Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

MESH ONLAY PATCH SURGIMESH T613-8S

Facility

$861.00

Hospital Charge Code	22714383
Hospital Revenue Code	272
Min. Negotiated Rate	$223.86
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Bisbee Police All Plans	$223.86
Rate for Payer: Cash Price	$688.80
Rate for Payer: Self Pay Self Pay	$688.80

MESH ONLAY PATCH SURGIMESH T613-8S

Facility

$861.00

Hospital Charge Code	22714383
Hospital Revenue Code	272
Min. Negotiated Rate	$129.15
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Aetna of AZ Medicare	$241.08
Rate for Payer: Allwell Medicare	$129.15
Rate for Payer: Amerigroup Medicare	$129.15
Rate for Payer: APIPA Medicare/Medicaid	$321.58
Rate for Payer: AZCH Complete Medicare	$129.15
Rate for Payer: Banner UC Health Medicare	$129.15
Rate for Payer: Bisbee Police All Plans	$223.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$585.48
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cigna of AZ Commercial	$602.70
Rate for Payer: Copperpoint Commercial	$213.10
Rate for Payer: Health Net of AZ Commercial	$516.60
Rate for Payer: Health Net of AZ Medicare	$241.08
Rate for Payer: Humana of AZ Medicare	$129.15
Rate for Payer: Self Pay Self Pay	$688.80
Rate for Payer: TriWest Medicare	$129.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$501.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$154.98

MESH TINTRA C15

Facility

$2,280.00

Hospital Charge Code	22354769
Hospital Revenue Code	270
Min. Negotiated Rate	$592.80
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna of AZ Commercial	$2,052.00
Rate for Payer: Bisbee Police All Plans	$592.80
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Self Pay Self Pay	$1,824.00

MESH TINTRA C15

Facility

$2,280.00

Hospital Charge Code	22354769
Hospital Revenue Code	270
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna of AZ Commercial	$2,052.00
Rate for Payer: Aetna of AZ Medicare	$638.40
Rate for Payer: Allwell Medicare	$342.00
Rate for Payer: Amerigroup Medicare	$342.00
Rate for Payer: APIPA Medicare/Medicaid	$851.58
Rate for Payer: AZCH Complete Medicare	$342.00
Rate for Payer: Banner UC Health Medicare	$342.00
Rate for Payer: Bisbee Police All Plans	$592.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,550.40
Rate for Payer: Cash Price	$1,824.00
Rate for Payer: Cigna of AZ Commercial	$1,596.00
Rate for Payer: Copperpoint Commercial	$564.30
Rate for Payer: Health Net of AZ Commercial	$1,368.00
Rate for Payer: Health Net of AZ Medicare	$638.40
Rate for Payer: Humana of AZ Medicare	$342.00
Rate for Payer: Self Pay Self Pay	$1,824.00
Rate for Payer: TriWest Medicare	$342.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,329.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$410.40

Metanephrines, Frac., Pl. Free LC

Facility

$408.00

Service Code	CPT 83835
Hospital Charge Code	2029237
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Aetna of AZ Medicare	$114.24
Rate for Payer: AHCCCS Medicaid	$16.94
Rate for Payer: Allwell Medicaid	$16.94
Rate for Payer: Allwell Medicare	$61.20
Rate for Payer: Amerigroup Medicare	$61.20
Rate for Payer: APIPA Medicare/Medicaid	$152.39
Rate for Payer: AZCH Complete Medicaid	$16.94
Rate for Payer: AZCH Complete Medicare	$61.20
Rate for Payer: Banner UC Health Medicaid	$16.94
Rate for Payer: Banner UC Health Medicare	$61.20
Rate for Payer: Bisbee Police All Plans	$106.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$277.44
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cigna of AZ Commercial	$265.20
Rate for Payer: Copperpoint Commercial	$100.98
Rate for Payer: Health Net of AZ Commercial	$244.80
Rate for Payer: Health Net of AZ Medicare	$114.24
Rate for Payer: Humana of AZ Medicare	$61.20
Rate for Payer: Mercy Care Medicaid	$16.94
Rate for Payer: Self Pay Self Pay	$326.40
Rate for Payer: TriWest Medicare	$61.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$237.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$73.44

Metanephrines, Frac., Pl. Free LC

Facility

$408.00

Service Code	CPT 83835
Hospital Charge Code	2029237
Hospital Revenue Code	301
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna of AZ Commercial	$367.20
Rate for Payer: Bisbee Police All Plans	$106.08
Rate for Payer: Cash Price	$326.40
Rate for Payer: Self Pay Self Pay	$326.40

Metanephrines, Frac, Qn, 24-Hr LC

Facility

$389.00

Service Code	CPT 83835
Hospital Charge Code	1909517
Hospital Revenue Code	301
Min. Negotiated Rate	$101.14
Max. Negotiated Rate	$350.10
Rate for Payer: Aetna of AZ Commercial	$350.10
Rate for Payer: Bisbee Police All Plans	$101.14
Rate for Payer: Cash Price	$311.20
Rate for Payer: Self Pay Self Pay	$311.20

Metanephrines, Frac, Qn, 24-Hr LC

Facility

$389.00

Service Code	CPT 83835
Hospital Charge Code	1909517
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$350.10
Rate for Payer: Aetna of AZ Commercial	$350.10
Rate for Payer: Aetna of AZ Medicare	$108.92
Rate for Payer: AHCCCS Medicaid	$16.94
Rate for Payer: Allwell Medicaid	$16.94
Rate for Payer: Allwell Medicare	$58.35
Rate for Payer: Amerigroup Medicare	$58.35
Rate for Payer: APIPA Medicare/Medicaid	$145.29
Rate for Payer: AZCH Complete Medicaid	$16.94
Rate for Payer: AZCH Complete Medicare	$58.35
Rate for Payer: Banner UC Health Medicaid	$16.94
Rate for Payer: Banner UC Health Medicare	$58.35
Rate for Payer: Bisbee Police All Plans	$101.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$264.52
Rate for Payer: Cash Price	$311.20
Rate for Payer: Cash Price	$311.20
Rate for Payer: Cigna of AZ Commercial	$252.85
Rate for Payer: Copperpoint Commercial	$96.28
Rate for Payer: Health Net of AZ Commercial	$233.40
Rate for Payer: Health Net of AZ Medicare	$108.92
Rate for Payer: Humana of AZ Medicare	$58.35
Rate for Payer: Mercy Care Medicaid	$16.94
Rate for Payer: Self Pay Self Pay	$311.20
Rate for Payer: TriWest Medicare	$58.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$226.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$70.02

METER PEAK FLOW ADULT

Facility

$75.00

Hospital Charge Code	22354322
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Aetna of AZ Medicare	$21.00
Rate for Payer: Allwell Medicare	$11.25
Rate for Payer: Amerigroup Medicare	$11.25
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicare	$11.25
Rate for Payer: Banner UC Health Medicare	$11.25
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Copperpoint Commercial	$18.56
Rate for Payer: Health Net of AZ Commercial	$45.00
Rate for Payer: Health Net of AZ Medicare	$21.00
Rate for Payer: Humana of AZ Medicare	$11.25
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$11.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

METER PEAK FLOW ADULT

Facility

$75.00

Hospital Charge Code	22354322
Hospital Revenue Code	270
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Cash Price	$60.00
Rate for Payer: Self Pay Self Pay	$60.00

metFORMIN 500 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904668961
Hospital Charge Code	105931108
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	$0.04
Rate for Payer: Self Pay Self Pay	$0.05

metFORMIN 500 mg Tab [CQCH]

Facility

$0.06

Service Code	NDC 904668961
Hospital Charge Code	105931108
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	$0.04
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

metFORMIN 850 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 60687014301
Hospital Charge Code	105931041
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.09
Rate for Payer: Self Pay Self Pay	$0.09

metFORMIN 850 mg Tab [CQCH]

Facility

$0.11

Service Code	NDC 60687014301
Hospital Charge Code	105931041
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.07
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

methocarbamol 500 mg Tab UD[CQCH]

Facility

$0.18

Service Code	NDC 63739099110
Hospital Charge Code	241829846
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Aetna of AZ Medicare	$0.05
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.12
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.11
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.14
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

methocarbamol 500 mg Tab UD[CQCH]

Facility

$0.18

Service Code	NDC 63739099110
Hospital Charge Code	241829846
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of AZ Commercial	$0.16
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.15
Rate for Payer: Self Pay Self Pay	$0.14

methohexital 500 mg IV Inj [CQCH]

Facility

$51.28

Service Code	NDC 42023010501
Hospital Charge Code	105931179
Hospital Revenue Code	251
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna of AZ Commercial	$46.15
Rate for Payer: Aetna of AZ Medicare	$14.36
Rate for Payer: Allwell Medicare	$7.69
Rate for Payer: Amerigroup Medicare	$7.69
Rate for Payer: APIPA Medicare/Medicaid	$19.15
Rate for Payer: AZCH Complete Medicare	$7.69
Rate for Payer: Banner UC Health Medicare	$7.69
Rate for Payer: Bisbee Police All Plans	$13.33
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$34.87
Rate for Payer: Cash Price	$41.02
Rate for Payer: Cigna of AZ Commercial	$33.33
Rate for Payer: Copperpoint Commercial	$12.69
Rate for Payer: Health Net of AZ Commercial	$30.77
Rate for Payer: Health Net of AZ Medicare	$14.36
Rate for Payer: Humana of AZ Medicare	$7.69
Rate for Payer: Self Pay Self Pay	$41.02
Rate for Payer: TriWest Medicare	$7.69
Rate for Payer: UnitedHealth Group of AZ Commercial	$29.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.23

methohexital 500 mg IV Inj [CQCH]

Facility

$51.28

Service Code	NDC 42023010501
Hospital Charge Code	105931179
Hospital Revenue Code	251
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$46.15
Rate for Payer: Aetna of AZ Commercial	$46.15
Rate for Payer: Bisbee Police All Plans	$13.33
Rate for Payer: Cash Price	$41.02
Rate for Payer: Self Pay Self Pay	$41.02

methylene blue 5 mg/mL Sol 10 mL vial [CQCH]

Facility

$16.19

Service Code	NDC 517037405
Hospital Charge Code	116777202
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna of AZ Commercial	$14.57
Rate for Payer: Aetna of AZ Medicare	$4.53
Rate for Payer: Allwell Medicare	$2.43
Rate for Payer: Amerigroup Medicare	$2.43
Rate for Payer: APIPA Medicare/Medicaid	$6.05
Rate for Payer: AZCH Complete Medicare	$2.43
Rate for Payer: Banner UC Health Medicare	$2.43
Rate for Payer: Bisbee Police All Plans	$4.21
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$11.01
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cigna of AZ Commercial	$10.52
Rate for Payer: Copperpoint Commercial	$4.01
Rate for Payer: Health Net of AZ Commercial	$9.71
Rate for Payer: Health Net of AZ Medicare	$4.53
Rate for Payer: Humana of AZ Medicare	$2.43
Rate for Payer: Self Pay Self Pay	$12.95
Rate for Payer: TriWest Medicare	$2.43
Rate for Payer: UnitedHealth Group of AZ Commercial	$9.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.91

methylene blue 5 mg/mL Sol 10 mL vial [CQCH]

Facility

$16.19

Service Code	NDC 517037405
Hospital Charge Code	116777202
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna of AZ Commercial	$14.57
Rate for Payer: Bisbee Police All Plans	$4.21
Rate for Payer: Cash Price	$12.95
Rate for Payer: Self Pay Self Pay	$12.95

methylergonovine 0.2 mg/mL Inj Sol [CQCH]

Facility

$5.81

Service Code	HCPCS J2210
Hospital Charge Code	105931380
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna of AZ Commercial	$5.23
Rate for Payer: Bisbee Police All Plans	$1.51
Rate for Payer: Cash Price	$4.65
Rate for Payer: Self Pay Self Pay	$4.65

methylergonovine 0.2 mg/mL Inj Sol [CQCH]

Facility

$5.81

Service Code	HCPCS J2210
Hospital Charge Code	105931380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$38.36
Rate for Payer: Aetna of AZ Commercial	$5.23
Rate for Payer: Aetna of AZ Medicare	$1.63
Rate for Payer: AHCCCS Medicaid	$38.36
Rate for Payer: Allwell Medicaid	$38.36
Rate for Payer: Allwell Medicare	$0.87
Rate for Payer: Amerigroup Medicare	$0.87
Rate for Payer: APIPA Medicare/Medicaid	$2.17
Rate for Payer: AZCH Complete Medicaid	$38.36
Rate for Payer: AZCH Complete Medicare	$0.87
Rate for Payer: Banner UC Health Medicaid	$38.36
Rate for Payer: Banner UC Health Medicare	$0.87
Rate for Payer: Bisbee Police All Plans	$1.51
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.95
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cigna of AZ Commercial	$3.78
Rate for Payer: Copperpoint Commercial	$1.44
Rate for Payer: Health Net of AZ Commercial	$3.49
Rate for Payer: Health Net of AZ Medicare	$1.63
Rate for Payer: Humana of AZ Medicare	$0.87
Rate for Payer: Mercy Care Medicaid	$38.36
Rate for Payer: Self Pay Self Pay	$4.65
Rate for Payer: TriWest Medicare	$0.87
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.05

Methylmalonic Acid, Serum LC

Facility

$402.00

Service Code	CPT 83921
Hospital Charge Code	2029210
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$361.80
Rate for Payer: Aetna of AZ Commercial	$361.80
Rate for Payer: Aetna of AZ Medicare	$112.56
Rate for Payer: AHCCCS Medicaid	$21.21
Rate for Payer: Allwell Medicaid	$21.21
Rate for Payer: Allwell Medicare	$60.30
Rate for Payer: Amerigroup Medicare	$60.30
Rate for Payer: APIPA Medicare/Medicaid	$150.15
Rate for Payer: AZCH Complete Medicaid	$21.21
Rate for Payer: AZCH Complete Medicare	$60.30
Rate for Payer: Banner UC Health Medicaid	$21.21
Rate for Payer: Banner UC Health Medicare	$60.30
Rate for Payer: Bisbee Police All Plans	$104.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$273.36
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cigna of AZ Commercial	$261.30
Rate for Payer: Copperpoint Commercial	$99.50
Rate for Payer: Health Net of AZ Commercial	$241.20
Rate for Payer: Health Net of AZ Medicare	$112.56
Rate for Payer: Humana of AZ Medicare	$60.30
Rate for Payer: Mercy Care Medicaid	$21.21
Rate for Payer: Self Pay Self Pay	$321.60
Rate for Payer: TriWest Medicare	$60.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$234.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.36

Methylmalonic Acid, Serum LC

Facility

$402.00

Service Code	CPT 83921
Hospital Charge Code	2029210
Hospital Revenue Code	301
Min. Negotiated Rate	$104.52
Max. Negotiated Rate	$361.80
Rate for Payer: Aetna of AZ Commercial	$361.80
Rate for Payer: Bisbee Police All Plans	$104.52
Rate for Payer: Cash Price	$321.60
Rate for Payer: Self Pay Self Pay	$321.60

methylPREDNISolone 125 mg Inj PF [CQCH]

Facility

$7.21

Service Code	HCPCS J2930
Hospital Charge Code	105955507
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$6.49
Rate for Payer: Aetna of AZ Commercial	$6.49
Rate for Payer: Bisbee Police All Plans	$1.87
Rate for Payer: Cash Price	$5.77
Rate for Payer: Self Pay Self Pay	$5.77

Know your out-of-pocket cost for care.

All Charges