Heights University Hospital

All Charges

Charge

Type

Setting

Price

CULTURE TYPING MRSA WITH KIT

Facility

$50.00

Service Code	HCPCS 87147
Hospital Charge Code	3036050
Hospital Revenue Code	309
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	$6.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
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

CULTURE,TYPING;OTHER METHODS

Facility

$37.00

Service Code	HCPCS 87158
Hospital Charge Code	38477042
Hospital Revenue Code	309
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

CULTURE,TYPING;OTHER METHODS

Facility

$37.00

Service Code	HCPCS 87158
Hospital Charge Code	38477042
Hospital Revenue Code	309
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.74
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	$28.36
Rate for Payer: Cigna Commercial	$7.74
Rate for Payer: Cigna Medicare Advantage	$3.87
Rate for Payer: Clover Medicare Advantage	$7.35
Rate for Payer: EmblemHealth Commercial	$23.22
Rate for Payer: Humana Medicare Advantage	$7.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.20
Rate for Payer: Wellcare Medicare Advantage	$7.74

CULTURE, UMBILICAL

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	3030152
Hospital Revenue Code	306
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

CULTURE, UMBILICAL

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	3030152
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.93
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.58
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.14
Rate for Payer: Wellcare Medicare Advantage	$8.62

CULTURE, URINE

Facility

$550.62

Service Code	HCPCS 87086
Hospital Charge Code	3009461
Hospital Revenue Code	306
Min. Negotiated Rate	$82.59
Max. Negotiated Rate	$82.59
Rate for Payer: Qualcare PPO/HMO/WC	$82.59

CULTURE, URINE

Facility

$550.62

Service Code	HCPCS 87086
Hospital Charge Code	3009461
Hospital Revenue Code	306
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.15
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.07
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	$29.57
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: Cigna Medicare Advantage	$4.04
Rate for Payer: Clover Medicare Advantage	$7.67
Rate for Payer: EmblemHealth Commercial	$24.21
Rate for Payer: Humana Medicare Advantage	$8.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.59
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.55
Rate for Payer: Wellcare Medicare Advantage	$8.07

CULTURE, URINE, BLADDER

Facility

$399.41

Service Code	HCPCS 87086
Hospital Charge Code	3009487
Hospital Revenue Code	306
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.15
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.07
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	$29.57
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: Cigna Medicare Advantage	$4.04
Rate for Payer: Clover Medicare Advantage	$7.67
Rate for Payer: EmblemHealth Commercial	$24.21
Rate for Payer: Humana Medicare Advantage	$8.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.91
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.55
Rate for Payer: Wellcare Medicare Advantage	$8.07

CULTURE, URINE, BLADDER

Facility

$399.41

Service Code	HCPCS 87086
Hospital Charge Code	3009487
Hospital Revenue Code	306
Min. Negotiated Rate	$59.91
Max. Negotiated Rate	$59.91
Rate for Payer: Qualcare PPO/HMO/WC	$59.91

CULTURE URINE ROUTINE-SO

Facility

$66.83

Service Code	HCPCS 87086
Hospital Charge Code	401387086
Hospital Revenue Code	306
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: Cigna Medicare Advantage	$4.04
Rate for Payer: Aetna Commercial	$26.15
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.07
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	$29.57
Rate for Payer: Clover Medicare Advantage	$7.67
Rate for Payer: EmblemHealth Commercial	$24.21
Rate for Payer: Humana Medicare Advantage	$8.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.55
Rate for Payer: Wellcare Medicare Advantage	$8.07

CULTURE URINE ROUTINE-SO

Facility

$66.83

Service Code	HCPCS 87086
Hospital Charge Code	401387086
Hospital Revenue Code	306
Min. Negotiated Rate	$10.02
Max. Negotiated Rate	$10.02
Rate for Payer: Qualcare PPO/HMO/WC	$10.02

CULTURE, VARICELLA ZOSTER

Facility

$390.00

Service Code	HCPCS 86171
Hospital Charge Code	3006806
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CULTURE, VARICELLA ZOSTER

Facility

$390.00

Service Code	HCPCS 86171
Hospital Charge Code	3006806
Hospital Revenue Code	302
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.43
Rate for Payer: Aetna Medicare Advantage	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.01
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	$36.68
Rate for Payer: Cigna Commercial	$10.01
Rate for Payer: Cigna Medicare Advantage	$5.00
Rate for Payer: Clover Medicare Advantage	$9.51
Rate for Payer: EmblemHealth Commercial	$30.03
Rate for Payer: Humana Medicare Advantage	$10.31
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	$10.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.61
Rate for Payer: Wellcare Medicare Advantage	$10.01

CULTURE, VIRAL

Facility

$287.25

Service Code	HCPCS 87252
Hospital Charge Code	3006772
Hospital Revenue Code	309
Min. Negotiated Rate	$43.09
Max. Negotiated Rate	$43.09
Rate for Payer: Qualcare PPO/HMO/WC	$43.09

CULTURE, VIRAL

Facility

$287.25

Service Code	HCPCS 87252
Hospital Charge Code	3006772
Hospital Revenue Code	309
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$84.47
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.52
Rate for Payer: Cigna Commercial	$26.07
Rate for Payer: Cigna Medicare Advantage	$13.04
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.63
Rate for Payer: Wellcare Medicare Advantage	$26.07

CULTURE,VIRAL,FLD,TISSUE

Facility

$390.00

Service Code	HCPCS 87252
Hospital Charge Code	39900496
Hospital Revenue Code	309
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$84.47
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.52
Rate for Payer: Cigna Commercial	$26.07
Rate for Payer: Cigna Medicare Advantage	$13.04
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
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	$26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.63
Rate for Payer: Wellcare Medicare Advantage	$26.07

CULTURE,VIRAL,FLD,TISSUE

Facility

$390.00

Service Code	HCPCS 87252
Hospital Charge Code	39900496
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CULTURE,VIRUS

Facility

$179.15

Service Code	HCPCS 87252
Hospital Charge Code	39900276
Hospital Revenue Code	309
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$84.47
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.52
Rate for Payer: Cigna Commercial	$26.07
Rate for Payer: Cigna Medicare Advantage	$13.04
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.87
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.63
Rate for Payer: Wellcare Medicare Advantage	$26.07

CULTURE,VIRUS

Facility

$179.15

Service Code	HCPCS 87252
Hospital Charge Code	39900276
Hospital Revenue Code	309
Min. Negotiated Rate	$26.87
Max. Negotiated Rate	$26.87
Rate for Payer: Qualcare PPO/HMO/WC	$26.87

CULTURE, WOUND

Facility

$32.00

Hospital Charge Code	3010147
Hospital Revenue Code	306
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CULTURE, WOUND

Facility

$770.30

Service Code	HCPCS 87070
Hospital Charge Code	3000148
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$115.55
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Aetna Commercial	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.58
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$115.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.14
Rate for Payer: Wellcare Medicare Advantage	$8.62

CULTURE, WOUND

Facility

$32.00

Hospital Charge Code	3010147
Hospital Revenue Code	306
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

CULTURE, WOUND

Facility

$770.30

Service Code	HCPCS 87070
Hospital Charge Code	3000148
Hospital Revenue Code	306
Min. Negotiated Rate	$115.55
Max. Negotiated Rate	$115.55
Rate for Payer: Qualcare PPO/HMO/WC	$115.55

CULTURE,YEAST DEFINITIVE ID @

Facility

$73.00

Service Code	HCPCS 87106
Hospital Charge Code	38477068
Hospital Revenue Code	309
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.81
Rate for Payer: Cigna Commercial	$10.32
Rate for Payer: Cigna Medicare Advantage	$5.16
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.94
Rate for Payer: Wellcare Medicare Advantage	$10.32

CULTURE,YEAST DEFINITIVE ID @

Facility

$73.00

Service Code	HCPCS 87106
Hospital Charge Code	38477068
Hospital Revenue Code	309
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

Know your out-of-pocket cost for care.

All Charges