Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PT Carry Goal Status G-8985 CN 100% impaired

Facility

$0.01

Service Code	CPT G8985 GP
Hospital Charge Code	5568991
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

PT Community/Work Reintegration Charge

Facility

$181.00

Service Code	CPT 97537 GP
Hospital Charge Code	22408476
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 Community/Work Reintegration Charge

Facility

$181.00

Service Code	CPT 97537 GP
Hospital Charge Code	22408476
Hospital Revenue Code	420
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

PT CONTRAST BATH @ 15 MIN

Facility

$181.00

Service Code	CPT 97034 GP
Hospital Charge Code	8865467
Hospital Revenue Code	420
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

PT CONTRAST BATH @ 15 MIN

Facility

$181.00

Service Code	CPT 97034 GP
Hospital Charge Code	8865467
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 ELEC STIM MANUAL @ 15 MIN

Facility

$172.00

Service Code	CPT 97032 GP
Hospital Charge Code	692259
Hospital Revenue Code	420
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

PT ELEC STIM MANUAL @ 15 MIN

Facility

$172.00

Service Code	CPT 97032 GP
Hospital Charge Code	692259
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 E-STIM UNATT 1 OR MORE

Facility

$155.00

Service Code	CPT 97014
Hospital Charge Code	1230068
Hospital Revenue Code	420
Min. Negotiated Rate	$40.30
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Cash Price	$124.00
Rate for Payer: Self Pay Self Pay	$124.00

PT E-STIM UNATT 1 OR MORE

Facility

$155.00

Service Code	CPT 97014
Hospital Charge Code	1230068
Hospital Revenue Code	420
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Aetna of AZ Medicare	$43.40
Rate for Payer: Allwell Medicare	$24.80
Rate for Payer: Amerigroup Medicare	$24.80
Rate for Payer: APIPA Medicare/Medicaid	$57.89
Rate for Payer: AZCH Complete Medicare	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Bisbee Police All Plans	$40.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$105.40
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Copperpoint Commercial	$38.36
Rate for Payer: Health Net of AZ Commercial	$93.00
Rate for Payer: Health Net of AZ Medicare	$43.40
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Self Pay Self Pay	$124.00
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$90.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.90

PT E-STIM W US EACH 15

Facility

$172.00

Service Code	CPT 97035 GP
Hospital Charge Code	2619719
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 E-STIM W US EACH 15

Facility

$172.00

Service Code	CPT 97035 GP
Hospital Charge Code	2619719
Hospital Revenue Code	420
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

PT EVAL 45 MIN

Facility

$537.00

Hospital Charge Code	1230396
Hospital Revenue Code	424
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

PT EVAL 45 MIN

Facility

$537.00

Hospital Charge Code	1230396
Hospital Revenue Code	424
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

PT EVAL HIGH COMPLEX

Facility

$697.00

Service Code	CPT 97163 GP
Hospital Charge Code	22528750
Hospital Revenue Code	424
Min. Negotiated Rate	$111.52
Max. Negotiated Rate	$627.30
Rate for Payer: Aetna of AZ Commercial	$627.30
Rate for Payer: Aetna of AZ Medicare	$195.16
Rate for Payer: Allwell Medicare	$111.52
Rate for Payer: Amerigroup Medicare	$111.52
Rate for Payer: APIPA Medicare/Medicaid	$260.33
Rate for Payer: AZCH Complete Medicare	$111.52
Rate for Payer: Banner UC Health Medicare	$111.52
Rate for Payer: Bisbee Police All Plans	$181.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$473.96
Rate for Payer: Cash Price	$557.60
Rate for Payer: Cigna of AZ Commercial	$487.90
Rate for Payer: Copperpoint Commercial	$172.51
Rate for Payer: Health Net of AZ Commercial	$418.20
Rate for Payer: Health Net of AZ Medicare	$195.16
Rate for Payer: Humana of AZ Medicare	$111.52
Rate for Payer: Self Pay Self Pay	$557.60
Rate for Payer: TriWest Medicare	$111.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$406.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$125.46

PT EVAL HIGH COMPLEX

Facility

$697.00

Service Code	CPT 97163 GP
Hospital Charge Code	22528750
Hospital Revenue Code	424
Min. Negotiated Rate	$181.22
Max. Negotiated Rate	$627.30
Rate for Payer: Aetna of AZ Commercial	$627.30
Rate for Payer: Bisbee Police All Plans	$181.22
Rate for Payer: Cash Price	$557.60
Rate for Payer: Self Pay Self Pay	$557.60

PT EVAL LOW COMPLEX

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	22528753
Hospital Revenue Code	424
Min. Negotiated Rate	$113.10
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna of AZ Commercial	$391.50
Rate for Payer: Bisbee Police All Plans	$113.10
Rate for Payer: Cash Price	$348.00
Rate for Payer: Self Pay Self Pay	$348.00

PT EVAL LOW COMPLEX

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	22528753
Hospital Revenue Code	424
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna of AZ Commercial	$391.50
Rate for Payer: Aetna of AZ Medicare	$121.80
Rate for Payer: Allwell Medicare	$69.60
Rate for Payer: Amerigroup Medicare	$69.60
Rate for Payer: APIPA Medicare/Medicaid	$162.47
Rate for Payer: AZCH Complete Medicare	$69.60
Rate for Payer: Banner UC Health Medicare	$69.60
Rate for Payer: Bisbee Police All Plans	$113.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$295.80
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cigna of AZ Commercial	$304.50
Rate for Payer: Copperpoint Commercial	$107.66
Rate for Payer: Health Net of AZ Commercial	$261.00
Rate for Payer: Health Net of AZ Medicare	$121.80
Rate for Payer: Humana of AZ Medicare	$69.60
Rate for Payer: Self Pay Self Pay	$348.00
Rate for Payer: TriWest Medicare	$69.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$253.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$78.30

PT EVAL MOD COMPLEX

Facility

$537.00

Service Code	CPT 97162 GP
Hospital Charge Code	22528754
Hospital Revenue Code	424
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

PT EVAL MOD COMPLEX

Facility

$537.00

Service Code	CPT 97162 GP
Hospital Charge Code	22528754
Hospital Revenue Code	424
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

PT FUNCTIONAL ACTIVITIES 15 MIN

Facility

$172.00

Service Code	CPT 97530 GP
Hospital Charge Code	5543179
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 FUNCTIONAL ACTIVITIES 15 MIN

Facility

$172.00

Service Code	CPT 97530 GP
Hospital Charge Code	5543179
Hospital Revenue Code	420
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

PT GAIT TRAINING @ 15 MIN

Facility

$173.00

Service Code	CPT 97116 GP
Hospital Charge Code	692247
Hospital Revenue Code	420
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Cash Price	$138.40
Rate for Payer: Self Pay Self Pay	$138.40

PT GAIT TRAINING @ 15 MIN

Facility

$173.00

Service Code	CPT 97116 GP
Hospital Charge Code	692247
Hospital Revenue Code	420
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Aetna of AZ Medicare	$48.44
Rate for Payer: Allwell Medicare	$27.68
Rate for Payer: Amerigroup Medicare	$27.68
Rate for Payer: APIPA Medicare/Medicaid	$64.62
Rate for Payer: AZCH Complete Medicare	$27.68
Rate for Payer: Banner UC Health Medicare	$27.68
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$117.64
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$121.10
Rate for Payer: Copperpoint Commercial	$42.82
Rate for Payer: Health Net of AZ Commercial	$103.80
Rate for Payer: Health Net of AZ Medicare	$48.44
Rate for Payer: Humana of AZ Medicare	$27.68
Rate for Payer: Self Pay Self Pay	$138.40
Rate for Payer: TriWest Medicare	$27.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.14

PTH

Facility

$334.00

Service Code	CPT 83970
Hospital Charge Code	22481499
Hospital Revenue Code	301
Min. Negotiated Rate	$53.44
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: Allwell Medicare	$53.44
Rate for Payer: Amerigroup Medicare	$53.44
Rate for Payer: APIPA Medicare/Medicaid	$124.75
Rate for Payer: AZCH Complete Medicare	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
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: Cigna of AZ Commercial	$217.10
Rate for Payer: Copperpoint Commercial	$82.67
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	$53.44
Rate for Payer: Self Pay Self Pay	$267.20
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$194.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.12

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

Know your out-of-pocket cost for care.

All Charges