Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PT Self-Care Current Status G-8987 CJ At least 20% but less than 40% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035381
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 Self-Care Current Status G-8987 CJ At least 20% but less than 40% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035381
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 Self-Care Current Status G-8987 CK At least 40% but less than 60% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035380
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 Self-Care Current Status G-8987 CK At least 40% but less than 60% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035380
Hospital Revenue Code	420
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$4.50
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
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

PT Self-Care Current Status G-8987 CL At least 60% but less than 80% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035379
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 Self-Care Current Status G-8987 CL At least 60% but less than 80% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035379
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 Self-Care Current Status G-8987 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035378
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 Self-Care Current Status G-8987 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035378
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 Self-Care Current Status G-8987 CN 100% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035377
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 Self-Care Current Status G-8987 CN 100% impaired

Facility

$5.00

Service Code	HCPCS G8987 GP
Hospital Charge Code	6035377
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 Self-Care Goal Status G-8988 CH 0% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035397
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 Self-Care Goal Status G-8988 CH 0% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035397
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 Self-Care Goal Status G-8988 CI At least 1% but less than 20% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035396
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 Self-Care Goal Status G-8988 CI At least 1% but less than 20% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035396
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 Self-Care Goal Status G-8988 CJ At least 20% but less than 40% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035395
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 Self-Care Goal Status G-8988 CJ At least 20% but less than 40% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035395
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 Self-Care Goal Status G-8988 CK At least 40% but less than 60% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035394
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 Self-Care Goal Status G-8988 CK At least 40% but less than 60% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035394
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 Self-Care Goal Status G-8988 CL At least 60% but less than 80% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035393
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 Self-Care Goal Status G-8988 CL At least 60% but less than 80% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035393
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 Self-Care Goal Status G-8988 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035392
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 Self-Care Goal Status G-8988 CM At least 80% but less than 100% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035392
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 Self-Care Goal Status G-8988 CN 100% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035391
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 Self-Care Goal Status G-8988 CN 100% impaired

Facility

$5.00

Service Code	HCPCS G8988 GP
Hospital Charge Code	6035391
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 Self Care Home Management Units

Facility

$181.00

Service Code	CPT 97535 GP
Hospital Charge Code	8798855
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

Know your out-of-pocket cost for care.

All Charges