Copper Queen Community Hospital

All Charges

Charge

Type

Price

Spinal Disorders And Injuries

Facility IP

$13,968.38

Service Code	APRDRG 403
Hospital Charge Code	APRDRG403
Min. Negotiated Rate	$13,968.38
Max. Negotiated Rate	$13,968.38
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$13,968.38
Rate for Payer: Arizona Complete Care Health Medicaid	$13,968.38
Rate for Payer: Banner University Family Care Medicaid	$13,968.38
Rate for Payer: Mercy Care Medicaid	$13,968.38

Spinal Disorders And Injuries

Facility IP

$6,868.11

Service Code	APRDRG 401
Hospital Charge Code	APRDRG401
Min. Negotiated Rate	$6,868.11
Max. Negotiated Rate	$6,868.11
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$6,868.11
Rate for Payer: Arizona Complete Care Health Medicaid	$6,868.11
Rate for Payer: Banner University Family Care Medicaid	$6,868.11
Rate for Payer: Mercy Care Medicaid	$6,868.11

Spinal Procedures

Facility IP

$25,776.45

Service Code	APRDRG 233
Hospital Charge Code	APRDRG233
Min. Negotiated Rate	$25,776.45
Max. Negotiated Rate	$25,776.45
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$25,776.45
Rate for Payer: Arizona Complete Care Health Medicaid	$25,776.45
Rate for Payer: Banner University Family Care Medicaid	$25,776.45
Rate for Payer: Mercy Care Medicaid	$25,776.45

Spinal Procedures

Facility IP

$14,480.40

Service Code	APRDRG 232
Hospital Charge Code	APRDRG232
Min. Negotiated Rate	$14,480.40
Max. Negotiated Rate	$14,480.40
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$14,480.40
Rate for Payer: Arizona Complete Care Health Medicaid	$14,480.40
Rate for Payer: Banner University Family Care Medicaid	$14,480.40
Rate for Payer: Mercy Care Medicaid	$14,480.40

Spinal Procedures

Facility IP

$40,597.73

Service Code	APRDRG 234
Hospital Charge Code	APRDRG234
Min. Negotiated Rate	$40,597.73
Max. Negotiated Rate	$40,597.73
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$40,597.73
Rate for Payer: Arizona Complete Care Health Medicaid	$40,597.73
Rate for Payer: Banner University Family Care Medicaid	$40,597.73
Rate for Payer: Mercy Care Medicaid	$40,597.73

Spinal Procedures

Facility IP

$10,554.67

Service Code	APRDRG 231
Hospital Charge Code	APRDRG231
Min. Negotiated Rate	$10,554.67
Max. Negotiated Rate	$10,554.67
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$10,554.67
Rate for Payer: Arizona Complete Care Health Medicaid	$10,554.67
Rate for Payer: Banner University Family Care Medicaid	$10,554.67
Rate for Payer: Mercy Care Medicaid	$10,554.67

Splenectomy

Facility IP

$28,723.73

Service Code	APRDRG 6504
Hospital Charge Code	APRDRG6504
Min. Negotiated Rate	$28,723.73
Max. Negotiated Rate	$28,723.73
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$28,723.73
Rate for Payer: Arizona Complete Care Health Medicaid	$28,723.73
Rate for Payer: Banner University Family Care Medicaid	$28,723.73
Rate for Payer: Mercy Care Medicaid	$28,723.73

Splenectomy

Facility IP

$11,694.44

Service Code	APRDRG 6502
Hospital Charge Code	APRDRG6502
Min. Negotiated Rate	$11,694.44
Max. Negotiated Rate	$11,694.44
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$11,694.44
Rate for Payer: Arizona Complete Care Health Medicaid	$11,694.44
Rate for Payer: Banner University Family Care Medicaid	$11,694.44
Rate for Payer: Mercy Care Medicaid	$11,694.44

Splenectomy

Facility IP

$9,085.94

Service Code	APRDRG 6501
Hospital Charge Code	APRDRG6501
Min. Negotiated Rate	$9,085.94
Max. Negotiated Rate	$9,085.94
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$9,085.94
Rate for Payer: Arizona Complete Care Health Medicaid	$9,085.94
Rate for Payer: Banner University Family Care Medicaid	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94

Splenectomy

Facility IP

$19,233.09

Service Code	APRDRG 6503
Hospital Charge Code	APRDRG6503
Min. Negotiated Rate	$19,233.09
Max. Negotiated Rate	$19,233.09
Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid	$19,233.09
Rate for Payer: Arizona Complete Care Health Medicaid	$19,233.09
Rate for Payer: Banner University Family Care Medicaid	$19,233.09
Rate for Payer: Mercy Care Medicaid	$19,233.09

SPLINT ANKLE

Facility IP

$62.00

Hospital Charge Code	22354257
Hospital Revenue Code	270
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna POS, PPO, HMO	$55.80
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$10.54
Rate for Payer: Amerigroup Medicare	$10.54
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$10.54
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$10.54
Rate for Payer: City of Bisbee Police Bisbee Police	$16.12
Rate for Payer: Copperpoint	$17.39
Rate for Payer: Humana Medicare	$10.54
Rate for Payer: SELF PAY	$49.60
Rate for Payer: Veterans (Triwest)	$10.54

SPLINT ANKLE

Facility OP

$62.00

Hospital Charge Code	22354257
Hospital Revenue Code	270
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna POS, PPO, HMO	$55.80
Rate for Payer: Aetna Medicare	$17.36
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$10.54
Rate for Payer: Amerigroup Medicare	$10.54
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$23.16
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$10.54
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$10.54
Rate for Payer: City of Bisbee Police Bisbee Police	$16.12
Rate for Payer: Cigna All Products	$43.40
Rate for Payer: Copperpoint	$17.39
Rate for Payer: HealthNet Commercial	$37.20
Rate for Payer: HealthNet Medicare	$17.36
Rate for Payer: Humana Medicare	$10.54
Rate for Payer: SELF PAY	$49.60
Rate for Payer: Veterans (Triwest)	$10.54
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$36.15
Rate for Payer: United Healthcare Medicare	$11.16

SPLINT COLLES LARGE LEFT HAND

Facility IP

$25.00

Hospital Charge Code	22354295
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25

SPLINT COLLES LARGE LEFT HAND

Facility OP

$25.00

Hospital Charge Code	22354295
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$9.34
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Cigna All Products	$17.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: HealthNet Commercial	$15.00
Rate for Payer: HealthNet Medicare	$7.00
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$14.57
Rate for Payer: United Healthcare Medicare	$4.50

SPLINT COLLES LARGE RIGHT HAND

Facility IP

$25.00

Hospital Charge Code	22354298
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25

SPLINT COLLES LARGE RIGHT HAND

Facility OP

$25.00

Hospital Charge Code	22354298
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$9.34
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Cigna All Products	$17.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: HealthNet Commercial	$15.00
Rate for Payer: HealthNet Medicare	$7.00
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$14.57
Rate for Payer: United Healthcare Medicare	$4.50

SPLINT COLLES MEDIUM LEFT HAND

Facility IP

$25.00

Hospital Charge Code	22354294
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25

SPLINT COLLES MEDIUM LEFT HAND

Facility OP

$25.00

Hospital Charge Code	22354294
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$9.34
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Cigna All Products	$17.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: HealthNet Commercial	$15.00
Rate for Payer: HealthNet Medicare	$7.00
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$14.57
Rate for Payer: United Healthcare Medicare	$4.50

SPLINT COLLES MEDIUM RIGHT HAND

Facility OP

$37.00

Hospital Charge Code	22354241
Hospital Revenue Code	270
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna POS, PPO, HMO	$33.30
Rate for Payer: Aetna Medicare	$10.36
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$6.29
Rate for Payer: Amerigroup Medicare	$6.29
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$13.82
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$6.29
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$6.29
Rate for Payer: City of Bisbee Police Bisbee Police	$9.62
Rate for Payer: Cigna All Products	$25.90
Rate for Payer: Copperpoint	$10.38
Rate for Payer: HealthNet Commercial	$22.20
Rate for Payer: HealthNet Medicare	$10.36
Rate for Payer: Humana Medicare	$6.29
Rate for Payer: SELF PAY	$29.60
Rate for Payer: Veterans (Triwest)	$6.29
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$21.57
Rate for Payer: United Healthcare Medicare	$6.66

SPLINT COLLES MEDIUM RIGHT HAND

Facility IP

$37.00

Hospital Charge Code	22354241
Hospital Revenue Code	270
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna POS, PPO, HMO	$33.30
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$6.29
Rate for Payer: Amerigroup Medicare	$6.29
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$6.29
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$6.29
Rate for Payer: City of Bisbee Police Bisbee Police	$9.62
Rate for Payer: Copperpoint	$10.38
Rate for Payer: Humana Medicare	$6.29
Rate for Payer: SELF PAY	$29.60
Rate for Payer: Veterans (Triwest)	$6.29

SPLINT COLLES SMALL LEFT HAND

Facility OP

$25.00

Hospital Charge Code	22354293
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$9.34
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Cigna All Products	$17.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: HealthNet Commercial	$15.00
Rate for Payer: HealthNet Medicare	$7.00
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$14.57
Rate for Payer: United Healthcare Medicare	$4.50

SPLINT COLLES SMALL LEFT HAND

Facility IP

$25.00

Hospital Charge Code	22354293
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25

SPLINT COLLES SMALL RIGHT HAND

Facility IP

$25.00

Hospital Charge Code	22354297
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25

SPLINT COLLES SMALL RIGHT HAND

Facility OP

$25.00

Hospital Charge Code	22354297
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna POS, PPO, HMO	$22.50
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$4.25
Rate for Payer: Amerigroup Medicare	$4.25
Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid	$9.34
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$4.25
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$4.25
Rate for Payer: City of Bisbee Police Bisbee Police	$6.50
Rate for Payer: Cigna All Products	$17.50
Rate for Payer: Copperpoint	$7.01
Rate for Payer: HealthNet Commercial	$15.00
Rate for Payer: HealthNet Medicare	$7.00
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: SELF PAY	$20.00
Rate for Payer: Veterans (Triwest)	$4.25
Rate for Payer: United Healthcare (PPO, HMO, HMO, POS)	$14.57
Rate for Payer: United Healthcare Medicare	$4.50

SPLINT COLLES X-SMALL LEFT HAND

Facility IP

$55.00

Hospital Charge Code	22354292
Hospital Revenue Code	270
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna POS, PPO, HMO	$49.50
Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage	$9.35
Rate for Payer: Amerigroup Medicare	$9.35
Rate for Payer: Arizona Complete Care Health Medicare Advantage	$9.35
Rate for Payer: Banner University Care Advantage Health Maintenance Organization	$9.35
Rate for Payer: City of Bisbee Police Bisbee Police	$14.30
Rate for Payer: Copperpoint	$15.43
Rate for Payer: Humana Medicare	$9.35
Rate for Payer: SELF PAY	$44.00
Rate for Payer: Veterans (Triwest)	$9.35

Copper Queen Community Hospital

Price Transparency.

All Charges