Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

dexamethasone 1 mg Tab [CQCH]

Facility

$0.25

Service Code	HCPCS J8540
Hospital Charge Code	105918089
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: AHCCCS Medicaid	$0.20
Rate for Payer: Allwell Medicaid	$0.20
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.09
Rate for Payer: AZCH Complete Medicaid	$0.20
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicaid	$0.20
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	$0.17
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.15
Rate for Payer: Health Net of AZ Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Mercy Care Medicaid	$0.20
Rate for Payer: Self Pay Self Pay	$0.20
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

dexamethasone 1 mg Tab [CQCH]

Facility

$0.25

Service Code	HCPCS J8540
Hospital Charge Code	105918089
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	$0.20
Rate for Payer: Self Pay Self Pay	$0.20

dexmedetomidine 100 mcg/mL Sol [CQCH]

Facility

$1.51

Service Code	NDC 143953225
Hospital Charge Code	145588585
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Cash Price	$1.21
Rate for Payer: Self Pay Self Pay	$1.21

dexmedetomidine 100 mcg/mL Sol [CQCH]

Facility

$1.51

Service Code	NDC 143953225
Hospital Charge Code	145588585
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Aetna of AZ Medicare	$0.42
Rate for Payer: Allwell Medicare	$0.23
Rate for Payer: Amerigroup Medicare	$0.23
Rate for Payer: APIPA Medicare/Medicaid	$0.56
Rate for Payer: AZCH Complete Medicare	$0.23
Rate for Payer: Banner UC Health Medicare	$0.23
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.03
Rate for Payer: Cash Price	$1.21
Rate for Payer: Cigna of AZ Commercial	$0.98
Rate for Payer: Copperpoint Commercial	$0.37
Rate for Payer: Health Net of AZ Commercial	$0.91
Rate for Payer: Health Net of AZ Medicare	$0.42
Rate for Payer: Humana of AZ Medicare	$0.23
Rate for Payer: Self Pay Self Pay	$1.21
Rate for Payer: TriWest Medicare	$0.23
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.27

Dextrose 10% in Water 500 mL IV soln [CQCH]

Facility

$0.01

Service Code	NDC 409793003
Hospital Charge Code	112006059
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 10% in Water 500 mL IV soln [CQCH]

Facility

$0.01

Service Code	NDC 409793003
Hospital Charge Code	112006059
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

dextrose 50% (25gm)IV Sol 50 mL [CQCH]

Facility

$0.16

Service Code	NDC 409751716
Hospital Charge Code	105924619
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.13

dextrose 50% (25gm)IV Sol 50 mL [CQCH]

Facility

$0.16

Service Code	NDC 409751716
Hospital Charge Code	105924619
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.11
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

Dextrose 5% in Water IV Sol 250 mL (DEHP-free) [CQCH]

Facility

$0.02

Service Code	HCPCS J7060
Hospital Charge Code	108156747
Hospital Revenue Code	250
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: AHCCCS Medicaid	$3.32
Rate for Payer: Allwell Medicaid	$3.32
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicaid	$3.32
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicaid	$3.32
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Mercy Care Medicaid	$3.32
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% in Water IV Sol 250 mL (DEHP-free) [CQCH]

Facility

$0.02

Service Code	HCPCS J7060
Hospital Charge Code	108156747
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

Dextrose 5% in Water IV soln 100 ml[CQCH]

Facility

$0.02

Service Code	HCPCS J7060
Hospital Charge Code	152070800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

Dextrose 5% in Water IV soln 100 ml[CQCH]

Facility

$0.02

Service Code	HCPCS J7060
Hospital Charge Code	152070800
Hospital Revenue Code	250
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: AHCCCS Medicaid	$3.32
Rate for Payer: Allwell Medicaid	$3.32
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicaid	$3.32
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicaid	$3.32
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Mercy Care Medicaid	$3.32
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% in Water Sol 1,000 mL [CQCH]

Facility

$0.01

Service Code	HCPCS J7060
Hospital Charge Code	107994985
Hospital Revenue Code	258
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: AHCCCS Medicaid	$3.32
Rate for Payer: Allwell Medicaid	$3.32
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicaid	$3.32
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicaid	$3.32
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Mercy Care Medicaid	$3.32
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% in Water Sol 1,000 mL [CQCH]

Facility

$0.01

Service Code	HCPCS J7060
Hospital Charge Code	107994985
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Dextrose 5% Water IV Sol 500 mL [CQCH]

Facility

$0.01

Service Code	HCPCS J7060
Hospital Charge Code	108643402
Hospital Revenue Code	258
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: AHCCCS Medicaid	$3.32
Rate for Payer: Allwell Medicaid	$3.32
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicaid	$3.32
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicaid	$3.32
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Mercy Care Medicaid	$3.32
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% Water IV Sol 500 mL [CQCH]

Facility

$0.01

Service Code	HCPCS J7060
Hospital Charge Code	108643402
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Dextrose 5% with 0.45% NaCl and KCl 20 mEq/l IV Sol 1000 mL [CQCH]

Facility

$0.01

Service Code	NDC 409790209
Hospital Charge Code	105918456
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% with 0.45% NaCl and KCl 20 mEq/l IV Sol 1000 mL [CQCH]

Facility

$0.01

Service Code	NDC 409790209
Hospital Charge Code	105918456
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Dextrose 5% with 0.45% NaCl IV Sol 1000 mL [CQCH]

Facility

$0.01

Service Code	NDC 409792609
Hospital Charge Code	105918393
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% with 0.45% NaCl IV Sol 1000 mL [CQCH]

Facility

$0.01

Service Code	NDC 409792609
Hospital Charge Code	105918393
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Dextrose 5% with 0.9% NaCl and KCl 20 mEq/L IV Sol [CQCH]

Facility

$0.01

Service Code	NDC 409710709
Hospital Charge Code	107995125
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% with 0.9% NaCl and KCl 20 mEq/L IV Sol [CQCH]

Facility

$0.01

Service Code	NDC 409710709
Hospital Charge Code	107995125
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Dextrose 5% with 0.9% NaCl and KCl 40 mEq/L intravenous solution Dextrose 5% with 0.9% NaCl and KCl 40 mEq/L Sol 1000 mL [CQCH]

Facility

$0.01

Service Code	NDC 409710909
Hospital Charge Code	108342386
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Self Pay Self Pay	$0.01

Dextrose 5% with 0.9% NaCl and KCl 40 mEq/L intravenous solution Dextrose 5% with 0.9% NaCl and KCl 40 mEq/L Sol 1000 mL [CQCH]

Facility

$0.01

Service Code	NDC 409710909
Hospital Charge Code	108342386
Hospital Revenue Code	258
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

Dextrose 5% with 0.9% NaCl Sol 1000 mL [CQCH]

Facility

$2.02

Service Code	HCPCS J7042
Hospital Charge Code	108072493
Hospital Revenue Code	258
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: AHCCCS Medicaid	$2.02
Rate for Payer: Allwell Medicaid	$2.02
Rate for Payer: AZCH Complete Medicaid	$2.02
Rate for Payer: Banner UC Health Medicaid	$2.02
Rate for Payer: Mercy Care Medicaid	$2.02

Know your out-of-pocket cost for care.

All Charges