Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PT EVAL MOD COMPLEX

Facility

$537.00

Service Code	CPT 97162 GP
Hospital Charge Code	22528754
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 Evaluation Low Complexity Units

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	28218186
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 Evaluation Low Complexity Units

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	28218186
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 Evaluation Low Complexity Units

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	28214760
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 Evaluation Low Complexity Units

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	28218322
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 Evaluation Low Complexity Units

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	28218322
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 Evaluation Low Complexity Units

Facility

$435.00

Service Code	CPT 97161 GP
Hospital Charge Code	28214760
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 FUNCTIONAL ACTIVITIES 15 MIN

Facility

$172.00

Service Code	CPT 97530 GP
Hospital Charge Code	5543179
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 FUNCTIONAL ACTIVITIES 15 MIN

Facility

$172.00

Service Code	CPT 97530 GP
Hospital Charge Code	5543179
Hospital Revenue Code	420
Min. Negotiated Rate	$27.24
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	$36.47
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 GAIT TRAINING @ 15 MIN

Facility

$173.00

Service Code	CPT 97116 GP
Hospital Charge Code	692247
Hospital Revenue Code	420
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Cash Price	$138.40

PT GAIT TRAINING @ 15 MIN

Facility

$173.00

Service Code	CPT 97116 GP
Hospital Charge Code	692247
Hospital Revenue Code	420
Min. Negotiated Rate	$27.40
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Arizona Complete Health Allwell	$27.68
Rate for Payer: Banner UC Health Medicare	$27.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$117.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.45
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$121.10
Rate for Payer: Devoted Health Medicare	$31.14
Rate for Payer: Humana of AZ Medicare	$27.68
Rate for Payer: Southwest Service Administrators UFCW	$117.64
Rate for Payer: TriWest Medicare	$27.68
Rate for Payer: United Healthcare Commercial	$98.96
Rate for Payer: United Healthcare Medicare	$27.68
Rate for Payer: United Healthcare New Mexico Commercial	$32.87
Rate for Payer: Veterans Affairs TRICARE	$27.40

PT Gait Training Units

Facility

$173.00

Service Code	CPT 97116 GP
Hospital Charge Code	8798844
Hospital Revenue Code	420
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Cash Price	$138.40

PT Gait Training Units

Facility

$173.00

Service Code	CPT 97116 GP
Hospital Charge Code	8798844
Hospital Revenue Code	420
Min. Negotiated Rate	$27.40
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Arizona Complete Health Allwell	$27.68
Rate for Payer: Banner UC Health Medicare	$27.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$117.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.45
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$121.10
Rate for Payer: Devoted Health Medicare	$31.14
Rate for Payer: Humana of AZ Medicare	$27.68
Rate for Payer: Southwest Service Administrators UFCW	$117.64
Rate for Payer: TriWest Medicare	$27.68
Rate for Payer: United Healthcare Commercial	$98.96
Rate for Payer: United Healthcare Medicare	$27.68
Rate for Payer: United Healthcare New Mexico Commercial	$32.87
Rate for Payer: Veterans Affairs TRICARE	$27.40

PTH

Facility

$334.00

Service Code	CPT 83970
Hospital Charge Code	22481499
Hospital Revenue Code	301
Min. Negotiated Rate	$300.60
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Cash Price	$267.20

PTH

Facility

$334.00

Service Code	CPT 83970
Hospital Charge Code	22481499
Hospital Revenue Code	301
Min. Negotiated Rate	$52.91
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Arizona Complete Health Allwell	$53.44
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$227.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.44
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$217.10
Rate for Payer: Devoted Health Medicare	$60.12
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Seven Corners Travel Insurance	$59.86
Rate for Payer: Southwest Service Administrators UFCW	$227.12
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: United Healthcare Commercial	$191.05
Rate for Payer: United Healthcare Medicare	$53.44
Rate for Payer: Veterans Affairs TRICARE	$52.91

PTH, Intact LC

Facility

$707.00

Service Code	CPT 83970
Hospital Charge Code	1285622
Hospital Revenue Code	301
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$636.30
Rate for Payer: Aetna of AZ Commercial	$636.30
Rate for Payer: Aetna of AZ Commercial	$436.50
Rate for Payer: Arizona Complete Health Allwell	$77.60
Rate for Payer: Arizona Complete Health Allwell	$113.12
Rate for Payer: Banner UC Health Medicare	$77.60
Rate for Payer: Banner UC Health Medicare	$113.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$480.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$329.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$77.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$113.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$77.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$113.12
Rate for Payer: Cash Price	$565.60
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cash Price	$565.60
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cigna of AZ Commercial	$459.55
Rate for Payer: Cigna of AZ Commercial	$315.25
Rate for Payer: Devoted Health Medicare	$127.26
Rate for Payer: Devoted Health Medicare	$87.30
Rate for Payer: Humana of AZ Medicare	$77.60
Rate for Payer: Humana of AZ Medicare	$113.12
Rate for Payer: Seven Corners Travel Insurance	$59.86
Rate for Payer: Seven Corners Travel Insurance	$59.86
Rate for Payer: Southwest Service Administrators UFCW	$329.80
Rate for Payer: Southwest Service Administrators UFCW	$480.76
Rate for Payer: TriWest Medicare	$77.60
Rate for Payer: TriWest Medicare	$113.12
Rate for Payer: United Healthcare Commercial	$404.40
Rate for Payer: United Healthcare Commercial	$277.42
Rate for Payer: United Healthcare Medicare	$77.60
Rate for Payer: United Healthcare Medicare	$113.12
Rate for Payer: Veterans Affairs TRICARE	$111.99
Rate for Payer: Veterans Affairs TRICARE	$76.82

PTH, Intact LC

Facility

$485.00

Service Code	CPT 83970
Hospital Charge Code	1285622
Hospital Revenue Code	301
Min. Negotiated Rate	$436.50
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna of AZ Commercial	$436.50
Rate for Payer: Aetna of AZ Commercial	$636.30
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cash Price	$565.60

PTHrP (PTH-Related Peptide) LC

Facility

$372.00

Service Code	CPT 82397
Hospital Charge Code	2087647
Hospital Revenue Code	301
Min. Negotiated Rate	$334.80
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Cash Price	$297.60

PTHrP (PTH-Related Peptide) LC

Facility

$372.00

Service Code	CPT 82397
Hospital Charge Code	2087647
Hospital Revenue Code	301
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$334.80
Rate for Payer: Aetna of AZ Commercial	$334.80
Rate for Payer: Arizona Complete Health Allwell	$59.52
Rate for Payer: Banner UC Health Medicare	$59.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$252.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$59.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$59.52
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cigna of AZ Commercial	$241.80
Rate for Payer: Devoted Health Medicare	$66.96
Rate for Payer: Humana of AZ Medicare	$59.52
Rate for Payer: Seven Corners Travel Insurance	$20.47
Rate for Payer: Southwest Service Administrators UFCW	$252.96
Rate for Payer: TriWest Medicare	$59.52
Rate for Payer: United Healthcare Commercial	$212.78
Rate for Payer: United Healthcare Medicare	$59.52
Rate for Payer: Veterans Affairs TRICARE	$58.92

PT IONTOPHORESIS @ 15 MIN

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	692258
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 IONTOPHORESIS @ 15 MIN

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	692258
Hospital Revenue Code	420
Min. Negotiated Rate	$19.83
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	$19.83
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 Iontophoresis Units

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	28218263
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 Iontophoresis Units

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	8798832
Hospital Revenue Code	420
Min. Negotiated Rate	$19.83
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	$19.83
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 Iontophoresis Units

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	28218263
Hospital Revenue Code	420
Min. Negotiated Rate	$19.83
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	$19.83
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 Iontophoresis Units

Facility

$172.00

Service Code	CPT 97033 GP
Hospital Charge Code	8798832
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

Know your out-of-pocket cost for care.

All Charges