Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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	$33.64
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 SELF CARE/HOME MGT TRG EACH 15

Facility

$181.00

Service Code	CPT 97535 GP
Hospital Charge Code	8772924
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	$33.64
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 SELF CARE/HOME MGT TRG EACH 15

Facility

$181.00

Service Code	CPT 97535 GP
Hospital Charge Code	8772924
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

PTT

Facility

$141.00

Service Code	CPT 85730
Hospital Charge Code	22481500
Hospital Revenue Code	305
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Arizona Complete Health Allwell	$22.56
Rate for Payer: Banner UC Health Medicare	$22.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$95.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.56
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cigna of AZ Commercial	$91.65
Rate for Payer: Devoted Health Medicare	$25.38
Rate for Payer: Humana of AZ Medicare	$22.56
Rate for Payer: Seven Corners Travel Insurance	$8.71
Rate for Payer: Southwest Service Administrators UFCW	$95.88
Rate for Payer: TriWest Medicare	$22.56
Rate for Payer: United Healthcare Commercial	$80.65
Rate for Payer: United Healthcare Medicare	$22.56
Rate for Payer: Veterans Affairs TRICARE	$22.33

PTT

Facility

$141.00

Service Code	CPT 85730
Hospital Charge Code	22481500
Hospital Revenue Code	305
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Cash Price	$112.80

PTT DED

Facility

$148.00

Service Code	CPT 85730
Hospital Charge Code	24151823
Hospital Revenue Code	305
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Arizona Complete Health Allwell	$23.68
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$100.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.68
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$96.20
Rate for Payer: Devoted Health Medicare	$26.64
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Seven Corners Travel Insurance	$8.71
Rate for Payer: Southwest Service Administrators UFCW	$100.64
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: United Healthcare Commercial	$84.66
Rate for Payer: United Healthcare Medicare	$23.68
Rate for Payer: Veterans Affairs TRICARE	$23.44

PTT DED

Facility

$148.00

Service Code	CPT 85730
Hospital Charge Code	24151823
Hospital Revenue Code	305
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Cash Price	$118.40

PT T E N S APPLICATION

Facility

$697.00

Service Code	CPT 64550 GP
Hospital Charge Code	1272337
Hospital Revenue Code	420
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 T E N S APPLICATION

Facility

$697.00

Service Code	CPT 64550 GP
Hospital Charge Code	1272337
Hospital Revenue Code	420
Min. Negotiated Rate	$110.40
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	$111.52
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 Therapeutic Activity Units

Facility

$172.00

Service Code	CPT 97530 GP
Hospital Charge Code	8798850
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 Therapeutic Activity Units

Facility

$172.00

Service Code	CPT 97530 GP
Hospital Charge Code	8798850
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 THERAPEUTIC EX @15 MIN

Facility

$172.00

Service Code	CPT 97110 GP
Hospital Charge Code	692217
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	$30.45
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 THERAPEUTIC EX @15 MIN

Facility

$172.00

Service Code	CPT 97110 GP
Hospital Charge Code	692217
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 Therapeutic Exercise Units

Facility

$172.00

Service Code	CPT 97110 GP
Hospital Charge Code	8798838
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 Therapeutic Exercise Units

Facility

$172.00

Service Code	CPT 97110 GP
Hospital Charge Code	8798838
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	$30.45
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 (Thromborel-S) LC

Facility

$141.00

Service Code	CPT 85730
Hospital Charge Code	22311162
Hospital Revenue Code	301
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Cash Price	$112.80

.PT (Thromborel-S) LC

Facility

$141.00

Service Code	CPT 85730
Hospital Charge Code	22311162
Hospital Revenue Code	301
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Arizona Complete Health Allwell	$22.56
Rate for Payer: Banner UC Health Medicare	$22.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$95.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.56
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cigna of AZ Commercial	$91.65
Rate for Payer: Devoted Health Medicare	$25.38
Rate for Payer: Humana of AZ Medicare	$22.56
Rate for Payer: Seven Corners Travel Insurance	$8.71
Rate for Payer: Southwest Service Administrators UFCW	$95.88
Rate for Payer: TriWest Medicare	$22.56
Rate for Payer: United Healthcare Commercial	$80.65
Rate for Payer: United Healthcare Medicare	$22.56
Rate for Payer: Veterans Affairs TRICARE	$22.33

PT TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	1230088
Hospital Revenue Code	420
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 TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	8798796
Hospital Revenue Code	420
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 TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	8798796
Hospital Revenue Code	420
Min. Negotiated Rate	$14.87
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	$14.87
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

PT TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	28214119
Hospital Revenue Code	420
Min. Negotiated Rate	$14.87
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	$14.87
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

PT TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	1230088
Hospital Revenue Code	420
Min. Negotiated Rate	$14.87
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	$14.87
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

PT TRACTION MECH 1 OR MORE AREAS

Facility

$537.00

Service Code	CPT 97012 GP
Hospital Charge Code	28214119
Hospital Revenue Code	420
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

.PTT SUB

Facility

$91.00

Service Code	CPT 85732
Hospital Charge Code	22481450
Hospital Revenue Code	305
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Cash Price	$72.80

.PTT SUB

Facility

$91.00

Service Code	CPT 85732
Hospital Charge Code	22481450
Hospital Revenue Code	305
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Arizona Complete Health Allwell	$14.56
Rate for Payer: Banner UC Health Medicare	$14.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.56
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$59.15
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Humana of AZ Medicare	$14.56
Rate for Payer: Seven Corners Travel Insurance	$9.38
Rate for Payer: Southwest Service Administrators UFCW	$61.88
Rate for Payer: TriWest Medicare	$14.56
Rate for Payer: United Healthcare Commercial	$52.05
Rate for Payer: United Healthcare Medicare	$14.56
Rate for Payer: Veterans Affairs TRICARE	$14.41

Know your out-of-pocket cost for care.

All Charges