Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH MICROALBUMIN,RANDOM URINE

Facility

$422.00

Service Code	HCPCS 82043
Hospital Charge Code	397071360
Hospital Revenue Code	307
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.73
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.18
Rate for Payer: Cigna Commercial	$5.78
Rate for Payer: Cigna Medicare Advantage	$2.89
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
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	$5.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.13
Rate for Payer: Wellcare Medicare Advantage	$5.78

CH MICROALBUMIN,RANDOM URINE

Facility

$422.00

Service Code	HCPCS 82043
Hospital Charge Code	397071360
Hospital Revenue Code	307
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$63.30
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

CH MICROSPORIDIA ID (STOOL)

Facility

$146.00

Service Code	HCPCS 87015
Hospital Charge Code	397071409
Hospital Revenue Code	300
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

CH MICROSPORIDIA ID (STOOL)

Facility

$146.00

Service Code	HCPCS 87015
Hospital Charge Code	397071409
Hospital Revenue Code	300
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
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	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

CH MIX LYMPHOCYTE CULT

Facility

$909.00

Service Code	HCPCS 86813
Hospital Charge Code	397031074
Hospital Revenue Code	302
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$136.35
Rate for Payer: Qualcare PPO/HMO/WC	$136.35

CH MIX LYMPHOCYTE CULT

Facility

$909.00

Service Code	HCPCS 86813
Hospital Charge Code	397031074
Hospital Revenue Code	302
Min. Negotiated Rate	$29.00
Max. Negotiated Rate	$212.51
Rate for Payer: Aetna Commercial	$187.92
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.51
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$29.00
Rate for Payer: Clover Medicare Advantage	$55.10
Rate for Payer: EmblemHealth Commercial	$174.00
Rate for Payer: Humana Medicare Advantage	$59.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$58.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$61.48
Rate for Payer: Wellcare Medicare Advantage	$58.00

CH MMR VZV PROFILE EIA

Facility

$159.00

Service Code	HCPCS 86765
Hospital Charge Code	397071366
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

CH MMR VZV PROFILE EIA

Facility

$159.00

Service Code	HCPCS 86765
Hospital Charge Code	397071366
Hospital Revenue Code	302
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

CH MOLD ALLERGY PROFILE

Facility

$79.00

Service Code	HCPCS 86003
Hospital Charge Code	397073680
Hospital Revenue Code	305
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

CH MOLD ALLERGY PROFILE

Facility

$79.00

Service Code	HCPCS 86003
Hospital Charge Code	397073680
Hospital Revenue Code	305
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.13
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: Cigna Medicare Advantage	$2.61
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.22

CH MOLECULE MUTATION SCAN

Facility

$113.00

Service Code	HCPCS 83903
Hospital Charge Code	397071199
Hospital Revenue Code	301
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.90
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH MOLECULE MUTATION SCAN

Facility

$113.00

Service Code	HCPCS 83903
Hospital Charge Code	397071199
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

CH MOLE NUCLEIC AMPLI 2 SEQ

Facility

$126.00

Service Code	HCPCS 81225
Hospital Charge Code	397073654
Hospital Revenue Code	310
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CH MOLE NUCLEIC AMPLI 2 SEQ

Facility

$126.00

Service Code	HCPCS 81225
Hospital Charge Code	397073654
Hospital Revenue Code	310
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$1,067.54
Rate for Payer: Aetna Commercial	$944.01
Rate for Payer: Aetna Medicare Advantage	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,067.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,067.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,067.54
Rate for Payer: Cigna Commercial	$291.36
Rate for Payer: Cigna Medicare Advantage	$145.68
Rate for Payer: Clover Medicare Advantage	$276.79
Rate for Payer: EmblemHealth Commercial	$874.08
Rate for Payer: Humana Medicare Advantage	$300.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.36
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$308.84
Rate for Payer: Wellcare Medicare Advantage	$291.36

CH MOLYBDENUM

Facility

$193.00

Service Code	HCPCS 83018
Hospital Charge Code	397071511
Hospital Revenue Code	301
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

CH MOLYBDENUM

Facility

$193.00

Service Code	HCPCS 83018
Hospital Charge Code	397071511
Hospital Revenue Code	301
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$71.15
Rate for Payer: Aetna Medicare Advantage	$21.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.46
Rate for Payer: Cigna Commercial	$21.96
Rate for Payer: Cigna Medicare Advantage	$10.98
Rate for Payer: Clover Medicare Advantage	$20.86
Rate for Payer: EmblemHealth Commercial	$65.88
Rate for Payer: Humana Medicare Advantage	$22.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.96
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.28
Rate for Payer: Wellcare Medicare Advantage	$21.96

CH MONONUCLEAR CELL ANTIGEN

Facility

$189.00

Service Code	HCPCS 86356
Hospital Charge Code	397073663
Hospital Revenue Code	302
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

CH MONONUCLEAR CELL ANTIGEN

Facility

$189.00

Service Code	HCPCS 86356
Hospital Charge Code	397073663
Hospital Revenue Code	302
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.77
Rate for Payer: Aetna Medicare Advantage	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.12
Rate for Payer: Cigna Commercial	$26.78
Rate for Payer: Cigna Medicare Advantage	$13.39
Rate for Payer: Clover Medicare Advantage	$25.44
Rate for Payer: EmblemHealth Commercial	$80.34
Rate for Payer: Humana Medicare Advantage	$27.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.39
Rate for Payer: Wellcare Medicare Advantage	$26.78

CH MONOSCREEN

Facility

$667.59

Service Code	HCPCS 86308
Hospital Charge Code	397041088
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH MONOSCREEN

Facility

$667.59

Service Code	HCPCS 86308
Hospital Charge Code	397041088
Hospital Revenue Code	302
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
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	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

CH M. PNEUMONIAE AB (IGM)

Facility

$332.00

Service Code	HCPCS 86738
Hospital Charge Code	397071427
Hospital Revenue Code	302
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CH M. PNEUMONIAE AB (IGM)

Facility

$332.00

Service Code	HCPCS 86738
Hospital Charge Code	397071427
Hospital Revenue Code	302
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
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	$48.51
Rate for Payer: Cigna Commercial	$13.24
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.03
Rate for Payer: Wellcare Medicare Advantage	$13.24

CH M TUBERCULOSIS SENSITIVTY

Facility

$384.00

Service Code	HCPCS 87190
Hospital Charge Code	397071385
Hospital Revenue Code	309
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$23.68
Rate for Payer: Aetna Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.78
Rate for Payer: Cigna Commercial	$7.31
Rate for Payer: Cigna Medicare Advantage	$3.65
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.75
Rate for Payer: Wellcare Medicare Advantage	$7.31

CH M TUBERCULOSIS SENSITIVTY

Facility

$384.00

Service Code	HCPCS 87190
Hospital Charge Code	397071385
Hospital Revenue Code	309
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

CH MUMPS AB IGG

Facility

$198.00

Service Code	HCPCS 86735
Hospital Charge Code	397041188
Hospital Revenue Code	302
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.28
Rate for Payer: Aetna Medicare Advantage	$13.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.82
Rate for Payer: Cigna Commercial	$13.05
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$12.40
Rate for Payer: EmblemHealth Commercial	$39.15
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.83
Rate for Payer: Wellcare Medicare Advantage	$13.05

Know your out-of-pocket cost for care.

All Charges