Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

92526 TREATMENT OF SWALLOWING AND FEEDING DISORDER

Facility

$469.00

Service Code	CPT 92526 GN
Hospital Charge Code	27724313
Hospital Revenue Code	440
Min. Negotiated Rate	$121.94
Max. Negotiated Rate	$422.10
Rate for Payer: Aetna of AZ Commercial	$422.10
Rate for Payer: Bisbee Police All Plans	$121.94
Rate for Payer: Cash Price	$375.20
Rate for Payer: Self Pay Self Pay	$375.20

92526 TREATMENT OF SWALLOWING AND FEEDING DISORDER

Facility

$469.00

Service Code	CPT 92526 GN
Hospital Charge Code	27724313
Hospital Revenue Code	440
Min. Negotiated Rate	$75.04
Max. Negotiated Rate	$422.10
Rate for Payer: Aetna of AZ Commercial	$422.10
Rate for Payer: Aetna of AZ Medicare	$131.32
Rate for Payer: Allwell Medicare	$75.04
Rate for Payer: Amerigroup Medicare	$75.04
Rate for Payer: APIPA Medicare/Medicaid	$175.17
Rate for Payer: AZCH Complete Medicare	$75.04
Rate for Payer: Banner UC Health Medicare	$75.04
Rate for Payer: Bisbee Police All Plans	$121.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$318.92
Rate for Payer: Cash Price	$375.20
Rate for Payer: Cigna of AZ Commercial	$328.30
Rate for Payer: Copperpoint Commercial	$116.08
Rate for Payer: Health Net of AZ Commercial	$281.40
Rate for Payer: Health Net of AZ Medicare	$131.32
Rate for Payer: Humana of AZ Medicare	$75.04
Rate for Payer: Self Pay Self Pay	$375.20
Rate for Payer: TriWest Medicare	$75.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$273.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$84.42

92610 EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION.

Facility

$370.00

Service Code	CPT 92610 GN
Hospital Charge Code	27724315
Hospital Revenue Code	444
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Aetna of AZ Medicare	$103.60
Rate for Payer: Allwell Medicare	$59.20
Rate for Payer: Amerigroup Medicare	$59.20
Rate for Payer: APIPA Medicare/Medicaid	$138.19
Rate for Payer: AZCH Complete Medicare	$59.20
Rate for Payer: Banner UC Health Medicare	$59.20
Rate for Payer: Bisbee Police All Plans	$96.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$251.60
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cigna of AZ Commercial	$259.00
Rate for Payer: Copperpoint Commercial	$91.58
Rate for Payer: Health Net of AZ Commercial	$222.00
Rate for Payer: Health Net of AZ Medicare	$103.60
Rate for Payer: Humana of AZ Medicare	$59.20
Rate for Payer: Self Pay Self Pay	$296.00
Rate for Payer: TriWest Medicare	$59.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$215.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$66.60

92610 EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION.

Facility

$370.00

Service Code	CPT 92610 GN
Hospital Charge Code	27724315
Hospital Revenue Code	444
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna of AZ Commercial	$333.00
Rate for Payer: Bisbee Police All Plans	$96.20
Rate for Payer: Cash Price	$296.00
Rate for Payer: Self Pay Self Pay	$296.00

92950 ER - CPR

Facility

$1,796.00

Service Code	CPT 92950
Hospital Charge Code	22282930
Hospital Revenue Code	450
Min. Negotiated Rate	$466.96
Max. Negotiated Rate	$1,616.40
Rate for Payer: Aetna of AZ Commercial	$1,616.40
Rate for Payer: Bisbee Police All Plans	$466.96
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Self Pay Self Pay	$1,436.80

92950 ER - CPR

Facility

$1,796.00

Service Code	CPT 92950
Hospital Charge Code	22282930
Hospital Revenue Code	450
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$1,616.40
Rate for Payer: Aetna of AZ Commercial	$1,616.40
Rate for Payer: Aetna of AZ Medicare	$502.88
Rate for Payer: AHCCCS Medicaid	$191.73
Rate for Payer: Allwell Medicaid	$191.73
Rate for Payer: Allwell Medicare	$287.36
Rate for Payer: Amerigroup Medicare	$287.36
Rate for Payer: APIPA Medicare/Medicaid	$670.81
Rate for Payer: AZCH Complete Medicaid	$191.73
Rate for Payer: AZCH Complete Medicare	$287.36
Rate for Payer: Banner UC Health Medicaid	$191.73
Rate for Payer: Banner UC Health Medicare	$287.36
Rate for Payer: Bisbee Police All Plans	$466.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,221.28
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cigna of AZ Commercial	$1,257.20
Rate for Payer: Copperpoint Commercial	$444.51
Rate for Payer: Health Net of AZ Commercial	$1,077.60
Rate for Payer: Health Net of AZ Medicare	$502.88
Rate for Payer: Humana of AZ Medicare	$287.36
Rate for Payer: Mercy Care Medicaid	$191.73
Rate for Payer: Self Pay Self Pay	$1,436.80
Rate for Payer: TriWest Medicare	$287.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,047.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$323.28

93225-Holter Monitor Hookup

Facility

$72.00

Service Code	CPT 93225
Hospital Charge Code	24384246
Hospital Revenue Code	731
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Cash Price	$57.60
Rate for Payer: Self Pay Self Pay	$57.60

93225-Holter Monitor Hookup

Facility

$72.00

Service Code	CPT 93225
Hospital Charge Code	24384246
Hospital Revenue Code	731
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$81.16
Rate for Payer: Aetna of AZ Commercial	$64.80
Rate for Payer: Aetna of AZ Medicare	$20.16
Rate for Payer: AHCCCS Medicaid	$81.16
Rate for Payer: Allwell Medicaid	$81.16
Rate for Payer: Allwell Medicare	$11.52
Rate for Payer: Amerigroup Medicare	$11.52
Rate for Payer: APIPA Medicare/Medicaid	$26.89
Rate for Payer: AZCH Complete Medicaid	$81.16
Rate for Payer: AZCH Complete Medicare	$11.52
Rate for Payer: Banner UC Health Medicaid	$81.16
Rate for Payer: Banner UC Health Medicare	$11.52
Rate for Payer: Bisbee Police All Plans	$18.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.96
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of AZ Commercial	$50.40
Rate for Payer: Copperpoint Commercial	$17.82
Rate for Payer: Health Net of AZ Commercial	$43.20
Rate for Payer: Health Net of AZ Medicare	$20.16
Rate for Payer: Humana of AZ Medicare	$11.52
Rate for Payer: Mercy Care Medicaid	$81.16
Rate for Payer: Self Pay Self Pay	$57.60
Rate for Payer: TriWest Medicare	$11.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.96

93270- Event Monitor Hookup

Facility

$22.00

Service Code	CPT 93270
Hospital Charge Code	24384245
Hospital Revenue Code	732
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$26.93
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Aetna of AZ Medicare	$6.16
Rate for Payer: AHCCCS Medicaid	$26.93
Rate for Payer: Allwell Medicaid	$26.93
Rate for Payer: Allwell Medicare	$3.52
Rate for Payer: Amerigroup Medicare	$3.52
Rate for Payer: APIPA Medicare/Medicaid	$8.22
Rate for Payer: AZCH Complete Medicaid	$26.93
Rate for Payer: AZCH Complete Medicare	$3.52
Rate for Payer: Banner UC Health Medicaid	$26.93
Rate for Payer: Banner UC Health Medicare	$3.52
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.96
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$15.40
Rate for Payer: Copperpoint Commercial	$5.45
Rate for Payer: Health Net of AZ Commercial	$13.20
Rate for Payer: Health Net of AZ Medicare	$6.16
Rate for Payer: Humana of AZ Medicare	$3.52
Rate for Payer: Mercy Care Medicaid	$26.93
Rate for Payer: Self Pay Self Pay	$17.60
Rate for Payer: TriWest Medicare	$3.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.96

93270- Event Monitor Hookup

Facility

$22.00

Service Code	CPT 93270
Hospital Charge Code	24384245
Hospital Revenue Code	732
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Cash Price	$17.60
Rate for Payer: Self Pay Self Pay	$17.60

93308 Echocardiography, transthoracic, real-time w/image doc

Facility

$541.00

Service Code	CPT 93308
Hospital Charge Code	27410734
Hospital Revenue Code	483
Min. Negotiated Rate	$140.66
Max. Negotiated Rate	$486.90
Rate for Payer: Aetna of AZ Commercial	$486.90
Rate for Payer: Bisbee Police All Plans	$140.66
Rate for Payer: Cash Price	$432.80
Rate for Payer: Self Pay Self Pay	$432.80

93308 Echocardiography, transthoracic, real-time w/image doc

Facility

$541.00

Service Code	CPT 93308
Hospital Charge Code	27410734
Hospital Revenue Code	483
Min. Negotiated Rate	$86.56
Max. Negotiated Rate	$486.90
Rate for Payer: Aetna of AZ Commercial	$486.90
Rate for Payer: Aetna of AZ Medicare	$151.48
Rate for Payer: AHCCCS Medicaid	$166.84
Rate for Payer: Allwell Medicaid	$166.84
Rate for Payer: Allwell Medicare	$86.56
Rate for Payer: Amerigroup Medicare	$86.56
Rate for Payer: APIPA Medicare/Medicaid	$202.06
Rate for Payer: AZCH Complete Medicaid	$166.84
Rate for Payer: AZCH Complete Medicare	$86.56
Rate for Payer: Banner UC Health Medicaid	$166.84
Rate for Payer: Banner UC Health Medicare	$86.56
Rate for Payer: Bisbee Police All Plans	$140.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$367.88
Rate for Payer: Cash Price	$432.80
Rate for Payer: Cash Price	$432.80
Rate for Payer: Cigna of AZ Commercial	$378.70
Rate for Payer: Copperpoint Commercial	$133.90
Rate for Payer: Health Net of AZ Commercial	$324.60
Rate for Payer: Health Net of AZ Medicare	$151.48
Rate for Payer: Humana of AZ Medicare	$86.56
Rate for Payer: Mercy Care Medicaid	$166.84
Rate for Payer: Self Pay Self Pay	$432.80
Rate for Payer: TriWest Medicare	$86.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$315.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.38

94010 PFT

Facility

$898.00

Service Code	CPT 94010
Hospital Charge Code	23897245
Hospital Revenue Code	460
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Aetna of AZ Medicare	$251.44
Rate for Payer: Allwell Medicare	$143.68
Rate for Payer: Amerigroup Medicare	$143.68
Rate for Payer: APIPA Medicare/Medicaid	$335.40
Rate for Payer: AZCH Complete Medicare	$143.68
Rate for Payer: Banner UC Health Medicare	$143.68
Rate for Payer: Bisbee Police All Plans	$233.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$610.64
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cigna of AZ Commercial	$628.60
Rate for Payer: Copperpoint Commercial	$222.25
Rate for Payer: Health Net of AZ Commercial	$538.80
Rate for Payer: Health Net of AZ Medicare	$251.44
Rate for Payer: Humana of AZ Medicare	$143.68
Rate for Payer: Self Pay Self Pay	$718.40
Rate for Payer: TriWest Medicare	$143.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$523.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$161.64

94010 PFT

Facility

$898.00

Service Code	CPT 94010
Hospital Charge Code	23897245
Hospital Revenue Code	460
Min. Negotiated Rate	$233.48
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Bisbee Police All Plans	$233.48
Rate for Payer: Cash Price	$718.40
Rate for Payer: Self Pay Self Pay	$718.40

96105 ASSESSMENT OF APHASIA WITH INTERPRETATION AND REPORT P

Facility

$513.00

Service Code	CPT 96105 GN
Hospital Charge Code	27728005
Hospital Revenue Code	440
Min. Negotiated Rate	$133.38
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of AZ Commercial	$461.70
Rate for Payer: Bisbee Police All Plans	$133.38
Rate for Payer: Cash Price	$410.40
Rate for Payer: Self Pay Self Pay	$410.40

96105 ASSESSMENT OF APHASIA WITH INTERPRETATION AND REPORT P

Facility

$513.00

Service Code	CPT 96105 GN
Hospital Charge Code	27728005
Hospital Revenue Code	440
Min. Negotiated Rate	$82.08
Max. Negotiated Rate	$461.70
Rate for Payer: Aetna of AZ Commercial	$461.70
Rate for Payer: Aetna of AZ Medicare	$143.64
Rate for Payer: Allwell Medicare	$82.08
Rate for Payer: Amerigroup Medicare	$82.08
Rate for Payer: APIPA Medicare/Medicaid	$191.61
Rate for Payer: AZCH Complete Medicare	$82.08
Rate for Payer: Banner UC Health Medicare	$82.08
Rate for Payer: Bisbee Police All Plans	$133.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$348.84
Rate for Payer: Cash Price	$410.40
Rate for Payer: Cigna of AZ Commercial	$359.10
Rate for Payer: Copperpoint Commercial	$126.97
Rate for Payer: Health Net of AZ Commercial	$307.80
Rate for Payer: Health Net of AZ Medicare	$143.64
Rate for Payer: Humana of AZ Medicare	$82.08
Rate for Payer: Self Pay Self Pay	$410.40
Rate for Payer: TriWest Medicare	$82.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$299.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$92.34

96125 STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR

Facility

$538.00

Service Code	CPT 96125 GN
Hospital Charge Code	27728006
Hospital Revenue Code	440
Min. Negotiated Rate	$139.88
Max. Negotiated Rate	$484.20
Rate for Payer: Aetna of AZ Commercial	$484.20
Rate for Payer: Bisbee Police All Plans	$139.88
Rate for Payer: Cash Price	$430.40
Rate for Payer: Self Pay Self Pay	$430.40

96125 STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR

Facility

$538.00

Service Code	CPT 96125 GN
Hospital Charge Code	27728006
Hospital Revenue Code	440
Min. Negotiated Rate	$86.08
Max. Negotiated Rate	$484.20
Rate for Payer: Aetna of AZ Commercial	$484.20
Rate for Payer: Aetna of AZ Medicare	$150.64
Rate for Payer: Allwell Medicare	$86.08
Rate for Payer: Amerigroup Medicare	$86.08
Rate for Payer: APIPA Medicare/Medicaid	$200.94
Rate for Payer: AZCH Complete Medicare	$86.08
Rate for Payer: Banner UC Health Medicare	$86.08
Rate for Payer: Bisbee Police All Plans	$139.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$365.84
Rate for Payer: Cash Price	$430.40
Rate for Payer: Cigna of AZ Commercial	$376.60
Rate for Payer: Copperpoint Commercial	$133.16
Rate for Payer: Health Net of AZ Commercial	$322.80
Rate for Payer: Health Net of AZ Medicare	$150.64
Rate for Payer: Humana of AZ Medicare	$86.08
Rate for Payer: Self Pay Self Pay	$430.40
Rate for Payer: TriWest Medicare	$86.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$313.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$96.84

96360 - Hydration, first hour

Facility

$268.00

Service Code	CPT 96360
Hospital Charge Code	22283161
Hospital Revenue Code	450
Min. Negotiated Rate	$42.88
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	$77.79
Rate for Payer: Allwell Medicaid	$77.79
Rate for Payer: Allwell Medicare	$42.88
Rate for Payer: Amerigroup Medicare	$42.88
Rate for Payer: APIPA Medicare/Medicaid	$100.10
Rate for Payer: AZCH Complete Medicaid	$77.79
Rate for Payer: AZCH Complete Medicare	$42.88
Rate for Payer: Banner UC Health Medicaid	$77.79
Rate for Payer: Banner UC Health Medicare	$42.88
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	$42.88
Rate for Payer: Mercy Care Medicaid	$77.79
Rate for Payer: Self Pay Self Pay	$214.40
Rate for Payer: TriWest Medicare	$42.88
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

$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

$362.00

Service Code	CPT 96360
Hospital Charge Code	22282932
Hospital Revenue Code	260
Min. Negotiated Rate	$57.92
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Aetna of AZ Medicare	$101.36
Rate for Payer: AHCCCS Medicaid	$77.79
Rate for Payer: Allwell Medicaid	$77.79
Rate for Payer: Allwell Medicare	$57.92
Rate for Payer: Amerigroup Medicare	$57.92
Rate for Payer: APIPA Medicare/Medicaid	$135.21
Rate for Payer: AZCH Complete Medicaid	$77.79
Rate for Payer: AZCH Complete Medicare	$57.92
Rate for Payer: Banner UC Health Medicaid	$77.79
Rate for Payer: Banner UC Health Medicare	$57.92
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.16
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cigna of AZ Commercial	$253.40
Rate for Payer: Copperpoint Commercial	$89.59
Rate for Payer: Health Net of AZ Commercial	$217.20
Rate for Payer: Health Net of AZ Medicare	$101.36
Rate for Payer: Humana of AZ Medicare	$57.92
Rate for Payer: Mercy Care Medicaid	$77.79
Rate for Payer: Self Pay Self Pay	$289.60
Rate for Payer: TriWest Medicare	$57.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.16

96360 IV FLUID HYDRATION INITAL HOUR

Facility

$362.00

Service Code	CPT 96360
Hospital Charge Code	22282932
Hospital Revenue Code	260
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Cash Price	$289.60
Rate for Payer: Self Pay Self Pay	$289.60

96361 - Hydration, each additional hour

Facility

$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

$173.00

Service Code	CPT 96361
Hospital Charge Code	22283162
Hospital Revenue Code	450
Min. Negotiated Rate	$27.68
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	$29.00
Rate for Payer: Allwell Medicaid	$29.00
Rate for Payer: Allwell Medicare	$27.68
Rate for Payer: Amerigroup Medicare	$27.68
Rate for Payer: APIPA Medicare/Medicaid	$64.62
Rate for Payer: AZCH Complete Medicaid	$29.00
Rate for Payer: AZCH Complete Medicare	$27.68
Rate for Payer: Banner UC Health Medicaid	$29.00
Rate for Payer: Banner UC Health Medicare	$27.68
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	$27.68
Rate for Payer: Mercy Care Medicaid	$29.00
Rate for Payer: Self Pay Self Pay	$138.40
Rate for Payer: TriWest Medicare	$27.68
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

$171.00

Service Code	CPT 96361
Hospital Charge Code	22282933
Hospital Revenue Code	450
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$153.90
Rate for Payer: Aetna of AZ Commercial	$153.90
Rate for Payer: Aetna of AZ Medicare	$47.88
Rate for Payer: AHCCCS Medicaid	$29.00
Rate for Payer: Allwell Medicaid	$29.00
Rate for Payer: Allwell Medicare	$27.36
Rate for Payer: Amerigroup Medicare	$27.36
Rate for Payer: APIPA Medicare/Medicaid	$63.87
Rate for Payer: AZCH Complete Medicaid	$29.00
Rate for Payer: AZCH Complete Medicare	$27.36
Rate for Payer: Banner UC Health Medicaid	$29.00
Rate for Payer: Banner UC Health Medicare	$27.36
Rate for Payer: Bisbee Police All Plans	$44.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.28
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna of AZ Commercial	$119.70
Rate for Payer: Copperpoint Commercial	$42.32
Rate for Payer: Health Net of AZ Commercial	$102.60
Rate for Payer: Health Net of AZ Medicare	$47.88
Rate for Payer: Humana of AZ Medicare	$27.36
Rate for Payer: Mercy Care Medicaid	$29.00
Rate for Payer: Self Pay Self Pay	$136.80
Rate for Payer: TriWest Medicare	$27.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$99.69
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.78

Know your out-of-pocket cost for care.

All Charges