Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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: Blue Cross Blue Shield of Arizona Health Choice	$40,597.73
Rate for Payer: Mercy Care Medicaid	$40,597.73
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$40,597.73
Rate for Payer: Mercy Care Medicaid	$40,597.73
Rate for Payer: NaphCare Correctional Healthcare	$40,597.73

Spinal Procedures

Facility

$10,554.67

Service Code	APR-DRG 0231
Hospital Charge Code	APRDRG0234
Min. Negotiated Rate	$10,554.67
Max. Negotiated Rate	$10,554.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,554.67
Rate for Payer: Mercy Care Medicaid	$10,554.67
Rate for Payer: NaphCare Correctional Healthcare	$10,554.67

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: Blue Cross Blue Shield of Arizona Health Choice	$14,480.40
Rate for Payer: Mercy Care Medicaid	$14,480.40
Rate for Payer: NaphCare Correctional Healthcare	$14,480.40

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: Blue Cross Blue Shield of Arizona Health Choice	$10,554.67
Rate for Payer: Mercy Care Medicaid	$10,554.67
Rate for Payer: NaphCare Correctional Healthcare	$10,554.67

Spinal Procedures

Facility

$25,776.45

Service Code	APR-DRG 0233
Hospital Charge Code	APRDRG0232
Min. Negotiated Rate	$25,776.45
Max. Negotiated Rate	$25,776.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$25,776.45
Rate for Payer: Mercy Care Medicaid	$25,776.45
Rate for Payer: NaphCare Correctional Healthcare	$25,776.45

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: Blue Cross Blue Shield of Arizona Health Choice	$25,776.45
Rate for Payer: Mercy Care Medicaid	$25,776.45
Rate for Payer: NaphCare Correctional Healthcare	$25,776.45

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: Blue Cross Blue Shield of Arizona Health Choice	$14,480.40
Rate for Payer: Mercy Care Medicaid	$14,480.40
Rate for Payer: NaphCare Correctional Healthcare	$14,480.40

Spinal Procedures

Facility

$14,480.40

Service Code	APR-DRG 0232
Hospital Charge Code	APRDRG0231
Min. Negotiated Rate	$14,480.40
Max. Negotiated Rate	$14,480.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,480.40
Rate for Payer: Mercy Care Medicaid	$14,480.40
Rate for Payer: NaphCare Correctional Healthcare	$14,480.40

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$44,091.99

Service Code	MSDRG 029
Min. Negotiated Rate	$44,091.99
Max. Negotiated Rate	$44,091.99
Rate for Payer: Seven Corners Travel Insurance	$44,091.99

SPINAL PROCEDURES WITH MCC

Facility

$77,652.13

Service Code	MSDRG 028
Min. Negotiated Rate	$77,652.13
Max. Negotiated Rate	$77,652.13
Rate for Payer: Seven Corners Travel Insurance	$77,652.13

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$28,371.06

Service Code	MSDRG 030
Min. Negotiated Rate	$28,371.06
Max. Negotiated Rate	$28,371.06
Rate for Payer: Seven Corners Travel Insurance	$28,371.06

Spirometry w/ Maximum Voluntary Ventilation Charge

Facility

$57.00

Service Code	CPT 94200
Hospital Charge Code	721132
Hospital Revenue Code	521
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Cash Price	$45.60

Spirometry w/ Maximum Voluntary Ventilation Charge

Facility

$57.00

Service Code	CPT 94200
Hospital Charge Code	721132
Hospital Revenue Code	521
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$91.28
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Arizona Complete Health Allwell	$9.12
Rate for Payer: Banner UC Health Medicare	$9.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$38.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.12
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Devoted Health Medicare	$10.26
Rate for Payer: Humana of AZ Medicare	$9.12
Rate for Payer: Seven Corners Travel Insurance	$91.28
Rate for Payer: Southwest Service Administrators UFCW	$38.76
Rate for Payer: TriWest Medicare	$9.12
Rate for Payer: United Healthcare Commercial	$32.60
Rate for Payer: United Healthcare Medicare	$9.12
Rate for Payer: Veterans Affairs TRICARE	$9.03

spironolactone 100 mg Tab [CQCH]

Facility

$0.82

Service Code	NDC 68084020801
Hospital Charge Code	105942367
Hospital Revenue Code	251
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of AZ Commercial	$0.74
Rate for Payer: Cash Price	$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	$0.13
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of AZ Commercial	$0.74
Rate for Payer: Arizona Complete Health Allwell	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.13
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.13
Rate for Payer: Cash Price	$0.66
Rate for Payer: Cigna of AZ Commercial	$0.53
Rate for Payer: Devoted Health Medicare	$0.15
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Southwest Service Administrators UFCW	$0.56
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: United Healthcare Commercial	$0.47
Rate for Payer: United Healthcare Medicare	$0.13
Rate for Payer: Veterans Affairs TRICARE	$0.13

spironolactone 25 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 63739054410
Hospital Charge Code	105942302
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Cash Price	$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: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.07
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.06
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

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: Blue Cross Blue Shield of Arizona Health Choice	$11,694.44
Rate for Payer: Mercy Care Medicaid	$11,694.44
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$28,723.73
Rate for Payer: Mercy Care Medicaid	$28,723.73
Rate for Payer: NaphCare Correctional Healthcare	$28,723.73

Splenectomy

Facility

$19,233.09

Service Code	APR-DRG 6503
Hospital Charge Code	APRDRG6504
Min. Negotiated Rate	$19,233.09
Max. Negotiated Rate	$19,233.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,233.09
Rate for Payer: Mercy Care Medicaid	$19,233.09
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$19,233.09
Rate for Payer: Mercy Care Medicaid	$19,233.09
Rate for Payer: NaphCare Correctional Healthcare	$19,233.09

Splenectomy

Facility

$9,085.94

Service Code	APR-DRG 6501
Hospital Charge Code	APRDRG6504
Min. Negotiated Rate	$9,085.94
Max. Negotiated Rate	$9,085.94
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94
Rate for Payer: NaphCare Correctional Healthcare	$9,085.94

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: Blue Cross Blue Shield of Arizona Health Choice	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94
Rate for Payer: NaphCare Correctional Healthcare	$9,085.94

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: Blue Cross Blue Shield of Arizona Health Choice	$9,085.94
Rate for Payer: Mercy Care Medicaid	$9,085.94
Rate for Payer: NaphCare Correctional Healthcare	$9,085.94

Know your out-of-pocket cost for care.

All Charges