Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Spinal Procedures

Facility

$25,776.45

Service Code	APR-DRG 0233
Hospital Charge Code	APRDRG0231
Min. Negotiated Rate	$25,776.45
Max. Negotiated Rate	$25,776.45
Rate for Payer: AHCCCS Medicaid	$25,776.45
Rate for Payer: Allwell Medicaid	$25,776.45
Rate for Payer: AZCH Complete Medicaid	$25,776.45
Rate for Payer: Banner UC Health Medicaid	$25,776.45
Rate for Payer: Mercy Care Medicaid	$25,776.45

Spinal Procedures

Facility

$10,554.67

Service Code	APR-DRG 0231
Hospital Charge Code	APRDRG0231
Min. Negotiated Rate	$10,554.67
Max. Negotiated Rate	$10,554.67
Rate for Payer: AHCCCS Medicaid	$10,554.67
Rate for Payer: Allwell Medicaid	$10,554.67
Rate for Payer: AZCH Complete Medicaid	$10,554.67
Rate for Payer: Banner UC Health Medicaid	$10,554.67
Rate for Payer: Mercy Care Medicaid	$10,554.67

Spinal Procedures

Facility

$40,597.73

Service Code	APR-DRG 0234
Hospital Charge Code	APRDRG0232
Min. Negotiated Rate	$40,597.73
Max. Negotiated Rate	$40,597.73
Rate for Payer: AHCCCS Medicaid	$40,597.73
Rate for Payer: Allwell Medicaid	$40,597.73
Rate for Payer: AZCH Complete Medicaid	$40,597.73
Rate for Payer: Banner UC Health Medicaid	$40,597.73
Rate for Payer: Mercy Care Medicaid	$40,597.73

Spinal Procedures

Facility

$14,480.40

Service Code	APR-DRG 0232
Hospital Charge Code	APRDRG0234
Min. Negotiated Rate	$14,480.40
Max. Negotiated Rate	$14,480.40
Rate for Payer: AHCCCS Medicaid	$14,480.40
Rate for Payer: Allwell Medicaid	$14,480.40
Rate for Payer: AZCH Complete Medicaid	$14,480.40
Rate for Payer: Banner UC Health Medicaid	$14,480.40
Rate for Payer: Mercy Care Medicaid	$14,480.40

Spinal Procedures

Facility

$14,480.40

Service Code	APR-DRG 0232
Hospital Charge Code	APRDRG0232
Min. Negotiated Rate	$14,480.40
Max. Negotiated Rate	$14,480.40
Rate for Payer: AHCCCS Medicaid	$14,480.40
Rate for Payer: Allwell Medicaid	$14,480.40
Rate for Payer: AZCH Complete Medicaid	$14,480.40
Rate for Payer: Banner UC Health Medicaid	$14,480.40
Rate for Payer: Mercy Care Medicaid	$14,480.40

Spinal Procedures

Facility

$40,597.73

Service Code	APR-DRG 0234
Hospital Charge Code	APRDRG0231
Min. Negotiated Rate	$40,597.73
Max. Negotiated Rate	$40,597.73
Rate for Payer: AHCCCS Medicaid	$40,597.73
Rate for Payer: Allwell Medicaid	$40,597.73
Rate for Payer: AZCH Complete Medicaid	$40,597.73
Rate for Payer: Banner UC Health Medicaid	$40,597.73
Rate for Payer: Mercy Care Medicaid	$40,597.73

Spinal Procedures

Facility

$40,597.73

Service Code	APR-DRG 0234
Hospital Charge Code	APRDRG0234
Min. Negotiated Rate	$40,597.73
Max. Negotiated Rate	$40,597.73
Rate for Payer: AHCCCS Medicaid	$40,597.73
Rate for Payer: Allwell Medicaid	$40,597.73
Rate for Payer: AZCH Complete Medicaid	$40,597.73
Rate for Payer: Banner UC Health Medicaid	$40,597.73
Rate for Payer: Mercy Care Medicaid	$40,597.73

Spinal Procedures

Facility

$25,776.45

Service Code	APR-DRG 0233
Hospital Charge Code	APRDRG0233
Min. Negotiated Rate	$25,776.45
Max. Negotiated Rate	$25,776.45
Rate for Payer: AHCCCS Medicaid	$25,776.45
Rate for Payer: Allwell Medicaid	$25,776.45
Rate for Payer: AZCH Complete Medicaid	$25,776.45
Rate for Payer: Banner UC Health Medicaid	$25,776.45
Rate for Payer: Mercy Care Medicaid	$25,776.45

Spinal Procedures

Facility

$10,554.67

Service Code	APR-DRG 0231
Hospital Charge Code	APRDRG0233
Min. Negotiated Rate	$10,554.67
Max. Negotiated Rate	$10,554.67
Rate for Payer: AHCCCS Medicaid	$10,554.67
Rate for Payer: Allwell Medicaid	$10,554.67
Rate for Payer: AZCH Complete Medicaid	$10,554.67
Rate for Payer: Banner UC Health Medicaid	$10,554.67
Rate for Payer: Mercy Care Medicaid	$10,554.67

spironolactone 100 mg Tab [CQCH]

Facility

$0.82

Service Code	NDC 68084020801
Hospital Charge Code	105942367
Hospital Revenue Code	251
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of AZ Commercial	$0.74
Rate for Payer: Bisbee Police All Plans	$0.21
Rate for Payer: Cash Price	$0.66
Rate for Payer: Self Pay Self Pay	$0.66

spironolactone 100 mg Tab [CQCH]

Facility

$0.82

Service Code	NDC 68084020801
Hospital Charge Code	105942367
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of AZ Commercial	$0.74
Rate for Payer: Aetna of AZ Medicare	$0.23
Rate for Payer: Allwell Medicare	$0.12
Rate for Payer: Amerigroup Medicare	$0.12
Rate for Payer: APIPA Medicare/Medicaid	$0.31
Rate for Payer: AZCH Complete Medicare	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Bisbee Police All Plans	$0.21
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.56
Rate for Payer: Cash Price	$0.66
Rate for Payer: Cigna of AZ Commercial	$0.53
Rate for Payer: Copperpoint Commercial	$0.20
Rate for Payer: Health Net of AZ Commercial	$0.49
Rate for Payer: Health Net of AZ Medicare	$0.23
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Self Pay Self Pay	$0.66
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

spironolactone 25 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 63739054410
Hospital Charge Code	105942302
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.09
Rate for Payer: Self Pay Self Pay	$0.09

spironolactone 25 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 63739054410
Hospital Charge Code	105942302
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.07
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

Splenectomy

Facility

$9,085.94

Service Code	APR-DRG 6501
Hospital Charge Code	APRDRG6503
Min. Negotiated Rate	$9,085.94
Max. Negotiated Rate	$9,085.94
Rate for Payer: AHCCCS Medicaid	$9,085.94
Rate for Payer: Allwell Medicaid	$9,085.94
Rate for Payer: AZCH Complete Medicaid	$9,085.94
Rate for Payer: Banner UC Health Medicaid	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94

Splenectomy

Facility

$11,694.44

Service Code	APR-DRG 6502
Hospital Charge Code	APRDRG6502
Min. Negotiated Rate	$11,694.44
Max. Negotiated Rate	$11,694.44
Rate for Payer: AHCCCS Medicaid	$11,694.44
Rate for Payer: Allwell Medicaid	$11,694.44
Rate for Payer: AZCH Complete Medicaid	$11,694.44
Rate for Payer: Banner UC Health Medicaid	$11,694.44
Rate for Payer: Mercy Care Medicaid	$11,694.44

Splenectomy

Facility

$28,723.73

Service Code	APR-DRG 6504
Hospital Charge Code	APRDRG6501
Min. Negotiated Rate	$28,723.73
Max. Negotiated Rate	$28,723.73
Rate for Payer: AHCCCS Medicaid	$28,723.73
Rate for Payer: Allwell Medicaid	$28,723.73
Rate for Payer: AZCH Complete Medicaid	$28,723.73
Rate for Payer: Banner UC Health Medicaid	$28,723.73
Rate for Payer: Mercy Care Medicaid	$28,723.73

Splenectomy

Facility

$9,085.94

Service Code	APR-DRG 6501
Hospital Charge Code	APRDRG6501
Min. Negotiated Rate	$9,085.94
Max. Negotiated Rate	$9,085.94
Rate for Payer: AHCCCS Medicaid	$9,085.94
Rate for Payer: Allwell Medicaid	$9,085.94
Rate for Payer: AZCH Complete Medicaid	$9,085.94
Rate for Payer: Banner UC Health Medicaid	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94

Splenectomy

Facility

$19,233.09

Service Code	APR-DRG 6503
Hospital Charge Code	APRDRG6502
Min. Negotiated Rate	$19,233.09
Max. Negotiated Rate	$19,233.09
Rate for Payer: AHCCCS Medicaid	$19,233.09
Rate for Payer: Allwell Medicaid	$19,233.09
Rate for Payer: AZCH Complete Medicaid	$19,233.09
Rate for Payer: Banner UC Health Medicaid	$19,233.09
Rate for Payer: Mercy Care Medicaid	$19,233.09

Splenectomy

Facility

$19,233.09

Service Code	APR-DRG 6503
Hospital Charge Code	APRDRG6501
Min. Negotiated Rate	$19,233.09
Max. Negotiated Rate	$19,233.09
Rate for Payer: AHCCCS Medicaid	$19,233.09
Rate for Payer: Allwell Medicaid	$19,233.09
Rate for Payer: AZCH Complete Medicaid	$19,233.09
Rate for Payer: Banner UC Health Medicaid	$19,233.09
Rate for Payer: Mercy Care Medicaid	$19,233.09

Splenectomy

Facility

$19,233.09

Service Code	APR-DRG 6503
Hospital Charge Code	APRDRG6503
Min. Negotiated Rate	$19,233.09
Max. Negotiated Rate	$19,233.09
Rate for Payer: AHCCCS Medicaid	$19,233.09
Rate for Payer: Allwell Medicaid	$19,233.09
Rate for Payer: AZCH Complete Medicaid	$19,233.09
Rate for Payer: Banner UC Health Medicaid	$19,233.09
Rate for Payer: Mercy Care Medicaid	$19,233.09

Splenectomy

Facility

$11,694.44

Service Code	APR-DRG 6502
Hospital Charge Code	APRDRG6503
Min. Negotiated Rate	$11,694.44
Max. Negotiated Rate	$11,694.44
Rate for Payer: AHCCCS Medicaid	$11,694.44
Rate for Payer: Allwell Medicaid	$11,694.44
Rate for Payer: AZCH Complete Medicaid	$11,694.44
Rate for Payer: Banner UC Health Medicaid	$11,694.44
Rate for Payer: Mercy Care Medicaid	$11,694.44

Splenectomy

Facility

$9,085.94

Service Code	APR-DRG 6501
Hospital Charge Code	APRDRG6502
Min. Negotiated Rate	$9,085.94
Max. Negotiated Rate	$9,085.94
Rate for Payer: AHCCCS Medicaid	$9,085.94
Rate for Payer: Allwell Medicaid	$9,085.94
Rate for Payer: AZCH Complete Medicaid	$9,085.94
Rate for Payer: Banner UC Health Medicaid	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94

Splenectomy

Facility

$28,723.73

Service Code	APR-DRG 6504
Hospital Charge Code	APRDRG6504
Min. Negotiated Rate	$28,723.73
Max. Negotiated Rate	$28,723.73
Rate for Payer: AHCCCS Medicaid	$28,723.73
Rate for Payer: Allwell Medicaid	$28,723.73
Rate for Payer: AZCH Complete Medicaid	$28,723.73
Rate for Payer: Banner UC Health Medicaid	$28,723.73
Rate for Payer: Mercy Care Medicaid	$28,723.73

Splenectomy

Facility

$11,694.44

Service Code	APR-DRG 6502
Hospital Charge Code	APRDRG6501
Min. Negotiated Rate	$11,694.44
Max. Negotiated Rate	$11,694.44
Rate for Payer: AHCCCS Medicaid	$11,694.44
Rate for Payer: Allwell Medicaid	$11,694.44
Rate for Payer: AZCH Complete Medicaid	$11,694.44
Rate for Payer: Banner UC Health Medicaid	$11,694.44
Rate for Payer: Mercy Care Medicaid	$11,694.44

Splenectomy

Facility

$28,723.73

Service Code	APR-DRG 6504
Hospital Charge Code	APRDRG6502
Min. Negotiated Rate	$28,723.73
Max. Negotiated Rate	$28,723.73
Rate for Payer: AHCCCS Medicaid	$28,723.73
Rate for Payer: Allwell Medicaid	$28,723.73
Rate for Payer: AZCH Complete Medicaid	$28,723.73
Rate for Payer: Banner UC Health Medicaid	$28,723.73
Rate for Payer: Mercy Care Medicaid	$28,723.73

Know your out-of-pocket cost for care.

All Charges