Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

96367 - IV tx, sequential infusion

Facility

$258.00

Service Code	CPT 96367
Hospital Charge Code	22283165
Hospital Revenue Code	450
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: AHCCCS Medicaid	$89.86
Rate for Payer: Allwell Medicaid	$89.86
Rate for Payer: Allwell Medicare	$38.70
Rate for Payer: Amerigroup Medicare	$38.70
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicaid	$89.86
Rate for Payer: AZCH Complete Medicare	$38.70
Rate for Payer: Banner UC Health Medicaid	$89.86
Rate for Payer: Banner UC Health Medicare	$38.70
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$180.60
Rate for Payer: Copperpoint Commercial	$63.86
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$38.70
Rate for Payer: Mercy Care Medicaid	$89.86
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$38.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

96367 - IV tx, sequential infusion

Facility

$258.00

Service Code	CPT 96367
Hospital Charge Code	22283165
Hospital Revenue Code	450
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

96368 Concurrent Infusion - CQCH

Facility

$110.00

Service Code	CPT 96368
Hospital Charge Code	24377526
Hospital Revenue Code	260
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna of AZ Commercial	$99.00
Rate for Payer: Bisbee Police All Plans	$28.60
Rate for Payer: Cash Price	$88.00
Rate for Payer: Self Pay Self Pay	$88.00

96368 Concurrent Infusion - CQCH

Facility

$110.00

Service Code	CPT 96368
Hospital Charge Code	24377526
Hospital Revenue Code	260
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna of AZ Commercial	$99.00
Rate for Payer: Aetna of AZ Medicare	$30.80
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$16.50
Rate for Payer: Amerigroup Medicare	$16.50
Rate for Payer: APIPA Medicare/Medicaid	$41.08
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$16.50
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$16.50
Rate for Payer: Bisbee Police All Plans	$28.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$74.80
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cigna of AZ Commercial	$77.00
Rate for Payer: Copperpoint Commercial	$27.22
Rate for Payer: Health Net of AZ Commercial	$66.00
Rate for Payer: Health Net of AZ Medicare	$30.80
Rate for Payer: Humana of AZ Medicare	$16.50
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$88.00
Rate for Payer: TriWest Medicare	$16.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$64.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.80

96368 - IV tx, concurrent infusion

Facility

$173.00

Service Code	CPT 96368
Hospital Charge Code	22283166
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

96368 - IV tx, concurrent infusion

Facility

$173.00

Service Code	CPT 96368
Hospital Charge Code	22283166
Hospital Revenue Code	450
Min. Negotiated Rate	$0.13
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	$0.13
Rate for Payer: Allwell Medicaid	$0.13
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	$0.13
Rate for Payer: AZCH Complete Medicare	$25.95
Rate for Payer: Banner UC Health Medicaid	$0.13
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	$0.13
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

96369 Subcutaneous infusion for therapy of prophylaxis initi

Facility

$851.00

Service Code	CPT 96369
Hospital Charge Code	24377528
Hospital Revenue Code	260
Min. Negotiated Rate	$127.65
Max. Negotiated Rate	$765.90
Rate for Payer: Aetna of AZ Commercial	$765.90
Rate for Payer: Aetna of AZ Medicare	$238.28
Rate for Payer: AHCCCS Medicaid	$295.08
Rate for Payer: Allwell Medicaid	$295.08
Rate for Payer: Allwell Medicare	$127.65
Rate for Payer: Amerigroup Medicare	$127.65
Rate for Payer: APIPA Medicare/Medicaid	$317.85
Rate for Payer: AZCH Complete Medicaid	$295.08
Rate for Payer: AZCH Complete Medicare	$127.65
Rate for Payer: Banner UC Health Medicaid	$295.08
Rate for Payer: Banner UC Health Medicare	$127.65
Rate for Payer: Bisbee Police All Plans	$221.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$578.68
Rate for Payer: Cash Price	$680.80
Rate for Payer: Cash Price	$680.80
Rate for Payer: Cigna of AZ Commercial	$595.70
Rate for Payer: Copperpoint Commercial	$210.62
Rate for Payer: Health Net of AZ Commercial	$510.60
Rate for Payer: Health Net of AZ Medicare	$238.28
Rate for Payer: Humana of AZ Medicare	$127.65
Rate for Payer: Mercy Care Medicaid	$295.08
Rate for Payer: Self Pay Self Pay	$680.80
Rate for Payer: TriWest Medicare	$127.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$496.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$153.18

96369 Subcutaneous infusion for therapy of prophylaxis initi

Facility

$851.00

Service Code	CPT 96369
Hospital Charge Code	24377528
Hospital Revenue Code	260
Min. Negotiated Rate	$221.26
Max. Negotiated Rate	$765.90
Rate for Payer: Aetna of AZ Commercial	$765.90
Rate for Payer: Bisbee Police All Plans	$221.26
Rate for Payer: Cash Price	$680.80
Rate for Payer: Self Pay Self Pay	$680.80

96372 IM INJ OF ANTIBIOTIC

Facility

$42.00

Service Code	CPT 96372
Hospital Charge Code	22282937
Hospital Revenue Code	450
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

96372 IM INJ OF ANTIBIOTIC

Facility

$42.00

Service Code	CPT 96372
Hospital Charge Code	22282937
Hospital Revenue Code	450
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$89.86
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: AHCCCS Medicaid	$89.86
Rate for Payer: Allwell Medicaid	$89.86
Rate for Payer: Allwell Medicare	$6.30
Rate for Payer: Amerigroup Medicare	$6.30
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicaid	$89.86
Rate for Payer: AZCH Complete Medicare	$6.30
Rate for Payer: Banner UC Health Medicaid	$89.86
Rate for Payer: Banner UC Health Medicare	$6.30
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.40
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.30
Rate for Payer: Mercy Care Medicaid	$89.86
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

96372 - Subq/IM Injection

Facility

$258.00

Service Code	CPT 96372
Hospital Charge Code	22283167
Hospital Revenue Code	450
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: AHCCCS Medicaid	$89.86
Rate for Payer: Allwell Medicaid	$89.86
Rate for Payer: Allwell Medicare	$38.70
Rate for Payer: Amerigroup Medicare	$38.70
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicaid	$89.86
Rate for Payer: AZCH Complete Medicare	$38.70
Rate for Payer: Banner UC Health Medicaid	$89.86
Rate for Payer: Banner UC Health Medicare	$38.70
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$180.60
Rate for Payer: Copperpoint Commercial	$63.86
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$38.70
Rate for Payer: Mercy Care Medicaid	$89.86
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$38.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

96372 - Subq/IM Injection

Facility

$258.00

Service Code	CPT 96372
Hospital Charge Code	22283167
Hospital Revenue Code	450
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

96372 THERAPTIC PROPHALACTIC I

Facility

$40.00

Service Code	CPT 96372
Hospital Charge Code	22282936
Hospital Revenue Code	450
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of AZ Commercial	$36.00
Rate for Payer: Bisbee Police All Plans	$10.40
Rate for Payer: Cash Price	$32.00
Rate for Payer: Self Pay Self Pay	$32.00

96372 THERAPTIC PROPHALACTIC I

Facility

$40.00

Service Code	CPT 96372
Hospital Charge Code	22282936
Hospital Revenue Code	450
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$89.86
Rate for Payer: Aetna of AZ Commercial	$36.00
Rate for Payer: Aetna of AZ Medicare	$11.20
Rate for Payer: AHCCCS Medicaid	$89.86
Rate for Payer: Allwell Medicaid	$89.86
Rate for Payer: Allwell Medicare	$6.00
Rate for Payer: Amerigroup Medicare	$6.00
Rate for Payer: APIPA Medicare/Medicaid	$14.94
Rate for Payer: AZCH Complete Medicaid	$89.86
Rate for Payer: AZCH Complete Medicare	$6.00
Rate for Payer: Banner UC Health Medicaid	$89.86
Rate for Payer: Banner UC Health Medicare	$6.00
Rate for Payer: Bisbee Police All Plans	$10.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.20
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cigna of AZ Commercial	$28.00
Rate for Payer: Copperpoint Commercial	$9.90
Rate for Payer: Health Net of AZ Commercial	$24.00
Rate for Payer: Health Net of AZ Medicare	$11.20
Rate for Payer: Humana of AZ Medicare	$6.00
Rate for Payer: Mercy Care Medicaid	$89.86
Rate for Payer: Self Pay Self Pay	$32.00
Rate for Payer: TriWest Medicare	$6.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.20

96373 - Intra-Arterial injection

Facility

$268.00

Service Code	CPT 96373
Hospital Charge Code	22283168
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

96373 - Intra-Arterial injection

Facility

$268.00

Service Code	CPT 96373
Hospital Charge Code	22283168
Hospital Revenue Code	450
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$295.08
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Aetna of AZ Medicare	$75.04
Rate for Payer: AHCCCS Medicaid	$295.08
Rate for Payer: Allwell Medicaid	$295.08
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	$295.08
Rate for Payer: AZCH Complete Medicare	$40.20
Rate for Payer: Banner UC Health Medicaid	$295.08
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	$295.08
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

96374 INTRAVENOUS PUSH ADMINISTRATI

Facility

$147.00

Service Code	CPT 96374
Hospital Charge Code	22282938
Hospital Revenue Code	450
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$155.58
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Aetna of AZ Medicare	$41.16
Rate for Payer: AHCCCS Medicaid	$155.58
Rate for Payer: Allwell Medicaid	$155.58
Rate for Payer: Allwell Medicare	$22.05
Rate for Payer: Amerigroup Medicare	$22.05
Rate for Payer: APIPA Medicare/Medicaid	$54.90
Rate for Payer: AZCH Complete Medicaid	$155.58
Rate for Payer: AZCH Complete Medicare	$22.05
Rate for Payer: Banner UC Health Medicaid	$155.58
Rate for Payer: Banner UC Health Medicare	$22.05
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$99.96
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cigna of AZ Commercial	$102.90
Rate for Payer: Copperpoint Commercial	$36.38
Rate for Payer: Health Net of AZ Commercial	$88.20
Rate for Payer: Health Net of AZ Medicare	$41.16
Rate for Payer: Humana of AZ Medicare	$22.05
Rate for Payer: Mercy Care Medicaid	$155.58
Rate for Payer: Self Pay Self Pay	$117.60
Rate for Payer: TriWest Medicare	$22.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$85.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.46

96374 INTRAVENOUS PUSH ADMINISTRATI

Facility

$147.00

Service Code	CPT 96374
Hospital Charge Code	22282938
Hospital Revenue Code	450
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Cash Price	$117.60
Rate for Payer: Self Pay Self Pay	$117.60

96374 - IV Injection, single/initial

Facility

$268.00

Service Code	CPT 96374
Hospital Charge Code	22283169
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

96374 - IV Injection, single/initial

Facility

$268.00

Service Code	CPT 96374
Hospital Charge Code	22283169
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

97032-Attended Estem

Facility

$181.00

Service Code	CPT 97032 GP
Hospital Charge Code	27373775
Hospital Revenue Code	420
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

97032-Attended Estem

Facility

$181.00

Service Code	CPT 97032 GP
Hospital Charge Code	27373775
Hospital Revenue Code	420
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

97110 Therapeutic Exercise Charges

Facility

$181.00

Service Code	CPT 97110 GP
Hospital Charge Code	24237124
Hospital Revenue Code	430
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

97110 Therapeutic Exercise Charges

Facility

$181.00

Service Code	CPT 97110 GP
Hospital Charge Code	24237124
Hospital Revenue Code	430
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

97112 PT Neuromuscular reeducation (Timed per 15 mins)

Facility

$181.00

Service Code	CPT 97112 GP
Hospital Charge Code	23955336
Hospital Revenue Code	420
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

Know your out-of-pocket cost for care.

All Charges