Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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: 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 CJ At least 20% but less than 40% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035335
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 CJ At least 20% but less than 40% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035335
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 CK At least 40% but less than 60% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035334
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 CK At least 40% but less than 60% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035334
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 CL At least 60% but less than 80% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035333
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 CL At least 60% but less than 80% impaired

Facility

$0.01

Service Code	CPT G8979 GP
Hospital Charge Code	6035333
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 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 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	$0.80
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	$0.80
Rate for Payer: Amerigroup Medicare	$0.80
Rate for Payer: APIPA Medicare/Medicaid	$1.87
Rate for Payer: AZCH Complete Medicare	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
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	$0.80
Rate for Payer: Self Pay Self Pay	$4.00
Rate for Payer: TriWest Medicare	$0.80
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 CN 100% impaired

Facility

$5.00

Service Code	CPT G8979 GP
Hospital Charge Code	6035331
Hospital Revenue Code	420
Min. Negotiated Rate	$0.80
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	$0.80
Rate for Payer: Amerigroup Medicare	$0.80
Rate for Payer: APIPA Medicare/Medicaid	$1.87
Rate for Payer: AZCH Complete Medicare	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
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	$0.80
Rate for Payer: Self Pay Self Pay	$4.00
Rate for Payer: TriWest Medicare	$0.80
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 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 NEURO RE-ED EACH 15MIN

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	692238
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 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

$203.00

Service Code	CPT 97760 GP
Hospital Charge Code	692243
Hospital Revenue Code	420
Min. Negotiated Rate	$32.48
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: Allwell Medicare	$32.48
Rate for Payer: Amerigroup Medicare	$32.48
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicare	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

PT ORTHO FITTRNG EACH 15

Facility

$203.00

Service Code	CPT 97760 GP
Hospital Charge Code	692243
Hospital Revenue Code	420
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

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	$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 Other Primary Current Status G-8990 CH 0% impaired

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035344
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 Other Primary Current Status G-8990 CH 0% impaired

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035344
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 Other Primary Current Status G-8990 CI At least 1% but less than 20% impaired

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035343
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 Other Primary Current Status G-8990 CI At least 1% but less than 20% impaired

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035343
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 Other Primary Current Status G-8990 CJ At least 20% but less than 40% impaire

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035342
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 Other Primary Current Status G-8990 CJ At least 20% but less than 40% impaire

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035342
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 Other Primary Current Status G-8990 CK At least 40% but less than 60% impaire

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035341
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 Other Primary Current Status G-8990 CK At least 40% but less than 60% impaire

Facility

$0.01

Service Code	CPT G8990 GP
Hospital Charge Code	6035341
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

Know your out-of-pocket cost for care.

All Charges