Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PT Dry Needling, 1-2 Muscles Units

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	23851309
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

PT Dry Needling, 1-2 Muscles Units

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	23851309
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	23851207
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

PT Dry Needling, 1-2 Muscles Units

Facility

$58.00

Service Code	CPT 20560
Hospital Charge Code	23851207
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, 3+ Muscles Units

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	23851208
Hospital Revenue Code	420
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Arizona Complete Health Allwell	$22.88
Rate for Payer: Banner UC Health Medicare	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.88
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Devoted Health Medicare	$25.74
Rate for Payer: Humana of AZ Medicare	$22.88
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$97.24
Rate for Payer: TriWest Medicare	$22.88
Rate for Payer: United Healthcare Commercial	$81.80
Rate for Payer: United Healthcare Medicare	$22.88
Rate for Payer: United Healthcare New Mexico Commercial	$27.17
Rate for Payer: Veterans Affairs TRICARE	$22.65

PT Dry Needling, 3+ Muscles Units

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	23851157
Hospital Revenue Code	420
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Arizona Complete Health Allwell	$22.88
Rate for Payer: Banner UC Health Medicare	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.88
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Devoted Health Medicare	$25.74
Rate for Payer: Humana of AZ Medicare	$22.88
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$97.24
Rate for Payer: TriWest Medicare	$22.88
Rate for Payer: United Healthcare Commercial	$81.80
Rate for Payer: United Healthcare Medicare	$22.88
Rate for Payer: United Healthcare New Mexico Commercial	$27.17
Rate for Payer: Veterans Affairs TRICARE	$22.65

PT Dry Needling, 3+ Muscles Units

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	23851157
Hospital Revenue Code	420
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Cash Price	$114.40

PT Dry Needling, 3+ Muscles Units

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	23851310
Hospital Revenue Code	420
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Arizona Complete Health Allwell	$22.88
Rate for Payer: Banner UC Health Medicare	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$97.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.88
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cigna of AZ Commercial	$100.10
Rate for Payer: Devoted Health Medicare	$25.74
Rate for Payer: Humana of AZ Medicare	$22.88
Rate for Payer: Seven Corners Travel Insurance	$44.75
Rate for Payer: Southwest Service Administrators UFCW	$97.24
Rate for Payer: TriWest Medicare	$22.88
Rate for Payer: United Healthcare Commercial	$81.80
Rate for Payer: United Healthcare Medicare	$22.88
Rate for Payer: United Healthcare New Mexico Commercial	$27.17
Rate for Payer: Veterans Affairs TRICARE	$22.65

PT Dry Needling, 3+ Muscles Units

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	23851310
Hospital Revenue Code	420
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Cash Price	$114.40

PT Dry Needling, 3+ Muscles Units

Facility

$143.00

Service Code	CPT 20561
Hospital Charge Code	23851208
Hospital Revenue Code	420
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna of AZ Commercial	$128.70
Rate for Payer: Cash Price	$114.40

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	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

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	$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 E-STIM UNATT 1 OR MORE

Facility

$155.00

Service Code	CPT 97014
Hospital Charge Code	8798798
Hospital Revenue Code	420
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$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	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Cash Price	$124.00

PT E-STIM UNATT 1 OR MORE

Facility

$155.00

Service Code	CPT 97014
Hospital Charge Code	8798798
Hospital Revenue Code	420
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.10
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: United Healthcare New Mexico Commercial	$29.45
Rate for Payer: Veterans Affairs TRICARE	$24.55

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	$13.10
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna of AZ Commercial	$139.50
Rate for Payer: Arizona Complete Health Allwell	$24.80
Rate for Payer: Banner UC Health Medicare	$24.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$105.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.10
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cigna of AZ Commercial	$108.50
Rate for Payer: Devoted Health Medicare	$27.90
Rate for Payer: Humana of AZ Medicare	$24.80
Rate for Payer: Southwest Service Administrators UFCW	$105.40
Rate for Payer: TriWest Medicare	$24.80
Rate for Payer: United Healthcare Commercial	$88.66
Rate for Payer: United Healthcare Medicare	$24.80
Rate for Payer: United Healthcare New Mexico Commercial	$29.45
Rate for Payer: Veterans Affairs TRICARE	$24.55

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	$14.87
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	$14.87
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 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	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

PT EVAL 45 MIN

Facility

$537.00

Hospital Charge Code	1230396
Hospital Revenue Code	424
Min. Negotiated Rate	$483.30
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Cash Price	$429.60

PT EVAL 45 MIN

Facility

$537.00

Hospital Charge Code	1230396
Hospital Revenue Code	424
Min. Negotiated Rate	$85.06
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Arizona Complete Health Allwell	$85.92
Rate for Payer: Banner UC Health Medicare	$85.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$365.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$85.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$85.92
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cigna of AZ Commercial	$375.90
Rate for Payer: Devoted Health Medicare	$96.66
Rate for Payer: Humana of AZ Medicare	$85.92
Rate for Payer: Southwest Service Administrators UFCW	$365.16
Rate for Payer: TriWest Medicare	$85.92
Rate for Payer: United Healthcare Commercial	$307.16
Rate for Payer: United Healthcare Medicare	$85.92
Rate for Payer: United Healthcare New Mexico Commercial	$102.03
Rate for Payer: Veterans Affairs TRICARE	$85.06

PT EVAL HIGH COMPLEX

Facility

$697.00

Service Code	CPT 97163 GP
Hospital Charge Code	22528750
Hospital Revenue Code	424
Min. Negotiated Rate	$627.30
Max. Negotiated Rate	$627.30
Rate for Payer: Aetna of AZ Commercial	$627.30
Rate for Payer: Cash Price	$557.60

PT EVAL HIGH COMPLEX

Facility

$697.00

Service Code	CPT 97163 GP
Hospital Charge Code	22528750
Hospital Revenue Code	424
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$627.30
Rate for Payer: Aetna of AZ Commercial	$627.30
Rate for Payer: Arizona Complete Health Allwell	$111.52
Rate for Payer: Banner UC Health Medicare	$111.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$473.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$111.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$102.33
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: Devoted Health Medicare	$125.46
Rate for Payer: Humana of AZ Medicare	$111.52
Rate for Payer: Southwest Service Administrators UFCW	$473.96
Rate for Payer: TriWest Medicare	$111.52
Rate for Payer: United Healthcare Commercial	$398.68
Rate for Payer: United Healthcare Medicare	$111.52
Rate for Payer: United Healthcare New Mexico Commercial	$132.43
Rate for Payer: Veterans Affairs TRICARE	$110.40

PT EVAL LOW COMPLEX

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	22528753
Hospital Revenue Code	424
Min. Negotiated Rate	$68.90
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna of AZ Commercial	$391.50
Rate for Payer: Arizona Complete Health Allwell	$69.60
Rate for Payer: Banner UC Health Medicare	$69.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$295.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$69.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$102.33
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cigna of AZ Commercial	$304.50
Rate for Payer: Devoted Health Medicare	$78.30
Rate for Payer: Humana of AZ Medicare	$69.60
Rate for Payer: Southwest Service Administrators UFCW	$295.80
Rate for Payer: TriWest Medicare	$69.60
Rate for Payer: United Healthcare Commercial	$248.82
Rate for Payer: United Healthcare Medicare	$69.60
Rate for Payer: United Healthcare New Mexico Commercial	$82.65
Rate for Payer: Veterans Affairs TRICARE	$68.90

PT EVAL LOW COMPLEX

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	22528753
Hospital Revenue Code	424
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna of AZ Commercial	$391.50
Rate for Payer: Cash Price	$348.00

PT EVAL MOD COMPLEX

Facility

$537.00

Service Code	CPT 97162 GP
Hospital Charge Code	22528754
Hospital Revenue Code	424
Min. Negotiated Rate	$85.06
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna of AZ Commercial	$483.30
Rate for Payer: Arizona Complete Health Allwell	$85.92
Rate for Payer: Banner UC Health Medicare	$85.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$365.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$85.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$102.33
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cigna of AZ Commercial	$375.90
Rate for Payer: Devoted Health Medicare	$96.66
Rate for Payer: Humana of AZ Medicare	$85.92
Rate for Payer: Southwest Service Administrators UFCW	$365.16
Rate for Payer: TriWest Medicare	$85.92
Rate for Payer: United Healthcare Commercial	$307.16
Rate for Payer: United Healthcare Medicare	$85.92
Rate for Payer: United Healthcare New Mexico Commercial	$102.03
Rate for Payer: Veterans Affairs TRICARE	$85.06

Know your out-of-pocket cost for care.

All Charges