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Service Code APR-DRG 0074
Hospital Charge Code APRDRG0073
Min. Negotiated Rate $137,807.57
Max. Negotiated Rate $137,807.57
Rate for Payer: AHCCCS Medicaid $137,807.57
Rate for Payer: Allwell Medicaid $137,807.57
Rate for Payer: AZCH Complete Medicaid $137,807.57
Rate for Payer: Banner UC Health Medicaid $137,807.57
Rate for Payer: Mercy Care Medicaid $137,807.57
Service Code NDC 51079020520
Hospital Charge Code 105909905
Hospital Revenue Code 251
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.23
Rate for Payer: Aetna of AZ Commercial $0.23
Rate for Payer: Bisbee Police All Plans $0.07
Rate for Payer: Cash Price $0.21
Rate for Payer: Self Pay Self Pay $0.21
Service Code NDC 51079020520
Hospital Charge Code 105909905
Hospital Revenue Code 251
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.23
Rate for Payer: Aetna of AZ Commercial $0.23
Rate for Payer: Aetna of AZ Medicare $0.07
Rate for Payer: Allwell Medicare $0.04
Rate for Payer: Amerigroup Medicare $0.04
Rate for Payer: APIPA Medicare/Medicaid $0.10
Rate for Payer: AZCH Complete Medicare $0.04
Rate for Payer: Banner UC Health Medicare $0.04
Rate for Payer: Bisbee Police All Plans $0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $0.18
Rate for Payer: Cash Price $0.21
Rate for Payer: Cigna of AZ Commercial $0.17
Rate for Payer: Copperpoint Commercial $0.06
Rate for Payer: Health Net of AZ Commercial $0.16
Rate for Payer: Health Net of AZ Medicare $0.07
Rate for Payer: Humana of AZ Medicare $0.04
Rate for Payer: Self Pay Self Pay $0.21
Rate for Payer: TriWest Medicare $0.04
Rate for Payer: UnitedHealth Group of AZ Commercial $0.15
Rate for Payer: UnitedHealth Group of AZ Medicare $0.05
Service Code CPT 82104
Hospital Charge Code 28008412
Hospital Revenue Code 302
Min. Negotiated Rate $11.56
Max. Negotiated Rate $65.03
Rate for Payer: Aetna of AZ Commercial $65.03
Rate for Payer: Aetna of AZ Medicare $20.23
Rate for Payer: Allwell Medicare $11.56
Rate for Payer: Amerigroup Medicare $11.56
Rate for Payer: APIPA Medicare/Medicaid $26.99
Rate for Payer: AZCH Complete Medicare $11.56
Rate for Payer: Banner UC Health Medicare $11.56
Rate for Payer: Bisbee Police All Plans $18.79
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $49.13
Rate for Payer: Cash Price $57.80
Rate for Payer: Cigna of AZ Commercial $46.96
Rate for Payer: Copperpoint Commercial $17.88
Rate for Payer: Health Net of AZ Commercial $43.35
Rate for Payer: Health Net of AZ Medicare $20.23
Rate for Payer: Humana of AZ Medicare $11.56
Rate for Payer: Self Pay Self Pay $57.80
Rate for Payer: TriWest Medicare $11.56
Rate for Payer: UnitedHealth Group of AZ Commercial $42.12
Rate for Payer: UnitedHealth Group of AZ Medicare $13.01
Service Code CPT 82104
Hospital Charge Code 28008412
Hospital Revenue Code 302
Min. Negotiated Rate $18.79
Max. Negotiated Rate $65.03
Rate for Payer: Aetna of AZ Commercial $65.03
Rate for Payer: Bisbee Police All Plans $18.79
Rate for Payer: Cash Price $57.80
Rate for Payer: Self Pay Self Pay $57.80
Service Code CPT 82103
Hospital Charge Code 1905910
Hospital Revenue Code 301
Min. Negotiated Rate $27.52
Max. Negotiated Rate $154.80
Rate for Payer: Aetna of AZ Commercial $154.80
Rate for Payer: Aetna of AZ Medicare $48.16
Rate for Payer: Allwell Medicare $27.52
Rate for Payer: Amerigroup Medicare $27.52
Rate for Payer: APIPA Medicare/Medicaid $64.24
Rate for Payer: AZCH Complete Medicare $27.52
Rate for Payer: Banner UC Health Medicare $27.52
Rate for Payer: Bisbee Police All Plans $44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $116.96
Rate for Payer: Cash Price $137.60
Rate for Payer: Cigna of AZ Commercial $111.80
Rate for Payer: Copperpoint Commercial $42.57
Rate for Payer: Health Net of AZ Commercial $103.20
Rate for Payer: Health Net of AZ Medicare $48.16
Rate for Payer: Humana of AZ Medicare $27.52
Rate for Payer: Self Pay Self Pay $137.60
Rate for Payer: TriWest Medicare $27.52
Rate for Payer: UnitedHealth Group of AZ Commercial $100.28
Rate for Payer: UnitedHealth Group of AZ Medicare $30.96
Service Code CPT 82103
Hospital Charge Code 1905910
Hospital Revenue Code 301
Min. Negotiated Rate $44.72
Max. Negotiated Rate $154.80
Rate for Payer: Aetna of AZ Commercial $154.80
Rate for Payer: Bisbee Police All Plans $44.72
Rate for Payer: Cash Price $137.60
Rate for Payer: Self Pay Self Pay $137.60
Service Code NDC 49884011074
Hospital Charge Code 205191087
Hospital Revenue Code 251
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.68
Rate for Payer: Aetna of AZ Commercial $0.68
Rate for Payer: Bisbee Police All Plans $0.20
Rate for Payer: Cash Price $0.60
Rate for Payer: Self Pay Self Pay $0.60
Service Code NDC 49884011074
Hospital Charge Code 205191087
Hospital Revenue Code 251
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.68
Rate for Payer: Aetna of AZ Commercial $0.68
Rate for Payer: Aetna of AZ Medicare $0.21
Rate for Payer: Allwell Medicare $0.12
Rate for Payer: Amerigroup Medicare $0.12
Rate for Payer: APIPA Medicare/Medicaid $0.28
Rate for Payer: AZCH Complete Medicare $0.12
Rate for Payer: Banner UC Health Medicare $0.12
Rate for Payer: Bisbee Police All Plans $0.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $0.51
Rate for Payer: Cash Price $0.60
Rate for Payer: Cigna of AZ Commercial $0.49
Rate for Payer: Copperpoint Commercial $0.19
Rate for Payer: Health Net of AZ Commercial $0.45
Rate for Payer: Health Net of AZ Medicare $0.21
Rate for Payer: Humana of AZ Medicare $0.12
Rate for Payer: Self Pay Self Pay $0.60
Rate for Payer: TriWest Medicare $0.12
Rate for Payer: UnitedHealth Group of AZ Commercial $0.44
Rate for Payer: UnitedHealth Group of AZ Medicare $0.14
Service Code NDC 904586061
Hospital Charge Code 105910004
Hospital Revenue Code 251
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.05
Rate for Payer: Aetna of AZ Commercial $0.05
Rate for Payer: Aetna of AZ Medicare $0.02
Rate for Payer: Allwell Medicare $0.01
Rate for Payer: Amerigroup Medicare $0.01
Rate for Payer: APIPA Medicare/Medicaid $0.02
Rate for Payer: AZCH Complete Medicare $0.01
Rate for Payer: Banner UC Health Medicare $0.01
Rate for Payer: Bisbee Police All Plans $0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $0.04
Rate for Payer: Cash Price $0.05
Rate for Payer: Cigna of AZ Commercial $0.04
Rate for Payer: Copperpoint Commercial $0.01
Rate for Payer: Health Net of AZ Commercial $0.04
Rate for Payer: Health Net of AZ Medicare $0.02
Rate for Payer: Humana of AZ Medicare $0.01
Rate for Payer: Self Pay Self Pay $0.05
Rate for Payer: TriWest Medicare $0.01
Rate for Payer: UnitedHealth Group of AZ Commercial $0.03
Rate for Payer: UnitedHealth Group of AZ Medicare $0.01
Service Code NDC 904586061
Hospital Charge Code 105910004
Hospital Revenue Code 251
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.05
Rate for Payer: Aetna of AZ Commercial $0.05
Rate for Payer: Bisbee Police All Plans $0.02
Rate for Payer: Cash Price $0.05
Rate for Payer: Self Pay Self Pay $0.05
Service Code HCPCS J2997
Hospital Charge Code 105910209
Hospital Revenue Code 636
Min. Negotiated Rate $1,451.16
Max. Negotiated Rate $8,162.78
Rate for Payer: Aetna of AZ Commercial $8,162.78
Rate for Payer: Aetna of AZ Medicare $2,539.53
Rate for Payer: Allwell Medicare $1,451.16
Rate for Payer: Amerigroup Medicare $1,451.16
Rate for Payer: APIPA Medicare/Medicaid $3,387.56
Rate for Payer: AZCH Complete Medicare $1,451.16
Rate for Payer: Banner UC Health Medicare $1,451.16
Rate for Payer: Bisbee Police All Plans $2,358.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $6,167.44
Rate for Payer: Cash Price $7,255.81
Rate for Payer: Cigna of AZ Commercial $6,348.83
Rate for Payer: Copperpoint Commercial $2,244.77
Rate for Payer: Health Net of AZ Commercial $5,441.86
Rate for Payer: Health Net of AZ Medicare $2,539.53
Rate for Payer: Humana of AZ Medicare $1,451.16
Rate for Payer: Self Pay Self Pay $7,255.81
Rate for Payer: TriWest Medicare $1,451.16
Rate for Payer: UnitedHealth Group of AZ Commercial $5,287.67
Rate for Payer: UnitedHealth Group of AZ Medicare $1,632.56
Service Code HCPCS J2997
Hospital Charge Code 105910209
Hospital Revenue Code 636
Min. Negotiated Rate $2,358.14
Max. Negotiated Rate $8,162.78
Rate for Payer: Aetna of AZ Commercial $8,162.78
Rate for Payer: Bisbee Police All Plans $2,358.14
Rate for Payer: Cash Price $7,255.81
Rate for Payer: Self Pay Self Pay $7,255.81
Service Code HCPCS J2997
Hospital Charge Code 105910142
Hospital Revenue Code 250
Min. Negotiated Rate $23.94
Max. Negotiated Rate $134.66
Rate for Payer: Aetna of AZ Commercial $134.66
Rate for Payer: Aetna of AZ Medicare $41.89
Rate for Payer: Allwell Medicare $23.94
Rate for Payer: Amerigroup Medicare $23.94
Rate for Payer: APIPA Medicare/Medicaid $55.88
Rate for Payer: AZCH Complete Medicare $23.94
Rate for Payer: Banner UC Health Medicare $23.94
Rate for Payer: Bisbee Police All Plans $38.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $101.74
Rate for Payer: Cash Price $119.70
Rate for Payer: Cigna of AZ Commercial $97.25
Rate for Payer: Copperpoint Commercial $37.03
Rate for Payer: Health Net of AZ Commercial $89.77
Rate for Payer: Health Net of AZ Medicare $41.89
Rate for Payer: Humana of AZ Medicare $23.94
Rate for Payer: Self Pay Self Pay $119.70
Rate for Payer: TriWest Medicare $23.94
Rate for Payer: UnitedHealth Group of AZ Commercial $87.23
Rate for Payer: UnitedHealth Group of AZ Medicare $26.93
Service Code HCPCS J2997
Hospital Charge Code 105910142
Hospital Revenue Code 250
Min. Negotiated Rate $38.90
Max. Negotiated Rate $134.66
Rate for Payer: Aetna of AZ Commercial $134.66
Rate for Payer: Bisbee Police All Plans $38.90
Rate for Payer: Cash Price $119.70
Rate for Payer: Self Pay Self Pay $119.70
Service Code HCPCS J2997
Hospital Charge Code 193296755
Hospital Revenue Code 636
Min. Negotiated Rate $644.19
Max. Negotiated Rate $3,623.54
Rate for Payer: Aetna of AZ Commercial $3,623.54
Rate for Payer: Aetna of AZ Medicare $1,127.32
Rate for Payer: Allwell Medicare $644.19
Rate for Payer: Amerigroup Medicare $644.19
Rate for Payer: APIPA Medicare/Medicaid $1,503.77
Rate for Payer: AZCH Complete Medicare $644.19
Rate for Payer: Banner UC Health Medicare $644.19
Rate for Payer: Bisbee Police All Plans $1,046.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $2,737.79
Rate for Payer: Cash Price $3,220.93
Rate for Payer: Cigna of AZ Commercial $2,818.31
Rate for Payer: Copperpoint Commercial $996.47
Rate for Payer: Health Net of AZ Commercial $2,415.70
Rate for Payer: Health Net of AZ Medicare $1,127.32
Rate for Payer: Humana of AZ Medicare $644.19
Rate for Payer: Self Pay Self Pay $3,220.93
Rate for Payer: TriWest Medicare $644.19
Rate for Payer: UnitedHealth Group of AZ Commercial $2,347.25
Rate for Payer: UnitedHealth Group of AZ Medicare $724.71
Service Code HCPCS J2997
Hospital Charge Code 193296755
Hospital Revenue Code 636
Min. Negotiated Rate $1,046.80
Max. Negotiated Rate $3,623.54
Rate for Payer: Aetna of AZ Commercial $3,623.54
Rate for Payer: Bisbee Police All Plans $1,046.80
Rate for Payer: Cash Price $3,220.93
Rate for Payer: Self Pay Self Pay $3,220.93
Service Code APR-DRG 0522
Hospital Charge Code APRDRG0524
Min. Negotiated Rate $4,524.03
Max. Negotiated Rate $4,524.03
Rate for Payer: AHCCCS Medicaid $4,524.03
Rate for Payer: Allwell Medicaid $4,524.03
Rate for Payer: AZCH Complete Medicaid $4,524.03
Rate for Payer: Banner UC Health Medicaid $4,524.03
Rate for Payer: Mercy Care Medicaid $4,524.03
Service Code APR-DRG 0523
Hospital Charge Code APRDRG0524
Min. Negotiated Rate $5,836.35
Max. Negotiated Rate $5,836.35
Rate for Payer: AHCCCS Medicaid $5,836.35
Rate for Payer: Allwell Medicaid $5,836.35
Rate for Payer: AZCH Complete Medicaid $5,836.35
Rate for Payer: Banner UC Health Medicaid $5,836.35
Rate for Payer: Mercy Care Medicaid $5,836.35
Service Code APR-DRG 0523
Hospital Charge Code APRDRG0523
Min. Negotiated Rate $5,836.35
Max. Negotiated Rate $5,836.35
Rate for Payer: AHCCCS Medicaid $5,836.35
Rate for Payer: Allwell Medicaid $5,836.35
Rate for Payer: AZCH Complete Medicaid $5,836.35
Rate for Payer: Banner UC Health Medicaid $5,836.35
Rate for Payer: Mercy Care Medicaid $5,836.35
Service Code APR-DRG 0523
Hospital Charge Code APRDRG0522
Min. Negotiated Rate $5,836.35
Max. Negotiated Rate $5,836.35
Rate for Payer: AHCCCS Medicaid $5,836.35
Rate for Payer: Allwell Medicaid $5,836.35
Rate for Payer: AZCH Complete Medicaid $5,836.35
Rate for Payer: Banner UC Health Medicaid $5,836.35
Rate for Payer: Mercy Care Medicaid $5,836.35
Service Code APR-DRG 0524
Hospital Charge Code APRDRG0524
Min. Negotiated Rate $13,677.30
Max. Negotiated Rate $13,677.30
Rate for Payer: AHCCCS Medicaid $13,677.30
Rate for Payer: Allwell Medicaid $13,677.30
Rate for Payer: AZCH Complete Medicaid $13,677.30
Rate for Payer: Banner UC Health Medicaid $13,677.30
Rate for Payer: Mercy Care Medicaid $13,677.30
Service Code APR-DRG 0524
Hospital Charge Code APRDRG0521
Min. Negotiated Rate $13,677.30
Max. Negotiated Rate $13,677.30
Rate for Payer: AHCCCS Medicaid $13,677.30
Rate for Payer: Allwell Medicaid $13,677.30
Rate for Payer: AZCH Complete Medicaid $13,677.30
Rate for Payer: Banner UC Health Medicaid $13,677.30
Rate for Payer: Mercy Care Medicaid $13,677.30
Service Code APR-DRG 0522
Hospital Charge Code APRDRG0523
Min. Negotiated Rate $4,524.03
Max. Negotiated Rate $4,524.03
Rate for Payer: AHCCCS Medicaid $4,524.03
Rate for Payer: Allwell Medicaid $4,524.03
Rate for Payer: AZCH Complete Medicaid $4,524.03
Rate for Payer: Banner UC Health Medicaid $4,524.03
Rate for Payer: Mercy Care Medicaid $4,524.03
Service Code APR-DRG 0524
Hospital Charge Code APRDRG0523
Min. Negotiated Rate $13,677.30
Max. Negotiated Rate $13,677.30
Rate for Payer: AHCCCS Medicaid $13,677.30
Rate for Payer: Allwell Medicaid $13,677.30
Rate for Payer: AZCH Complete Medicaid $13,677.30
Rate for Payer: Banner UC Health Medicaid $13,677.30
Rate for Payer: Mercy Care Medicaid $13,677.30