Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PTH, Intact LC

Facility

$485.00

Service Code	CPT 83970
Hospital Charge Code	1285622
Hospital Revenue Code	301
Min. Negotiated Rate	$126.10
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna of AZ Commercial	$436.50
Rate for Payer: Bisbee Police All Plans	$126.10
Rate for Payer: Cash Price	$388.00
Rate for Payer: Self Pay Self Pay	$388.00

PTH, Intact LC

Facility

$485.00

Service Code	CPT 83970
Hospital Charge Code	1285622
Hospital Revenue Code	301
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna of AZ Commercial	$436.50
Rate for Payer: Aetna of AZ Medicare	$135.80
Rate for Payer: Allwell Medicare	$77.60
Rate for Payer: Amerigroup Medicare	$77.60
Rate for Payer: APIPA Medicare/Medicaid	$181.15
Rate for Payer: AZCH Complete Medicare	$77.60
Rate for Payer: Banner UC Health Medicare	$77.60
Rate for Payer: Bisbee Police All Plans	$126.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$329.80
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cigna of AZ Commercial	$315.25
Rate for Payer: Copperpoint Commercial	$120.04
Rate for Payer: Health Net of AZ Commercial	$291.00
Rate for Payer: Health Net of AZ Medicare	$135.80
Rate for Payer: Humana of AZ Medicare	$77.60
Rate for Payer: Self Pay Self Pay	$388.00
Rate for Payer: TriWest Medicare	$77.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$282.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.30

PTHrP (PTH-Related Peptide) LC

Facility

$372.00

Service Code	CPT 82397
Hospital Charge Code	2087647
Hospital Revenue Code	301
Min. Negotiated Rate	$59.52
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Aetna of AZ Medicare	$104.16
Rate for Payer: Allwell Medicare	$59.52
Rate for Payer: Amerigroup Medicare	$59.52
Rate for Payer: APIPA Medicare/Medicaid	$138.94
Rate for Payer: AZCH Complete Medicare	$59.52
Rate for Payer: Banner UC Health Medicare	$59.52
Rate for Payer: Bisbee Police All Plans	$96.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$252.96
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cigna of AZ Commercial	$241.80
Rate for Payer: Copperpoint Commercial	$92.07
Rate for Payer: Health Net of AZ Commercial	$223.20
Rate for Payer: Health Net of AZ Medicare	$104.16
Rate for Payer: Humana of AZ Medicare	$59.52
Rate for Payer: Self Pay Self Pay	$297.60
Rate for Payer: TriWest Medicare	$59.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$216.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$66.96

PTHrP (PTH-Related Peptide) LC

Facility

$372.00

Service Code	CPT 82397
Hospital Charge Code	2087647
Hospital Revenue Code	301
Min. Negotiated Rate	$96.72
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Bisbee Police All Plans	$96.72
Rate for Payer: Cash Price	$297.60
Rate for Payer: Self Pay Self Pay	$297.60

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 IONTOPHORESIS @ 15 MIN

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	692258
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 MASSAGE 15 MIN

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	692251
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 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 Mobility Discharge Status G-8980 CH 0% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035330
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Discharge Status G-8980 CH 0% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035330
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 Mobility Discharge Status G-8980 CI At least 1% but less than 20% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035329
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 Mobility Discharge Status G-8980 CI At least 1% but less than 20% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035329
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Discharge Status G-8980 CJ At least 20% but less than 40% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035328
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 Mobility Discharge Status G-8980 CJ At least 20% but less than 40% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035328
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Discharge Status G-8980 CK At least 40% but less than 60% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035327
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 Mobility Discharge Status G-8980 CK At least 40% but less than 60% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035327
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Discharge Status G-8980 CL At least 60% but less than 80% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035326
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 Mobility Discharge Status G-8980 CL At least 60% but less than 80% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035326
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Discharge Status G-8980 CM At least 80% but less than 100% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035325
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Discharge Status G-8980 CM At least 80% but less than 100% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035325
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 Mobility Discharge Status G-8980 CN 100% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035324
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 Mobility Discharge Status G-8980 CN 100% impaired

Facility

$0.01

Service Code	CPT G8980 GP
Hospital Charge Code	6035324
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Goal Status G-8979 CH 0% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035337
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 Mobility Goal Status G-8979 CH 0% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035337
Hospital Revenue Code	420
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

PT Mobility Goal Status G-8979 CI At least 1% but less than 20% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035336
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

Know your out-of-pocket cost for care.

All Charges