Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH ANTI CARDIOLIPIN, IGM

Facility

$235.00

Service Code	HCPCS 86147
Hospital Charge Code	397073094
Hospital Revenue Code	302
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.46
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.25
Rate for Payer: Cigna Commercial	$25.45
Rate for Payer: Cigna Medicare Advantage	$12.72
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.98
Rate for Payer: Wellcare Medicare Advantage	$25.45

CH ANTI CARDIOLIPIN, IGM

Facility

$235.00

Service Code	HCPCS 86147
Hospital Charge Code	397073094
Hospital Revenue Code	302
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

CH ANTIGEN TYPING

Facility

$131.00

Service Code	HCPCS 86902
Hospital Charge Code	397031012
Hospital Revenue Code	300
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

CH ANTIGEN TYPING

Facility

$131.00

Service Code	HCPCS 86902
Hospital Charge Code	397031012
Hospital Revenue Code	300
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$20.57
Rate for Payer: Aetna Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.27
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$3.17
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.73
Rate for Payer: Wellcare Medicare Advantage	$6.35

CH ANTI GLIAIAN AB IGG

Facility

$144.00

Service Code	HCPCS 83520
Hospital Charge Code	397071014
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH ANTI GLIAIAN AB IGG

Facility

$144.00

Service Code	HCPCS 83520
Hospital Charge Code	397071014
Hospital Revenue Code	301
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

CH ANTI GLOMERULAR BSMT

Facility

$184.00

Service Code	HCPCS 86256
Hospital Charge Code	397071230
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

CH ANTI GLOMERULAR BSMT

Facility

$184.00

Service Code	HCPCS 86256
Hospital Charge Code	397071230
Hospital Revenue Code	302
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

CH ANTI MULLERIAN HORMONE

Facility

$429.00

Service Code	HCPCS 83520
Hospital Charge Code	397071380
Hospital Revenue Code	301
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$64.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.35

CH ANTI MULLERIAN HORMONE

Facility

$429.00

Service Code	HCPCS 83520
Hospital Charge Code	397071380
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH ANTI MULLERIAN HORMONE

Facility

$104.00

Service Code	HCPCS 83520
Hospital Charge Code	397071463
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH ANTI MULLERIAN HORMONE

Facility

$104.00

Service Code	HCPCS 83520
Hospital Charge Code	397071463
Hospital Revenue Code	301
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

CH ANTI MYELOPEROXIDASE

Facility

$944.00

Service Code	HCPCS 88319
Hospital Charge Code	397073153
Hospital Revenue Code	310
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$141.60
Rate for Payer: Qualcare PPO/HMO/WC	$141.60

CH ANTI MYELOPEROXIDASE

Facility

$944.00

Service Code	HCPCS 88319
Hospital Charge Code	397073153
Hospital Revenue Code	310
Min. Negotiated Rate	$75.64
Max. Negotiated Rate	$1,918.64
Rate for Payer: Aetna Commercial	$283.20
Rate for Payer: Aetna Medicare Advantage	$283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.72
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$75.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH ANTI NEUTROPHIL CYTO AB

Facility

$435.00

Service Code	HCPCS 86021
Hospital Charge Code	397041155
Hospital Revenue Code	302
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

CH ANTI NEUTROPHIL CYTO AB

Facility

$435.00

Service Code	HCPCS 86021
Hospital Charge Code	397041155
Hospital Revenue Code	302
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$65.25
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

CH ANTI PLATELET ANTIBODY

Facility

$422.00

Service Code	HCPCS 86022
Hospital Charge Code	397071226
Hospital Revenue Code	302
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.52
Rate for Payer: Aetna Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.31
Rate for Payer: Cigna Commercial	$18.37
Rate for Payer: Cigna Medicare Advantage	$9.19
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.47
Rate for Payer: Wellcare Medicare Advantage	$18.37

CH ANTI PLATELET ANTIBODY

Facility

$422.00

Service Code	HCPCS 86022
Hospital Charge Code	397071226
Hospital Revenue Code	302
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$63.30
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

CH ANTI RH (D)

Facility

$101.00

Service Code	HCPCS 86901
Hospital Charge Code	397031154
Hospital Revenue Code	300
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$9.69
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$1.50
Rate for Payer: Clover Medicare Advantage	$2.84
Rate for Payer: EmblemHealth Commercial	$8.97
Rate for Payer: Humana Medicare Advantage	$3.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.17
Rate for Payer: Wellcare Medicare Advantage	$2.99

CH ANTI RH (D)

Facility

$101.00

Service Code	HCPCS 86901
Hospital Charge Code	397031154
Hospital Revenue Code	300
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

CH ANTI. S. CEREVISIAE

Facility

$210.00

Service Code	HCPCS 86671
Hospital Charge Code	397073659
Hospital Revenue Code	302
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.69
Rate for Payer: Aetna Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.88
Rate for Payer: Cigna Commercial	$12.25
Rate for Payer: Cigna Medicare Advantage	$6.12
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.98
Rate for Payer: Wellcare Medicare Advantage	$12.25

CH ANTI. S. CEREVISIAE

Facility

$210.00

Service Code	HCPCS 86671
Hospital Charge Code	397073659
Hospital Revenue Code	302
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

CH ANTI SKIN AB

Facility

$161.00

Service Code	HCPCS 86256
Hospital Charge Code	397073104
Hospital Revenue Code	302
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

CH ANTI SKIN AB

Facility

$161.00

Service Code	HCPCS 86256
Hospital Charge Code	397073104
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

CH ANTI STREPTOLYSIN O

Facility

$390.00

Service Code	HCPCS 86060
Hospital Charge Code	397041230
Hospital Revenue Code	302
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$23.65
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.75
Rate for Payer: Cigna Commercial	$7.30
Rate for Payer: Cigna Medicare Advantage	$3.65
Rate for Payer: Clover Medicare Advantage	$6.93
Rate for Payer: EmblemHealth Commercial	$21.90
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.74
Rate for Payer: Wellcare Medicare Advantage	$7.30

Know your out-of-pocket cost for care.

All Charges