Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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: 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

$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: 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

$11,694.44

Service Code	APR-DRG 6502
Hospital Charge Code	APRDRG6504
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

$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: 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

$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: 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

$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: 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

$28,723.73

Service Code	APR-DRG 6504
Hospital Charge Code	APRDRG6503
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	APRDRG6503
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

$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: 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

SPLENIC PROCEDURES WITH CC

Facility

$36,309.07

Service Code	MSDRG 800
Min. Negotiated Rate	$36,309.07
Max. Negotiated Rate	$36,309.07
Rate for Payer: Seven Corners Travel Insurance	$36,309.07

SPLENIC PROCEDURES WITH MCC

Facility

$58,532.14

Service Code	MSDRG 799
Min. Negotiated Rate	$58,532.14
Max. Negotiated Rate	$58,532.14
Rate for Payer: Seven Corners Travel Insurance	$58,532.14

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$24,670.89

Service Code	MSDRG 801
Min. Negotiated Rate	$24,670.89
Max. Negotiated Rate	$24,670.89
Rate for Payer: Seven Corners Travel Insurance	$24,670.89

Splint

Facility

$84.00

Service Code	HCPCS A4570
Hospital Charge Code	1287756
Hospital Revenue Code	521
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Cash Price	$67.20

Splint

Facility

$84.00

Service Code	HCPCS A4570
Hospital Charge Code	1287756
Hospital Revenue Code	521
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Arizona Complete Health Allwell	$13.44
Rate for Payer: Banner UC Health Medicare	$13.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$57.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.44
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$58.80
Rate for Payer: Devoted Health Medicare	$15.12
Rate for Payer: Humana of AZ Medicare	$13.44
Rate for Payer: Southwest Service Administrators UFCW	$57.12
Rate for Payer: TriWest Medicare	$13.44
Rate for Payer: United Healthcare Commercial	$48.05
Rate for Payer: United Healthcare Medicare	$13.44
Rate for Payer: Veterans Affairs TRICARE	$13.31

SPLINT ANKLE

Facility

$65.00

Hospital Charge Code	22354257
Hospital Revenue Code	270
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Cash Price	$52.00

SPLINT ANKLE

Facility

$65.00

Hospital Charge Code	22354257
Hospital Revenue Code	270
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Arizona Complete Health Allwell	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.40
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Devoted Health Medicare	$11.70
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Southwest Service Administrators UFCW	$44.20
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: United Healthcare Commercial	$37.18
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: Veterans Affairs TRICARE	$10.30

SPLINT COLLES LARGE LEFT HAND

Facility

$26.00

Hospital Charge Code	22354295
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

SPLINT COLLES LARGE LEFT HAND

Facility

$26.00

Hospital Charge Code	22354295
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

SPLINT COLLES LARGE RIGHT HAND

Facility

$26.00

Hospital Charge Code	22354298
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

SPLINT COLLES LARGE RIGHT HAND

Facility

$26.00

Hospital Charge Code	22354298
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

SPLINT COLLES MEDIUM LEFT HAND

Facility

$26.00

Hospital Charge Code	22354294
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

SPLINT COLLES MEDIUM LEFT HAND

Facility

$26.00

Hospital Charge Code	22354294
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

SPLINT COLLES MEDIUM RIGHT HAND

Facility

$39.00

Hospital Charge Code	22354241
Hospital Revenue Code	270
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Arizona Complete Health Allwell	$6.24
Rate for Payer: Banner UC Health Medicare	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.24
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Devoted Health Medicare	$7.02
Rate for Payer: Humana of AZ Medicare	$6.24
Rate for Payer: Southwest Service Administrators UFCW	$26.52
Rate for Payer: TriWest Medicare	$6.24
Rate for Payer: United Healthcare Commercial	$22.31
Rate for Payer: United Healthcare Medicare	$6.24
Rate for Payer: Veterans Affairs TRICARE	$6.18

SPLINT COLLES MEDIUM RIGHT HAND

Facility

$39.00

Hospital Charge Code	22354241
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Cash Price	$31.20

SPLINT COLLES SMALL LEFT HAND

Facility

$26.00

Hospital Charge Code	22354293
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

Know your out-of-pocket cost for care.

All Charges