Heights University Hospital

All Charges

Charge

Type

Setting

Price

HPV TYPES 16 & 18 ONLY

Facility

$241.20

Service Code	HCPCS 87625
Hospital Charge Code	39990236
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

HPV TYPES 16 & 18 ONLY

Facility

$190.45

Service Code	HCPCS 87625
Hospital Charge Code	38430036
Hospital Revenue Code	306
Min. Negotiated Rate	$20.27
Max. Negotiated Rate	$148.58
Rate for Payer: Aetna Commercial	$131.38
Rate for Payer: Aetna Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.58
Rate for Payer: Cigna Commercial	$40.55
Rate for Payer: Cigna Medicare Advantage	$20.27
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$42.98
Rate for Payer: Wellcare Medicare Advantage	$40.55

HPV TYPES 16 & 18 ONLY

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	3039036
Hospital Revenue Code	306
Min. Negotiated Rate	$20.27
Max. Negotiated Rate	$148.58
Rate for Payer: Aetna Commercial	$131.38
Rate for Payer: Aetna Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.58
Rate for Payer: Cigna Commercial	$40.55
Rate for Payer: Cigna Medicare Advantage	$20.27
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
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	$40.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$42.98
Rate for Payer: Wellcare Medicare Advantage	$40.55

HPV TYPES 16 & 18 ONLY

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	3039036
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HPV TYPES 16 & 18 ONLY

Facility

$190.45

Service Code	HCPCS 87625
Hospital Charge Code	397061380
Hospital Revenue Code	306
Min. Negotiated Rate	$20.27
Max. Negotiated Rate	$148.58
Rate for Payer: Aetna Commercial	$131.38
Rate for Payer: Aetna Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.58
Rate for Payer: Cigna Commercial	$40.55
Rate for Payer: Cigna Medicare Advantage	$20.27
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$42.98
Rate for Payer: Wellcare Medicare Advantage	$40.55

HPV TYPES 16 & 18 ONLY

Facility

$190.45

Service Code	HCPCS 87625
Hospital Charge Code	38430036
Hospital Revenue Code	306
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

H PYLORI

Facility

$18.60

Hospital Charge Code	270626321
Hospital Revenue Code	270
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$2.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.79

H PYLORI

Facility

$18.60

Hospital Charge Code	270626321
Hospital Revenue Code	270
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$9.30
Rate for Payer: Aetna Commercial	$5.58
Rate for Payer: Aetna Medicare Advantage	$5.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.74
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.42
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.79
Rate for Payer: UnitedHealthcare Commercial	$9.30

H. PYLORI AB (IGA)

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	39900376
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
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	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

H. PYLORI AB (IGA)

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	39900376
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H. PYLORI AB(IGA)

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	3035113
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H. PYLORI AB(IGA)

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	3035113
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
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	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

H.PYLORI AB (IGG),IB

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	39900377
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI AB (IGG),IB

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	39900377
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
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	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

H.PYLORI AB (IGM)

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	39900237
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI AB (IGM)

Facility

$390.00

Service Code	HCPCS 86677
Hospital Charge Code	39900237
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
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	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

H.PYLORI,AB,IGM

Facility

$1,080.00

Service Code	HCPCS 86677
Hospital Charge Code	38479103
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

H.PYLORI,AB,IGM

Facility

$1,080.00

Service Code	HCPCS 86677
Hospital Charge Code	38479103
Hospital Revenue Code	302
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

H.PYLORI AG,QL,STOOL

Facility

$390.00

Service Code	HCPCS 87338
Hospital Charge Code	39900285
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI AG,QL,STOOL

Facility

$390.00

Service Code	HCPCS 87338
Hospital Charge Code	39900285
Hospital Revenue Code	306
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.59
Rate for Payer: Aetna Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.69
Rate for Payer: Cigna Commercial	$14.38
Rate for Payer: Cigna Medicare Advantage	$7.19
Rate for Payer: Clover Medicare Advantage	$13.66
Rate for Payer: EmblemHealth Commercial	$43.14
Rate for Payer: Humana Medicare Advantage	$14.81
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	$14.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.24
Rate for Payer: Wellcare Medicare Advantage	$14.38

H PYLORI BREATH TEST

Facility

$587.25

Service Code	HCPCS 83013
Hospital Charge Code	3037010
Hospital Revenue Code	301
Min. Negotiated Rate	$88.09
Max. Negotiated Rate	$88.09
Rate for Payer: Qualcare PPO/HMO/WC	$88.09

H PYLORI BREATH TEST

Facility

$587.25

Service Code	HCPCS 83013
Hospital Charge Code	3037010
Hospital Revenue Code	301
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$246.81
Rate for Payer: Aetna Commercial	$218.25
Rate for Payer: Aetna Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.81
Rate for Payer: Cigna Commercial	$67.36
Rate for Payer: Cigna Medicare Advantage	$33.68
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.36
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$71.40
Rate for Payer: Wellcare Medicare Advantage	$67.36

H.PYLORI BREATH TEST

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39900482
Hospital Revenue Code	301
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$246.81
Rate for Payer: Aetna Commercial	$218.25
Rate for Payer: Aetna Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.81
Rate for Payer: Cigna Commercial	$67.36
Rate for Payer: Cigna Medicare Advantage	$33.68
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
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	$67.36
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$71.40
Rate for Payer: Wellcare Medicare Advantage	$67.36

H.PYLORI BREATH TEST

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39900482
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI,IGG

Facility

$1,080.00

Service Code	HCPCS 86677
Hospital Charge Code	38479102
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
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	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

Know your out-of-pocket cost for care.

All Charges