Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

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

$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	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

SPLINT ANKLE

Facility

$65.00

Hospital Charge Code	22354257
Hospital Revenue Code	270
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

SPLINT ANKLE

Facility

$65.00

Hospital Charge Code	22354257
Hospital Revenue Code	270
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

SPLINT COLLES LARGE LEFT HAND

Facility

$26.00

Hospital Charge Code	22354295
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

SPLINT COLLES LARGE LEFT HAND

Facility

$26.00

Hospital Charge Code	22354295
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SPLINT COLLES LARGE RIGHT HAND

Facility

$26.00

Hospital Charge Code	22354298
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SPLINT COLLES LARGE RIGHT HAND

Facility

$26.00

Hospital Charge Code	22354298
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

SPLINT COLLES MEDIUM LEFT HAND

Facility

$26.00

Hospital Charge Code	22354294
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SPLINT COLLES MEDIUM LEFT HAND

Facility

$26.00

Hospital Charge Code	22354294
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

SPLINT COLLES MEDIUM RIGHT HAND

Facility

$39.00

Hospital Charge Code	22354241
Hospital Revenue Code	270
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: Allwell Medicare	$5.85
Rate for Payer: Amerigroup Medicare	$5.85
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicare	$5.85
Rate for Payer: Banner UC Health Medicare	$5.85
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$5.85
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$5.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

SPLINT COLLES MEDIUM RIGHT HAND

Facility

$39.00

Hospital Charge Code	22354241
Hospital Revenue Code	270
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

SPLINT COLLES SMALL LEFT HAND

Facility

$26.00

Hospital Charge Code	22354293
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

SPLINT COLLES SMALL LEFT HAND

Facility

$26.00

Hospital Charge Code	22354293
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SPLINT COLLES SMALL RIGHT HAND

Facility

$26.00

Hospital Charge Code	22354297
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$3.90
Rate for Payer: Amerigroup Medicare	$3.90
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$3.90
Rate for Payer: Banner UC Health Medicare	$3.90
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.68
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.60
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$3.90
Rate for Payer: Self Pay Self Pay	$20.80
Rate for Payer: TriWest Medicare	$3.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

SPLINT COLLES SMALL RIGHT HAND

Facility

$26.00

Hospital Charge Code	22354297
Hospital Revenue Code	270
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.80
Rate for Payer: Self Pay Self Pay	$20.80

SPLINT COLLES X-SMALL LEFT HAND

Facility

$58.00

Hospital Charge Code	22354292
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$8.70
Rate for Payer: Amerigroup Medicare	$8.70
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$8.70
Rate for Payer: Banner UC Health Medicare	$8.70
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$8.70
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$8.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

SPLINT COLLES X-SMALL LEFT HAND

Facility

$58.00

Hospital Charge Code	22354292
Hospital Revenue Code	270
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Cash Price	$46.40
Rate for Payer: Self Pay Self Pay	$46.40

SPLINT COLLES X-SMALL RIGHT HAND

Facility

$58.00

Hospital Charge Code	22354296
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$8.70
Rate for Payer: Amerigroup Medicare	$8.70
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$8.70
Rate for Payer: Banner UC Health Medicare	$8.70
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$8.70
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$8.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

SPLINT COLLES X-SMALL RIGHT HAND

Facility

$58.00

Hospital Charge Code	22354296
Hospital Revenue Code	270
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Cash Price	$46.40
Rate for Payer: Self Pay Self Pay	$46.40

SPLINT LEG LARGE

Facility

$102.00

Hospital Charge Code	22354301
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Aetna of AZ Medicare	$28.56
Rate for Payer: Allwell Medicare	$15.30
Rate for Payer: Amerigroup Medicare	$15.30
Rate for Payer: APIPA Medicare/Medicaid	$38.10
Rate for Payer: AZCH Complete Medicare	$15.30
Rate for Payer: Banner UC Health Medicare	$15.30
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$69.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cigna of AZ Commercial	$71.40
Rate for Payer: Copperpoint Commercial	$25.24
Rate for Payer: Health Net of AZ Commercial	$61.20
Rate for Payer: Health Net of AZ Medicare	$28.56
Rate for Payer: Humana of AZ Medicare	$15.30
Rate for Payer: Self Pay Self Pay	$81.60
Rate for Payer: TriWest Medicare	$15.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$59.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.36

SPLINT LEG LARGE

Facility

$102.00

Hospital Charge Code	22354301
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Cash Price	$81.60
Rate for Payer: Self Pay Self Pay	$81.60

SPLINT LEG MEDIUM

Facility

$102.00

Hospital Charge Code	22354300
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Cash Price	$81.60
Rate for Payer: Self Pay Self Pay	$81.60

Know your out-of-pocket cost for care.

All Charges