Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH CARBON MONOXIDE

Facility

$311.00

Service Code	HCPCS 82375
Hospital Charge Code	397072040
Hospital Revenue Code	301
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.92
Rate for Payer: Aetna Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.14
Rate for Payer: Cigna Commercial	$12.32
Rate for Payer: Cigna Medicare Advantage	$6.16
Rate for Payer: Clover Medicare Advantage	$11.70
Rate for Payer: EmblemHealth Commercial	$36.96
Rate for Payer: Humana Medicare Advantage	$12.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.06
Rate for Payer: Wellcare Medicare Advantage	$12.32

CH CARBOXYHEMOGLOBIN

Facility

$390.00

Service Code	HCPCS 82375
Hospital Charge Code	397071514
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH CARBOXYHEMOGLOBIN

Facility

$390.00

Service Code	HCPCS 82375
Hospital Charge Code	397071514
Hospital Revenue Code	301
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.92
Rate for Payer: Aetna Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.14
Rate for Payer: Cigna Commercial	$12.32
Rate for Payer: Cigna Medicare Advantage	$6.16
Rate for Payer: Clover Medicare Advantage	$11.70
Rate for Payer: EmblemHealth Commercial	$36.96
Rate for Payer: Humana Medicare Advantage	$12.69
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	$12.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.06
Rate for Payer: Wellcare Medicare Advantage	$12.32

CH CARNITINE

Facility

$105.00

Service Code	HCPCS 82131
Hospital Charge Code	397073598
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CH CARNITINE

Facility

$105.00

Service Code	HCPCS 82131
Hospital Charge Code	397073598
Hospital Revenue Code	301
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.46
Rate for Payer: Aetna Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.20
Rate for Payer: Cigna Commercial	$22.98
Rate for Payer: Cigna Medicare Advantage	$11.49
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.36
Rate for Payer: Wellcare Medicare Advantage	$22.98

CH CAROTENE

Facility

$152.00

Service Code	HCPCS 82380
Hospital Charge Code	397071216
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.87
Rate for Payer: Aetna Medicare Advantage	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.78
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: Cigna Medicare Advantage	$4.61
Rate for Payer: Clover Medicare Advantage	$8.76
Rate for Payer: EmblemHealth Commercial	$27.66
Rate for Payer: Humana Medicare Advantage	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.77
Rate for Payer: Wellcare Medicare Advantage	$9.22

CH CAROTENE

Facility

$152.00

Service Code	HCPCS 82380
Hospital Charge Code	397071216
Hospital Revenue Code	301
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

CH CATECHOLAMINES

Facility

$417.00

Service Code	HCPCS 82384
Hospital Charge Code	397073004
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

CH CATECHOLAMINES

Facility

$417.00

Service Code	HCPCS 82384
Hospital Charge Code	397073004
Hospital Revenue Code	301
Min. Negotiated Rate	$12.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$81.81
Rate for Payer: Aetna Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.52
Rate for Payer: Cigna Commercial	$25.25
Rate for Payer: Cigna Medicare Advantage	$12.62
Rate for Payer: Clover Medicare Advantage	$23.99
Rate for Payer: EmblemHealth Commercial	$75.75
Rate for Payer: Humana Medicare Advantage	$26.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.77
Rate for Payer: Wellcare Medicare Advantage	$25.25

CH CATECHOLAMINES FRAC P

Facility

$489.00

Service Code	HCPCS 82384
Hospital Charge Code	397071212
Hospital Revenue Code	301
Min. Negotiated Rate	$73.35
Max. Negotiated Rate	$73.35
Rate for Payer: Qualcare PPO/HMO/WC	$73.35

CH CATECHOLAMINES FRAC P

Facility

$489.00

Service Code	HCPCS 82384
Hospital Charge Code	397071212
Hospital Revenue Code	301
Min. Negotiated Rate	$12.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$81.81
Rate for Payer: Aetna Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.52
Rate for Payer: Cigna Commercial	$25.25
Rate for Payer: Cigna Medicare Advantage	$12.62
Rate for Payer: Clover Medicare Advantage	$23.99
Rate for Payer: EmblemHealth Commercial	$75.75
Rate for Payer: Humana Medicare Advantage	$26.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.77
Rate for Payer: Wellcare Medicare Advantage	$25.25

CH CATECHOLAMINES FRACTION U

Facility

$299.00

Service Code	HCPCS 82384
Hospital Charge Code	397072042
Hospital Revenue Code	301
Min. Negotiated Rate	$12.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$81.81
Rate for Payer: Aetna Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.52
Rate for Payer: Cigna Commercial	$25.25
Rate for Payer: Cigna Medicare Advantage	$12.62
Rate for Payer: Clover Medicare Advantage	$23.99
Rate for Payer: EmblemHealth Commercial	$75.75
Rate for Payer: Humana Medicare Advantage	$26.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.77
Rate for Payer: Wellcare Medicare Advantage	$25.25

CH CATECHOLAMINES FRACTION U

Facility

$299.00

Service Code	HCPCS 82384
Hospital Charge Code	397072042
Hospital Revenue Code	301
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

CH CATECHOLAMINES FREE

Facility

$158.00

Service Code	HCPCS 82384
Hospital Charge Code	397072043
Hospital Revenue Code	301
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

CH CATECHOLAMINES FREE

Facility

$158.00

Service Code	HCPCS 82384
Hospital Charge Code	397072043
Hospital Revenue Code	301
Min. Negotiated Rate	$12.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$81.81
Rate for Payer: Aetna Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.52
Rate for Payer: Cigna Commercial	$25.25
Rate for Payer: Cigna Medicare Advantage	$12.62
Rate for Payer: Clover Medicare Advantage	$23.99
Rate for Payer: EmblemHealth Commercial	$75.75
Rate for Payer: Humana Medicare Advantage	$26.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.77
Rate for Payer: Wellcare Medicare Advantage	$25.25

CH CATECHOLAMINES TOTAL U

Facility

$129.00

Service Code	HCPCS 82382
Hospital Charge Code	397071214
Hospital Revenue Code	301
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.45
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.03
Rate for Payer: Cigna Commercial	$27.30
Rate for Payer: Cigna Medicare Advantage	$13.65
Rate for Payer: Clover Medicare Advantage	$25.93
Rate for Payer: EmblemHealth Commercial	$81.90
Rate for Payer: Humana Medicare Advantage	$28.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.94
Rate for Payer: Wellcare Medicare Advantage	$27.30

CH CATECHOLAMINES TOTAL U

Facility

$129.00

Service Code	HCPCS 82382
Hospital Charge Code	397071214
Hospital Revenue Code	301
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

CH CATHEPSIN D PARAFFI BLOCK 1

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061010
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

CH CATHEPSIN D PARAFFI BLOCK 1

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061010
Hospital Revenue Code	310
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$324.69
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH CBC

Facility

$531.04

Service Code	HCPCS 85025
Hospital Charge Code	397021020
Hospital Revenue Code	305
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.17
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$7.77
Rate for Payer: Cigna Medicare Advantage	$3.88
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.66
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.24
Rate for Payer: Wellcare Medicare Advantage	$7.77

CH CBC

Facility

$531.04

Service Code	HCPCS 85025
Hospital Charge Code	397021020
Hospital Revenue Code	305
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$79.66
Rate for Payer: Qualcare PPO/HMO/WC	$79.66

CH CBC/MANUAL DIFFERENTIAL

Facility

$531.04

Service Code	HCPCS 85025
Hospital Charge Code	397021287
Hospital Revenue Code	305
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$79.66
Rate for Payer: Qualcare PPO/HMO/WC	$79.66

CH CBC/MANUAL DIFFERENTIAL

Facility

$531.04

Service Code	HCPCS 85025
Hospital Charge Code	397021287
Hospital Revenue Code	305
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.17
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$7.77
Rate for Payer: Cigna Medicare Advantage	$3.88
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.66
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.24
Rate for Payer: Wellcare Medicare Advantage	$7.77

CH C DIFFICILE TOXIN ASSAY

Facility

$667.59

Service Code	HCPCS 87230
Hospital Charge Code	397041304
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH C DIFFICILE TOXIN ASSAY

Facility

$667.59

Service Code	HCPCS 87230
Hospital Charge Code	397041304
Hospital Revenue Code	309
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$63.96
Rate for Payer: Aetna Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.33
Rate for Payer: Cigna Commercial	$19.74
Rate for Payer: Cigna Medicare Advantage	$9.87
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.92
Rate for Payer: Wellcare Medicare Advantage	$19.74

Know your out-of-pocket cost for care.

All Charges