Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PT Manual Therapy Units

Facility

$181.00

Service Code	CPT 97140 GP
Hospital Charge Code	8798848
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 Manual Therapy Units

Facility

$181.00

Service Code	CPT 97140 GP
Hospital Charge Code	8798848
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	$29.03
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 MASSAGE 15 MIN

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	692251
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	$30.81
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 MASSAGE 15 MIN

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	692251
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 Massage Units

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	8798846
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	$30.81
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 Massage Units

Facility

$181.00

Service Code	CPT 97124 GP
Hospital Charge Code	8798846
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 Mobility Goal Status G-8979 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	HCPCS G8979 GP
Hospital Charge Code	6035332
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Cash Price	$4.00

PT Mobility Goal Status G-8979 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	HCPCS G8979 GP
Hospital Charge Code	6035332
Hospital Revenue Code	420
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Arizona Complete Health Allwell	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.80
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Southwest Service Administrators UFCW	$3.40
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: United Healthcare Commercial	$2.86
Rate for Payer: United Healthcare Medicare	$0.80
Rate for Payer: United Healthcare New Mexico Commercial	$0.95
Rate for Payer: Veterans Affairs TRICARE	$0.79

PT Mobility Goal Status G-8979 CN 100% impaired

Facility

$5.00

Service Code	HCPCS G8979 GP
Hospital Charge Code	6035331
Hospital Revenue Code	420
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Arizona Complete Health Allwell	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.80
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Southwest Service Administrators UFCW	$3.40
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: United Healthcare Commercial	$2.86
Rate for Payer: United Healthcare Medicare	$0.80
Rate for Payer: United Healthcare New Mexico Commercial	$0.95
Rate for Payer: Veterans Affairs TRICARE	$0.79

PT Mobility Goal Status G-8979 CN 100% impaired

Facility

$5.00

Service Code	HCPCS G8979 GP
Hospital Charge Code	6035331
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Cash Price	$4.00

PT Neuromuscular Reeducation Units

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	8798852
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 Neuromuscular Reeducation Units

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	8798852
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	$33.99
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 NEURO RE-ED EACH 15MIN

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	692238
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 NEURO RE-ED EACH 15MIN

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	692238
Hospital Revenue Code	420
Min. Negotiated Rate	$28.67
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	$33.99
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 ORTHO FITTRNG EACH 15

Facility

$203.00

Service Code	CPT 97760 GP
Hospital Charge Code	692243
Hospital Revenue Code	420
Min. Negotiated Rate	$32.16
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 Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.80
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: 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 ORTHO FITTRNG EACH 15

Facility

$203.00

Service Code	CPT 97760 GP
Hospital Charge Code	692243
Hospital Revenue Code	420
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 ORTHO/PROS CKOUT @ 15 MIN

Facility

$172.00

Service Code	CPT 97762 GP
Hospital Charge Code	2781053
Hospital Revenue Code	420
Min. Negotiated Rate	$27.24
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	$27.52
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 ORTHO/PROS CKOUT @ 15 MIN

Facility

$172.00

Service Code	CPT 97762 GP
Hospital Charge Code	2781053
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 Orthotic Management Train Units

Facility

$203.00

Service Code	CPT 97760 GP
Hospital Charge Code	8798867
Hospital Revenue Code	420
Min. Negotiated Rate	$32.16
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 Medicare	$32.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.80
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: 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 Orthotic Management Train Units

Facility

$203.00

Service Code	CPT 97760 GP
Hospital Charge Code	8798867
Hospital Revenue Code	420
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 Other Primary Goal Status G-8991 CH 0% impaired

Facility

$5.00

Service Code	HCPCS G8991 GP
Hospital Charge Code	6035358
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Cash Price	$4.00

PT Other Primary Goal Status G-8991 CH 0% impaired

Facility

$5.00

Service Code	HCPCS G8991 GP
Hospital Charge Code	6035358
Hospital Revenue Code	420
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Arizona Complete Health Allwell	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.80
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Southwest Service Administrators UFCW	$3.40
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: United Healthcare Commercial	$2.86
Rate for Payer: United Healthcare Medicare	$0.80
Rate for Payer: United Healthcare New Mexico Commercial	$0.95
Rate for Payer: Veterans Affairs TRICARE	$0.79

PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired

Facility

$5.00

Service Code	HCPCS G8991 GP
Hospital Charge Code	6035357
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Cash Price	$4.00

PT Other Primary Goal Status G-8991 CI At least 1% but less than 20% impaired

Facility

$5.00

Service Code	HCPCS G8991 GP
Hospital Charge Code	6035357
Hospital Revenue Code	420
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Arizona Complete Health Allwell	$0.80
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.80
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna of AZ Commercial	$3.50
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Southwest Service Administrators UFCW	$3.40
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: United Healthcare Commercial	$2.86
Rate for Payer: United Healthcare Medicare	$0.80
Rate for Payer: United Healthcare New Mexico Commercial	$0.95
Rate for Payer: Veterans Affairs TRICARE	$0.79

PT Other Primary Goal Status G-8991 CJ At least 20% but less than 40% impaired

Facility

$5.00

Service Code	HCPCS G8991 GP
Hospital Charge Code	6035356
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of AZ Commercial	$4.50
Rate for Payer: Cash Price	$4.00

Know your out-of-pocket cost for care.

All Charges