Heights University Hospital

All Charges

Charge

Type

Setting

Price

ESTRIDIOL

Facility

$205.65

Service Code	HCPCS 82670
Hospital Charge Code	39900418
Hospital Revenue Code	301
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$90.53
Rate for Payer: Aetna Medicare Advantage	$27.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.94
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	$102.37
Rate for Payer: Cigna Commercial	$27.94
Rate for Payer: Cigna Medicare Advantage	$13.97
Rate for Payer: Clover Medicare Advantage	$26.54
Rate for Payer: EmblemHealth Commercial	$83.82
Rate for Payer: Humana Medicare Advantage	$28.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.62
Rate for Payer: Wellcare Medicare Advantage	$27.94

ESTRIOL

Facility

$520.00

Service Code	HCPCS 82677
Hospital Charge Code	38472263
Hospital Revenue Code	301
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

ESTRIOL

Facility

$520.00

Service Code	HCPCS 82677
Hospital Charge Code	38472263
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.34
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.60
Rate for Payer: Cigna Commercial	$24.18
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.63
Rate for Payer: Wellcare Medicare Advantage	$24.18

ESTRIOL SERUM

Facility

$231.25

Service Code	HCPCS 82677
Hospital Charge Code	3001162
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.34
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.60
Rate for Payer: Cigna Commercial	$24.18
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.63
Rate for Payer: Wellcare Medicare Advantage	$24.18

ESTRIOL SERUM

Facility

$231.25

Service Code	HCPCS 82677
Hospital Charge Code	3001162
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

ESTRIOL,SERUM

Facility

$166.25

Service Code	HCPCS 82677
Hospital Charge Code	39900076
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.34
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.60
Rate for Payer: Cigna Commercial	$24.18
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.94
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.63
Rate for Payer: Wellcare Medicare Advantage	$24.18

ESTRIOL,SERUM

Facility

$166.25

Service Code	HCPCS 82677
Hospital Charge Code	39900076
Hospital Revenue Code	301
Min. Negotiated Rate	$24.94
Max. Negotiated Rate	$24.94
Rate for Payer: Qualcare PPO/HMO/WC	$24.94

ESTRIOL URINE

Facility

$231.25

Service Code	HCPCS 82677
Hospital Charge Code	3001161
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.34
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.60
Rate for Payer: Cigna Commercial	$24.18
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.63
Rate for Payer: Wellcare Medicare Advantage	$24.18

ESTRIOL URINE

Facility

$231.25

Service Code	HCPCS 82677
Hospital Charge Code	3001161
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

ESTROGEN RECEPTOR ASSAY

Facility

$961.00

Service Code	HCPCS 84233
Hospital Charge Code	38474004
Hospital Revenue Code	301
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$321.99
Rate for Payer: Aetna Commercial	$284.73
Rate for Payer: Aetna Medicare Advantage	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.99
Rate for Payer: Cigna Commercial	$87.88
Rate for Payer: Cigna Medicare Advantage	$43.94
Rate for Payer: Clover Medicare Advantage	$83.49
Rate for Payer: EmblemHealth Commercial	$263.64
Rate for Payer: Humana Medicare Advantage	$90.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$93.15
Rate for Payer: Wellcare Medicare Advantage	$87.88

ESTROGEN RECEPTOR ASSAY

Facility

$961.00

Service Code	HCPCS 84233
Hospital Charge Code	38474004
Hospital Revenue Code	301
Min. Negotiated Rate	$144.15
Max. Negotiated Rate	$144.15
Rate for Payer: Qualcare PPO/HMO/WC	$144.15

ESTROGEN RECEPTOR ASSAY (ERA)

Facility

$1,637.65

Service Code	HCPCS 84233
Hospital Charge Code	3004959
Hospital Revenue Code	301
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$321.99
Rate for Payer: Aetna Commercial	$284.73
Rate for Payer: Aetna Medicare Advantage	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$87.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.99
Rate for Payer: Cigna Commercial	$87.88
Rate for Payer: Cigna Medicare Advantage	$43.94
Rate for Payer: Clover Medicare Advantage	$83.49
Rate for Payer: EmblemHealth Commercial	$263.64
Rate for Payer: Humana Medicare Advantage	$90.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$245.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$93.15
Rate for Payer: Wellcare Medicare Advantage	$87.88

ESTROGEN RECEPTOR ASSAY (ERA)

Facility

$1,637.65

Service Code	HCPCS 84233
Hospital Charge Code	3004959
Hospital Revenue Code	301
Min. Negotiated Rate	$245.65
Max. Negotiated Rate	$245.65
Rate for Payer: Qualcare PPO/HMO/WC	$245.65

ESTROGENS CONJ 30GM VAG CR

Facility

$1,182.97

Hospital Charge Code	606350907
Hospital Revenue Code	250
Min. Negotiated Rate	$153.79
Max. Negotiated Rate	$591.49
Rate for Payer: Aetna Commercial	$354.89
Rate for Payer: Aetna Medicare Advantage	$354.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.66
Rate for Payer: Cigna Commercial	$591.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.79
Rate for Payer: Oxford Commercial	$591.49
Rate for Payer: Qualcare PPO/HMO/WC	$177.45
Rate for Payer: UnitedHealthcare Commercial	$591.49

ESTROGENS CONJ 30GM VAG CR

Facility

$1,182.97

Hospital Charge Code	606350907
Hospital Revenue Code	250
Min. Negotiated Rate	$177.45
Max. Negotiated Rate	$177.45
Rate for Payer: Qualcare PPO/HMO/WC	$177.45

ESTROGENS, FRACTIONATED

Facility

$323.25

Service Code	HCPCS 82672
Hospital Charge Code	3001179
Hospital Revenue Code	301
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$48.49
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

ESTROGENS, FRACTIONATED

Facility

$323.25

Service Code	HCPCS 82672
Hospital Charge Code	3001179
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.31
Rate for Payer: Aetna Medicare Advantage	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.70
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	$79.51
Rate for Payer: Cigna Commercial	$21.70
Rate for Payer: Cigna Medicare Advantage	$10.85
Rate for Payer: Clover Medicare Advantage	$20.61
Rate for Payer: EmblemHealth Commercial	$65.10
Rate for Payer: Humana Medicare Advantage	$22.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.00
Rate for Payer: Wellcare Medicare Advantage	$21.70

ESTROGENS, FRACTIONATED, SERUM

Facility

$533.00

Service Code	HCPCS 82671
Hospital Charge Code	38472266
Hospital Revenue Code	301
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$79.95
Rate for Payer: Qualcare PPO/HMO/WC	$79.95

ESTROGENS, FRACTIONATED, SERUM

Facility

$533.00

Service Code	HCPCS 82671
Hospital Charge Code	38472266
Hospital Revenue Code	301
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$118.35
Rate for Payer: Aetna Commercial	$104.65
Rate for Payer: Aetna Medicare Advantage	$32.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.35
Rate for Payer: Cigna Commercial	$32.30
Rate for Payer: Cigna Medicare Advantage	$16.15
Rate for Payer: Clover Medicare Advantage	$30.68
Rate for Payer: EmblemHealth Commercial	$96.90
Rate for Payer: Humana Medicare Advantage	$33.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$34.24
Rate for Payer: Wellcare Medicare Advantage	$32.30

ESTROGENS,TOTAL,SERUM

Facility

$390.00

Service Code	HCPCS 82672
Hospital Charge Code	39900075
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.31
Rate for Payer: Aetna Medicare Advantage	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.70
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	$79.51
Rate for Payer: Cigna Commercial	$21.70
Rate for Payer: Cigna Medicare Advantage	$10.85
Rate for Payer: Clover Medicare Advantage	$20.61
Rate for Payer: EmblemHealth Commercial	$65.10
Rate for Payer: Humana Medicare Advantage	$22.35
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	$21.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.00
Rate for Payer: Wellcare Medicare Advantage	$21.70

ESTROGENS,TOTAL,SERUM

Facility

$390.00

Service Code	HCPCS 82672
Hospital Charge Code	39900075
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ESTROGEN TOTAL

Facility

$633.00

Service Code	HCPCS 82672
Hospital Charge Code	38472272
Hospital Revenue Code	301
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

ESTROGEN TOTAL

Facility

$633.00

Service Code	HCPCS 82672
Hospital Charge Code	38472272
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.31
Rate for Payer: Aetna Medicare Advantage	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.70
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	$79.51
Rate for Payer: Cigna Commercial	$21.70
Rate for Payer: Cigna Medicare Advantage	$10.85
Rate for Payer: Clover Medicare Advantage	$20.61
Rate for Payer: EmblemHealth Commercial	$65.10
Rate for Payer: Humana Medicare Advantage	$22.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.00
Rate for Payer: Wellcare Medicare Advantage	$21.70

ESTROL

Facility

$520.00

Service Code	HCPCS 82677
Hospital Charge Code	38479405
Hospital Revenue Code	301
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

ESTROL

Facility

$520.00

Service Code	HCPCS 82677
Hospital Charge Code	38479405
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.34
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.60
Rate for Payer: Cigna Commercial	$24.18
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.63
Rate for Payer: Wellcare Medicare Advantage	$24.18

Know your out-of-pocket cost for care.

All Charges