	CPT 97116 GP
Hospital Charge Code	692247
Hospital Revenue Code	420
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

PT GAIT TRAINING @ 15 MIN

Facility

$172.00

Service Code	CPT 97116 GP
Hospital Charge Code	692247
Hospital Revenue Code	420
Min. Negotiated Rate	$25.80
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	$25.80
Rate for Payer: Amerigroup Medicare	$25.80
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$25.80
Rate for Payer: Banner UC Health Medicare	$25.80
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	$25.80
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$25.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

PTH

Facility

$334.00

Service Code	CPT 83970
Hospital Charge Code	22481499
Hospital Revenue Code	301
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Cash Price	$267.20
Rate for Payer: Self Pay Self Pay	$267.20

PTH

Facility

$334.00

Service Code	CPT 83970
Hospital Charge Code	22481499
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Aetna of AZ Medicare	$93.52
Rate for Payer: AHCCCS Medicaid	$41.28
Rate for Payer: Allwell Medicaid	$41.28
Rate for Payer: Allwell Medicare	$50.10
Rate for Payer: Amerigroup Medicare	$50.10
Rate for Payer: APIPA Medicare/Medicaid	$124.75
Rate for Payer: AZCH Complete Medicaid	$41.28
Rate for Payer: AZCH Complete Medicare	$50.10
Rate for Payer: Banner UC Health Medicaid	$41.28
Rate for Payer: Banner UC Health Medicare	$50.10
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$227.12
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Copperpoint Commercial	$82.66
Rate for Payer: Health Net of AZ Commercial	$200.40
Rate for Payer: Health Net of AZ Medicare	$93.52
Rate for Payer: Humana of AZ Medicare	$50.10
Rate for Payer: Mercy Care Medicaid	$41.28
Rate for Payer: Self Pay Self Pay	$267.20
Rate for Payer: TriWest Medicare	$50.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$194.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.12

PTH, Intact LC

Facility

$512.00

Service Code	CPT 83970
Hospital Charge Code	1285622
Hospital Revenue Code	301
Min. Negotiated Rate	$133.12
Max. Negotiated Rate	$460.80
Rate for Payer: Aetna of AZ Commercial	$460.80
Rate for Payer: Bisbee Police All Plans	$133.12
Rate for Payer: Cash Price	$409.60
Rate for Payer: Self Pay Self Pay	$409.60

PTH, Intact LC

Facility

$512.00

Service Code	CPT 83970
Hospital Charge Code	1285622
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$460.80
Rate for Payer: Aetna of AZ Commercial	$460.80
Rate for Payer: Aetna of AZ Medicare	$143.36
Rate for Payer: AHCCCS Medicaid	$41.28
Rate for Payer: Allwell Medicaid	$41.28
Rate for Payer: Allwell Medicare	$76.80
Rate for Payer: Amerigroup Medicare	$76.80
Rate for Payer: APIPA Medicare/Medicaid	$191.23
Rate for Payer: AZCH Complete Medicaid	$41.28
Rate for Payer: AZCH Complete Medicare	$76.80
Rate for Payer: Banner UC Health Medicaid	$41.28
Rate for Payer: Banner UC Health Medicare	$76.80
Rate for Payer: Bisbee Police All Plans	$133.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$348.16
Rate for Payer: Cash Price	$409.60
Rate for Payer: Cash Price	$409.60
Rate for Payer: Cigna of AZ Commercial	$332.80
Rate for Payer: Copperpoint Commercial	$126.72
Rate for Payer: Health Net of AZ Commercial	$307.20
Rate for Payer: Health Net of AZ Medicare	$143.36
Rate for Payer: Humana of AZ Medicare	$76.80
Rate for Payer: Mercy Care Medicaid	$41.28
Rate for Payer: Self Pay Self Pay	$409.60
Rate for Payer: TriWest Medicare	$76.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$298.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$92.16

PTHrP (PTH-Related Peptide) LC

Facility

$392.00

Service Code	CPT 82397
Hospital Charge Code	2087647
Hospital Revenue Code	301
Min. Negotiated Rate	$14.12
Max. Negotiated Rate	$352.80
Rate for Payer: Aetna of AZ Commercial	$352.80
Rate for Payer: Aetna of AZ Medicare	$109.76
Rate for Payer: AHCCCS Medicaid	$14.12
Rate for Payer: Allwell Medicaid	$14.12
Rate for Payer: Allwell Medicare	$58.80
Rate for Payer: Amerigroup Medicare	$58.80
Rate for Payer: APIPA Medicare/Medicaid	$146.41
Rate for Payer: AZCH Complete Medicaid	$14.12
Rate for Payer: AZCH Complete Medicare	$58.80
Rate for Payer: Banner UC Health Medicaid	$14.12
Rate for Payer: Banner UC Health Medicare	$58.80
Rate for Payer: Bisbee Police All Plans	$101.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$266.56
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cigna of AZ Commercial	$254.80
Rate for Payer: Copperpoint Commercial	$97.02
Rate for Payer: Health Net of AZ Commercial	$235.20
Rate for Payer: Health Net of AZ Medicare	$109.76
Rate for Payer: Humana of AZ Medicare	$58.80
Rate for Payer: Mercy Care Medicaid	$14.12
Rate for Payer: Self Pay Self Pay	$313.60
Rate for Payer: TriWest Medicare	$58.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$228.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$70.56

PTHrP (PTH-Related Peptide) LC

Facility

$392.00

Service Code	CPT 82397
Hospital Charge Code	2087647
Hospital Revenue Code	301
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$352.80
Rate for Payer: Aetna of AZ Commercial	$352.80
Rate for Payer: Bisbee Police All Plans	$101.92
Rate for Payer: Cash Price	$313.60
Rate for Payer: Self Pay Self Pay	$313.60

PT IONTOPHORESIS @ 15 MIN

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	692258
Hospital Revenue Code	420
Min. Negotiated Rate	$25.80
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	$25.80
Rate for Payer: Amerigroup Medicare	$25.80
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$25.80
Rate for Payer: Banner UC Health Medicare	$25.80
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	$25.80
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$25.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

PT IONTOPHORESIS @ 15 MIN

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	692258
Hospital Revenue Code	420
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

PT MASSAGE 15 MIN

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	692251
Hospital Revenue Code	420
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

PT MASSAGE 15 MIN

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	692251
Hospital Revenue Code	420
Min. Negotiated Rate	$27.15
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	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicare	$27.15
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	$27.15
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

PT Mobility Goal Status G-8979 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	CPT G8979 GP
Hospital Charge Code	6035332
Hospital Revenue Code	420
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Aetna of AZ Medicare	$1.40
Rate for Payer: Allwell Medicare	$0.75
Rate for Payer: Amerigroup Medicare	$0.75
Rate for Payer: APIPA Medicare/Medicaid	$1.87
Rate for Payer: AZCH Complete Medicare	$0.75
Rate for Payer: Banner UC Health Medicare	$0.75
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.40
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Copperpoint Commercial	$1.24
Rate for Payer: Health Net of AZ Commercial	$3.00
Rate for Payer: Health Net of AZ Medicare	$1.40
Rate for Payer: Humana of AZ Medicare	$0.75
Rate for Payer: Self Pay Self Pay	$4.00
Rate for Payer: TriWest Medicare	$0.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.90

PT Mobility Goal Status G-8979 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	CPT G8979 GP
Hospital Charge Code	6035332
Hospital Revenue Code	420
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Cash Price	$4.00
Rate for Payer: Self Pay Self Pay	$4.00

PT Mobility Goal Status G-8979 CN 100% impaired

Facility

$5.00

Service Code	CPT G8979 GP
Hospital Charge Code	6035331
Hospital Revenue Code	420
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Cash Price	$4.00
Rate for Payer: Self Pay Self Pay	$4.00

PT Mobility Goal Status G-8979 CN 100% impaired

Facility

$5.00

Service Code	CPT G8979 GP
Hospital Charge Code	6035331
Hospital Revenue Code	420
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Aetna of AZ Medicare	$1.40
Rate for Payer: Allwell Medicare	$0.75
Rate for Payer: Amerigroup Medicare	$0.75
Rate for Payer: APIPA Medicare/Medicaid	$1.87
Rate for Payer: AZCH Complete Medicare	$0.75
Rate for Payer: Banner UC Health Medicare	$0.75
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.40
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Copperpoint Commercial	$1.24
Rate for Payer: Health Net of AZ Commercial	$3.00
Rate for Payer: Health Net of AZ Medicare	$1.40
Rate for Payer: Humana of AZ Medicare	$0.75
Rate for Payer: Self Pay Self Pay	$4.00
Rate for Payer: TriWest Medicare	$0.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.90

PT NEURO RE-ED EACH 15MIN

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	692238
Hospital Revenue Code	420
Min. Negotiated Rate	$27.15
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	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicare	$27.15
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	$27.15
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

PT NEURO RE-ED EACH 15MIN

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	692238
Hospital Revenue Code	420
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

PT ORTHO FITTRNG EACH 15

Facility

$181.00

Service Code	CPT 97760 GP
Hospital Charge Code	692243
Hospital Revenue Code	420
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

PT ORTHO FITTRNG EACH 15

Facility

$181.00

Service Code	CPT 97760 GP
Hospital Charge Code	692243
Hospital Revenue Code	420
Min. Negotiated Rate	$27.15
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	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicare	$27.15
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	$27.15
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

PT ORTHO/PROS CKOUT @ 15 MIN

Facility

$172.00

Service Code	CPT 97762 GP
Hospital Charge Code	2781053
Hospital Revenue Code	420
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

PT ORTHO/PROS CKOUT @ 15 MIN

Facility

$172.00

Service Code	CPT 97762 GP
Hospital Charge Code	2781053
Hospital Revenue Code	420
Min. Negotiated Rate	$25.80
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	$25.80
Rate for Payer: Amerigroup Medicare	$25.80
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$25.80
Rate for Payer: Banner UC Health Medicare	$25.80
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	$25.80
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$25.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

PT Other Primary Goal Status G-8991 CH 0% impaired

Facility

$5.00

Service Code	CPT G8991 GP
Hospital Charge Code	6035358
Hospital Revenue Code	420
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Aetna of AZ Medicare	$1.40
Rate for Payer: Allwell Medicare	$0.75
Rate for Payer: Amerigroup Medicare	$0.75
Rate for Payer: APIPA Medicare/Medicaid	$1.87
Rate for Payer: AZCH Complete Medicare	$0.75
Rate for Payer: Banner UC Health Medicare	$0.75
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.40
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Copperpoint Commercial	$1.24
Rate for Payer: Health Net of AZ Commercial	$3.00
Rate for Payer: Health Net of AZ Medicare	$1.40
Rate for Payer: Humana of AZ Medicare	$0.75
Rate for Payer: Self Pay Self Pay	$4.00
Rate for Payer: TriWest Medicare	$0.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.90

PT Other Primary Goal Status G-8991 CH 0% impaired

Facility

$5.00

Service Code	CPT G8991 GP
Hospital Charge Code	6035358
Hospital Revenue Code	420
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Cash Price	$4.00
Rate for Payer: Self Pay Self Pay	$4.00

PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired

Facility

$5.00

Service Code	CPT G8991 GP
Hospital Charge Code	6035357
Hospital Revenue Code	420
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Bisbee Police All Plans	$1.30
Rate for Payer: Cash Price	$4.00
Rate for Payer: Self Pay Self Pay	$4.00

Know your out-of-pocket cost for care.

All Charges