Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PSA Screen

Facility

$223.00

Hospital Charge Code	1019535
Hospital Revenue Code	301
Min. Negotiated Rate	$200.70
Max. Negotiated Rate	$200.70
Rate for Payer: Aetna of AZ Commercial	$200.70
Rate for Payer: Aetna of AZ Commercial	$270.90
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cash Price	$240.80

PSA Screen

Facility

$223.00

Hospital Charge Code	1019535
Hospital Revenue Code	301
Min. Negotiated Rate	$35.32
Max. Negotiated Rate	$200.70
Rate for Payer: Aetna of AZ Commercial	$200.70
Rate for Payer: Aetna of AZ Commercial	$270.90
Rate for Payer: Arizona Complete Health Allwell	$48.16
Rate for Payer: Arizona Complete Health Allwell	$35.68
Rate for Payer: Banner UC Health Medicare	$35.68
Rate for Payer: Banner UC Health Medicare	$48.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$204.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$151.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$35.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$35.68
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$178.40
Rate for Payer: Cigna of AZ Commercial	$195.65
Rate for Payer: Cigna of AZ Commercial	$144.95
Rate for Payer: Devoted Health Medicare	$40.14
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Humana of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$35.68
Rate for Payer: Southwest Service Administrators UFCW	$204.68
Rate for Payer: Southwest Service Administrators UFCW	$151.64
Rate for Payer: TriWest Medicare	$35.68
Rate for Payer: TriWest Medicare	$48.16
Rate for Payer: United Healthcare Commercial	$172.17
Rate for Payer: United Healthcare Commercial	$127.56
Rate for Payer: United Healthcare Medicare	$35.68
Rate for Payer: United Healthcare Medicare	$48.16
Rate for Payer: Veterans Affairs TRICARE	$47.68
Rate for Payer: Veterans Affairs TRICARE	$35.32

PSA Total+% Free (Serial) LC

Facility

$257.00

Service Code	CPT 84154
Hospital Charge Code	1909550
Hospital Revenue Code	301
Min. Negotiated Rate	$231.30
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Cash Price	$205.60

PSA Total+% Free (Serial) LC

Facility

$257.00

Service Code	CPT 84154
Hospital Charge Code	1909550
Hospital Revenue Code	301
Min. Negotiated Rate	$26.67
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Arizona Complete Health Allwell	$41.12
Rate for Payer: Banner UC Health Medicare	$41.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$174.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$41.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$41.12
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Devoted Health Medicare	$46.26
Rate for Payer: Humana of AZ Medicare	$41.12
Rate for Payer: Seven Corners Travel Insurance	$26.67
Rate for Payer: Southwest Service Administrators UFCW	$174.76
Rate for Payer: TriWest Medicare	$41.12
Rate for Payer: United Healthcare Commercial	$147.00
Rate for Payer: United Healthcare Medicare	$41.12
Rate for Payer: Veterans Affairs TRICARE	$40.71

PSA Ultra. W/Serial Monitor LC

Facility

$250.00

Service Code	CPT 84153
Hospital Charge Code	22311204
Hospital Revenue Code	301
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Cash Price	$200.00

PSA Ultra. W/Serial Monitor LC

Facility

$250.00

Service Code	CPT 84153
Hospital Charge Code	22311204
Hospital Revenue Code	301
Min. Negotiated Rate	$26.67
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Arizona Complete Health Allwell	$40.00
Rate for Payer: Banner UC Health Medicare	$40.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$170.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cigna of AZ Commercial	$162.50
Rate for Payer: Devoted Health Medicare	$45.00
Rate for Payer: Humana of AZ Medicare	$40.00
Rate for Payer: Seven Corners Travel Insurance	$26.67
Rate for Payer: Southwest Service Administrators UFCW	$170.00
Rate for Payer: TriWest Medicare	$40.00
Rate for Payer: United Healthcare Commercial	$143.00
Rate for Payer: United Healthcare Medicare	$40.00
Rate for Payer: Veterans Affairs TRICARE	$39.60

pseudoephedrine 30 mg Tab [CQCH]

Facility

$0.03

Service Code	NDC 904505359
Hospital Charge Code	105938744
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Cash Price	$0.02

pseudoephedrine 30 mg Tab [CQCH]

Facility

$0.03

Service Code	NDC 904505359
Hospital Charge Code	105938744
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

PSYCHOSES

Facility

$18,054.54

Service Code	MSDRG 885
Min. Negotiated Rate	$18,054.54
Max. Negotiated Rate	$18,054.54
Rate for Payer: Seven Corners Travel Insurance	$18,054.54

psyllium 5.8 g oral pkt [CQCH]

Facility

$0.42

Service Code	NDC 37000002404
Hospital Charge Code	205060988
Hospital Revenue Code	251
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Cash Price	$0.34

psyllium 5.8 g oral pkt [CQCH]

Facility

$0.42

Service Code	NDC 37000002404
Hospital Charge Code	205060988
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Arizona Complete Health Allwell	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.29
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.07
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.29
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.24
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.07

PT Attended E-Stim Units

Facility

$172.00

Service Code	CPT 97032 GP
Hospital Charge Code	8798830
Hospital Revenue Code	420
Min. Negotiated Rate	$15.23
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.23
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: United Healthcare New Mexico Commercial	$32.68
Rate for Payer: Veterans Affairs TRICARE	$27.24

PT Attended E-Stim Units

Facility

$172.00

Service Code	CPT 97032 GP
Hospital Charge Code	8798830
Hospital Revenue Code	420
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

PT CANALITH REPOSITIONING

Facility

$203.00

Service Code	CPT 95992 GP
Hospital Charge Code	4836205
Hospital Revenue Code	424
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Cash Price	$162.40

PT CANALITH REPOSITIONING

Facility

$203.00

Service Code	CPT 95992 GP
Hospital Charge Code	4836205
Hospital Revenue Code	424
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Arizona Complete Health Allwell	$32.48
Rate for Payer: Banner UC Health Medicare	$32.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.16
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Devoted Health Medicare	$36.54
Rate for Payer: Humana of AZ Medicare	$32.48
Rate for Payer: Mercy Care Medicaid	$6.97
Rate for Payer: NaphCare Correctional Healthcare	$6.97
Rate for Payer: Southwest Service Administrators UFCW	$138.04
Rate for Payer: TriWest Medicare	$32.48
Rate for Payer: United Healthcare Commercial	$116.12
Rate for Payer: United Healthcare Medicare	$32.48
Rate for Payer: United Healthcare New Mexico Commercial	$38.57
Rate for Payer: Veterans Affairs TRICARE	$32.16

PT Community/Work Reintegration Charge

Facility

$181.00

Service Code	CPT 97537 GP
Hospital Charge Code	22408476
Hospital Revenue Code	420
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$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	$28.67
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.28
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

PT CommunityWork Reintegration Units

Facility

$181.00

Service Code	CPT 97537 GP
Hospital Charge Code	8798857
Hospital Revenue Code	420
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

PT CommunityWork Reintegration Units

Facility

$181.00

Service Code	CPT 97537 GP
Hospital Charge Code	8798857
Hospital Revenue Code	420
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.28
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

PT CONTRAST BATH @ 15 MIN

Facility

$181.00

Service Code	CPT 97034 GP
Hospital Charge Code	8865467
Hospital Revenue Code	420
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.52
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

PT CONTRAST BATH @ 15 MIN

Facility

$181.00

Service Code	CPT 97034 GP
Hospital Charge Code	8865467
Hospital Revenue Code	420
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

PT Contrast Bath Units

Facility

$181.00

Service Code	CPT 97034 GP
Hospital Charge Code	8798834
Hospital Revenue Code	420
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

PT Contrast Bath Units

Facility

$181.00

Service Code	CPT 97034 GP
Hospital Charge Code	8798834
Hospital Revenue Code	420
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.52
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

PT Dry Needling, 1-2 Muscles Units

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	23851156
Hospital Revenue Code	420
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Arizona Complete Health Allwell	$9.28
Rate for Payer: Banner UC Health Medicare	$9.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$39.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.28
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Devoted Health Medicare	$10.44
Rate for Payer: Humana of AZ Medicare	$9.28
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$39.44
Rate for Payer: TriWest Medicare	$9.28
Rate for Payer: United Healthcare Commercial	$33.18
Rate for Payer: United Healthcare Medicare	$9.28
Rate for Payer: United Healthcare New Mexico Commercial	$11.02
Rate for Payer: Veterans Affairs TRICARE	$9.19

PT Dry Needling, 1-2 Muscles Units

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	23851156
Hospital Revenue Code	420
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Cash Price	$46.40

Know your out-of-pocket cost for care.

All Charges