Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH HEPATITIS B CORE ANT, IGM

Facility

$390.00

Service Code	HCPCS 86705
Hospital Charge Code	397071168
Hospital Revenue Code	302
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.13
Rate for Payer: Aetna Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.13
Rate for Payer: Cigna Commercial	$11.77
Rate for Payer: Cigna Medicare Advantage	$5.88
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
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	$11.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.48
Rate for Payer: Wellcare Medicare Advantage	$11.77

CH HEPATITIS B CORE, TOTAL

Facility

$140.00

Service Code	HCPCS 86704
Hospital Charge Code	397073053
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

CH HEPATITIS B CORE, TOTAL

Facility

$140.00

Service Code	HCPCS 86704
Hospital Charge Code	397073053
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	$24.31
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	$18.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
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 HEPATITIS B DNA(QUAN)

Facility

$510.00

Service Code	HCPCS 87517
Hospital Charge Code	397073193
Hospital Revenue Code	306
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

CH HEPATITIS B DNA(QUAN)

Facility

$510.00

Service Code	HCPCS 87517
Hospital Charge Code	397073193
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$156.97
Rate for Payer: Aetna Commercial	$138.80
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.97
Rate for Payer: Cigna Commercial	$42.84
Rate for Payer: Cigna Medicare Advantage	$21.42
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$45.41
Rate for Payer: Wellcare Medicare Advantage	$42.84

CH HEPATITIS B E AG

Facility

$71.00

Service Code	HCPCS 87350
Hospital Charge Code	397072081
Hospital Revenue Code	306
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

CH HEPATITIS B E AG

Facility

$71.00

Service Code	HCPCS 87350
Hospital Charge Code	397072081
Hospital Revenue Code	306
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

CH HEPATITIS BE ANTIBODY

Facility

$71.00

Service Code	HCPCS 86707
Hospital Charge Code	397071095
Hospital Revenue Code	302
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.49
Rate for Payer: Aetna Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.39
Rate for Payer: Cigna Commercial	$11.57
Rate for Payer: Cigna Medicare Advantage	$5.79
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.26
Rate for Payer: Wellcare Medicare Advantage	$11.57

CH HEPATITIS BE ANTIBODY

Facility

$71.00

Service Code	HCPCS 86707
Hospital Charge Code	397071095
Hospital Revenue Code	302
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

CH HEPATITIS B SURFACE AB

Facility

$557.01

Service Code	HCPCS 86706
Hospital Charge Code	397072082
Hospital Revenue Code	302
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$83.55
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

CH HEPATITIS B SURFACE AB

Facility

$557.01

Service Code	HCPCS 86706
Hospital Charge Code	397072082
Hospital Revenue Code	302
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.35
Rate for Payer: Cigna Commercial	$10.74
Rate for Payer: Cigna Medicare Advantage	$5.37
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.38
Rate for Payer: Wellcare Medicare Advantage	$10.74

CH HEPATITIS B SURFACE AG

Facility

$667.59

Service Code	HCPCS 87340
Hospital Charge Code	397071158
Hospital Revenue Code	306
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.47
Rate for Payer: Aetna Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.85
Rate for Payer: Cigna Commercial	$10.33
Rate for Payer: Cigna Medicare Advantage	$5.17
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
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	$10.33
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.95
Rate for Payer: Wellcare Medicare Advantage	$10.33

CH HEPATITIS B SURFACE AG

Facility

$667.59

Service Code	HCPCS 87340
Hospital Charge Code	397071158
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH HEPATITIS B SURF AG CONF

Facility

$390.00

Service Code	HCPCS 8734091
Hospital Charge Code	397072009
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

CH HEPATITIS B SURF AG CONF

Facility

$390.00

Service Code	HCPCS 8734091
Hospital Charge Code	397072009
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH HEPATITIS C AB

Facility

$667.59

Service Code	HCPCS 86803
Hospital Charge Code	397072083
Hospital Revenue Code	302
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.23
Rate for Payer: Aetna Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.29
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: Cigna Medicare Advantage	$7.13
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
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	$14.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.13
Rate for Payer: Wellcare Medicare Advantage	$14.27

CH HEPATITIS C AB

Facility

$667.59

Service Code	HCPCS 86803
Hospital Charge Code	397072083
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH HEPATITIS C AB (RIBA)

Facility

$146.00

Service Code	HCPCS 86804
Hospital Charge Code	397073191
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.19
Rate for Payer: Aetna Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.76
Rate for Payer: Cigna Commercial	$15.49
Rate for Payer: Cigna Medicare Advantage	$7.75
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.42
Rate for Payer: Wellcare Medicare Advantage	$15.49

CH HEPATITIS C AB (RIBA)

Facility

$146.00

Service Code	HCPCS 86804
Hospital Charge Code	397073191
Hospital Revenue Code	302
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

CH HEPATITIS C CONF

Facility

$324.00

Service Code	HCPCS 86804
Hospital Charge Code	397073035
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.19
Rate for Payer: Aetna Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.76
Rate for Payer: Cigna Commercial	$15.49
Rate for Payer: Cigna Medicare Advantage	$7.75
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.42
Rate for Payer: Wellcare Medicare Advantage	$15.49

CH HEPATITIS C CONF

Facility

$324.00

Service Code	HCPCS 86804
Hospital Charge Code	397073035
Hospital Revenue Code	302
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

CH HEPATITIS C DNA BY PCR

Facility

$824.00

Service Code	HCPCS 87522
Hospital Charge Code	397072162
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$228.14
Rate for Payer: Aetna Commercial	$138.80
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.97
Rate for Payer: Cigna Commercial	$42.84
Rate for Payer: Cigna Medicare Advantage	$21.42
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$45.41
Rate for Payer: Wellcare Medicare Advantage	$42.84

CH HEPATITIS C DNA BY PCR

Facility

$824.00

Service Code	HCPCS 87522
Hospital Charge Code	397072162
Hospital Revenue Code	306
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$123.60
Rate for Payer: Qualcare PPO/HMO/WC	$123.60

CH HEPATITIS C GENOTYPE

Facility

$1,587.00

Service Code	HCPCS 87902
Hospital Charge Code	397073603
Hospital Revenue Code	306
Min. Negotiated Rate	$238.05
Max. Negotiated Rate	$238.05
Rate for Payer: Qualcare PPO/HMO/WC	$238.05

CH HEPATITIS C GENOTYPE

Facility

$1,587.00

Service Code	HCPCS 87902
Hospital Charge Code	397073603
Hospital Revenue Code	306
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$943.30
Rate for Payer: Aetna Commercial	$834.14
Rate for Payer: Aetna Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$943.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$943.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$943.30
Rate for Payer: Cigna Commercial	$257.45
Rate for Payer: Cigna Medicare Advantage	$128.72
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$238.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$272.90
Rate for Payer: Wellcare Medicare Advantage	$257.45

Know your out-of-pocket cost for care.

All Charges