Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PTT DED

Facility

$148.00

Service Code	CPT 85730
Hospital Charge Code	24151823
Hospital Revenue Code	305
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

PT T E N S APPLICATION

Facility

$697.00

Service Code	CPT 64550 GP
Hospital Charge Code	1272337
Hospital Revenue Code	420
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 T E N S APPLICATION

Facility

$697.00

Service Code	CPT 64550 GP
Hospital Charge Code	1272337
Hospital Revenue Code	420
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 THERAPEUTIC EX @15 MIN

Facility

$172.00

Service Code	CPT 97110 GP
Hospital Charge Code	692217
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 THERAPEUTIC EX @15 MIN

Facility

$172.00

Service Code	CPT 97110 GP
Hospital Charge Code	692217
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 (Thromborel-S) LC

Facility

$141.00

Service Code	CPT 85730
Hospital Charge Code	22311162
Hospital Revenue Code	301
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Bisbee Police All Plans	$36.66
Rate for Payer: Cash Price	$112.80
Rate for Payer: Self Pay Self Pay	$112.80

.PT (Thromborel-S) LC

Facility

$141.00

Service Code	CPT 85730
Hospital Charge Code	22311162
Hospital Revenue Code	301
Min. Negotiated Rate	$22.56
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Aetna of AZ Medicare	$39.48
Rate for Payer: Allwell Medicare	$22.56
Rate for Payer: Amerigroup Medicare	$22.56
Rate for Payer: APIPA Medicare/Medicaid	$52.66
Rate for Payer: AZCH Complete Medicare	$22.56
Rate for Payer: Banner UC Health Medicare	$22.56
Rate for Payer: Bisbee Police All Plans	$36.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$95.88
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cigna of AZ Commercial	$91.65
Rate for Payer: Copperpoint Commercial	$34.90
Rate for Payer: Health Net of AZ Commercial	$84.60
Rate for Payer: Health Net of AZ Medicare	$39.48
Rate for Payer: Humana of AZ Medicare	$22.56
Rate for Payer: Self Pay Self Pay	$112.80
Rate for Payer: TriWest Medicare	$22.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.38

PT TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	1230088
Hospital Revenue Code	420
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 TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	1230088
Hospital Revenue Code	420
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

.PTT SUB

Facility

$91.00

Service Code	CPT 85732
Hospital Charge Code	22481450
Hospital Revenue Code	305
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Aetna of AZ Medicare	$25.48
Rate for Payer: Allwell Medicare	$14.56
Rate for Payer: Amerigroup Medicare	$14.56
Rate for Payer: APIPA Medicare/Medicaid	$33.99
Rate for Payer: AZCH Complete Medicare	$14.56
Rate for Payer: Banner UC Health Medicare	$14.56
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.88
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$59.15
Rate for Payer: Copperpoint Commercial	$22.52
Rate for Payer: Health Net of AZ Commercial	$54.60
Rate for Payer: Health Net of AZ Medicare	$25.48
Rate for Payer: Humana of AZ Medicare	$14.56
Rate for Payer: Self Pay Self Pay	$72.80
Rate for Payer: TriWest Medicare	$14.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.38

.PTT SUB

Facility

$91.00

Service Code	CPT 85732
Hospital Charge Code	22481450
Hospital Revenue Code	305
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Cash Price	$72.80
Rate for Payer: Self Pay Self Pay	$72.80

PT ULTRASOUND EACH 15 MIN

Facility

$181.00

Service Code	CPT 97035 GP
Hospital Charge Code	692237
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 ULTRASOUND EACH 15 MIN

Facility

$181.00

Service Code	CPT 97035 GP
Hospital Charge Code	692237
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 UNLISTED THER PROCDUR

Facility

$39.00

Service Code	CPT 97139 GP
Hospital Charge Code	20731357
Hospital Revenue Code	420
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

PT UNLISTED THER PROCDUR

Facility

$39.00

Service Code	CPT 97139 GP
Hospital Charge Code	20731357
Hospital Revenue Code	420
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: Allwell Medicare	$6.24
Rate for Payer: Amerigroup Medicare	$6.24
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicare	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

PT VASOPNEUMATIC DEVICE

Facility

$104.00

Service Code	CPT 97016
Hospital Charge Code	11428383
Hospital Revenue Code	420
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$16.64
Rate for Payer: Amerigroup Medicare	$16.64
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$16.64
Rate for Payer: Banner UC Health Medicare	$16.64
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$16.64
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$16.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

PT VASOPNEUMATIC DEVICE

Facility

$104.00

Service Code	CPT 97016
Hospital Charge Code	11428383
Hospital Revenue Code	420
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

PT WHEELCHAIR MGT/PROP EACH 15

Facility

$172.00

Service Code	CPT 97542 GP
Hospital Charge Code	692240
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 WHEELCHAIR MGT/PROP EACH 15

Facility

$172.00

Service Code	CPT 97542 GP
Hospital Charge Code	692240
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 WOUND CARE GREATER THAN 20 CM

Facility

$697.00

Service Code	CPT 97598 GP
Hospital Charge Code	2619686
Hospital Revenue Code	420
Min. Negotiated Rate	$103.14
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: AHCCCS Medicaid	$103.14
Rate for Payer: Allwell Medicaid	$103.14
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 Medicaid	$103.14
Rate for Payer: AZCH Complete Medicare	$111.52
Rate for Payer: Banner UC Health Medicaid	$103.14
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: 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: Mercy Care Medicaid	$103.14
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 WOUND CARE GREATER THAN 20 CM

Facility

$697.00

Service Code	CPT 97598 GP
Hospital Charge Code	2619686
Hospital Revenue Code	420
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 WOUND CARE LESS THAN 20 CM

Facility

$358.00

Service Code	CPT 97597 GP
Hospital Charge Code	2734847
Hospital Revenue Code	420
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: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
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 Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$57.28
Rate for Payer: Banner UC Health Medicaid	$130.17
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: 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: Mercy Care Medicaid	$130.17
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

PT WOUND CARE LESS THAN 20 CM

Facility

$358.00

Service Code	CPT 97597 GP
Hospital Charge Code	2734847
Hospital Revenue Code	420
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

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1341
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: AHCCCS Medicaid	$5,001.68
Rate for Payer: Allwell Medicaid	$5,001.68
Rate for Payer: AZCH Complete Medicaid	$5,001.68
Rate for Payer: Banner UC Health Medicaid	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68

Pulmonary Embolism

Facility

$5,001.68

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG1344
Min. Negotiated Rate	$5,001.68
Max. Negotiated Rate	$5,001.68
Rate for Payer: AHCCCS Medicaid	$5,001.68
Rate for Payer: Allwell Medicaid	$5,001.68
Rate for Payer: AZCH Complete Medicaid	$5,001.68
Rate for Payer: Banner UC Health Medicaid	$5,001.68
Rate for Payer: Mercy Care Medicaid	$5,001.68

Know your out-of-pocket cost for care.

All Charges