|
96361 IV HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
22282933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna of AZ Commercial |
$153.90
|
| Rate for Payer: Bisbee Police All Plans |
$44.46
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Self Pay Self Pay |
$136.80
|
|
|
96365 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24377522
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$342.90 |
| Rate for Payer: Aetna of AZ Commercial |
$342.90
|
| Rate for Payer: Bisbee Police All Plans |
$99.06
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Self Pay Self Pay |
$304.80
|
|
|
96365 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24377522
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$342.90 |
| Rate for Payer: Aetna of AZ Commercial |
$342.90
|
| Rate for Payer: Aetna of AZ Medicare |
$106.68
|
| Rate for Payer: AHCCCS Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicare |
$60.96
|
| Rate for Payer: Amerigroup Medicare |
$60.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$142.30
|
| Rate for Payer: AZCH Complete Medicaid |
$147.54
|
| Rate for Payer: AZCH Complete Medicare |
$60.96
|
| Rate for Payer: Banner UC Health Medicaid |
$147.54
|
| Rate for Payer: Banner UC Health Medicare |
$60.96
|
| Rate for Payer: Bisbee Police All Plans |
$99.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$259.08
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna of AZ Commercial |
$266.70
|
| Rate for Payer: Copperpoint Commercial |
$94.30
|
| Rate for Payer: Health Net of AZ Commercial |
$228.60
|
| Rate for Payer: Health Net of AZ Medicare |
$106.68
|
| Rate for Payer: Humana of AZ Medicare |
$60.96
|
| Rate for Payer: Mercy Care Medicaid |
$147.54
|
| Rate for Payer: Self Pay Self Pay |
$304.80
|
| Rate for Payer: TriWest Medicare |
$60.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$222.12
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$68.58
|
|
|
96365 IV DRUG FIRST HOUR
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
22282934
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.22 |
| Max. Negotiated Rate |
$762.30 |
| Rate for Payer: Aetna of AZ Commercial |
$762.30
|
| Rate for Payer: Bisbee Police All Plans |
$220.22
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Self Pay Self Pay |
$677.60
|
|
|
96365 IV DRUG FIRST HOUR
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
22282934
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$762.30 |
| Rate for Payer: Aetna of AZ Commercial |
$762.30
|
| Rate for Payer: Aetna of AZ Medicare |
$237.16
|
| Rate for Payer: AHCCCS Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicare |
$135.52
|
| Rate for Payer: Amerigroup Medicare |
$135.52
|
| Rate for Payer: APIPA Medicare/Medicaid |
$316.35
|
| Rate for Payer: AZCH Complete Medicaid |
$147.54
|
| Rate for Payer: AZCH Complete Medicare |
$135.52
|
| Rate for Payer: Banner UC Health Medicaid |
$147.54
|
| Rate for Payer: Banner UC Health Medicare |
$135.52
|
| Rate for Payer: Bisbee Police All Plans |
$220.22
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$575.96
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cigna of AZ Commercial |
$592.90
|
| Rate for Payer: Copperpoint Commercial |
$209.63
|
| Rate for Payer: Health Net of AZ Commercial |
$508.20
|
| Rate for Payer: Health Net of AZ Medicare |
$237.16
|
| Rate for Payer: Humana of AZ Medicare |
$135.52
|
| Rate for Payer: Mercy Care Medicaid |
$147.54
|
| Rate for Payer: Self Pay Self Pay |
$677.60
|
| Rate for Payer: TriWest Medicare |
$135.52
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$493.80
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$152.46
|
|
|
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 |
$136.96 |
| 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 |
$147.54
|
| Rate for Payer: Allwell Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicare |
$136.96
|
| Rate for Payer: Amerigroup Medicare |
$136.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$319.72
|
| Rate for Payer: AZCH Complete Medicaid |
$147.54
|
| Rate for Payer: AZCH Complete Medicare |
$136.96
|
| Rate for Payer: Banner UC Health Medicaid |
$147.54
|
| Rate for Payer: Banner UC Health Medicare |
$136.96
|
| 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 |
$136.96
|
| Rate for Payer: Mercy Care Medicaid |
$147.54
|
| Rate for Payer: Self Pay Self Pay |
$684.80
|
| Rate for Payer: TriWest Medicare |
$136.96
|
| 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
|
$156.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24377525
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
|
|
96366 INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGN
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24377525
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Aetna of AZ Medicare |
$43.68
|
| Rate for Payer: AHCCCS Medicaid |
$29.00
|
| Rate for Payer: Allwell Medicaid |
$29.00
|
| Rate for Payer: Allwell Medicare |
$24.96
|
| Rate for Payer: Amerigroup Medicare |
$24.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$58.27
|
| Rate for Payer: AZCH Complete Medicaid |
$29.00
|
| Rate for Payer: AZCH Complete Medicare |
$24.96
|
| Rate for Payer: Banner UC Health Medicaid |
$29.00
|
| Rate for Payer: Banner UC Health Medicare |
$24.96
|
| Rate for Payer: Bisbee Police All Plans |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$106.08
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna of AZ Commercial |
$109.20
|
| Rate for Payer: Copperpoint Commercial |
$38.61
|
| Rate for Payer: Health Net of AZ Commercial |
$93.60
|
| Rate for Payer: Health Net of AZ Medicare |
$43.68
|
| Rate for Payer: Humana of AZ Medicare |
$24.96
|
| Rate for Payer: Mercy Care Medicaid |
$29.00
|
| Rate for Payer: Self Pay Self Pay |
$124.80
|
| Rate for Payer: TriWest Medicare |
$24.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$90.95
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$28.08
|
|
|
96366 IV DRUG ADDITIONAL HOUR
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
22282935
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Aetna of AZ Medicare |
$65.52
|
| Rate for Payer: AHCCCS Medicaid |
$29.00
|
| Rate for Payer: Allwell Medicaid |
$29.00
|
| Rate for Payer: Allwell Medicare |
$37.44
|
| Rate for Payer: Amerigroup Medicare |
$37.44
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.40
|
| Rate for Payer: AZCH Complete Medicaid |
$29.00
|
| Rate for Payer: AZCH Complete Medicare |
$37.44
|
| Rate for Payer: Banner UC Health Medicaid |
$29.00
|
| Rate for Payer: Banner UC Health Medicare |
$37.44
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$159.12
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of AZ Commercial |
$163.80
|
| Rate for Payer: Copperpoint Commercial |
$57.91
|
| Rate for Payer: Health Net of AZ Commercial |
$140.40
|
| Rate for Payer: Health Net of AZ Medicare |
$65.52
|
| Rate for Payer: Humana of AZ Medicare |
$37.44
|
| Rate for Payer: Mercy Care Medicaid |
$29.00
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
| Rate for Payer: TriWest Medicare |
$37.44
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$136.42
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$42.12
|
|
|
96366 IV DRUG ADDITIONAL HOUR
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
22282935
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna of AZ Commercial |
$210.60
|
| Rate for Payer: Bisbee Police All Plans |
$60.84
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Self Pay Self Pay |
$187.20
|
|
|
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
|
|
|
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 |
$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
|
|
|
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 |
$26.08 |
| 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 |
$44.93
|
| Rate for Payer: Allwell Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicare |
$26.08
|
| Rate for Payer: Amerigroup Medicare |
$26.08
|
| Rate for Payer: APIPA Medicare/Medicaid |
$60.88
|
| Rate for Payer: AZCH Complete Medicaid |
$44.93
|
| Rate for Payer: AZCH Complete Medicare |
$26.08
|
| Rate for Payer: Banner UC Health Medicaid |
$44.93
|
| Rate for Payer: Banner UC Health Medicare |
$26.08
|
| 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 |
$26.08
|
| Rate for Payer: Mercy Care Medicaid |
$44.93
|
| Rate for Payer: Self Pay Self Pay |
$130.40
|
| Rate for Payer: TriWest Medicare |
$26.08
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$95.03
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$29.34
|
|
|
96367 - IV tx, sequential infusion
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
22283165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna of AZ Commercial |
$313.20
|
| Rate for Payer: Bisbee Police All Plans |
$90.48
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Self Pay Self Pay |
$278.40
|
|
|
96367 - IV tx, sequential infusion
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
22283165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.93 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna of AZ Commercial |
$313.20
|
| Rate for Payer: Aetna of AZ Medicare |
$97.44
|
| Rate for Payer: AHCCCS Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicare |
$55.68
|
| Rate for Payer: Amerigroup Medicare |
$55.68
|
| Rate for Payer: APIPA Medicare/Medicaid |
$129.98
|
| Rate for Payer: AZCH Complete Medicaid |
$44.93
|
| Rate for Payer: AZCH Complete Medicare |
$55.68
|
| Rate for Payer: Banner UC Health Medicaid |
$44.93
|
| Rate for Payer: Banner UC Health Medicare |
$55.68
|
| Rate for Payer: Bisbee Police All Plans |
$90.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$236.64
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna of AZ Commercial |
$243.60
|
| Rate for Payer: Copperpoint Commercial |
$86.13
|
| Rate for Payer: Health Net of AZ Commercial |
$208.80
|
| Rate for Payer: Health Net of AZ Medicare |
$97.44
|
| Rate for Payer: Humana of AZ Medicare |
$55.68
|
| Rate for Payer: Mercy Care Medicaid |
$44.93
|
| Rate for Payer: Self Pay Self Pay |
$278.40
|
| Rate for Payer: TriWest Medicare |
$55.68
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$202.88
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$62.64
|
|
|
96368 Concurrent Infusion - CQCH
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
24377526
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Aetna of AZ Medicare |
$41.72
|
| Rate for Payer: Allwell Medicare |
$23.84
|
| Rate for Payer: Amerigroup Medicare |
$23.84
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.65
|
| Rate for Payer: AZCH Complete Medicare |
$23.84
|
| Rate for Payer: Banner UC Health Medicare |
$23.84
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$101.32
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cigna of AZ Commercial |
$104.30
|
| Rate for Payer: Copperpoint Commercial |
$36.88
|
| Rate for Payer: Health Net of AZ Commercial |
$89.40
|
| Rate for Payer: Health Net of AZ Medicare |
$41.72
|
| Rate for Payer: Humana of AZ Medicare |
$23.84
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
| Rate for Payer: TriWest Medicare |
$23.84
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.87
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.82
|
|
|
96368 Concurrent Infusion - CQCH
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
24377526
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of AZ Commercial |
$134.10
|
| Rate for Payer: Bisbee Police All Plans |
$38.74
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Self Pay Self Pay |
$119.20
|
|
|
96368 - IV tx, concurrent infusion
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
22283166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
|
|
96368 - IV tx, concurrent infusion
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
22283166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Aetna of AZ Commercial |
$209.70
|
| Rate for Payer: Aetna of AZ Medicare |
$65.24
|
| Rate for Payer: Allwell Medicare |
$37.28
|
| Rate for Payer: Amerigroup Medicare |
$37.28
|
| Rate for Payer: APIPA Medicare/Medicaid |
$87.03
|
| Rate for Payer: AZCH Complete Medicare |
$37.28
|
| Rate for Payer: Banner UC Health Medicare |
$37.28
|
| Rate for Payer: Bisbee Police All Plans |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$158.44
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cigna of AZ Commercial |
$163.10
|
| Rate for Payer: Copperpoint Commercial |
$57.67
|
| Rate for Payer: Health Net of AZ Commercial |
$139.80
|
| Rate for Payer: Health Net of AZ Medicare |
$65.24
|
| Rate for Payer: Humana of AZ Medicare |
$37.28
|
| Rate for Payer: Self Pay Self Pay |
$186.40
|
| Rate for Payer: TriWest Medicare |
$37.28
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$135.84
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$41.94
|
|
|
96369 Subcutaneous infusion for therapy of prophylaxis initi
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
24377528
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$136.16 |
| 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 |
$147.54
|
| Rate for Payer: Allwell Medicaid |
$147.54
|
| Rate for Payer: Allwell Medicare |
$136.16
|
| Rate for Payer: Amerigroup Medicare |
$136.16
|
| Rate for Payer: APIPA Medicare/Medicaid |
$317.85
|
| Rate for Payer: AZCH Complete Medicaid |
$147.54
|
| Rate for Payer: AZCH Complete Medicare |
$136.16
|
| Rate for Payer: Banner UC Health Medicaid |
$147.54
|
| Rate for Payer: Banner UC Health Medicare |
$136.16
|
| 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 |
$136.16
|
| Rate for Payer: Mercy Care Medicaid |
$147.54
|
| Rate for Payer: Self Pay Self Pay |
$680.80
|
| Rate for Payer: TriWest Medicare |
$136.16
|
| 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
|
IP
|
$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
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
22282937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Aetna of AZ Commercial |
$37.80
|
| Rate for Payer: Aetna of AZ Medicare |
$11.76
|
| Rate for Payer: AHCCCS Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicaid |
$44.93
|
| Rate for Payer: Allwell Medicare |
$6.72
|
| Rate for Payer: Amerigroup Medicare |
$6.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$15.69
|
| Rate for Payer: AZCH Complete Medicaid |
$44.93
|
| Rate for Payer: AZCH Complete Medicare |
$6.72
|
| Rate for Payer: Banner UC Health Medicaid |
$44.93
|
| Rate for Payer: Banner UC Health Medicare |
$6.72
|
| 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 |
$10.39
|
| 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 |
$6.72
|
| Rate for Payer: Mercy Care Medicaid |
$44.93
|
| Rate for Payer: Self Pay Self Pay |
$33.60
|
| Rate for Payer: TriWest Medicare |
$6.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$24.49
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$7.56
|
|
|
96372 IM INJ OF ANTIBIOTIC
|
Facility
|
IP
|
$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
|
|
