|
96105 ASSESSMENT OF APHASIA WITH INTERPRETATION AND REPORT P
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
27728005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of AZ Commercial |
$486.00
|
| Rate for Payer: Bisbee Police All Plans |
$140.40
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Self Pay Self Pay |
$432.00
|
|
|
96125 STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
27728006
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$147.16 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Aetna of AZ Commercial |
$509.40
|
| Rate for Payer: Bisbee Police All Plans |
$147.16
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Self Pay Self Pay |
$452.80
|
|
|
96125 STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
27728006
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Aetna of AZ Commercial |
$509.40
|
| Rate for Payer: Aetna of AZ Medicare |
$158.48
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$84.90
|
| Rate for Payer: Amerigroup Medicare |
$84.90
|
| Rate for Payer: APIPA Medicare/Medicaid |
$211.40
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$84.90
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$84.90
|
| Rate for Payer: Bisbee Police All Plans |
$147.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$384.88
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cigna of AZ Commercial |
$396.20
|
| Rate for Payer: Copperpoint Commercial |
$140.08
|
| Rate for Payer: Health Net of AZ Commercial |
$339.60
|
| Rate for Payer: Health Net of AZ Medicare |
$158.48
|
| Rate for Payer: Humana of AZ Medicare |
$84.90
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$452.80
|
| Rate for Payer: TriWest Medicare |
$84.90
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$329.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$101.88
|
|
|
96360 - Hydration, first hour
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
22283161
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Aetna of AZ Medicare |
$75.04
|
| Rate for Payer: AHCCCS Medicaid |
$155.58
|
| Rate for Payer: Allwell Medicaid |
$155.58
|
| Rate for Payer: Allwell Medicare |
$40.20
|
| Rate for Payer: Amerigroup Medicare |
$40.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.10
|
| Rate for Payer: AZCH Complete Medicaid |
$155.58
|
| Rate for Payer: AZCH Complete Medicare |
$40.20
|
| Rate for Payer: Banner UC Health Medicaid |
$155.58
|
| Rate for Payer: Banner UC Health Medicare |
$40.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$182.24
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cigna of AZ Commercial |
$187.60
|
| Rate for Payer: Copperpoint Commercial |
$66.33
|
| Rate for Payer: Health Net of AZ Commercial |
$160.80
|
| Rate for Payer: Health Net of AZ Medicare |
$75.04
|
| Rate for Payer: Humana of AZ Medicare |
$40.20
|
| Rate for Payer: Mercy Care Medicaid |
$155.58
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
| Rate for Payer: TriWest Medicare |
$40.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$156.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.24
|
|
|
96360 - Hydration, first hour
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
22283161
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
|
|
96360 IV FLUID HYDRATION INITAL HOUR
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
22282932
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna of AZ Commercial |
$188.10
|
| Rate for Payer: Aetna of AZ Medicare |
$58.52
|
| Rate for Payer: AHCCCS Medicaid |
$155.58
|
| Rate for Payer: Allwell Medicaid |
$155.58
|
| Rate for Payer: Allwell Medicare |
$31.35
|
| Rate for Payer: Amerigroup Medicare |
$31.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$78.06
|
| Rate for Payer: AZCH Complete Medicaid |
$155.58
|
| Rate for Payer: AZCH Complete Medicare |
$31.35
|
| Rate for Payer: Banner UC Health Medicaid |
$155.58
|
| Rate for Payer: Banner UC Health Medicare |
$31.35
|
| Rate for Payer: Bisbee Police All Plans |
$54.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$142.12
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cigna of AZ Commercial |
$146.30
|
| Rate for Payer: Copperpoint Commercial |
$51.73
|
| Rate for Payer: Health Net of AZ Commercial |
$125.40
|
| Rate for Payer: Health Net of AZ Medicare |
$58.52
|
| Rate for Payer: Humana of AZ Medicare |
$31.35
|
| Rate for Payer: Mercy Care Medicaid |
$155.58
|
| Rate for Payer: Self Pay Self Pay |
$167.20
|
| Rate for Payer: TriWest Medicare |
$31.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$121.85
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$37.62
|
|
|
96360 IV FLUID HYDRATION INITAL HOUR
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
22282932
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna of AZ Commercial |
$188.10
|
| Rate for Payer: Bisbee Police All Plans |
$54.34
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Self Pay Self Pay |
$167.20
|
|
|
96361 - Hydration, each additional hour
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22283162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna of AZ Commercial |
$155.70
|
| Rate for Payer: Bisbee Police All Plans |
$44.98
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Self Pay Self Pay |
$138.40
|
|
|
96361 - Hydration, each additional hour
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22283162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna of AZ Commercial |
$155.70
|
| Rate for Payer: Aetna of AZ Medicare |
$48.44
|
| Rate for Payer: AHCCCS Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicare |
$25.95
|
| Rate for Payer: Amerigroup Medicare |
$25.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.62
|
| Rate for Payer: AZCH Complete Medicaid |
$58.00
|
| Rate for Payer: AZCH Complete Medicare |
$25.95
|
| Rate for Payer: Banner UC Health Medicaid |
$58.00
|
| Rate for Payer: Banner UC Health Medicare |
$25.95
|
| Rate for Payer: Bisbee Police All Plans |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$117.64
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cigna of AZ Commercial |
$121.10
|
| Rate for Payer: Copperpoint Commercial |
$42.82
|
| Rate for Payer: Health Net of AZ Commercial |
$103.80
|
| Rate for Payer: Health Net of AZ Medicare |
$48.44
|
| Rate for Payer: Humana of AZ Medicare |
$25.95
|
| Rate for Payer: Mercy Care Medicaid |
$58.00
|
| Rate for Payer: Self Pay Self Pay |
$138.40
|
| Rate for Payer: TriWest Medicare |
$25.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.14
|
|
|
96361 IV HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22282933
|
|
Hospital Revenue Code
|
450
|
| 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: AHCCCS Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicaid |
$58.00
|
| 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 Medicaid |
$58.00
|
| Rate for Payer: AZCH Complete Medicare |
$15.30
|
| Rate for Payer: Banner UC Health Medicaid |
$58.00
|
| 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: 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: Mercy Care Medicaid |
$58.00
|
| 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
|
|
|
96361 IV HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22282933
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
96365 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24377522
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Bisbee Police All Plans |
$98.28
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Self Pay Self Pay |
$302.40
|
|
|
96365 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24377522
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna of AZ Commercial |
$340.20
|
| Rate for Payer: Aetna of AZ Medicare |
$105.84
|
| Rate for Payer: AHCCCS Medicaid |
$295.08
|
| Rate for Payer: Allwell Medicaid |
$295.08
|
| Rate for Payer: Allwell Medicare |
$56.70
|
| Rate for Payer: Amerigroup Medicare |
$56.70
|
| Rate for Payer: APIPA Medicare/Medicaid |
$141.18
|
| Rate for Payer: AZCH Complete Medicaid |
$295.08
|
| Rate for Payer: AZCH Complete Medicare |
$56.70
|
| Rate for Payer: Banner UC Health Medicaid |
$295.08
|
| Rate for Payer: Banner UC Health Medicare |
$56.70
|
| Rate for Payer: Bisbee Police All Plans |
$98.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$257.04
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna of AZ Commercial |
$264.60
|
| Rate for Payer: Copperpoint Commercial |
$93.56
|
| Rate for Payer: Health Net of AZ Commercial |
$226.80
|
| Rate for Payer: Health Net of AZ Medicare |
$105.84
|
| Rate for Payer: Humana of AZ Medicare |
$56.70
|
| Rate for Payer: Mercy Care Medicaid |
$295.08
|
| Rate for Payer: Self Pay Self Pay |
$302.40
|
| Rate for Payer: TriWest Medicare |
$56.70
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$220.37
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.04
|
|
|
96365 IV DRUG FIRST HOUR
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
22282934
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna of AZ Commercial |
$306.90
|
| Rate for Payer: Bisbee Police All Plans |
$88.66
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Self Pay Self Pay |
$272.80
|
|
|
96365 IV DRUG FIRST HOUR
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
22282934
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Aetna of AZ Commercial |
$306.90
|
| Rate for Payer: Aetna of AZ Medicare |
$95.48
|
| Rate for Payer: AHCCCS Medicaid |
$295.08
|
| Rate for Payer: Allwell Medicaid |
$295.08
|
| Rate for Payer: Allwell Medicare |
$51.15
|
| Rate for Payer: Amerigroup Medicare |
$51.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$127.36
|
| Rate for Payer: AZCH Complete Medicaid |
$295.08
|
| Rate for Payer: AZCH Complete Medicare |
$51.15
|
| Rate for Payer: Banner UC Health Medicaid |
$295.08
|
| Rate for Payer: Banner UC Health Medicare |
$51.15
|
| Rate for Payer: Bisbee Police All Plans |
$88.66
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$231.88
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cigna of AZ Commercial |
$238.70
|
| Rate for Payer: Copperpoint Commercial |
$84.40
|
| Rate for Payer: Health Net of AZ Commercial |
$204.60
|
| Rate for Payer: Health Net of AZ Medicare |
$95.48
|
| Rate for Payer: Humana of AZ Medicare |
$51.15
|
| Rate for Payer: Mercy Care Medicaid |
$295.08
|
| Rate for Payer: Self Pay Self Pay |
$272.80
|
| Rate for Payer: TriWest Medicare |
$51.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$198.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$61.38
|
|
|
96365 - IV tx, first hour
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
22283163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.56 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna of AZ Commercial |
$770.40
|
| Rate for Payer: Bisbee Police All Plans |
$222.56
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Self Pay Self Pay |
$684.80
|
|
|
96365 - IV tx, first hour
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
22283163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna of AZ Commercial |
$770.40
|
| Rate for Payer: Aetna of AZ Medicare |
$239.68
|
| Rate for Payer: AHCCCS Medicaid |
$295.08
|
| Rate for Payer: Allwell Medicaid |
$295.08
|
| Rate for Payer: Allwell Medicare |
$128.40
|
| Rate for Payer: Amerigroup Medicare |
$128.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$319.72
|
| Rate for Payer: AZCH Complete Medicaid |
$295.08
|
| Rate for Payer: AZCH Complete Medicare |
$128.40
|
| Rate for Payer: Banner UC Health Medicaid |
$295.08
|
| Rate for Payer: Banner UC Health Medicare |
$128.40
|
| Rate for Payer: Bisbee Police All Plans |
$222.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$582.08
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cigna of AZ Commercial |
$599.20
|
| Rate for Payer: Copperpoint Commercial |
$211.86
|
| Rate for Payer: Health Net of AZ Commercial |
$513.60
|
| Rate for Payer: Health Net of AZ Medicare |
$239.68
|
| Rate for Payer: Humana of AZ Medicare |
$128.40
|
| Rate for Payer: Mercy Care Medicaid |
$295.08
|
| Rate for Payer: Self Pay Self Pay |
$684.80
|
| Rate for Payer: TriWest Medicare |
$128.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$499.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$154.08
|
|
|
96366 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24377525
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
|
|
96366 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24377525
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of AZ Commercial |
$104.40
|
| Rate for Payer: Aetna of AZ Medicare |
$32.48
|
| Rate for Payer: AHCCCS Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicare |
$17.40
|
| Rate for Payer: Amerigroup Medicare |
$17.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$43.33
|
| Rate for Payer: AZCH Complete Medicaid |
$58.00
|
| Rate for Payer: AZCH Complete Medicare |
$17.40
|
| Rate for Payer: Banner UC Health Medicaid |
$58.00
|
| Rate for Payer: Banner UC Health Medicare |
$17.40
|
| Rate for Payer: Bisbee Police All Plans |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$78.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cigna of AZ Commercial |
$81.20
|
| Rate for Payer: Copperpoint Commercial |
$28.71
|
| Rate for Payer: Health Net of AZ Commercial |
$69.60
|
| Rate for Payer: Health Net of AZ Medicare |
$32.48
|
| Rate for Payer: Humana of AZ Medicare |
$17.40
|
| Rate for Payer: Mercy Care Medicaid |
$58.00
|
| Rate for Payer: Self Pay Self Pay |
$92.80
|
| Rate for Payer: TriWest Medicare |
$17.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$67.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$20.88
|
|
|
96366 IV DRUG ADDITIONAL HOUR
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
22282935
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of AZ Commercial |
$93.60
|
| Rate for Payer: Aetna of AZ Medicare |
$29.12
|
| Rate for Payer: AHCCCS Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicare |
$15.60
|
| Rate for Payer: Amerigroup Medicare |
$15.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$38.84
|
| Rate for Payer: AZCH Complete Medicaid |
$58.00
|
| Rate for Payer: AZCH Complete Medicare |
$15.60
|
| Rate for Payer: Banner UC Health Medicaid |
$58.00
|
| Rate for Payer: Banner UC Health Medicare |
$15.60
|
| Rate for Payer: Bisbee Police All Plans |
$27.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$70.72
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cigna of AZ Commercial |
$72.80
|
| Rate for Payer: Copperpoint Commercial |
$25.74
|
| Rate for Payer: Health Net of AZ Commercial |
$62.40
|
| Rate for Payer: Health Net of AZ Medicare |
$29.12
|
| Rate for Payer: Humana of AZ Medicare |
$15.60
|
| Rate for Payer: Mercy Care Medicaid |
$58.00
|
| Rate for Payer: Self Pay Self Pay |
$83.20
|
| Rate for Payer: TriWest Medicare |
$15.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$60.63
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$18.72
|
|
|
96366 IV DRUG ADDITIONAL HOUR
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
22282935
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of AZ Commercial |
$93.60
|
| Rate for Payer: Bisbee Police All Plans |
$27.04
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Self Pay Self Pay |
$83.20
|
|
|
96366 - IV tx, each additional hour
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
22283164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna of AZ Commercial |
$155.70
|
| Rate for Payer: Aetna of AZ Medicare |
$48.44
|
| Rate for Payer: AHCCCS Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicare |
$25.95
|
| Rate for Payer: Amerigroup Medicare |
$25.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$64.62
|
| Rate for Payer: AZCH Complete Medicaid |
$58.00
|
| Rate for Payer: AZCH Complete Medicare |
$25.95
|
| Rate for Payer: Banner UC Health Medicaid |
$58.00
|
| Rate for Payer: Banner UC Health Medicare |
$25.95
|
| Rate for Payer: Bisbee Police All Plans |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$117.64
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cigna of AZ Commercial |
$121.10
|
| Rate for Payer: Copperpoint Commercial |
$42.82
|
| Rate for Payer: Health Net of AZ Commercial |
$103.80
|
| Rate for Payer: Health Net of AZ Medicare |
$48.44
|
| Rate for Payer: Humana of AZ Medicare |
$25.95
|
| Rate for Payer: Mercy Care Medicaid |
$58.00
|
| Rate for Payer: Self Pay Self Pay |
$138.40
|
| Rate for Payer: TriWest Medicare |
$25.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$100.86
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$31.14
|
|
|
96366 - IV tx, each additional hour
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
22283164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna of AZ Commercial |
$155.70
|
| Rate for Payer: Bisbee Police All Plans |
$44.98
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Self Pay Self Pay |
$138.40
|
|
|
96367 Additional sequential infusion of a new drug/substance
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
11340910
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of AZ Commercial |
$146.70
|
| Rate for Payer: Bisbee Police All Plans |
$42.38
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Self Pay Self Pay |
$130.40
|
|
|
96367 Additional sequential infusion of a new drug/substance
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
11340910
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna of AZ Commercial |
$146.70
|
| Rate for Payer: Aetna of AZ Medicare |
$45.64
|
| Rate for Payer: AHCCCS Medicaid |
$89.86
|
| Rate for Payer: Allwell Medicaid |
$89.86
|
| Rate for Payer: Allwell Medicare |
$24.45
|
| Rate for Payer: Amerigroup Medicare |
$24.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$60.88
|
| Rate for Payer: AZCH Complete Medicaid |
$89.86
|
| Rate for Payer: AZCH Complete Medicare |
$24.45
|
| Rate for Payer: Banner UC Health Medicaid |
$89.86
|
| Rate for Payer: Banner UC Health Medicare |
$24.45
|
| Rate for Payer: Bisbee Police All Plans |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cigna of AZ Commercial |
$114.10
|
| Rate for Payer: Copperpoint Commercial |
$40.34
|
| Rate for Payer: Health Net of AZ Commercial |
$97.80
|
| Rate for Payer: Health Net of AZ Medicare |
$45.64
|
| Rate for Payer: Humana of AZ Medicare |
$24.45
|
| Rate for Payer: Mercy Care Medicaid |
$89.86
|
| Rate for Payer: Self Pay Self Pay |
$130.40
|
| Rate for Payer: TriWest Medicare |
$24.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$95.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.34
|
|
