Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$44,864.87

Service Code	MSDRG 574
Min. Negotiated Rate	$44,864.87
Max. Negotiated Rate	$44,864.87
Rate for Payer: Seven Corners Travel Insurance	$44,864.87

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$84,671.20

Service Code	MSDRG 573
Min. Negotiated Rate	$84,671.20
Max. Negotiated Rate	$84,671.20
Rate for Payer: Seven Corners Travel Insurance	$84,671.20

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$23,224.69

Service Code	MSDRG 575
Min. Negotiated Rate	$23,224.69
Max. Negotiated Rate	$23,224.69
Rate for Payer: Seven Corners Travel Insurance	$23,224.69

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$23,184.62

Service Code	MSDRG 623
Min. Negotiated Rate	$23,184.62
Max. Negotiated Rate	$23,184.62
Rate for Payer: Seven Corners Travel Insurance	$23,184.62

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$45,999.58

Service Code	MSDRG 622
Min. Negotiated Rate	$45,999.58
Max. Negotiated Rate	$45,999.58
Rate for Payer: Seven Corners Travel Insurance	$45,999.58

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$16,218.48

Service Code	MSDRG 624
Min. Negotiated Rate	$16,218.48
Max. Negotiated Rate	$16,218.48
Rate for Payer: Seven Corners Travel Insurance	$16,218.48

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$47,471.67

Service Code	MSDRG 904
Min. Negotiated Rate	$47,471.67
Max. Negotiated Rate	$47,471.67
Rate for Payer: Seven Corners Travel Insurance	$47,471.67

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$19,171.64

Service Code	MSDRG 905
Min. Negotiated Rate	$19,171.64
Max. Negotiated Rate	$19,171.64
Rate for Payer: Seven Corners Travel Insurance	$19,171.64

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46
Rate for Payer: NaphCare Correctional Healthcare	$3,886.46

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73
Rate for Payer: NaphCare Correctional Healthcare	$4,726.73

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46
Rate for Payer: NaphCare Correctional Healthcare	$3,886.46

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46
Rate for Payer: NaphCare Correctional Healthcare	$3,886.46

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73
Rate for Payer: NaphCare Correctional Healthcare	$4,726.73

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97
Rate for Payer: NaphCare Correctional Healthcare	$15,164.97

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73
Rate for Payer: NaphCare Correctional Healthcare	$4,726.73

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97
Rate for Payer: NaphCare Correctional Healthcare	$15,164.97

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41
Rate for Payer: NaphCare Correctional Healthcare	$7,217.41

Skin Ulcers

Facility

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46
Rate for Payer: NaphCare Correctional Healthcare	$3,886.46

Skin Ulcers

Facility

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73
Rate for Payer: NaphCare Correctional Healthcare	$4,726.73

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41
Rate for Payer: NaphCare Correctional Healthcare	$7,217.41

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97
Rate for Payer: NaphCare Correctional Healthcare	$15,164.97

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41
Rate for Payer: NaphCare Correctional Healthcare	$7,217.41

Skin Ulcers

Facility

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97
Rate for Payer: NaphCare Correctional Healthcare	$15,164.97

Skin Ulcers

Facility

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41
Rate for Payer: NaphCare Correctional Healthcare	$7,217.41

SKIN ULCERS WITH CC

Facility

$15,387.25

Service Code	MSDRG 593
Min. Negotiated Rate	$15,387.25
Max. Negotiated Rate	$15,387.25
Rate for Payer: Seven Corners Travel Insurance	$15,387.25

Know your out-of-pocket cost for care.

All Charges