Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH IMMUNE COMPLEX PANEL

Facility

$531.00

Service Code	HCPCS 86332
Hospital Charge Code	397072092
Hospital Revenue Code	302
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$79.65
Rate for Payer: Qualcare PPO/HMO/WC	$79.65

CH IMMUNE COMPLEX PANEL

Facility

$531.00

Service Code	HCPCS 86332
Hospital Charge Code	397072092
Hospital Revenue Code	302
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.96
Rate for Payer: Aetna Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.29
Rate for Payer: Cigna Commercial	$24.37
Rate for Payer: Cigna Medicare Advantage	$12.19
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.83
Rate for Payer: Wellcare Medicare Advantage	$24.37

CH IMMUNE COMPLEX RAJI CELL

Facility

$392.00

Service Code	HCPCS 86332
Hospital Charge Code	397072093
Hospital Revenue Code	302
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$58.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.80

CH IMMUNE COMPLEX RAJI CELL

Facility

$392.00

Service Code	HCPCS 86332
Hospital Charge Code	397072093
Hospital Revenue Code	302
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.96
Rate for Payer: Aetna Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.29
Rate for Payer: Cigna Commercial	$24.37
Rate for Payer: Cigna Medicare Advantage	$12.19
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.83
Rate for Payer: Wellcare Medicare Advantage	$24.37

CH IMMUNE COMPLEX SELEC

Facility

$331.00

Service Code	HCPCS 86332
Hospital Charge Code	397071341
Hospital Revenue Code	302
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$49.65
Rate for Payer: Qualcare PPO/HMO/WC	$49.65

CH IMMUNE COMPLEX SELEC

Facility

$331.00

Service Code	HCPCS 86332
Hospital Charge Code	397071341
Hospital Revenue Code	302
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.96
Rate for Payer: Aetna Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.29
Rate for Payer: Cigna Commercial	$24.37
Rate for Payer: Cigna Medicare Advantage	$12.19
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.83
Rate for Payer: Wellcare Medicare Advantage	$24.37

CH IMMUNODIFFUSION OUCHTERIO

Facility

$72.00

Service Code	HCPCS 86331
Hospital Charge Code	397071486
Hospital Revenue Code	302
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

CH IMMUNODIFFUSION OUCHTERIO

Facility

$72.00

Service Code	HCPCS 86331
Hospital Charge Code	397071486
Hospital Revenue Code	302
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

CH IMMUNOELECTROPHORESIS S

Facility

$207.00

Service Code	HCPCS 86334
Hospital Charge Code	397071067
Hospital Revenue Code	302
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.85
Rate for Payer: Cigna Commercial	$22.34
Rate for Payer: Cigna Medicare Advantage	$11.17
Rate for Payer: Clover Medicare Advantage	$21.22
Rate for Payer: EmblemHealth Commercial	$67.02
Rate for Payer: Humana Medicare Advantage	$23.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.68
Rate for Payer: Wellcare Medicare Advantage	$22.34

CH IMMUNOELECTROPHORESIS S

Facility

$207.00

Service Code	HCPCS 86334
Hospital Charge Code	397071067
Hospital Revenue Code	302
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.05

CH IMMUNOGLOBULIN SUBCLASSX4

Facility

$339.00

Service Code	HCPCS 82787
Hospital Charge Code	397073577
Hospital Revenue Code	301
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

CH IMMUNOGLOBULIN SUBCLASSX4

Facility

$339.00

Service Code	HCPCS 82787
Hospital Charge Code	397073577
Hospital Revenue Code	301
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$127.16
Rate for Payer: Aetna Commercial	$25.98
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.39
Rate for Payer: Cigna Commercial	$8.02
Rate for Payer: Cigna Medicare Advantage	$4.01
Rate for Payer: Clover Medicare Advantage	$7.62
Rate for Payer: EmblemHealth Commercial	$24.06
Rate for Payer: Humana Medicare Advantage	$8.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.50
Rate for Payer: Wellcare Medicare Advantage	$8.02

CH INDIA INK PREP

Facility

$43.25

Service Code	HCPCS 87210
Hospital Charge Code	397041044
Hospital Revenue Code	309
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

CH INDIA INK PREP

Facility

$43.25

Service Code	HCPCS 87210
Hospital Charge Code	397041044
Hospital Revenue Code	309
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

CH INFLUENZA A,B RNA,QI,PCR

Facility

$423.00

Hospital Charge Code	3970734
Hospital Revenue Code	301
Min. Negotiated Rate	$54.99
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna Commercial	$126.90
Rate for Payer: Aetna Medicare Advantage	$126.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.86
Rate for Payer: Cigna Commercial	$211.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.45
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH INFLUENZA A,B RNA,QI,PCR

Facility

$423.00

Hospital Charge Code	3970734
Hospital Revenue Code	301
Min. Negotiated Rate	$63.45
Max. Negotiated Rate	$63.45
Rate for Payer: Qualcare PPO/HMO/WC	$63.45

CH INHIBIN A

Facility

$97.00

Service Code	HCPCS 86336
Hospital Charge Code	397073632
Hospital Revenue Code	302
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.51
Rate for Payer: Aetna Medicare Advantage	$15.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$15.59
Rate for Payer: Cigna Medicare Advantage	$7.79
Rate for Payer: Clover Medicare Advantage	$14.81
Rate for Payer: EmblemHealth Commercial	$46.77
Rate for Payer: Humana Medicare Advantage	$16.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.59
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.53
Rate for Payer: Wellcare Medicare Advantage	$15.59

CH INHIBIN A

Facility

$97.00

Service Code	HCPCS 86336
Hospital Charge Code	397073632
Hospital Revenue Code	302
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

CH INITIAL MRSA SCREEN

Facility

$358.65

Service Code	HCPCS 87081
Hospital Charge Code	397043276
Hospital Revenue Code	309
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.48
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.29
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: Cigna Medicare Advantage	$3.31
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.03
Rate for Payer: Wellcare Medicare Advantage	$6.63

CH INITIAL MRSA SCREEN

Facility

$358.65

Service Code	HCPCS 87081
Hospital Charge Code	397043276
Hospital Revenue Code	309
Min. Negotiated Rate	$53.80
Max. Negotiated Rate	$53.80
Rate for Payer: Qualcare PPO/HMO/WC	$53.80

CH INSULIN

Facility

$214.00

Service Code	HCPCS 83525
Hospital Charge Code	397071065
Hospital Revenue Code	301
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.03
Rate for Payer: Aetna Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.43
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	$41.88
Rate for Payer: Cigna Commercial	$11.43
Rate for Payer: Cigna Medicare Advantage	$5.71
Rate for Payer: Clover Medicare Advantage	$10.86
Rate for Payer: EmblemHealth Commercial	$34.29
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.43
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.12
Rate for Payer: Wellcare Medicare Advantage	$11.43

CH INSULIN

Facility

$214.00

Service Code	HCPCS 83525
Hospital Charge Code	397071065
Hospital Revenue Code	301
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

CH INSULIN ANTIBODY

Facility

$303.00

Service Code	HCPCS 86337
Hospital Charge Code	397072010
Hospital Revenue Code	302
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

CH INSULIN ANTIBODY

Facility

$303.00

Service Code	HCPCS 86337
Hospital Charge Code	397072010
Hospital Revenue Code	302
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$69.37
Rate for Payer: Aetna Medicare Advantage	$21.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.45
Rate for Payer: Cigna Commercial	$21.41
Rate for Payer: Cigna Medicare Advantage	$10.71
Rate for Payer: Clover Medicare Advantage	$20.34
Rate for Payer: EmblemHealth Commercial	$64.23
Rate for Payer: Humana Medicare Advantage	$22.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.41
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.69
Rate for Payer: Wellcare Medicare Advantage	$21.41

CH INTERLEUKIN-6 (IL-6)

Facility

$573.00

Service Code	HCPCS 83520
Hospital Charge Code	397070014
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	$74.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
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

Know your out-of-pocket cost for care.

All Charges