Heights University Hospital

All Charges

Charge

Type

Setting

Price

ANTI-SARS-COV2-IGG QUALIT

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679A
Hospital Revenue Code	302
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

ANTI-SARS-COV2-IGG QUALIT

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679A
Hospital Revenue Code	302
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$154.36
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.36
Rate for Payer: Cigna Commercial	$42.13
Rate for Payer: Cigna Medicare Advantage	$21.07
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.66
Rate for Payer: Wellcare Medicare Advantage	$42.13

ANTI-SARS-COV2-TOTAL (IGG-IGM)

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679B
Hospital Revenue Code	302
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$154.36
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.36
Rate for Payer: Cigna Commercial	$42.13
Rate for Payer: Cigna Medicare Advantage	$21.07
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.66
Rate for Payer: Wellcare Medicare Advantage	$42.13

ANTI-SARS-COV2-TOTAL (IGG-IGM)

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679B
Hospital Revenue Code	302
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

ANTISPERM ANTIBODIES

Facility

$226.45

Service Code	HCPCS 89325
Hospital Charge Code	3002521
Hospital Revenue Code	309
Min. Negotiated Rate	$33.97
Max. Negotiated Rate	$33.97
Rate for Payer: Qualcare PPO/HMO/WC	$33.97

ANTISPERM ANTIBODIES

Facility

$226.45

Service Code	HCPCS 89325
Hospital Charge Code	3002521
Hospital Revenue Code	309
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.57
Rate for Payer: Aetna Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.09
Rate for Payer: Cigna Commercial	$10.67
Rate for Payer: Cigna Medicare Advantage	$5.33
Rate for Payer: Clover Medicare Advantage	$10.14
Rate for Payer: EmblemHealth Commercial	$32.01
Rate for Payer: Humana Medicare Advantage	$10.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.31
Rate for Payer: Wellcare Medicare Advantage	$10.67

ANTISTREPTOLYSIN (ASO TITER)**

Facility

$32.00

Hospital Charge Code	3010337
Hospital Revenue Code	309
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

ANTISTREPTOLYSIN (ASO TITER)**

Facility

$32.00

Hospital Charge Code	3010337
Hospital Revenue Code	309
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ANTI STREPTOLYSIN O

Facility

$292.00

Service Code	HCPCS 86063
Hospital Charge Code	38476006
Hospital Revenue Code	302
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.14
Rate for Payer: Cigna Commercial	$5.77
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.12
Rate for Payer: Wellcare Medicare Advantage	$5.77

ANTI STREPTOLYSIN O

Facility

$292.00

Service Code	HCPCS 86063
Hospital Charge Code	38476006
Hospital Revenue Code	302
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

ANTI STREPTOLYSIN O TITER

Facility

$100.00

Service Code	HCPCS 86060
Hospital Charge Code	3000338
Hospital Revenue Code	302
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$23.65
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.75
Rate for Payer: Cigna Commercial	$7.30
Rate for Payer: Cigna Medicare Advantage	$3.65
Rate for Payer: Clover Medicare Advantage	$6.93
Rate for Payer: EmblemHealth Commercial	$21.90
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.74
Rate for Payer: Wellcare Medicare Advantage	$7.30

ANTI STREPTOLYSIN O TITER

Facility

$100.00

Service Code	HCPCS 86060
Hospital Charge Code	3000338
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

ANTI-STRIATED AB SCREEN

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3030335
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

ANTI-STRIATED AB SCREEN

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3030335
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

Antithrombin Activity

Facility

$81.45

Service Code	HCPCS 85300
Hospital Charge Code	39888015
Hospital Revenue Code	305
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$12.22
Rate for Payer: Qualcare PPO/HMO/WC	$12.22

Antithrombin Activity

Facility

$81.45

Service Code	HCPCS 85300
Hospital Charge Code	39888015
Hospital Revenue Code	305
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.39
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.85
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	$43.42
Rate for Payer: Cigna Commercial	$11.85
Rate for Payer: Cigna Medicare Advantage	$5.92
Rate for Payer: Clover Medicare Advantage	$11.26
Rate for Payer: EmblemHealth Commercial	$35.55
Rate for Payer: Humana Medicare Advantage	$12.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.22
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.56
Rate for Payer: Wellcare Medicare Advantage	$11.85

ANTI-THROMBIN III

Facility

$296.00

Service Code	HCPCS 85301
Hospital Charge Code	38478056
Hospital Revenue Code	305
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

ANTI-THROMBIN III

Facility

$296.00

Service Code	HCPCS 85301
Hospital Charge Code	38478056
Hospital Revenue Code	305
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.02
Rate for Payer: Aetna Medicare Advantage	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.61
Rate for Payer: Cigna Commercial	$10.81
Rate for Payer: Cigna Medicare Advantage	$5.41
Rate for Payer: Clover Medicare Advantage	$10.27
Rate for Payer: EmblemHealth Commercial	$32.43
Rate for Payer: Humana Medicare Advantage	$11.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.46
Rate for Payer: Wellcare Medicare Advantage	$10.81

ANTI-THROMBIN III,ACTIVIT

Facility

$667.59

Service Code	HCPCS 85300
Hospital Charge Code	39900163
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ANTI-THROMBIN III,ACTIVIT

Facility

$667.59

Service Code	HCPCS 85300
Hospital Charge Code	39900163
Hospital Revenue Code	305
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.39
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.85
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	$43.42
Rate for Payer: Cigna Commercial	$11.85
Rate for Payer: Cigna Medicare Advantage	$5.92
Rate for Payer: Clover Medicare Advantage	$11.26
Rate for Payer: EmblemHealth Commercial	$35.55
Rate for Payer: Humana Medicare Advantage	$12.21
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	$11.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.56
Rate for Payer: Wellcare Medicare Advantage	$11.85

ANTITHROMBIN III ACTIVITY

Facility

$390.00

Service Code	HCPCS 85300
Hospital Charge Code	401485300
Hospital Revenue Code	305
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.39
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.85
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	$43.42
Rate for Payer: Cigna Commercial	$11.85
Rate for Payer: Cigna Medicare Advantage	$5.92
Rate for Payer: Clover Medicare Advantage	$11.26
Rate for Payer: EmblemHealth Commercial	$35.55
Rate for Payer: Humana Medicare Advantage	$12.21
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	$11.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.56
Rate for Payer: Wellcare Medicare Advantage	$11.85

ANTITHROMBIN III ACTIVITY

Facility

$390.00

Service Code	HCPCS 85300
Hospital Charge Code	401485300
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTI THROMBIN III, ANTIGEN

Facility

$256.00

Service Code	HCPCS 85301
Hospital Charge Code	3007135B
Hospital Revenue Code	305
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.02
Rate for Payer: Aetna Medicare Advantage	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.61
Rate for Payer: Cigna Commercial	$10.81
Rate for Payer: Cigna Medicare Advantage	$5.41
Rate for Payer: Clover Medicare Advantage	$10.27
Rate for Payer: EmblemHealth Commercial	$32.43
Rate for Payer: Humana Medicare Advantage	$11.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.46
Rate for Payer: Wellcare Medicare Advantage	$10.81

ANTI THROMBIN III, ANTIGEN

Facility

$256.00

Service Code	HCPCS 85301
Hospital Charge Code	3007135B
Hospital Revenue Code	305
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

ANTI-THROMBIN III,ANTIGEN

Facility

$74.30

Service Code	HCPCS 85301
Hospital Charge Code	39900164
Hospital Revenue Code	305
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.02
Rate for Payer: Aetna Medicare Advantage	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.61
Rate for Payer: Cigna Commercial	$10.81
Rate for Payer: Cigna Medicare Advantage	$5.41
Rate for Payer: Clover Medicare Advantage	$10.27
Rate for Payer: EmblemHealth Commercial	$32.43
Rate for Payer: Humana Medicare Advantage	$11.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.46
Rate for Payer: Wellcare Medicare Advantage	$10.81

Know your out-of-pocket cost for care.

All Charges