Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH H.PYLORI, IMMUNO 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061372
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 H PYLORI SERUM

Facility

$464.00

Service Code	HCPCS 86677
Hospital Charge Code	397041254
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

CH H PYLORI SERUM

Facility

$464.00

Service Code	HCPCS 86677
Hospital Charge Code	397041254
Hospital Revenue Code	302
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

CH HTLV-I/II ABS CSF (LIA)

Facility

$812.00

Service Code	HCPCS 86689
Hospital Charge Code	397073636
Hospital Revenue Code	302
Min. Negotiated Rate	$121.80
Max. Negotiated Rate	$121.80
Rate for Payer: Qualcare PPO/HMO/WC	$121.80

CH HTLV-I/II ABS CSF (LIA)

Facility

$812.00

Service Code	HCPCS 86689
Hospital Charge Code	397073636
Hospital Revenue Code	302
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$121.80
Rate for Payer: Aetna Commercial	$62.69
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.90
Rate for Payer: Cigna Commercial	$19.35
Rate for Payer: Cigna Medicare Advantage	$9.68
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$121.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.51
Rate for Payer: Wellcare Medicare Advantage	$19.35

CH HYDROPROLINE FREE

Facility

$410.00

Service Code	HCPCS 83500
Hospital Charge Code	397073583
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

CH HYDROPROLINE FREE

Facility

$410.00

Service Code	HCPCS 83500
Hospital Charge Code	397073583
Hospital Revenue Code	301
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

CH HYDROPROLINE TOTAL

Facility

$654.00

Service Code	HCPCS 83505
Hospital Charge Code	397073584
Hospital Revenue Code	301
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$98.10

CH HYDROPROLINE TOTAL

Facility

$654.00

Service Code	HCPCS 83505
Hospital Charge Code	397073584
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.73
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.04
Rate for Payer: Cigna Commercial	$24.30
Rate for Payer: Cigna Medicare Advantage	$12.15
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.76
Rate for Payer: Wellcare Medicare Advantage	$24.30

CH HYDROXY 5 INDOLE ACE

Facility

$345.00

Service Code	HCPCS 83497
Hospital Charge Code	397071077
Hospital Revenue Code	301
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
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	$47.27
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: Cigna Medicare Advantage	$6.45
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.67
Rate for Payer: Wellcare Medicare Advantage	$12.90

CH HYDROXY 5 INDOLE ACE

Facility

$345.00

Service Code	HCPCS 83497
Hospital Charge Code	397071077
Hospital Revenue Code	301
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

CH HYDROXYCORTICOST - 17

Facility

$268.00

Service Code	HCPCS 83491
Hospital Charge Code	397072146
Hospital Revenue Code	301
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.00
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.59
Rate for Payer: Cigna Commercial	$17.90
Rate for Payer: Cigna Medicare Advantage	$8.95
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.97
Rate for Payer: Wellcare Medicare Advantage	$17.90

CH HYDROXYCORTICOST - 17

Facility

$268.00

Service Code	HCPCS 83491
Hospital Charge Code	397072146
Hospital Revenue Code	301
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.20

CH HYDROXYPROGESTERONE - 17

Facility

$324.00

Service Code	HCPCS 83498
Hospital Charge Code	397072143
Hospital Revenue Code	301
Min. Negotiated Rate	$13.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.03
Rate for Payer: Aetna Medicare Advantage	$27.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.55
Rate for Payer: Cigna Commercial	$27.17
Rate for Payer: Cigna Medicare Advantage	$13.59
Rate for Payer: Clover Medicare Advantage	$25.81
Rate for Payer: EmblemHealth Commercial	$81.51
Rate for Payer: Humana Medicare Advantage	$27.99
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	$27.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.80
Rate for Payer: Wellcare Medicare Advantage	$27.17

CH HYDROXYPROGESTERONE - 17

Facility

$324.00

Service Code	HCPCS 83498
Hospital Charge Code	397072143
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

CH HYDROXYPROLINE

Facility

$150.00

Service Code	HCPCS 83505
Hospital Charge Code	397073252
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

CH HYDROXYPROLINE

Facility

$150.00

Service Code	HCPCS 83505
Hospital Charge Code	397073252
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$24.30
Rate for Payer: Aetna Commercial	$78.73
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.04
Rate for Payer: Cigna Medicare Advantage	$12.15
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.76
Rate for Payer: Wellcare Medicare Advantage	$24.30

CH HYDROXYPROLINE FREE

Facility

$480.00

Service Code	HCPCS 83500
Hospital Charge Code	397072090
Hospital Revenue Code	301
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

CH HYDROXYPROLINE FREE

Facility

$480.00

Service Code	HCPCS 83500
Hospital Charge Code	397072090
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

CH HYDROXYPROLINE FREE+TOTAL

Facility

$1,002.00

Service Code	HCPCS 83500
Hospital Charge Code	397072089
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$150.30
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

CH HYDROXYPROLINE FREE+TOTAL

Facility

$1,002.00

Service Code	HCPCS 83500
Hospital Charge Code	397072089
Hospital Revenue Code	301
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$150.30
Rate for Payer: Qualcare PPO/HMO/WC	$150.30

CH HYDROXYPROLINE, TOTAL

Facility

$767.00

Service Code	HCPCS 83505
Hospital Charge Code	397073080
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$115.05
Rate for Payer: Aetna Commercial	$78.73
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.04
Rate for Payer: Cigna Commercial	$24.30
Rate for Payer: Cigna Medicare Advantage	$12.15
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$115.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.76
Rate for Payer: Wellcare Medicare Advantage	$24.30

CH HYDROXYPROLINE, TOTAL

Facility

$767.00

Service Code	HCPCS 83505
Hospital Charge Code	397073080
Hospital Revenue Code	301
Min. Negotiated Rate	$115.05
Max. Negotiated Rate	$115.05
Rate for Payer: Qualcare PPO/HMO/WC	$115.05

CH HYPOGLYCEMIC PANEL

Facility

$146.60

Service Code	HCPCS 83789
Hospital Charge Code	397071461
Hospital Revenue Code	301
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$21.99
Rate for Payer: Qualcare PPO/HMO/WC	$21.99

CH HYPOGLYCEMIC PANEL

Facility

$146.60

Service Code	HCPCS 83789
Hospital Charge Code	397071461
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.12
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.34
Rate for Payer: Cigna Commercial	$24.11
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.99
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.56
Rate for Payer: Wellcare Medicare Advantage	$24.11

Know your out-of-pocket cost for care.

All Charges