Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH PROINSULIN

Facility

$390.00

Service Code	HCPCS 84206
Hospital Charge Code	397072120
Hospital Revenue Code	301
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.48
Rate for Payer: Aetna Medicare Advantage	$26.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.69
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	$97.79
Rate for Payer: Cigna Commercial	$26.69
Rate for Payer: Cigna Medicare Advantage	$13.35
Rate for Payer: Clover Medicare Advantage	$25.36
Rate for Payer: EmblemHealth Commercial	$80.07
Rate for Payer: Humana Medicare Advantage	$27.49
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	$26.69
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.29
Rate for Payer: Wellcare Medicare Advantage	$26.69

CH PROLACTIN

Facility

$353.00

Service Code	HCPCS 84146
Hospital Charge Code	397071017
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.79
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$71.01
Rate for Payer: Cigna Commercial	$19.38
Rate for Payer: Cigna Medicare Advantage	$9.69
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.54
Rate for Payer: Wellcare Medicare Advantage	$19.38

CH PROLACTIN

Facility

$353.00

Service Code	HCPCS 84146
Hospital Charge Code	397071017
Hospital Revenue Code	301
Min. Negotiated Rate	$52.95
Max. Negotiated Rate	$52.95
Rate for Payer: Qualcare PPO/HMO/WC	$52.95

CH PROLACTIN, TOTAL & FREE

Facility

$416.00

Service Code	HCPCS 84146
Hospital Charge Code	397071494
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.79
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$71.01
Rate for Payer: Cigna Commercial	$19.38
Rate for Payer: Cigna Medicare Advantage	$9.69
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.54
Rate for Payer: Wellcare Medicare Advantage	$19.38

CH PROLACTIN, TOTAL & FREE

Facility

$416.00

Service Code	HCPCS 84146
Hospital Charge Code	397071494
Hospital Revenue Code	301
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

CH PROPOXPHENE CONF GCMS

Facility

$318.00

Service Code	HCPCS 80300
Hospital Charge Code	397073077
Hospital Revenue Code	301
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

CH PROPOXPHENE CONF GCMS

Facility

$318.00

Service Code	HCPCS 80300
Hospital Charge Code	397073077
Hospital Revenue Code	301
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$95.40
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH PRO-PREDICTRX METAB

Facility

$1,323.00

Service Code	HCPCS 80299
Hospital Charge Code	397070007
Hospital Revenue Code	301
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$198.45
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

CH PRO-PREDICTRX METAB

Facility

$1,323.00

Service Code	HCPCS 80299
Hospital Charge Code	397070007
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$198.45
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH PRO PREDICTRX METABOLITES

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	397070023
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

CH PRO PREDICTRX METABOLITES

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	397070023
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
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	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

CH PROSTATIC ACID PHOSP

Facility

$244.00

Service Code	HCPCS 84066
Hospital Charge Code	397071207
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.30
Rate for Payer: Aetna Medicare Advantage	$9.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.66
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	$35.39
Rate for Payer: Cigna Commercial	$9.66
Rate for Payer: Cigna Medicare Advantage	$4.83
Rate for Payer: Clover Medicare Advantage	$9.18
Rate for Payer: EmblemHealth Commercial	$28.98
Rate for Payer: Humana Medicare Advantage	$9.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.66
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.24
Rate for Payer: Wellcare Medicare Advantage	$9.66

CH PROSTATIC ACID PHOSP

Facility

$244.00

Service Code	HCPCS 84066
Hospital Charge Code	397071207
Hospital Revenue Code	301
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

CH PROTEIN 24HR URINE

Facility

$75.00

Service Code	HCPCS 84156
Hospital Charge Code	397071080
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

CH PROTEIN 24HR URINE

Facility

$75.00

Service Code	HCPCS 84156
Hospital Charge Code	397071080
Hospital Revenue Code	301
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.89
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.45
Rate for Payer: Cigna Commercial	$3.67
Rate for Payer: Cigna Medicare Advantage	$1.83
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.89
Rate for Payer: Wellcare Medicare Advantage	$3.67

CH PROTEIN BODY FLUIDS

Facility

$68.75

Service Code	HCPCS 84157
Hospital Charge Code	397071110
Hospital Revenue Code	301
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

CH PROTEIN BODY FLUIDS

Facility

$68.75

Service Code	HCPCS 84157
Hospital Charge Code	397071110
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$15,880.57
Rate for Payer: Aetna Better Health Medicaid	$15,569.19
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: Cigna Medicare Advantage	$2.00
Rate for Payer: Clover Medicare Advantage	$3.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Humana Medicare Advantage	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.24
Rate for Payer: Wellcare Medicare Advantage	$4.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57

CH PROTEIN C

Facility

$75.00

Service Code	HCPCS 85302
Hospital Charge Code	397072068
Hospital Revenue Code	305
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

CH PROTEIN C

Facility

$449.00

Service Code	HCPCS 85302
Hospital Charge Code	397021298
Hospital Revenue Code	305
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
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	$44.00
Rate for Payer: Cigna Commercial	$12.01
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.01

CH PROTEIN C

Facility

$449.00

Service Code	HCPCS 85302
Hospital Charge Code	397021298
Hospital Revenue Code	305
Min. Negotiated Rate	$67.35
Max. Negotiated Rate	$67.35
Rate for Payer: Qualcare PPO/HMO/WC	$67.35

CH PROTEIN C

Facility

$75.00

Service Code	HCPCS 85302
Hospital Charge Code	397072068
Hospital Revenue Code	305
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
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	$44.00
Rate for Payer: Cigna Commercial	$12.01
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.01

CH PROTEIN C, ANTIGEN

Facility

$72.00

Service Code	HCPCS 85302
Hospital Charge Code	397071447
Hospital Revenue Code	305
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

CH PROTEIN C, ANTIGEN

Facility

$72.00

Service Code	HCPCS 85302
Hospital Charge Code	397071447
Hospital Revenue Code	305
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
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	$44.00
Rate for Payer: Cigna Commercial	$12.01
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
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	$12.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.01

CH PROTEIN ELECTRO FL

Facility

$68.00

Service Code	HCPCS 84165
Hospital Charge Code	397071193
Hospital Revenue Code	301
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

CH PROTEIN ELECTRO FL

Facility

$68.00

Service Code	HCPCS 84165
Hospital Charge Code	397071193
Hospital Revenue Code	301
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	$11.22
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	$8.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
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

Know your out-of-pocket cost for care.

All Charges